Background: Proximal third femur fractures are common fractures seen in community. Till date large numbers of intramedullary and extramedullary implant were used in the treatment of these fractures. These fractures differ significantly from femoral shaft fractures and more proximal femoral fractures in mechanisms, treatment and complications. In 1996 AO group has introduced proximal femoral nail (PFN) for treatment of these fractures. The use of PFN in both these fractures resulted in rotational stability along with union in more anatomic position. Aims & Objective: To prove the advantages of PFN like (1) close reduction of fracture which decreases the blood loss and chance of infection; (2) controlled impaction of the fracture; (3) rotational stability; and (4) load bearing capacity of the implant. Material and Methods: We have done a retrospective study of proximal femur fractures operated with proximal femoral nailing at our institute with follow up of 5-36 months. Our study included 30 patients with 8 patients having intertrochanteric fracture and 22 patients having subtrochanteric fracture. Patient was asked to come for follow up on 1, 2, 3 and 6 months from the date of surgery. At each follow up patient was assessed clinically as per Harris Hip score12 and x ray AP/LAT view of hip with femur is taken. Results: It concludes that according to Boyd and Griffith classification type II is the most common variety. In our study excellent to good results noted in 74% patients. All of them performing their routine normal activity well. 5 patients had poor results. Complication rate in our study was much lower. There was only one infection which was known case of diabetes mellitus. Conclusion: The procedure takes less time and the patient can be mobilized fast postoperatively as well after fixation with PFN. PFN should always be considered for management of subtrochanteric fractures in young as well as elderly patients who have multiple pre-existing illnesses. PFN is a closed nailing procedure which achieves a Biological Fracture fixation with minimal blood loss, preserving the fracture hematoma and helping easy healing of the unstable subtrochanteric femoral fracture as well as intertrochanteric fracture.

Introduction:The following study was conducted to examine the long term clinical, radiological and functional results of unstable intertrochanteric femur fractures treated with long Proximal Femoral Nail. Materials and Methods: This was a prospective, non-randomized study of 50 cases of intertrochanteric fractures of unstable variety treated by long Proximal Femoral Nail at the Department of Orthopedics, B J Medical College and Civil Hospital, Ahmedabad, between 2014 to 2016. Patients were undergoing primary surgery, with unstable types of fracture pattern AO/OTA type 31A2.2 to 31A3.3. Pathological fractures and patients with previous surgery on proximal femur were excluded. Results: The sample consisted fifty patients, 33 were males and 17 females. The patients' ages ranged from 18 -90 years with mean of 68.2 years. Majority (86%) of the intertrochanteric fractures occurred following trivial trauma usually a domestic accident like fall in bathroom or fall from stairs. Associated bony injuries were present in 3 cases (6%). Most common associated injury was fracture lower end radius (in all 3 cases). 29(58%) patients had an osteoporosis Grade 5 while 17 (34%) had Grade 4. AO/OTA Type A2.3 type of fractures were most common in 31 (62%) patients, followed by A2.2, A3.1 and A3.3. Functional Outcome was assessed with modified Harris Hip Score in which 70% of the patients had good to excellent functional results on final follow up at 1 year. Conclusion:The proximal femoral nail, is an optimum implant for the internal fixation of unstable intertrochanteric fractures with advantages of stable fixation, perfect reduction, early weight bearing and ambulation, shortened hospital stay and improved rate of union with early resumption of independent life style.

Introduction: Distal tibial metaphyseal fracture is common but the treatment of choice is still controversial. Objectives: This study was performed to see the functional outcome and complication rates of distal metaphyseal fracture by both the methods at 1 year interval. Materials and Method: We have studied 40 patinets in civil hospital Ahmedabad from periods July 2015 to December 2017. The study was prospective and comparative for the methods used for management of the fracture. Results: Age range of the patients was 20-60 years. Most common mode of trauma in both the groups is road traffic accident. Associated fibula fracture was present in 18 (90%) participants in group 1 (nailing) and 17(85%) patients in group 2 (plating). Differences between two groups regarding duration of surgery is not significant. No significant intraoperative complications were noted in both groups. Time after which partial weight bearing and full weight bearing was started were significantly shorter in group-1 (p=0.005). The average time before union was 23.45 weeks (range, 16-36 weeks) in group 1 and 26 weeks (range,19-41 weeks), (p=0.09). Malalignment was found in 25% of patients in group 1 and 10% of patients in group 2. Angulation in group 1 was 3.4 degree (range, 0-12) and 1.0 degree (range, 0-9) in group2 (p=0.04). Conclusion:The overall results were comparable and most patients were satisfied with the results. These results indicate that both modalities of treatment deserve a place in treating distal metaphyseal fractures of tibia.

Introduction:The goal of fusion of the lumbar spine is to alleviate pain. Different circumferential fusion techniques have been described such as combined anterior-posterior fusion (APF), instrumented posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). The TLIF procedure has rapidly gained popularity because of its posterolateral transforaminal discectomy and fusion. It has been reported as a safe technique, without the potential complications described when using combined APF and PLIF techniques. Materials and methods:A retrospective clinical and radiographic study of 52 patients with symptomatic degenerative lumbar spine treated with TLIF was performed. Through a classic posterior midline incision, the side of facetectomy was chosen according to the subject's symptoms of leg pain if present. A posterolateral discectomy, endplate preparation and insertion of a peek cage with additional bone graft locally harvested were performed. The posterior fusion was instrumented with pedicle screws and titanium rods. Results: Improvement in ODI score from 63% to 13% and in mJOA score from 9 to 25 at final follow up shows TLIF procedure improves the general condition of patient. Few complications (Dural tear, Local wound infection, Broken implant) encountered during study (observed in 25% patients) do not affect overall long term outcome. PLIF has been associated with high incidences of neurological complications, up to 13.6% permanent neurologic lesions in Barnes' et al. study, which is not observed in TLIF. Conclusion: TLIF allows surgeon to achieve anterior fusion with low risk of injuring the nerve root by minimal retraction of the root. The advantages of this technique are: less complications, the simplicity and speed of execution and versatility. Adjacent segment disease and accelerated disc degeneration above or below the level of fusion is major concern on long term follow up.

Autologous blood injection (ABI) into the articular cavity, It is one of the treatments for recurrent temporomandibular joint dislocation, was recently reintroduced, here we present a case report of the management of recurrent temporomandibular joint dislocation by Autologous blood injection (ABI) in a 45 -year-old neurologically disabled female. After the treatment, the left condylar process had settled just beneath the articular tubercle, the dislocation had improved, the patient was able to close her mouth & patient was followed on 3 rd day, 15 th day, 1 month, 3 rd month, 6 th month, 1 year for 1 year.