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The humeral supracondylar process and Struthers ligament comprise a relatively rare but well-known anatomic variant. They are usually asymptomatic but may produce clinical symptoms related to compression of the median nerve or brachial artery below the ligament. Previously, surgery has been performed with an open ligament release and supracondylar process excision. This article reports on the use of endoscopic findings and the method of ligament release and process excision. Endoscopy is a minimally invasive technique that provides excellent visualization and enables the surgeon to perform dissection with magnification and precision. It allows the surgeon to introduce open surgical techniques into the depths of the wound in a controlled manner. Because of the dead space created, there is a risk of hematoma formation. Many of the concepts used in open surgery are now being used for endoscopic surgery, and vice versa. The barriers and differences among endoscopic, arthroscopic, and open procedures are being broken down. We report another endoscopic technique, which is part of the ongoing evolution of musculoskeletal surgery.

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Introduction:India is now a polio-free nation, but a huge load of ambulatory polio survivors present with challenging deformities and fractures to the present generation of orthopedic surgeons. These fractures are more challenging, because of the paralyzed, contracted shaft of femur fracture tissues, and inappropriate muscle forces, causing deformities. Also hypoplastic, osteoporotic, and less vascularized bone will influence the reduction maneuver, implant selection, fracture healing, and final outcome. We assess the outcome of surgical management of femoral and tibial fractures in the post-polio residual paralytic limb and the challenges encountered. Materials and methods: Out of 22 cases with 23 fractures analyzed, 2 cases were lost to follow-up and hence excluded and the remaining 20 patients were analyzed. Pre-injury deformity, range of movement, mode of ambulation (Vignos scoring), mode of injury, surgical technique, rehabilitation, and outcomes were assessed. Results: Minimum follow-up duration was 30 months; union was achieved by 18-24 weeks. We had one delayed union and one nonunion, which were managed with bone grafting. None of our patients had infection. A total of 16 patients regained their prefracture mobility; 4 patients developed hand to knee gait due to further weakness of the quadriceps muscle. Conclusion:In our series, femur was the most commonly fractured bone among the post-polio residual paralytic limbs. Fractures don't heel as readily as in normal bone. Conservative treatment has guarded prognosis. Decision of surgical treatment will be challenging. Pre-injury state, surgical planning, technique, and implant choice will be key factors with appropriate rehabilitation to have a satisfactory outcome.