Osteoarticular tuberculosis is a relatively uncommon type of extrapulmonary tuberculosis. It is an important cause of mortality and morbidity and accounts for approximately 10-15% of all extrapulmonary forms of tuberculosis. The diagnosis is difficult and hence often late. The disability resulting from osteoarticular tuberculosis is directly related to the time of detection of disease and initiation of treatment. A prospective study of 36 patients suspected with osteoarticular tuberculosis was done from August 2010 to December 2012 was done at St. stephens hospital Delhi. For the purpose of this study, a diagnosis of osteoarticular TB was based on a combination of suggestive clinical features, in conjunction with typical radiological findings associated with osteoarticular TB. The specimens were subjected to ZN staining, Real Time PCR, Bac-T alert culture & Accuprobe. The sensitivity of real time PCR was 100%, specificity was 58.8%, positive predictive value was 73%, negative predictive value was 100%, efficiency was 80.5% considering culture as gold standard. As shown by the study, each diagnostic test including Real time PCR has its own disadvantages and shortcomings and does not provide 100% accuracy in diagnosing osteoarticular tuberculosis, therefore, strong clinical suspicion and correlation along with radiological and laboratory evidence is a must in establishing a diagnosis.

Introduction: The presence of thrombus within deep veins of the extremity is termed as deep vein thrombosis (DVT). If not recognized deep venous thrombi can embolize to pulmonary arterial circulation which can be fatal within few hours of onset. The thrombosis occurs due to inappropriate activation of the process of normal hemostasis as a response of the blood to injury. Study was done to find out the prevalence of DVT in patients with surgeries around knee. Material and Methods: The study was a non analytical cohort study. The study was conducted in the department of Orthopedics, St Stephen's Hospital Tis Hazari,New Delhi between oct '12 to Dec '14. A detailed history, clinical and radiological examination along with investigations was carried out in all 74 patients. 74 cases were included in study out of which 51 fracture patients and 23 arthroplasty patients. 16 cases of VTE were seen with highest prevalence in patients with fracture around knee. Results: The overall prevalence of VTE was found to be 22%. Clinical DVT was 8% and subclinical DVT was 14%. In other words,62% of DVT was subclinical while 38% was clinical. Among the patients with DVT, 10 cases i.e 71% cases had proximal DVT and rest of 4 cases ie 29% cases had distal DVT. Conclusion: Conservatively treated cases shows statistically significant more risk for VTE than operated cases.In our study, 63% cases of diagnosed VTE were clinically asymptomatic as compared to 37% of clinically symptomatic cases.Among the operative cases, use of tourniquet with DVT was assessed. But since the number of patients were too less, no adequate correlation can be made out.

Aim of study was to use the allogenic bone graft with or without vancimpregnation in osteoreconstrutive surgery and compare the results with respect to:  Efficacy and safety in prevention of graft related and surgical site infection.  Effect on bone healing and osteointegration. Materials & Methods: In our study a total of 30 patients who required allogenic bone grafting for varied indications and gave informed consent for participation in the study were included. Patients with active osteoarticular infection at the proposed surgical site and with any medical contraindication to the use of vancomycin were excluded from the study. Broadly three indications for which allogenic bone graft was used included fractures, benign osteolytic lesions and miscellaneous indications which included allograft use for lumbar spinal fusion and for augmenting acetabular reconstruction. Observation & Result Infection: An overall infection rate of 3.3% (1 out of 30 cases) was found in this study which is much lower than what is mentioned in the literature as infection rates ranging from 4-12% have been reported by different workers Osteointegration: The overall success rate in terms of adequate osteointegration in our study was 83.33% (5 failure cases out of 30) with 12 cases (80%) out of 15 in study group and 13 cases (86.7%) out of 15 achieving adequate osteointegration and there was no significant difference (p value=1) between the two groups. Bone Healing: Fractures: In cases of fractures a good overall union rate of 88.8% was obtained with 16 out of 18 patients achieving adequate union. The two failure cases brought down the union rate to about 77.7% in the study group as compared to 100% union rate in the control group but this difference was not statistically significant with p value of 0.384 Thus vancomycin impregnation was not found to affect fracture union in our study. Benign bone lesion: A total of eight patients (3 each of SBC and GCT and 2 of ABC) were included. After random allocation five patients (2 each of SBC and GCT and 1 of ABC) came under the study group and three patients (1 patient each of SBC, GCT and ABC) under control group. The mean age of patients in the study group and control groups was 25.2 years and 34.1 years respectively and thus were comparable. There was no significant difference in terms of lesion healing between the two groups (p value= 0.684) as all the eight patients (100%) showed adequate healing as defined by Neer's classification [1] .

Background: We Assessed patients with Functional recovery between two treatment modality intramedullary interlocking nail and locking plate fixation in the surgical management of extra-articular distal tibia fracture. In high energy distal tibial fractures younger age groups are involved due to road traffic accident and fall from height. Axial loading, compression and torsional forces are involved in the mechanism of injury. Distal tibial fractures are very commonly encountered by orthopaedic surgeons. Aims and Objectives: To study and compare clinical and radiological outcome in extra articular fractures of distal tibia treated by multidirectional interlocking intramedullary nails and anterolateral locking compression plates with reference to rate of healing, functional outcome and complications. Material and Methods: In this study 26 patients with distal tibia extra-articular fractures, AO type 43 A1, 43A 2,43A3 were randomly selected and 13 of them were operated with multidirectional interlocking nailing and remaining 13 with anterolateral locking compression plate. The patients were regularly followed up for a period of one year and were evaluated clinically and radiologically with respect to tenderness at fracture site, abnormal mobility, infection, pain on movement of knee, ankle joints and anteroposterior and lateral radiographs of the leg for union of the fracture. Results: About 42 to 52% complication rate was attributed in internal fixation device and extensive surgical procedure due to soft tissue injury. Therefore ankle spanning external fixation became popular to maintain the articular surface of tibia with minimal internal fixation. In multidirectional Interlocking intramedullary group average time for union was 4.5 months compared to 6.4 months in plating group which was significant (p value<0.00). Also the average time required for partial and full weight bearing in the nailing group was 4.2 weeks and 9.6 weeks respectively which was significantly less (p value <0.00) as compared to 7.12 weeks and 13.42 weeks in the plating group. Lesser complications in terms of implant irritation, ankle stiffness and infection (superficial and deep) were seen in interlocking group as compared to plating group. Conclusion: Here we will conclude lateral radiographs of the distal third of the tibia are of great importance for the diagnosis. The management of these fractures is usually operative. Plate fixation for distal tibia fracture is associated with non-union, delayed union, sloughing of overlying skin, and infection. Interlocking intramedullary nailing is now more preferred weight bearing, early union of the fracture and decreased implant related problems and closed in treatment of distal tibia fractures.