INTRODUCTIONSurgical treatment of high-energy tibial plateau fractures remains a challenge due to problems encountered which include wound complications, infection, varus collapse, knee stiffness, and articular malreductions.1-3 High energy tibial fractures usually affect the younger age group in productive life years and have significant socioeconomic impact due to late recovery time and subsequent requirement of early total knee replacement in some complicated cases. 4 Schatzker classified fractures of tibial plateau radiologically from type I to VI.5 Schatzker type V and VI fractures are high-energy fractures often accompanied by other injuries and complications. The complexity of the fracture pattern and the associated soft tissue disruption of these types of fractures contribute to high rate of failure and unsatisfactory results which follow both operative and non-operative management.6,7Several fixation methods could be used for tibial plateau fractures including unilateral fixation with a single plate, dual-plate, a hybrid external fixator or a less invasive stabilizing system. [8][9][10] There is a considerable debate regarding the best method for treating proximal tibia fractures and there is no clear consensus on which leads ABSTRACT Background: Complex tibial plateau fractures remain a challenge to even the most experienced surgeons. These injuries usually affect the young population in their productive years thereby causing socioeconomic impact. We performed a retrospective study to evaluate the functional outcome of of Schatzker type V and VI managed through open reduction and internal fixation. Methods: 26 patients with Schatzker type V and type VI tibial plateau fractures treated with open reduction and internal fixation using plates were included in the study. Three patients were lost to follow up, 23 patients were evaluated in the final analysis. The preoperative, intraoperative data was noted from the indoor files.The final evaluation was done using Oxford knee score and VAS score. Results: There were nine Schatzker type V fractures and 14 patients with Schatzker type VI fractures. The mean duration of follow-up was 68.32 months ranging from 41 months to 126 months. The mean Oxford knee score was 39.78. Patients with Schatzker type VI had mean OKS of 37.7.The mean MPTA and mean PPTA were 88.75 degrees and 7.35 degrees respectively. Average VAS Score was 2.8 ranging from 1 to 3.9. All patients returned to their preinjury level of activity and employment. There were no patients of deep infection. Conclusions:We conclude that open reduction and internal fixation of high-energy tibial plateau fractures gives excellent to good functional outcome with minimal soft tissue complications. The complications can be minimized with proper patient selection and soft tissue dissection.

<p class="abstract"><strong>Background:</strong> The femoral neck-shaft angle is the measurement of the angle formed between the oblique oriented neck with the vertical shaft and is an important anatomic measurement for the evaluation of biomechanics of hip.<span> The neck shaft angle is important in surgeries that involve the neck of femur, Intertrochanteric fractures, slipped capital femoral epiphysis, and developmental dysplasia of hip. Different variation of neck shaft angle has been seen in different literature and all the orthopedic implants are designed according to the values of the western literature which is different from the Indian subcontinent</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span>Pelvic radiographs of patients who presented to Accident and emergency care or the outpatient department were used in the study</span> 110 patients radiographs were assessed in the study. There were 55 males and 55 females in our study. The mean age for males was 46.5 years and that for females was 43.2 years. The pelvis radiographs were studied for neck shaft angle .The measurements were performed bilaterally on the digital screen using the PACS (picture archiving and communication system) with handheld 360 degree goniometer.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean neck shaft angle in our study was129.26 degree for males and 126.62 degree for females .The overall mean neck shaft angle in 110 radiographs was 128.60 degree<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">We conclude that consideration of neck shaft angles in orthopedics surgery and designing of implant can give more angle options for the surgeons which can improve the overall prognosis of the patient.</span></p>

PurposeFractures of distal radius are one of the common orthopaedic injuries. Placing the plate on volar surface requires release of underlying pronator quadratus (PQ) muscle. No consensus is present in the literature about the repair or not of the PQ. The purpose of this study was to evaluate the influence of PQ repair on functional outcome and complications.MethodsRetrospectively 83 patients of distal radius fractures managed with volar plating between 2014 and 2016 were evaluated. Demographic data, operative notes and physical therapy records were retrieved. Patients were divided into group A where PQ repair was done and group B where no repair was done. Functional data such as range of motion (ROM), grip strength, visual analogue scale (VAS) score and disabilities of arm, shoulder and hand (DASH) score at 4 weeks, 3 months, 6 months and finial follow-up were retrieved.ResultsTotally 63 patients (n = 29 in group A and n = 34 in group B) with the mean age of 51.64 years were examined. Patients were followed up for a mean of 35.2 months (range 27.2–47.1 months) in group A and 38.6 months (range 28.6–51.0 months) in group B. Though functional outcome of the affected limb was not significantly different between two groups after 3 months, PQ repair did affect the recovery at an early stage. Repair group had significantly better ROM (p = 0.0383) and VAS score at 4 weeks (p = 0.017) while grip strength (p = 0.014) was significantly better at 3 months.ConclusionsRepair of PQ may provide pain relief and increased ROM in early postoperative period and hence every attempt should be made to achieve the repair.

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Complex forearm injuries are often associated with contamination, crushing, loss of tissues and patient arrives at odd hours when specialists are not available. These injuries can lead to complications like infective non-union, stiffness, disabilities and secondary amputations.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">23 patients having complex forearm injuries treated primarily at tertiary care center by single surgeon were included in the study. Pinch strength, grip strength, residual deformity and DASH score was assessed at final follow-up. In 23 patients treated, 16 patients underwent primary internal fixation of both bone, primary external fixator was done in 4 patient, delayed fixations in 6patients, primary bone grafting in 3 patients and in 1 patient delayed bone grafting was done Skin grafting was performed in 6 cases, and flaps in 13 patients. Vascular repair was done in four patients</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">All 23 patients came for follow-up. An average number of surgery performed per patient was 3.81 and mean hospital stay of 28.2 days. The mean duration of follow up was 47.2 months. The average DASH score was 10.24 with average key and tip pinch and grip strength of 62.24%, 58.48% and 54.75% respectively. 3 patients had superficial infection and two patient deep infections. Superficial infections were managed with IV antibiotics. The patients with nerve and vascular injuries had higher DASH score. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Early wound coverage can improve functional outcomes. Training in plastic coverage of wounds using pedicle flaps and skin grafting, microsurgical nerve and vessel repairs for orthopedic surgeon can be of great help for the patients.</span></p>

There is little data regarding Vitamin D deficiency in Greece. Also conflicting are the data regarding the bone turnover during the acute hip fracture interval and the situation is even more complex considering the recently developed bone turnover markers (BTMs). The aim of this study was to evaluate the parameters of bone mineral homeostasis of women with fragility hip fracture using the recently developed BTMs of carboxy-terminal collagen crosslinks (CTx) and the procollagen type 1 aminoterminal propeptide (PINP) and to determinate vitamin D (25-OHD) levels of elderly Greek women with acute hip fracture. 38 self-sufficient, community-living Greek women with acute hip fracture were included. A similar number of age-and sex-matched controls with no clinically evident fractures were included in the study meeting the same inclusion and exclusion criteria. To exclude the effect of trauma blood samples were drawn within 24 hours from the fracture. Hip fracture group had significantly lower serum 25-OHD levels and significantly higher intact parathormone (PTH) levels compared to the control group but no correlation between PTH and 25-OHD was found in both groups. CTx was significantly correlated with PINP in the total group and in both groups separately but there was no statistical difference of their levels between the two groups. There was high prevalence of severe Vitamin D deficiency within the postmenopausal Greek women with acute hip fracture and the fracture did not influence the above mentioned BTMs. The processes of bone resorption and bone production are in balance during the first 24 hours after the fracture.