BACKGROUND: Spondylolisthesis is a heterogenous disorder characterised by subluxation of a vertebral body in sagittal plane occuring frequently at l4-5 and l5-S1commonest being isthmic and degenerative variety. While majority are asymptomatic, a subset do produce pain with neurology. Complete decompression of roots is essential, as is the need for solid stabilization. Several fusion techniques were reported in literature like PLF, TLIF, PLF, ALIF On theoretical grounds, TLIF has been suggested to be safe and result in an improved outcome compared to other techniques. Data to support this view, are lacking. METHODS: A total of 21 patients (age range, 27-62 years) with adult isthmic and degenerative spondylolisthesis were operated. There were 8 males and 13 females with mean age of 46.8 pre-op and 2-year followup, pain (VAS) and functional disability were quantified by Oswestry Disability Index (ODI).Radiological union assessed with xrays by Brantigen and Steffee criteria. The global outcome was excellent in 90%.and 92% fusion. 2 patients presented motor deficit which did not recover. RESULTS: The follow-up was for 2 years. The mean VAS score for low back pain improved from 7.0 preoperatively to 2.1, as did the mean VAS score for leg pain from 6.7 to 1.4 and the mean ODI from 59.5% to 11.3%. CONCLUSION: TLIF does affect the 2-year outcome of surgical treatment of spondylolisthesis with decreased back pain and ODI's, with advantages of minimal thecal retraction, restored segmental lordosis and preserved posterior tension band.

BACKGROUND: Clavicle fractures are usually known for its conservative treatment, but for displaced middle third comminuted fractures (Robinson type 2B) plate osteosynthesis is a promising option. AIM: To evaluate the functional outcome of middle third clavicular fracture (2B1, and B2 Robinson classification) in 30 patients managed with Open reduction and internal fixation with plate and screw. METHODS AND MATERIAL: We performed a prospective study between Jan 2009 to May 2012 of 30 acute displaced comminuted middle third clavicle fractures in adults which were treated with plate osteosynthesis. There were 22 males, 8 females, the mean age of the patient was 35.6 years and 10 patients had associated injuries and average follow up was 18 month, minimum of 6 months. RESULTS: Union was achieved in 12-16 weeks. Post operatively 2 patients had superficial infection, 3 patients had scar hypertrophy, 3 Patients had hard ware prominence, no patients had hardware failure and none of the patients had deep infection. The average constant score was 96 and patients were relatively satisfied with the treatment. CONCLUSION: Plate Osteosynthesis for displaced middle third shaft fracture in adults gives excellent results.

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Patellar neoplasms are rare. Patella is an uncommon site for giant cell tumour. We report a rare presentation of giant cell tumour of the patella in a thirty year old female manual labourer who presented with pain and swelling of the knee. The first clinical symptom was anterior knee pain. The tumour mass restricted her daily activities. We present a case of this rare entity along with its clinical and radiographic features. To relieve her of her symptoms she was operated and the tumour mass was excised. Autogenous and synthetic graft mix was used to pack the defect. At the end of one year follow up patient is pain free and is able to carry her daily activities.

BACKGROUND: Undisplaced and minimally displaced fractures of the distal radius are one of the most common injuries. The conservative management of these fractures with closed manipulative reduction and Plaster of Paris casting and assessment of the functional results and complications is the aim of this study. MATERIALS & METHODS:One hundred cases of distal radius fractures in patients aged above 40 years who attended the orthopaedic OPD at King George Hospital, Visakhapatnam from September 2010 to August 2012 were studied retrospectively for a period of 2 years. Only extra articular distal radius fractures treated by closed manipulation and pop cast immobilization were included in this study. POP cast was removed at 6 weeks and patients were sent for rehabilitation to physiotherapy department. All Patients were functionally assessed at regular intervals for a period of 3 months. RESULTS: Functional evaluation was done based on Demerit point system of Gartland & Werley with Sarmiento et al modification. 12% of the patients had excellent outcome, 39% good results, 41% had fair outcome and 8% poor results. CONCLUSION: Better results were achieved in undisplaced and minimally displaced fractures treated conservatively by closed manipulative reduction and cast immobilization. However as the degree of displacement increases the results obtained were poor. Gross displacement and communition were associated with poor results even though accurate reduction was obtained during manipulation. Hence it may be concluded that conservative management still holds good for undisplaced and minimally displaced fractures, however in fractures of distal radius with significant displacement and comminution especially if the quality of bone is not good, it is difficult to obtain good functional outcome through conservative management alone. HOW TO CITE THIS ARTICLE