National reports published annually by Transport Research Wing of the Ministry of Road Transport & Highways and National Crimes Records Bureau of Ministry of Home Affairs, Government of India describe national statistical trends and normalized indicators of road accidents, injuries & fatalities. This article highlights trends, indicators, interstate comparisons and the latest characteristics of road traffic accidents in India. While the official road traffic fatality data may be close to the actual number, the injury data are gross underestimates. As per bibliometric analysis, India contributed only 0.7 per cent papers on road traffic injuries and had less than one article on road traffic injuries per 1,000 road traffic related deaths. To be effective, policies on injury prevention and safety must be based on local evidence and research. Health professionals and their professional bodies across wide disciplines need to take an initiative for the same with active commitment.

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Pelvic fractures are one of the common cause of mortality in polytrauma patients, especially following high velocity trauma. The management in emergency requires good clinical judgment and access to radiological modalities. There are various classifications to define the pattern of injury in pelvic fractures. Previously, fracture patterns were described on the basis of anatomical fracture pattern on radiographs. With the introduction of concept of force vector and stability defined by Pennal and Tile, which was further modified by Young and Burgess, the corrective forces required to reduce such fractures were defined. With the introduction of these newer classification systems along with the introduction of external fixators, the mortality and morbidity has significantly reduced in pelvic fractures.

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With the advances in the trauma management, the protocol of the treatment of fractures of pelvis has evolved with control of mortality and morbidity, which is associated with these fractures. The goal of management is to achieve anatomical reduction with stable fixation of these fractures with optimum functional outcome. Despite of the better understanding of the pathophysiology of these fractures and advances in the surgical techniques to fix these fractures, the long term outcomes of these fractures are not predictable. Though in majority of patients, we may achieve the pelvic stability and pain free walking, but still we are not able to define a reproducible approach to achieve the optimum functional outcomes in all the patients with fractures of pelvis. The present paper deals with a systematic review of available literature related with controversies related with all aspect of surgical treatment of these fractures including various methods of management, various methods of fixation, techniques of fixation, determination of type and amount of pelvic stablisation and evaluation of long term functional outcome and its correlation with various factors.

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The pelvic trauma can be a simple isolated one or can involve multiple skeletal structures or viscera also. Women of childbearing age who suffer from pelvic trauma have always a question in their mind regarding the future fertility and type of delivery they are going to have. The final functional outcome of pelvic injury depends on the severity of trauma and the type of surgical management. The aim of this article is to review the female pelvic anatomy, pelvic injuries, management options and future reproductive potential and other impacts of pelvic trauma in women of childbearing age.The pelvic trauma can be a simple isolated one or can involve multiple skeletal structures or viscera also. Women of childbearing age who suffer from pelvic trauma have always a question in their mind regarding the future fertility and type of delivery they are going to have. The final functional outcome of pelvic injury depends on the severity of trauma and the type of surgical management. The aim of this article is to review the female pelvic anatomy, pelvic injuries, management options and future reproductive potential and other impacts of pelvic trauma in women of childbearing age.

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Polytrauma remains the leading cause of death and disability in children and young adults. Systematic organized team effort is essential for improving the survival in trauma victims. Initial assessment includes preparation, triage, rapid primary survey and resuscitation, secondary survey and definitive care. ABCDE of primary survey includes airway maintenance with cervical spine control, breathing and ventilation. Circulation and hemorrhage control, disability and exposure with prevention of hypothermia. Secondary survey includes head to toe examination of the trauma patient including a complete history and physical examination and reassessment of all vital signs. Definitive care may involve shifting the patient to radiology/operating room/intensive care unit.

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Trauma during pregnancy is an important cause of nonobstetrical cause of maternal mortality & morbidity. Apart from type of injury affecting the maternal & fetal outcome there are several life threatening complications unique to pregnancy like abruption placentae, uterine rupture, amniotic fluid embolism, & direct fetal trauma which needs immediate interventions. Maternal assessment & management during pregnancy needs special consideration to physiological changes during pregnancy as well as fetal surveillance to improve the maternal & fetal outcome. All pregnant trauma patient needs multi disciplinary approach involving obstetrician, neonatologist, obstetric anaesthetist & trauma surgeons.

