A Posterior Tibial Tendon injury associated with Bimalleolar ankle fracture was identified in a 57 year old male intraoperatively and was subsequently fixed with non-absorbable sutures. The patient was followed up for 4 months post operatively to denote posterior tibial tendon healing and outcome compared to contralateral side. High resolution usg monitoring was done and findings are disclosed.

Background Brachial plexus injuries are debilitating injuries resulting in paralyzed shoulder to global paralysis of the upper extremity. Treatment strategies have evolved over the years with nerve transfer forming the mainstay of surgical management. Phrenic nerve provides certain advantages as donor over other options but has been less preferred due to fear of pulmonary complications. In this study, we assess the functional outcomes of phrenic nerve transfer in brachial plexus injuries. Materials and Methods A retrospective study was performed on 18 patients operated between 2012 and 2017. The mean duration of injury to surgery was 4.56 months and mean follow-up was for 3.66 years. Phrenic nerve was used as donor to neurotize either biceps and brachialis branch of musculocutaneous nerve or suprascapular nerve. Assessment was done through Waikakul score for elbow flexion and Medical Research Council grading for shoulder abduction. Respiratory function assessment was done through questionnaire. Results Twelve (80%) patients recovered grade 3 and above elbow flexion with 6 patients having a positive endurance test according to Waikakul and a “very good” result. In phrenic to suprascapular transfer group (3 patients), all patients had more than grade 3 recovery of shoulder abduction. No patient complained of respiratory problems. Conclusion Phrenic nerve can be used as a reliable donor with suitable patient selection with good results in regaining muscle power without any anticipated effects on respiratory function.

Proximal phalangeal fractures are common fractures of the hand. The fracture are difficult to treat because of vicinity of 2 important joints and presence of tight osseofascious tunnel. The purpose of this study was to evaluate the efficacy of extension block splint in the management of selective proximal phalangeal fracture of hand. 21 Patients with proximal phalangeal fractures were treated by extension block splint and evaluated prospectively. Patient were followed up after 1 week, 3 weeks, and thereafter on monthly basis. Average follow up period was 9.8 months and outcomes were assessed by Belsky’s criteria. In our study, 76.19% patients had excellent outcomes, 19.04% had good, 4.76% had poor outcomes. 2 patients had extensor lag which subsided at further follow up at 1 year. The results of this prospective study shows that with careful selection of patients extension block splint is a simple, safe and effective technique for managing proximal phalanx fracture of hand.

A case of olecranon fracture treated with tension band wiring presented to us with symptoms of ulnar nerve injury. The ulnar nerve was explored and injury was identified between two heads of flexor carpi ulnaris (FCU) distal to the level of cubital tunnel. The injured nerve was repaired using sural nerve grafts and the patient improved as witnessed on regular follow-up.