Elastic stable intramedullary nails have been commonly used to treat unstable long bone fractures in children. The nail tip at the insertion site can cause problems. The nail tip should be of optimal length as a prominent nail tip or a short nail tip, or both, may cause different sets of problems. If the nail tip is short, nail removal after fracture union can be difficult and may pose challenges. A short nail tip may lead to difficulty in nail removal, longer duration of surgery, and need for special equipment for extracting the nail. Few techniques have been suggested in the past for removing elastic nail with the short tip, but all these techniques need special instruments. We describe a surgical technique using a metallic suction cannula to aid elastic nail removal. This method utilizes an easily available instrument in the operating room and does not need any special equipment.

The main aim of this study is to evaluate functional and radiological outcomes after treatment of intra-articular distal radius fractures by close reduction external fixation. Materials and Methods: Twenty five patients of intra-articular fracture distal radius fulfilling the inclusion criteria were treated between Jan. 2016 to Nov. 2017 with close reduction external fixation using principle of ligamentotaxis. The fixator was removed after 6-8 weeks and patients were followed up for 6 months postoperatively. At final follow up functional assessment was done using Gartland and Werley score and radiological assessment done measuring radial inclination, volar tilt and ulnar variance. Results: Seventeen (68%) male and eight (32%) females with mean age 45.4 years with intra-articular distal radius fractures were treated with external fixator. At 6 months follow up functional assessment was done using Gartland and Werley score, reported excellent to good outcome in 88% cases and satisfactory outcome in 12% cases and radiological parameters were within acceptable range. There was no correlation of age, sex or fracture type (as per AO classification) with functional outcome. Conclusions: External fixator is a simple, cost-effective and reliable means of treating intra-articular distal radius fractures with good functional outcomes.

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Introduction: Interlocking tibia nail fixation for tibia shaft fracture treatment is one of the most commonest procedures performed in orthopedic trauma practices. We report one such case of a rare complication of anterior tibial artery (ATA) pseudo-aneurysm caused by the proximal coronal locking bolt performed by an unusual entry from lateral to medial side during shaft of tibia fracture fixation. Case Report: A 86- years old female sustained a road traffic accident and was diagnosed with a closed tibia shaft fracture of the right leg for which she underwent intramedullary interlocking nail IMIL nailing elsewhere. She presented to us three 3 weeks after primary surgery with persistent pain and swelling in the right leg proximally. We investigated and diagnosed her as having a pseudoaneurysm of the Anterior Tibial Artery on color Doppler and magnetic resonance imaging (MRI) angiography. The pseudoaneurysm of ATA was clipped without any complications. To avoid the rupture of the pseudoaneurysm during manipulation of nail and bolts, their positions were not changed as they were supporting the fracture well and the fracture was also not united at that time. Conclusion: Though Although interlocking nailing of tibia shaft fracture is a commonly performed procedure, it can lead to disastrous vascular complications if the procedure is not performed with utmost care. ATA injury by proximal locking bolts of the tibia nail mandates the need for reconsideration of the nail design with better screw hole positions. We recommend preferring standard AO manual instructions for proximal tibia locking bolt direction. Keywords: Pseudo-aneurysm, tibia nail, locking bolt, anterior tibial artery.

The main aim of this study is to radiologically assess the components alignment in various planes in total knee replacement and to assess its relationship to the functional outcome using the knee society score. Materials and Methods: This hospital based prospective observational study of 30 patients was conducted in the department of Orthopaedics at Maharaja Agrasen Hospital, New Delhi on patients who underwent elective primary Total Knee Arthroplasty and the period of study being 24 months from June 2016 to May 2018. All patients were assessed clinically and functionally using the Knee Society Score pre and post operatively for a follow up period of 6 months. Results: The mean coronal alignment and rotational alignment of femoral component in our study was 5.87 degrees and 2.99 degrees of external rotation respectively. The mean tibial component coronal and rotational alignment in our study was 90 degrees and 17.77 degrees respectively. The mean preoperative flexion of 81.33 degrees increased to 113.5 degrees postoperatively with a significant p value of <0.001. There was significant improvement of Knee Clinical Score and Knee Functional Score following Total Knee Arthroplasty with a p value <0.001. Conclusion:In our study the use of conventional extra medullary guide for tibia and intramedullary guide for femur to align a total knee replacement provided acceptable alignment and gives a good functional outcome as measured by knee society score.