Post-operative pain management in Total Knee Arthroplasty (TKA) remains a challenging issue even though it is a commonly performed procedure today. Majority of the patients report severe pain following surgery due to which mobilization and early rehabilitation is hampered. Therefore, appropriate pain management is the need of the hour and Local Infiltration Analgesia (LIA) using periarticular cocktail injection is one of the preferred techniques. The objective of this study was to assess the functional outcome and patient satisfaction after using LIA in the form of periarticular Ranawat-cocktail among post-TKA patients. Materials and Methods: This study was conducted at SGITO, Bangalore during the period between August 2017 to April 2018. In this study, we used LIA consisting of the Ranawat Regimen for TKA patients which contains (bupivacaine with adrenaline, morphine, methylprednisolone, cefazoline and normal saline) to manage postoperative pain in all 53 patients presenting to our institute for primary TKA. Functional outcome was assessed in terms of post-op VAS score, ROM, and SLRT at 12hrs, 24hrs, and 48hrs post-op. Opioid consumption, and patient satisfaction was recorded and statistical analysis was done. Results: The mean age of patients in the study was 60.83. Mean VAS pain score at 12hrs, 24hrs, and 48hrs post-op were found to be 5, 3.5 and 2.79 respectively which indicated a highly significant (p<0.001) reduction in pain following TKA. Majority of the patients (71.7%) did not require any opioid rescue analgesia. Post-op ROM was satisfactory and all patients were able to do SLRT by day 1 and there was excellent patient satisfaction at time of discharge. Conclusion: Local Infiltration Analgesia is a safe, simple and efficient method of reducing postoperative pain after total knee arthroplasty (TKA) which facilitates early rehabilitation among the patients and has an overall improvement in patient satisfaction with the procedure.

Standard open reduction and internal fixation techniques have been successful in restoring osseous alignment for proximal tibial fractures; however, surgical morbidity, especially soft tissue infection and wound necrosis, has been reported frequently. For this reason, several investigators have proposed minimally invasive methods of fracture reduction. To our knowledge, there have been no studies to assess the functional outcome of these fractures. During study period 30 patients were treated for proximal tibial fractures treated by open reduction and internal fixation with buttress plate and LCP. Out of which 8cases lost for follow up. In the present study there were 26 proximal metaphyseal fractures managed plate osteosynthesis. All the fractures united at an average of 13 weeks. There were 4 excellent, 16 good and 2 fair, 1 poor results. There were 1 patients with superficial infections which healed with regular dressings, no patients (5%) with knee stiffness, 2 patients with knee pain, no patients with delayed union, 1 patient with non union. Plating offers a good treatment option for difficult proximal tibial fractures, because plateosteosynthesis provide improved healing rates, restoration of the articular surface, and decreased complications.

Fractures of distal end radius are common fractures of the upper limb, and constitute 17% of all fractures and 75% of all forearm fractures. This fracture shows bimodal distribution of age with the fracture more commonly seen in children and elderly. Fractures that involve the articular surfaces of the distal radius can jeopardize the congruence and kinematics of the wrist joint. Anatomical articular reduction greatly reduces the incidence of post-traumatic osteoarthrosis and the quality of reduction relates directly to the final outcome. These types of fractures have been treated by various methods. Many fixation techniques have been described including pin and plaster fixation, percutaneous pinning, intramedullary pinning, external fixation (bridging or nonbridging, static or dynamic) and various forms of internal fixation with customised implants. The advantages of external fixation are the relative ease of application, minimal surgical exposure, and reduced surgical trauma. The disadvantages are prolonged immobilisation of the radiocarpal joint, indirect reduction of fracture fragments, loss of ligamentotaxis over time, and pin related complications. The advantages of plate osteosynthesis are direct fracture reduction, stable rigid fixation, and the possibility of immediate postoperative motion. Open reduction of the fracture allows reduction of the fracture under direct vision and should lead to accurate restoration of anatomy. Dorsal plates were associated with tendon rupture, tenosynovitis, reoperation, and 25% of collapse while the complication of volar plating is relatively low. The volar surface of the distal radius may be biologically more acceptable for open reduction and internal fixation than the dorsal surface because the flexor tendons are not as close to the bone sur faceas the extensor tendons.

Introduction: Management of distal metaphyseal tibial fractures is a formidable challenge to the orthopaedic surgeon. Some of the confounding factors in management are delicate soft tissue in this area, presence of ankle joint in close proximity, small distal fragment size, ligament injuries, occasional fibular fractures and compaction of cancellous bone among others. The conventional implants are unsuitable for managing such fractures successfully. Material and method: The 3.5mm anatomical anterolateral locking compression plates are precontoured plates that have been designed and developed especially for fixation of distal tibial metaphyseal fractures to overcome some of these problems. 34 patients underwent management using this implant. The study was done prospectively. Aim: The aim of the study was to evaluate the management of such fractures with this implant and to assess the functional outcome of the same. Results: 83% of patients in our study had excellent to good functional outcome. Conclusions: We concluded that that the anatomical anterolateral plate is an excellent option for managing such fractures and gives consistent and reproducible clinical results.

A basic understanding of the mechanism of fracture production has always aided in the treatment of specific fractures. Tibial plateau fractures are usually caused by high velocity trauma causing valgus or rarely varus force with or without axial loading as in road traffic accidents (Bumper fracture) or fall from a height. Valgus loading in the range of 2250 to 3750-inch pounds produce "mixed" fracture with large variation in the amount and the degree of joint and condylar disruption. This study of surgical management of proximal tibial fractures was conducted in the Department of orthopaedics and during study period, 30 patients were treated for proximal tibial fractures were treated by open reduction and internal fixation with buttress plate and LCP. Out of which 4 cases lost for follow up. All the required data was collected from the patients during their stay in the hospital, during follow up at regular intervals and from the medical records. 30 cases of fractures of the proximal tibia were treated with plate osteosynthesis. The follow up ranged from 6-24 months. Males were predominant. Majority of fractures were due to Road Traffic Accidents. The average age of the affected patients was 40 years. Most of the fractures were closed.