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Context: Diaphyseal fractures of the radius and ulna are common in the pediatric population. The standard management for pediatric forearm fractures remains conservative management with closed reduction and immobilization with above-elbow plaster cast. Although the fracture unites readily, malunion is very common. Stiffness of joints and compartment syndrome are other complications of conservative management with plaster cast. The introduction of titanium elastic nailing system (TENS) has changed the treatment scenario of fracture of both-bone forearm. Aims: The aim of this study is to evaluate the functional and cosmetic outcome of the management of fracture both-bone forearm by closed reduction and internal fixation with titanium elastic nail system. Subjects and Methods: A total of 40 patients aged 5–15 years with fracture of both radius and ulna were managed by internal fixation with titanium elastic nail. Closed reduction under image intensifier control was achieved in most of the patients. Prospective follow-up was done for 6 months. Results: Results were analyzed in reference to union, symptoms, and range of motion of adjacent joints using Price et al. criteria for outcome evaluation. In our study, 87.5% of patients showed excellent, 10% showed good, and 2.5% showed fair outcome. Conclusion: Better functional and cosmetic outcome with minimal complications is achieved with internal fixation with titanium elastic nail system. TENS may be considered as an alternative to conservative treatment.

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The burn patients need a very special care as besides skin burn; they can have associated mechanical injuries, inhalational injury and altered physiology with the risk of hypothermia. Once the patient survives from the acute phase, the appropriate wound management is the further challenge. The psychological trauma starts from time of injury to long after survival. Thus focused approach of burn patients allows critical care support, early surgical excision and closure of the burn wounds, patient and family psychosocial support, patient and family education, continuous long-term rehabilitation, re-entry into the society and reconstructive surgical needs.

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Introduction: Various fixations techniques are available for fixation of tibial spine avulsion fracture. Arthroscopic assisted fixation can be achieved by screw fixation, pull through sutures, and using suture anchors. We conducted a prospective study to analyze the results of arthroscopic assisted pull through suture technique for treatment of tibial spine avulsion. Materials and Methods: Ten patients with displaced tibial spine avulsion fractures without other associated ligament injuries were included in the study. Ten patients (2 female and 8 male) with a mean age of 29.2 years (19-42 years) underwent arthroscopic assisted fixation with pull through suture technique. The postoperative results were analyzed using clinical tests, radiological evaluation and International Knee Documentation Committee (IKDC), Lysholm score and Tegner activity level. Observations and Results: The mean follow-up period was 21.7 months. We evaluated all patients at 18 months after the surgery. Radiographs showed that all fracture healed anatomically at an average duration of 3 months after surgery. At the final follow-up, all patients reported no symptoms of instability, such as giving – way episodes, clinical signs of anterior cruciate ligament deficiency were negative. The mean Lysholm score was 96.9 (range 91-100), mean IKDC score was 87.9 (range 83-93), and all patients achieved their pre injury Tegner activity levels. One patient had postoperative arthrofibrosis with the loss of terminal extension of 5° which responded to arthroscopic adhesiolysis and physiotherapy. We had no case of infection. Conclusion: Arthroscopic suture pull through a technique for tibial spine fracture is a minimally invasive technique with good functional and radiological results with a lesser risk of arthrofibrosis, infection, and need for hardware removal.

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Background: This study was conducted with the aim to find difference between two types of foot abduction brace (Denis Brown splint and Steenbeek) in corrected clubfoot for maintenance of correction. Materials and Methods: Total 30 patients in each group were selected. Denis browne splint used in 47 feet (30 patients) and Steenbeek brace in 49 feet (30 patients). The patients were followed up for 1 year. Results: All the idiopathic club feet were corrected by Ponseti method and full correction was achieved. After correction foot abduction brace was given. The appearance of abrasion, duration of painful episode with brace, adjustment with brace, relapse of deformity, breakage of brace, requirement of tenotomy and other complications were compared for both types of braces. Conclusion: Use of different type of foot abduction brace makes no difference in maintenance of corrected clubfoot.

