Background: Osteoarthritis of knee is one of the common conditions seen in older individuals and known to affect quality of life considerably. It makes it difficult for individuals with knee osteoarthritis to climb stairs, walk long distances, and stand for long time and squatting. In intractable cases not responding to conservative management surgical management such as proximal fibular Osteotomy (PFO) or high tibial Osteotomy (HTO) is routinely done. We conducted this comparative study to analyse the functional outcome of patients who had undergone HTO and PFO for medial compartment osteoarthritis of knee joint. Aims and Objectives: 1) To analyse the functional outcome of patients who had undergone HTO and PFO for medial compartment osteoarthritis of knee joint. 2) To compare complication rates in both the groups. Materials and Methods: A total of 60 patients with medial compartment knee osteoarthritis were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were randomized to 2 groups. Thirty patients undergoing proximal fibular osteotomy (Group A) and 30 patients undergoing high tibial osteotomy (Group B). The patients were followed up for improvements in functional outcome for 12 months. The statistical analysis was done using SSPS 21.0 software and p value less than 0.05 were taken as statistically significant. Results: Mean time for surgery was less for PFO surgery as compared to HTO and the difference was statistically significant. Moreover mean bleeding amount, drainage volume and time required for full weight bearing was low in PFO group as compared to HTO group and the difference was found to be statistically significant (P<0.05). The mean VAS score at the time of presentation in PFO and HTO groups was found to be 4.9 +/- 1.12 and 4.7 +/- 1.02 respectively. A statistically significant reduction in pain was documented at the time of follow up of 4 weeks in both the groups. The functional outcome and complication rates were comparable in both the groups. Conclusion: Proximal fibular osteotomy is a better option as compared to high tibial osteotomy in terms of mean surgery time, mean bleeding amount, drainage volume and time required for full weight bearing. Functional outcome and improvement in VAS were comparable in both the groups.

Introduction: Union of fracture is a complex process involving many systemic as well as local factors. Disturbance in any of these factors may lead to failure of process of union. This non-union is associated with increased morbidity, pain and functional disability. Autologous platelet injection at local site has been reported to be one of the effective measures in managing the cases of fracture of long bones complicated by non-union. We conducted this prospective study to know the effectiveness of autologous platelet injection at the fracture site in cases of fracture of long bones complicated by non-union. Materials and Methods:This was a prospective interventional study comprising of 30 cases of fracture of long bones complicated by non-union. The patients were included in this study on the basis of a predefined inclusion and exclusion criteria. The patients with established nonunion after fracture femur, tibia, humerus, radius and ulna were included in this study. Patients who were treated either by, by internal fixation, bone grafting or conservatively were added in this study. Imaging was done by X-rays and if needed by computerized tomography. Imaging was done till definite evidence of union was obtained. Results: Out of 30 cases there were 18 males and 12 females with a M:F ratio of 0.66. The most common bones involved were femur (60%), tibia (16.67%) and humerus (16.67%). Combined fractures of Radius and Ulna were seen in 3 (10 %) patients. The mechanism of injury was Road traffic accidents (66.66%) followed by direct blow and fall from height. All patients initially were treated conservatively or by surgery depending upon type of fractures. Non-union of fractures were treated by autologous platelet injection. All fractures showed radiological evidence of union within 4 months of treatment. Conclusion: Autologous platelet injection at local site is an effective management strategy in patients of fracture of long bones complicated by non-union. A non-infected site is the pre-requisite of this treatment.

Background: Distal femoral fractures are one of the common type of fractures seen after motor vehicular accidents. The optimal management of these fractures requires open reduction and internal fixation by plates and screws. Various studies have shown that open reduction and internal fixation by plates and screws result in early post-operative knee mobilization which is essential for good union and better functional outcome. Aims and Objective: The current study was conducted to evaluate the results of fracture lower end of femur treated by open reduction and internal fixation using locking compression plate. Materials and Methods: This was a prospective clinical study in which the cases with fracture lower end of femur were included on the basis of a predefined inclusion and exclusion criteria. Fractures were categorised by Mullers classification. All patients were treated by distal femoral locking compression plates and screws. The cases were followed up for radiological union and functional outcome (Neer’s scoring). The statistical analysis was done using SSPS 21.0 software. P value less than 0.05 was taken as statistically significant. Results: Out of the 20 studied cases there were 13 (65%) males and 7 (35%) females with a M:F ratio of 1:0.53. Road traffic accidents were the most common cause (75%) of distal femoral fractures. The most common type of fracture seen in studied cases was found to be Mullers C2 type of fracture (45%) followed by Mullers C3 (20%) and Mullers C1 (15%). All patients were treated by open reduction and internal fixation. Mean Injury to surgery interval was found to be 4.25 days in studied cases. Postoperatively desirable knee flexion (1100) was achieved in 10 (50%) cases whereas in 8 patients 910-1090knee flexion was achieved. In 2 (10%) patients less than 900 knee flexion could be achieved. The functional outcome (as assessed by Neer’s score) showed that Good and fair results were seen in 13 (65 %) and 6 (30 %) patients. Poor functional outcome was seen in only 1 (5 %) patient. Conclusion: Locking compression plate is found to have good results in patients with traumatic distal femoral fractures in terms of early mobilization and functional outcome. Particularly in intra-articular fractures it provides good angular stability by its triangular reconstruction principle.

