Background: Patellar instability may manifest as acute patellar dislocation, recurrent patellar dislocation or subluxation, habitual patellar dislocation or chronic patellar dislocation. Habitual patellar dislocation is a condition where the patella dislocates whenever the knee is flexed and spontaneously relocates with extension of the knee. The purpose of this study is to know the functional and radiological outcome following proximal realignment procedure (Campbell technique) for habitual patellar dislocation. Methods: The study was conducted from June 2017 to January 2019 with a minimum follow up of 6 months and a maximum follow up of 2 years. Inclusion Criteria: All patients with habitual patellar dislocation, age between 5 to 40 years. Exclusion Criteria: Patient age less than 5 years and aged above > 40 years, past history of knee surgery, acute patellar dislocation and knee effusions. Radiological assessment was done by measuring sulcus angle and congruence angle. Functional outcome was assessed by Kujala score. Conclusion:Campbell technique (lateral release of tight structures and medial plication of patellar retinaculum) is a safe and effective procedure for treating habitual patellar dislocation. Functional outcome evaluated by Kujala score was good for most of our patient's. Radiological parameters (sulcus angle and congruence angle) were brought back to normal. There were no significant changes in sulcus angle. Congruence angle was brought back to normal, which was statistically significant (p<0.001).

Introduction: Foot deformities caused by altered or abnormal muscle forces are common in patients with cerebral palsy. The incidence of foot deformities in cerebral palsy is approximately 70% to 90%. The most common deformity is ankle equinus, with equinovarus and equinovalgus deformities being equally common. A foot deformity can have significant effects on the patient's overall ambulatory level. The purpose of this study was to assess the functional outcome of batchelor's extra-articular subtalar arthrodesis in spastic planovalgus foot in cerebral palsy children. Materials and Methods: This is a prospective study of 40 patients (68 feet) with spastic planovalgus foot deformity presenting to BIRRD (T) Hospital from October 2015 to October 2017. Children with spastic planovalgus foot between 6 yrs-14 yrs were included in study. There were 24 male and 16 female children. The mean age at the time of surgery was 10 yrs. Both feet were involved in 28 children, 8 had right foot involvement and 4 had left foot involvement. In our study we had 12 hemiplegics and 28 diplegics. Children with mental retardation, extra pyramidal type of cerebral palsy, rigid plano-valgus foot, spastic quadriplegia were excluded from the study. All patients underwent batchelor's arthrodesis with fibular graft and were immobilized in below knee POP cast for 8 weeks. 24 patients underwent gastrosoleus lengthening along with batchelor's arthrodesis. Clinical and functional outcome was assessed based on AOFAS (American orthopaedic foot and ankle score) clinical rating system. Radiological assessment was done by measuring Lateral talocalcaneal angle and Talar declination angle. The results of batchelor's arthrodesis are stated as satisfactory and unsatisfactory. Satisfactory: Clinical and roentgenographic stabilization of the hind foot and no recurrence of planovalgus deformity. Unsatisfactory: Clinical and roentogenographic evidence of failure of stabilization. Results and Discussion: All children had spastic type of cerebral palsy. Post-operatively children were followed-up for an average period of 14 months, with range from 4 to 24 months. Among 40 patients (68 feet), 8 feet (12 percent) had residual valgus, 12 feet (18 percent) had graft absorption, 4 feet (6 percent) had fracture of the graft and none had varus deformity after an average follow-up of 14 months. Out of 68 feet, 44 feet had "satisfactory" result (65 percent) and 24 feet had "unsatisfactory" result (35 percent). Conclusion: Our experience concludes that batchelor's extra-articular arthrodesis of sub-talar joint is a good procedure for correction of plano-valgus foot deformity in cerebral palsy patients. Advantages of the procedure are simplicity of the technique, immediate firm fixation and early weight bearing.

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Introduction: Patella fractures are common and it constitutes about 1% of all skeletal injuries resulting from either direct or indirect trauma. The subcutaneous location of the patella makes it vulnerable to direct trauma as in dashboard injuries or a fall on the flexed knee, whereas violent contraction of the quadriceps results in indirect fractures of patella. These fractures are usually transverse and are associated with tears of medial or lateral retinacular expansions. In this study a series of 30 cases of fracture patella were studied after treating with Modified Tension Band Wiring technique. Methods: This prospective study was done in Department of Orthopaedics at Balaji Institute of surgery research and rehabilitation for the disabled (BIRRD) Hospital, Tirupati, Andhra Pradesh during the period from November 2013 to May 2015 over a period of one and half year. This study consists of 30 cases of fracture patella treated by modified tension band wiring. The cases were selected based on inclusion and exclusion criteria. Conclusion: Our study shows that modified tension band wiring is a definitive procedure in management of displaced transverse patellar fracture with least complications and also helps for early mobilization post-operatively. In our study we observed excellent result in 86.6% and good in about 10% and poor in 3.3% of cases. 4 Out of 30 cases had complications. Early post-operative Physiotherapy is a very essential tool of success in the management of these fractures, which helps in reducing complication like stiffness of knee and in providing good function. Long-term follow up is necessary to assess late complications like osteoarthritis and late functional outcome.

Objective: Tendon transfers are indicated when dynamic muscle imbalance results in a deformity that interferes with ambulation or function of the extremities. Foot and ankle are the most dependent parts of the body and are subjected to greater strain than other parts. Calcaneo-valgus deformity is one of the common deformities seen in Post-Polio Residual Paralysis. A host of operative procedures have been described in the management of this deformity. We report the results of the study conducted in our institute where Achilles tendon plication and transfer of Peroneus Longus tendon to Achilles tendon has been done for dynamic calcaneo-valgus deformity of the foot in patients of post-polio residual paralysis. Methods: This is a prospective study of 37 patients with Calcaneovalgus deformity having Post-Polio Residual Paralysis presenting to Balaji Institute of Surgery, Research and Rehabilitation for the Disabled Hospital from December 2009 to December 2012. Informed consent was taken from the parents of all the patients. Ethical committee approval was also taken. Patients with age more than 7 years, ability to walk without support and Peroneal tendon having minimum motor power of grade 4 or 5 as per MRC classification are included in our study. Patients with fixed deformity at ankle joint or subtalar joint are excluded from the study. Pre-operative evaluation included detailed motor examination of the involved lower limbs as per MRC (Medical research council) classification, evaluation of deformity in the hip and knee and range of motion at ankle. AOFAS (American Orthopaedic Foot and Ankle Society) clinical rating system was used to assess the patient pre-operatively and post-operatively. The aggregate score of the AOFAS ankle-hind foot clinical rating scale pre and post operatively were analyzed with use of chisquare analysis. The level of significance of < 0.05 was considered to be significant. The surgical procedure was done under spinal anesthesia with the patient in lateral position under pneumatic tourniquet. A longitudinal incision is made starting from the tip of lateral malleolus midway between the posterior border of lateral malleolus & Achilles tendon to about 8-10cm proximally. Skin flaps are mobilized without dissecting the subcutaneous fat. The two peroneal tendons are identified as they pass down the leg and around the back of the lateral malleolus. The peroneus longus tendon is divided as distally as possible and mobilized. Similarly the Achilles tendon is identified. Plication of the Achilles tendon is done in its middle third with nylon sutures and the peroneus longus tendon is transferred through it using Fish-Mouth (Pulvertaft) tendon suturing technique and is secured over itself proximally under tension providing the tenodesis effect. While this is done the ankle is kept in plantar flexion. The deep fascia is closed over the tendon. Pneumatic tourniquet was released, and the incision was closed in layers after hemostasis was achieved. Below knee cast is applied with the foot in plantar...