Objective: To clinically evaluate, the effectiveness of percutaneous tenotomy of Achilles tendon using a 16 gauge needle in clubfoot treatment by ponseti technique. Material and methods: forty five affected foot were prospectively evaluated in Twenty five patients with ctev attending orthopedics OPD in K R Hospital, Mysore and treated conservatively using ponseti technique between June 2016 and November 2017.out of forty five affected feet ,thirty nine feet required tenotomy and percutaneous tenotomy done using a 16 gauge needle and assessed clinically. Results: all 39 feet successfully managed, the reported complications of conventional tenotomy by knife [excessive bleeding, pseudo-aneurysm or neurovascular compromise] were not encountered with this technique. Conclusion: This percutaneous tenotomy technique using a 16 needle is a simple procedure, safe and very effective and gives predictable results without any complications which were reported with tenotomy by knife.Keywords: Percutaneous tenotomy, Achilles tendon, 16 gauge needle, management, clubfoot Introduction Clubfoot or CTEV( congenital talipes equino-varus ) with an incidence of about 1 in 1000 live births [1,2] makes it one of the most commonly encountered congenital deformity in clinical practice. Equinus at ankle joint, varus of hind foot, fore-foot adduction, and mid-foot cavus are the four components of this deformity [3][4][5][6] . Historically, Hippocrates introduced the conservative management for clubfoot in around 400 BC [10,11] . Later, Kite introduced a method [12] in 1993, which included manipulation and casting technique, but the success rate was poor [7,8,13] . Later, in 1963 Ponseti developed a conservative method, called as Ponseti technique, which consists of serial manipulation and casting followed by tendoachilles tenotomy, if needed to correct residual equinus and casting and it takes about four to five weeks to achieve the full correction of all four components of the deformity [14,15] . Ponseti management, over the past two decades has become accepted throughout the world as the most effective and less expensive treatment of ctev. The technique involves serial manipulation and casting and possible percutaneous tendoachilles tenotomy. However, in about 85% of the cases there was a residual equinus deformity which needed further correction by tenotomy of Achilles tendon [16][17][18][19] Originally, as Ponseti described, tenotomy is performed using a surgical blade, such as a no.11 or no.15, or any other small blade, such as an ophthalmic knife. However, complications related to the procedure, such as excessive bleeding [23] , formation of a pseudo-aneurysm [24] and neurovascular injuries [25] , were described. To avoid these complications, many modifications have been introduced. Recently, new technique by using wide bore surgical needle is increasingly used which was first described by Minkowitz et al. [20,21,22] . The technique of performing tenotomy with a needle may have advantages over other tenotomy techniques, as ...

BackgroundBony ankylosis of elbow is challenging and difficult problem to treat. The options are excision arthroplasty and total elbow replacement. We report our midterm results on nine patients, who underwent inverted 'V' osteotomy excision arthroplasty in our hospital with good functional results.MaterialsOur case series includes 9 patients (seven males and two females) with the mean age of 34 years (13-56 years). Five patients had trauma, two had pyogenic arthritis, one had tuberculous arthritis, and one had pyogenic arthritis following surgical fixation.ResultsThe average duration of follow up is 65 months (45 months-80 months). The mean Mayo's elbow performance score (MEPS) preoperatively was 48 (35-70). The MEPS at final follow up was 80 (60-95). With no movement at elbow and fixed in various degrees of either flexion or extension preoperatively, the mean preoperative position of elbow was 64°(30°to 100°). The mean post operative range of motion at final follow up was 27°of extension (20-500), 116°of flexion (1100-1300), and the arc of motion was 88°(800-1000). One patient had ulnar nerve neuropraxia and another patient developed median nerve neuropraxia, and both recovered completely in six weeks. No patient had symptomatic instability of the elbow. All patients were asymptomatic except one patient, who had pain mainly on heavy activities.ConclusionWe conclude that inverted 'V' osteotomy excision arthroplasty is a viable option in the treatment of bony ankylosis of the elbow in young patients.

Pigmented villonodular synovitis is a very rare but still an aggressive tumour which involves bursae, tendon sheaths and synovium. The foot and ankle involvement in PVNS is around 2 -10%. We conducted a prospective study of 8 patients with PVNS of foot and ankle with diagnosis confirmed by X-ray, MRI, histopathology at Mysore Medical College. Mean age was 28.87 (14-46) at diagnosis. All the patients underwent open synovectomy followed by postoperative radiotherapy. At an average follow up of 22 months, 6patients reported better functional outcomes. Although 2 patients were symptomatic, none of the patients had recurrence of the disease. Thus we conclude that open synovectomy with radiation therapy would reduce the risk of recurrence in diffuse PVNS without causing functional impairment.