Background: Although femoral neck fractures are common in elderly individuals, it is an uncommon occurrence in young patients. It is crucial to achieve anatomical reduction as well as stable fixation so as to avoid complications in young individuals who are expected to have considerable functional demand in post-surgical period. Dynamic hip screws are commonly used for internal fixation of these fractures. Although satisfactory functional outcomes have been reported in the patients treated by DHS, complications such as malunion and osteonecrosis remain an area of concern. Aims and Objectives: The aims of the study were to study the functional outcome of young patients with femoral neck fractures treated by DHS with CC screws and to study the complications in young patients with femoral neck fractures treated by DHS with CC screws. Materials and Methods: This was a prospective cohort study in which 80 young adults (below the age of 45 years) having femoral neck fractures and treated by DHS with 2CC screws were included in this study on the basis of a predefined inclusion and exclusion criteria. Gender and distribution, nature of injury, type of fracture, functional outcome, and complications were studied in studied cases. Open reduction and internal fixation was done using dynamic hip screw. The functional outcome was assessed using modified Harris hip score. All patients were assessed for complications such as non-union, malunion, and osteonecrosis. Statistical analysis was done using SSPS 21.0 software and P<0.05 was taken as statistically significant. Results: Out of 80 studied cases having femoral neck fractures, there were 54 (67.50%) males and 26 (32.50%) females with an M: F ratio of 1:0.48. The mean age of male and female patients was found to be 38.37±4.62 and 38.80±4.97 years, respectively. The most frequent cause of fracture was fall from height (48 cases) followed by road traffic accident (31 cases). Forty-six patients had complete fracture with partial displacement (Type III) and remaining 34 patients had complete fracture with total displacement (Type IV). Associated injuries were seen in 9 (11.25%) patients. Nine (11.25%) cases of avascular necrosis of femoral head were seen in our study. Surgery more than 48 h after injury and complete fracture with total displacement were associated with increased risk of avascular necrosis of femoral head (P<0.05). Conclusion: Femoral neck fractures in young patients treated by dynamic hip screws with CC screws have found to have excellent functional results in majority of cases. The complications such as osteonecrosis of femoral head can be minimized by decreased time duration between fracture and surgical intervention.

Background: Distal femur fractures are generally due to high velocity trauma particularly form road traffic accidents and fall from height. The treatment of distal femur fractures has evolved from conservative to operative to fixation of both lateral and medial columns of femur. Aims and Objective:  The aim of this study was to evaluate the functional outcome of operated cases of comminuted fracture of lower end of femur fixed with locking compression plate laterally and augmented with titanium elastic nail system medially. Materials and Methods: The present study was a prospective study carried out in Bharati Vidyapeeth Medical College and Hospital, Sangli after approval from institutional ethical committee. In this study, 20 patients with communited fracture of lower end of femur were included on the basis of a predefined inclusion and exclusion criteria. Detailed history was taken and clinical examination was done in all cases. After preanesthetic evaluation and relevant investigations patients were treated by reduction (close or open) and fixation was done by locking compression plate laterally and augmented with titanium elastic nail system medially. Patients were followed up at 6, 10 and 14 weeks for functional outcome by Neer’s scoring system and degree of flexion at knee joint. Results: Out of 20 studied cases there were 16 (80%) males and 4 (20%) were females with a M:F ratio of 4:1. The mean age of male patients was found to be 42.81+/-14.79 whereas mean age of female patients was 40.5 +/- 14.36. The mean age of male and female patients was found to be comparable with no statistically significant difference (P=0.78). Most of the patient were diagnosed with the fracture of AO TYPE C3 (7 cases), followed by AO TYPE C1 (4 cases). Full weight bearing was achieved in 8 (40%) patients within 18 weeks whereas remaining 12 (60%) patients required more than 20 weeks for full weight bearing. 14 (70%) patients had excellent outcome whereas, Good, Fair and poor outcomes were seen in 4 (20%), 1 (5%) and 1 (5%) patient. On one-way ANOVA analysis, showed that the flexion was significantly higher in 12 weeks as that of the 6 weeks (P =<0.0001). Further the flexion was significantly higher in 24 weeks as that of the 6 and 12 weeks (P =<0.0001). Conclusion: Our study found that locking compression plating laterally augmented with titanium elastic nail system medially for comminuted distal femoral fractures is a good fixation system and provides good angular stability.