Structured abstract:Medial compartment osteoarthritis of knee in young adults has a variety of management options. Realignment surgeries by high tibial osteotomy unload the medial joint and are gaining popularity with increasing focus on knee preservation surgeries. Medial opening wedge osteotomy is one such time tested technique with the fixation being done using internal or external fixators. Here we present the early outcomes of infra-tubercle medial opening wedge osteotomy using a dynamic axial external fixator. Methodology: A single group cohort study was conducted to assess the functional outcomes of high tibial osteotomy with a uni-axial dynamic external fixator for medial compartmental osteoarthritis in younger patient. Results:Function was assessed using knee scores at 6 months and 12 months follow-up which was 85.5 and 83.1 respectively. On bivariate analysis of pre and post-operative Knee-scores, significant improvement was noted with average being 44.2 ± 4.01 which was statistically significant p value-<0.00001. Excellent results were obtained in 15 cases (75%) and good results in 5 cases (25%). Three patients developed pin track infections and were treated with antibiotics and pin tract care. Conclusion: High tibial osteotomy using dynamic external fixator is a simple and effective option for management of medial compartment osteoarthritis in young patients with good short-term functional outcomes and low risk of infection.

BACKGROUND Air in the peritoneal cavity is called as Pneumoperitoneum. Not all the cases of pneumoperitoneum are due to hollow viscus perforation. Most common cause of pneumoperitoneum is due to hollow viscus perforation in 90% cases, mostly due to duodenal ulcer perforation or gastric perforation. In 10% of the cases, the pneumoperitoneum does not indicate the perforation nor warranted the surgery. Pneumoperitoneum that is non-iatrogenic that does not need surgery is called as spontaneous pneumoperitoneum. MATERIALS AND METHODS This study analyses the spontaneous/non-surgical causes of pneumoperitoneum and our experience in our institute for the past 5 years that is from June 2011 to May 2016 and also aims to create awareness about the non-surgical causes of pneumoperitoneum, identifying cases for which negative laparotomy can be avoided. RESULTS In this period 11 patients were identified with nonsurgical causes of pneumoperitoneum, from that 2 patients underwent emergency laparotomy which was negative and 9 patients were managed conservatively. CONCLUSION In our study totally 11 patients were presented with pneumoperitoneum, out of which 9 patients were managed conservatively and 2 patients underwent negative laparotomy. Most common cause of spontaneous pneumoperitoneum in our study is thoracic cause.

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