Background:A complex nonunion of the shaft of the tibia is a major cause of morbidity and mortality in patients with lower extremity injuries.Aims:The aim of this study was to evaluate the outcome of the functional and radiological outcome of complex nonunion shaft of tibia, treated by radical debridement, Ilizarov ring fixator with compression and distraction osteogenesis.Methods:From 2005 to 2010, sixty cases of complex nonunion shaft of tibia were included in our study. All infected nonunions were managed by radical debridement, fixed with Ilizarov ring fixator, monofocal/bifocal compression, and distraction osteogenesis. The average duration of follow-up is 36 months (26–50 months). The functional evaluation was done by using Association for the Study and Application of Methods of Ilizarov (ASAMI) scoring system and bone union with serial radiographs.Results:All patients had a successful union. The mean time for union was 7 months (5–9 months). The mean time of fixator removal is 12 months (8–14 months). Every patient had pin tract infections which were successfully treated with oral antibiotics. Four patients had an equinus deformity, one patient had insignificant limb shortening (1.5 cm), and three patients had soft tissue dystrophy. Using the ASAMI scoring system, we obtained 45 excellent, 10 good, 3 fair, and 2 poor functional results.Conclusions:The Ilizarov technique for complex nonunions has a high rate of success in achieving union and eradicating infection, bone loss, and malalignment. Radical debridement is the key step to control bone infection.

Background:Supracondylar fractures are the commonest elbow injury in children. Most displaced Supracondylar fractures are manipulated and held with a medial/lateral entry or two lateral Kirschner wires. It was the purpose of this study to investigate the treatment of this injury in this unique patient population.Materials and Methods:This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2005 to July 2010. One hundred seventy patients were recruited from Emergency and outpatient department having closed displaced Supracondylar fractures of humerus in children. They were treated either with medial-lateral pin fixation (n = 85) or with 2-lateral pin fixation (n = 85). All patients were operated under general anaesthesia. All patients were followed for 6 months. Results were analysed using Flynn's criteria.Statistical Analysis Used:Chi Square Test. Chi Square calculator was used as a software.Results:All children achieved union in a mean time of 4 weeks (range: 3-6 weeks). Post-operatively, eight patients (4.70%) got ulnar nerve injury and six (3.52%) patients got pin tract infection. Comparison between two groups such as cross K-wire group (85) and lateral K-wire group (n = 85) by using the Chi Square Test showed that in case of 8 weeks with (P-values = 0.89), in 16 weeks (P = 0.91) and 24 weeks (P = 0.85) with respective excellent, good, fair and poor categories were not found statistically significant.Conclusion:The lateral percutaneous pinning technique of displaced Supracondylar fractures of the humerus offers a viable alternative to the crossed pinning group as it offers the same stability without the incipient risk of iatrogenic ulnar nerve injury.

ObjectivesThe aim of this study was to assess the results of percutaneous injection of autologous bone marrow in the treatment of fractures presenting with delayed union or non-union after internal fixation.MethodsThis prospective study was carried out at the Orthopeedics Department from June 2005 to June 2010. A total of 93 patients with delayed union and non-union (56 delayed unions and 37 non-unions) of the long bone were recruited from the Emergency and Outpatient Departments and treated with percutaneous autologous bone marrow injections. The clinical results of this study were rated on the basis of the criteria of union. All patients were followed for 24 months.ResultsAll the fractures (delayed union and non-union) were united within 12 weeks. Most of the patients had discomfort at the donor site for few days; none had problems of persistent pain. The results were excellent in 68.81% (64/93) of cases, good in 19.35% (18/93) of cases, and poor in 11.82% (11/93) of cases.ConclusionPercutaneous autologous bone marrow injection is an effective and safe method for the treatment of diaphyseal non-union and delayed union. Thus, it is concluded that with an adequate amount of autologous bone marrow injection, successful union in delayed union and non-union of fractures of long bones can be achieved.

Background:Fractures of the humeral shaft are uncommon, representing less than 10 percent of all fractures in children. Humeral shaft fractures in children can be treated by immobilisation alone. A small number of fractures are unable to be reduced adequately or maintained in adequate alignment, and these should be treated surgically. In the present study, Kirschner wires (K-wire) were used to achieve a closed intramedullary fixation of humeral shaft fractures. The objective of this study was to evaluate the efficacy of intramedullary K-wires for the treatment of humeral shaft fracture in children.Patients and Methods:This prospective study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from June 2005 to June 2010. Sixty-eight children with a mean age of 7.7 years (range, 2-14 years) were recruited from Emergency and out patient department having closed fracture of humerus shaft. All patients were operated under general anaesthesia. All patients were followed for 12 months.Results:Out of 68 patients, 64 patients underwent union in 42-70 days with a mean of 56 days. Complications found in four patients who had insignificant delayed union which were united next 3 weeks. Intramedullary K-wires were removed after an average of 5 months without any complications. The results were excellent in 94.11% and good in 5% children.Conclusion:This technique is simple, quick to perform, safe and reliable and avoids prolonged hospitalization with good results and is economical.

ObjectivesTo evaluate the results of percutaneous golfer's elbow release under local anesthesia.MethodsFrom December 2010 to December 2013, 34 elbows in 34 patients (10 males and 24 females) that presented golfer's elbow for over one year were recruited from the outpatient department. All patients were operated under local anesthesia and were followed-up for 12 months. The functional outcome was evaluated through the Mayo Elbow Performance Index (MEPI).ResultsPain relief was achieved on average eight weeks after surgery. The results were excellent in 88.23% (30/34) cases and good in 11.76% (4/34) cases. Neither wound-related complications nor ulnar nerve complications were observed. On subjective evaluations, 88.23% (30/34) patients reported full satisfaction and 11.76% (4/34) patients reported partial satisfaction with the results of treatment.ConclusionPercutaneous golfer's elbow release under local anesthesia is a minimally invasive procedure that can be performed in an outpatient setting. This procedure is easy, quick, and economical, presenting a low complication rate with good results.