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Background: To compare functional outcome of cemented and uncemented total hip replacement (THR). Materials and Methods: In this hospital based, randomized, comparative type of observational study, 25 patients were included in each group. Each patient examined thoroughly and underwent radiological assessment. Follow-up done at 6 weeks, 3 months, 6 months, and 2 years and pain score, Harris Hip Score (HHS), subjective complaints, and joint stability were recorded. Results: Mean age of the patient in cemented group was 60.64 years and in uncemented group was 59.72 years. Pain score was compared at each follow-up which came out significant at 6 weeks (P ≤ 0.05) and 3 months (P = 0.002) explaining better early bone integration with cemented THR. However, at 6 months difference in pain score between two groups was nonsignificant (P = 0.176). Difference in function score between cemented and uncemented group was significant at 6 weeks (P = 0.003) and 3 months (P ≤ 0.05) which later become nonsignificant at 6 months (P = 0.38). The difference of HHS between cemented and uncemented group was significant at 6 weeks (P ≤ 0.05) and 3 months (P = 0.011). This difference became nonsignificant at 6 months. HHS is further divided into four grading – poor (<70), fair (70–79), good (80–89), and excellent (90–100). Overall in our study, 88% of patients in cemented group showed excellent and good results and 84% in uncemented group showed excellent and good results. There was one case of excessive blood loss during surgery in uncemented group and one case of foot drop in cemented group. Conclusion: Cemented implants are cheaper than the uncemented implants. Better short-term clinical outcomes mainly improved pain and early pain-free full weight bearing was obtained from cemented fixation.

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Introduction: Open fractures are fairly common in developing countries. Causes of open fractures vary widely including road traffic accident, fall from height, gunshot, assault, machine injuries and others. Infection is a common complication of open fractures. Chronic osteomyelitis, nonunion, loss of function or even limb loss are some serious outcome of deep fracture site infections. Primary goal in management of open fractures is prevention of infection of bone and soft tissue by early debridement, irrigation of wound and administration of broad spectrum antibiotics with stabilization of fractures. Aim: The aim of the study is to elucidate pattern of microbial isolates in open fractures so as to form rationale antibiotic regimen for treating open fractures. Methods: 70 patients were taken into study of all ages, both the sexes with open fracture classified according to Gustilo Anderson classification. Primarily wound was examined and description of the wound was recorded with 1^st culture swab taken at that time followed by 2^nd culture swab on 1^st dressing after debridement and 3^rd culture swab if infection continues further. Culture and sensitivity reports were collected for studying pattern of bacterial isolate and their sensitivity. Results: Pre-debridement cultures are of no importance. Post-debridement cultures are important in formulating an antibiotic regime. Gram negative organisms are the most probable cause of infection. Aminoglycosides are the most sensitive group of drugs in both gram positive and gram negative bacteria. Cephalosporins or quinolones should be used in combination with aminoglycosides in all cases of open fracture in our vicinity. Conclusion: All institutions and hospitals should find out the most common infecting pathogen in their environment and formulate an antibiotic policy accordingly.

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Background: Osteoarthritis (OA) is a chronic degenerative condition of the joint. Current physiotherapy interventions for OA focus on pain reduction, improve knee range of motion, and muscle strength. OA of knee impairs quadriceps function which affects balance and gait reducing patient's mobility and function. Therefore, there is a need to find out the effect of combined proprioceptive exercises with conventional physiotherapy in Patient with knee osteoarthritis (PKOA). Aim: The aim of this study is to analyze the effect of combined proprioceptive exercises and conventional physiotherapy in PKOA. Methods: A total of 40 female POAK were recruited for the study and were divided into two groups as follows: Group A (conventional group) and Group B (experimental group). Group B in addition to the conventional treatment received proprioceptive exercises. Both the groups were instructed to perform exercises for 5 days in a week for 3 months. Visual analog scale (VAS) for pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were noted pre- and post-intervention. Results: On comparing the mean values of Group A and Group B on VAS and WOMAC scores, both the groups showed a significant decrease (P < 0.001) in the posttest mean, but Group B (experimental group) was more effective than Group A (conventional group). Conclusion: The present study concluded that 3 months duration of combining proprioceptive exercises with conventional physiotherapy is more effective than conventional physiotherapy alone in PKOA.

