Osteoarthritis constitutes a major burden for health care besides posing great impediments to quality of life in progressively widening population of the aged. There have been on-going efforts to rationally address the preventive and corrective interventions. Destruction of articular cartilage is a cardinal consideration in this regard. The dilemma persists over that being a cause or effect of the osteoarthritic syndrome. The aging diseases are typically accompanied by comorbidities and decline in physiological functions. This article appraises the pathological process of cartilage destruction in such context to reflect on interventional perspectives ahead.

Background: Distal end radius fracture is a common fracture seen in the routine orthopedic practice. Although most of these fractures are managed by cast application, the loss of reduction and malunion rates are high. Closed reduction, percutaneous pinning, and cast application offers a simple method of managing these fractures. This study was done to evaluate the functional and radiological of extra-articular and simple intra-articular distal radius fractures using closed pinning and cast immobilization. Materials and Methods: A prospective study of 73 skeletally mature patients with displaced extra- and intra-articular fractures without significant comminution was done. Closed reduction was done under anesthesia and fixation done with 2 or 3 Kirschner-wires followed by cast for 6 weeks. Final follow-up was done after 6 months using Sarmiento's modification of Lindstrom criteria and demerit point system of Gartland and Werley. Results: The fracture united in all the 73 patients. The average preoperative radial height changed from 2.7 to 13.2 mm postoperatively and a final value of 10.9 mm. The average volar tilt changed from −11.25° preoperatively, 12.1° postoperatively, and 9.7° at the final follow-up. Only two patients had a significant loss of reduction. Pin tract infection, joint stiffness, pin migration, and complex regional pain syndrome were the major complications. Conclusion: Closed reduction, percutaneous pinning, and cast immobilization is a technically simple and an effective method for managing displaced extra-articular and simple intra-articular distal radius fractures.

Objectives: Among the various options available for correction of genu valgum deformities, supracondylar “V” osteotomy is a sparsely used technique. We used the technique for correction of postrachitic deformity in late childhood and adolescence and report the outcome achieved. Patients and Methods: Our operative criteria were age range between 10 and 12 years, a normal metabolic profile, and genu valgum deformity with a standing radiological tibiofemoral angle ≥15°. Patients who had gross collateral ligament instability, any restriction of knee range of motion, genu recurvatum, predominant tibial deformity component, epiphyseal irregularities, active metabolic disease were excluded from the study. Correction was undertaken using “V” osteotomy technique described by Aglietti et al. and was stabilized by two Kirschner wires. Functional outcome was assessed using Böstman et al. score. Results: Seventeen limbs in nine patients with a mean age of 11 years were operated. All the genu valgum deformities were postrachitic but with healed status. Mean follow-up of patients was 24.8 months. Preoperative radiological tibio-femoral angle had a mean value of 20.2° which improved to a mean of 3.05° postoperatively. Knee score was excellent in 88.8%, good in 11.1%. All patients recovered full range of knee motion within 6 weeks after removal of the cast. Two main complications were deep infection and partial slippage of lower femoral physis in one case each. Conclusions: Supracondylar “V” osteotomy is a viable option for the correction of postrachitic genu valgum deformity in older children and adolescents with limited residual physeal growth not amenable to growth modulation procedures.

Background: Optimum management of ipsilateral fracture neck and shaft of femur is controversial and lacks general consensus. Both fractures should be treated with implants that optimize fracture healing while minimizing complications. Major issues are diagnosing occult fracture neck of femur combined with ipsilateral shaft fracture which may be part of polytrauma, surgical decision making, and work up to prioritize fixation and the selection of optimal implant. In this study, we report 18 cases of ipsilateral fracture neck and shaft treated with two methods, i.e., single implant which is a nail versus double implants for two fractures which can be cannulated hip screw, dynamic hip screw (DHS), and plate or distal femoral nail. Materials and Methods: A total of 18 patients were treated and divided into two groups. Group 1 included eight patients (six males, two females) who were operated with cancellous hip screws or DHS for fracture neck and compression plate fixation for fracture shaft of femur. Group II included ten patients (eight males and two females) who were operated with cephalomedullary nailing. Results: The mean age was 32 and 36 years in Group I and Group II, respectively. The mean delay in surgery was 5 and 6 days, respectively. Average union time for femoral neck fracture in Group I and Group II were 14.1 and 16.2 weeks, respectively, and for shaft fractures, these time were 20 and 22 weeks, respectively. There were 6 (75%) good, 2 (25%) fair functional results in Group I. There were 7 (70%) good, 2 (20%) fair, and 1 (10%) poor functional results in Group II. Conclusion: Both the treatment methods used in the study gives satisfactory functional results. In displaced fracture neck of femur, it is better to use double implants for both the fractures. Unlike isolated fracture neck of femur, union in fracture neck, and shaft is usually better. In most of the cases, fracture neck of femur was undisplaced and gave satisfactory results with cephalomedullary nails.

Objectives: The aim of this study is to determine the incidence of contrast-induced nephropathy (CIN) after computed tomography angiography (CTA) in orthopedic trauma patients. Design: Retrospective chart review. Setting: Mount Sinai St. Luke's-Roosevelt patient data. Patients and Methods: Patients who presented to our Level I emergency department after a trauma who were diagnosed with a high energy or penetrating injury to an extremity or pelvis and who underwent CTA as a part of their initial work-up from July 2004 to June 2014. Intervention: The incidence of CIN was assessed. Main Outcome Measurements: The main outcome measure was the development of CIN after CTA. CIN was defined as an increase in baseline creatinine of 25% or greater or an increase in baseline creatinine of 0.5 mg/dL within 48–72 h of contrast exposure. Results: A total of 51 patients were included in this study. Of these patients, 27 had a repeat creatinine level available for review. The incidence of CIN was found to be 3.7% in this specific population of patients. The creatinine level of the 1 patient who developed CIN normalized by hospital day 2. None of the patients included in this study developed symptoms of or were readmitted for kidney injury. Conclusions: This review supports the use of CTA as a relatively safe diagnostic tool in orthopedic trauma patients.

Background: Club foot is one of the most common congenital birth defects, with approximate incidence of 1 in 1000 live births. It is one of the unsolved clinical challenge for the orthopedic surgeons. The results of Ponseti treatment have been encouraging. There have been many reports of successful treatment of idiopathic clubfoot with Ponseti method in the western world, but there are only few studies done in the developing country like India. So the present study was undertaken with the following objective. Objective: To evaluate the efficacy of Ponseti method in the treatment of idiopathic clubfoot A prospective study was done among all the patients below 1 year of age with Idiopathic Clubfoot presenting to AIIMS Raipur from August 2015 to December 2016 who were treated by Ponseti method. Twenty feets [mean Pirani score (total) 5.6] in 13 children were treated by the Ponseti method. A prospective follow-up for a mean duration of 6 months (range 6–30 months) was undertaken. Evaluation of the deformity by Pirani score was performed, before and after the treatment and the results were assessed.

Introduction: Early Internal fixation of any fracture now days given us great advantage with relation to early mobilization and early returns to daily activity. Rate of infection related to implant surgery reported by numerous study ranges from 0.5% to 4-5% in closed fractures and up to 10% in cases of compound fractures. Post operative infection with implant in place is one of the most difficult conditions to manage. In our study we tried to retain the implants in these cases and evaluated long term result in these cases. Material and Method: We selected total 108 cases of infected implant without union from regular follow cases of operated post operative cases of upper and lower limb long bones managed by nailing and plating 2006 to 2014. Out of 108 cases 94 cases completed their follow up duration. We managed these cases with retention of implant for as long as possible with regular debridement, incision and drainage, pus culture and sensitivity and antibiotics accordingly off and on till attainment of bony union. Final results were evaluated and any implant failure and other revision surgery rates recorded. Results: Out of 94 cases bony union were achieved in 76 cases (81%) with retention of same implant with proper antibiotic coverage, regular follow up and guarded weight bearing. 8 of our cases shows implant failure due to delayed and non union. In 10 cases, removal of implant was required before bony union. Infection related to implant was also cured once implant were removed after attaining bony union without any long term complications. Conclusion: This increase incidence of infection related to implant also aggravated by various drug resistant microorganism. In most of these cases of infected implant, implants can be retained in situ till bony union achieved. Low grade infection with implant didn't have any severe negative consequence on bony union. This infection can be cured with removal of implant once bony union achieved.

Background: Tendoachillis tenotomy is an integral step of ponseti method of treatment of clubfoot. Not all cases require tenotomy. It is important to study the factors predicting the need for tenotomy to aid in the selection of clubfeet requiring tenotomy and to determine the outcome of such cases in relation to those not requiring tenotomy. Aims and Objectives: The purpose of this study was to determine the factors which help in predicting the need for tenotomy in the Ponseti method of treatment of clubfoot. Materials and Methods: 35 cases with 55 clubfeet were assessed at presentation based on scoring system by Pirani et al. They were treated with Ponseti method. Tenotomy was performed in 37 of the 55 clubfeet (67%). Result: Need for tenotomy was significantly increased in clubfeet which were more severe at presentation (86.4% of cases with a Pirani score >=5) and more rigid (89.5% of clubfeet requiring >=7 casts). Hind foot contracture also correlated with increased need for tenotomy (81.25% clubfeet with hind foot score >2). Pirani scoring done following removal of last cast showed a score between 0 to 1, with a median score of 0.5 in both instances where tenotomy was required or not required. Conclusion: Clubfoot can be successfully treated with Ponseti technique by serial casting. Tenotomy is not required in all cases. Severity of the deformity at presentation, especially the hindfoot contracture along with the rigidity of the clubfoot can predict the need for tenotomy. Both cases requiring tenotomy and those not requiring, were well corrected at the end of casting. The need for tenotomy does not indicate poorer outcome.

Aim: To evaluate the results of tibiocalcaneal arthrodesis using intramedullary nails in adults with severe rigid equinovarus deformity of foot. Background: Foot is an amazing structure of support, balance, locomotion and sensibility. Impairment of one or more of these functions can lead to catastrophic sequelae. Equinovarus deformities of foot can be very disabling by marring the ambulation, daily activities, shoe wear and hygiene. In this paper we tend to share our experience of treating patients with posttraumatic severe rigid equinovarus deformities via tibiocalcaneal arthrodesis with retrograde intramedullary nailing. Settings and Design: Prospective follow up study. Materials and Methods: We selected 10 patients (3 females, 7 males) aged 18–60 years, suffering from disabling non-braceable posttraumatic severe rigid equinovarus deformity of foot. The patients were treated via tibiocalcaneal arthrodesis with retrograde intramedullary nailing and functional outcome was evaluated by comparing the preoperative and postoperative Kitaoka Patzer ankle arthrodesis scores and Mazur ankle arthrodesis scores. Statistical Analysis Used: SPSS program for Windows, version 17.0 (SPSS, Chicago, Illinois). Result: The comparison of the preoperative and postoperative scores showed significant improvement from poor to good after tibiocalcaneal arthrodesis was done in such patients. Conclusion: We can conclude that tibiocalcaneal arthrodesis using intramedullary nails is a good option to provide a stable plantigrade foot to the patient though further improvements in implant designs may bring better options.

Context: Synovium is the site for a series of pathologic processes that are characteristic and in some cases specific, to a particular disease. Examination of the synovial biopsies plays a key role in the diagnosis of joint diseases as the disease affecting the joints can have varied clinical presentations. Materials and Methods: We present here the different spectrum of synovial lesions that was diagnosed on synovial biopsy. Results: There were ten cases of synovium and related diseases which includes two cases of Chronic nonspecific synovitis, one case of Septic arthritis, two cases of Tuberculous synovitis, one case of Rheumatoid arthritis, one case of Tenosynovial giant cell tumor of tendon sheath, one case of Synovial lipomatosis, and two cases of Secondary chondromatosis. Conclusion: This series highlights the various spectrums of joint diseases. Synovial biopsy is an important and final tool for definitive diagnosis of joint disorders. Correlation with clinical, radiological, and serological findings helps to arrive at an accurate diagnosis.

Isolated subtalar dislocation (SD) is an exceptionally rare foot injury. Prompt gentle reduction, injury severity, and duration of postreduction immobilization are prognostic determinants of functional outcome. Consensus has eluded the orthopedic community regarding optimal duration of immobilization and weight-bearing protocol, following successful reduction of SDs. This case report highlights the functional outcome following early postreduction immobilization and weight-bearing in isolated SD and reviews the current evidence.

A gangrenous limb is a dead limb resulting from compromise of the vascular supply to the limb. The gangrenous limb is a source of infection which can lead to septicaemia with eventual mortality of the patient, hence it is an orthopaedic emergency. Limb gangrene is common in orthopaedic practice but rare in neonatal age group. These are two cases of neonate lower limb gangrene, one was following application of tight polythene bag on the leg to protect the local tattoo (LELE ) applied on the foot of a two week old neonate for cosmesis and the second patient was a complication of traditional bone setter (TBS) intervention in a 10 day old neonate. The first patient was offered a knee disarticulation but the parents declined, took her away from the hospital but she was brought back dead to the same hospital two days later. The second patient had left knee disarticulation, sepsis treated and he was discharge home healthy about three weeks later. There is a need to provide an alternative for protection of applied “LELE” especially in the neonatal age group. Awareness need to be increased on the problems caused by traditional bone setters so that their patronage can reduce.

Aneurysmal bone cysts (ABCs) localized in the talus are extremely rare. ABC or giant cell variants when located in the talus may be difficult to differentiate and tend to exhibit a less aggressive biological behavior with a more favorable prognosis than the more classical proximal lesions. Talectomy is not indicated as the primary treatment, curettage with or without bone graft has a high success rate, and cryosurgery should be reserved for a recurrent lesion.

Recurrence of giant cell tumor (GCT) of hand is a common occurrence in this otherwise rare condition. We are reporting a case of GCT arising from the middle phalanx of little finger, which was treated with curettage and bone grafting and reported an early recurrence. The case was treated with total middle phalangectomy followed by reconstruction by iliac crest bone grafting and fusion successfully.

Subacute acetabular osteomyelitis is uncommon and often misdiagnosed due to ill-defined symptomology and indolent disease course. An afebrile 11-year-old boy re-presented with 4 weeks atraumatic limp and increasingly severe right hip pain previously believed to be transient synovitis. Examination revealed hip tenderness and reduced mobility. X-rays showed loss of bone density in the proximal femur and a visible joint effusion. T2-weighted magnetic resonance imaging demonstrated the regions of high signal superior to the triradiate cartilage, widening of the cartilage space and a sympathetic effusion, consistent with acetabular osteomyelitis. Six weeks following antibiotic therapy, pain subsided and normal hip mobility was achieved. Review magnetic resonance scan confirmed clinical findings with reduced bone marrow edema, surrounding swelling, and hip effusion. Clinical resolution was confirmed 8 weeks postpresentation. Subacute acetabular osteomyelitis is rare and largely misdiagnosed at first presentation. It should be considered in all cases of atraumatic limp and low-grade hip pain.

As shoulder joint stability is mainly provided by muscles and connective tissue, it has a wide range of movement and is the joint where dislocation is most often seen due to frequent exposure to trauma. Inferior shoulder dislocation is seen rarely and has been determined in literature as 0.5% of all shoulder dislocations. In this study, two cases of inferior shoulder dislocation are discussed in the light of the information in literature.