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Background: Titanium elastic nailing has emerged as a treatment of choice for stabilization of paediatric diaphyseal femoral fractures. Materials and Methods: Between 2007 and 2012, we treated 18 fractures of the femur using closed titanium elastic nailing (TEN),in pediatric patients. This study was done as a retrospective study on 18 cases of fracture of the femoral diaphysis, operated between 2007 and 2010. An assessment of the available postoperative radiographs revealed 88.8% (16 of 18) of the fractures had nails, which formed a divergent C configuration; cortical contact by both nails was visible in 77.7% (14 of 18) and the nails crossed above and below the fracture site in 83.3% (15 of 18). Results: The final outcome was adjudged as excellent when there was anatomical or near anatomical alignment with no postoperative problems in 61.1% (11 of 18) of the patients, satisfactory when there was acceptable alignment and leg length, with resolution of postoperative problems in 22.2% (4 of 18) of the cases, and poor in the presence of unacceptable alignment or leg length, with unresolved postoperative problems in 16.6% (3 of 18) of the cases. Minor or major complications occurred in seven patients. Poor outcomes were due to limb length discrepancy> 2 cm in one1 patient (5.5%), rotational deformity in one patient (5.5%), and varus malunion in one patient (5.5%). Conclusion: We recommend TEN in pediatric patients.

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Open fractures of the tibia/fibula are common in renal tubular acidosis patients and may be fraught with complications such as malunion, delayed union, non-union, infection, deformity, bone loss and dead and necrotic bones. The Ilizarov method, as originally described for lengthening, treatment of non-union and bone transport, does not involve the use of bone-grafting at the docking site to aid rapid healing. The most common complication is non-union of the docking site. In this report, we present a case of 18-year-old man with open fracture tibia/fibula treated initially with unilateral external fixation and followed by Ilizarov's distraction osteogenesis technique for skeletal defect created after adequate debridement and resection of the necrotic bone as a result of open fracture. We aimed to demonstrate the success of docking site augmentation of iliac crest cancellous bone graft has been shown to rapid consolidation, decrease the rate of non-union and decrease the time of prolonged fixator use with respect to patient compliance managing complex frame adjustments.

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Although hormone therapy using estrogens plus progestogens (EPT) is effective for the management of menopausal symptoms (e.g., vasomotor symptoms and vulvar/vaginal atrophy) and prevention/treatment of postmenopausal osteoporosis, EPT is associated with safety and tolerability concerns. A new alternative to EPT is the tissue selective estrogen complex (TSEC), which partners a selective estrogen receptor modulator (SERM) with one or more estrogens and is designed to treat menopausal symptoms and prevent postmenopausal osteoporosis without the tolerability concerns associated with EPT. The first TSEC to reach advanced clinical development is a combination of the SERM bazedoxifene (BZA) with conjugated estrogens (CE). BZA has been shown to inhibit the stimulatory activity of CE on uterine tissue and breast in vitro and in vivo. In clinical studies, BZA/CE treatment has been associated with significant improvements in menopausal symptoms including hot flushes and vulvar/vaginal atrophy and significant increases in bone mineral density, coupled with reductions in bone turnover marker levels and improvements in sleep and health-related quality of life. Additionally, BZA/CE has been shown to have a neutral effect on endometrial and breast tissue because BZA inhibits the stimulatory effects of estrogens in selective tissue fashion in these two organs. Taken together, results of these preclinical and clinical studies indicate that the benefits of estrogens for treating menopausal symptoms are maintained with BZA/CE without endometrial or breast stimulation, resulting in a safe and effective treatment for symptomatic postmenopausal women.

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It has been found that many orthopaedic patients who have sustained multiple injuries benefit from the early total care of major bone fractures. However, early surgery has been found to be harmful to some multiply injured patients. Damage control orthopaedics is an approach that contains and stabilizes orthopaedic injuries so that the patient's overall physiology can improve. Its purpose is to avoid worsening of the patient's condition by the "second hit" of a major orthopaedic procedure and to delay definitive fracture repair until a time when the overall condition of the patient is optimized. The article deals with principles involve in damage control orthopaedics pertaining to diagnosis and management.

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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.

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Background: Salter-Harris type III fracture involves the medial or lateral condyle of femur. The fracture line usually exits through - the inter-condylar notch. These fractures are not common but have a high rate of complications and only very few cases have been reported. Objective: The aim of the surgery is to minimize the complications of epiphyseal injury by early fracture Fixation. Design: A 28 months prospective follow-up study. Setting: Unicentric study, operating on a total of 22 patients during a period of 5 years. Materials and Methods: From July 2005 to July 2010, 22 patients (16 males and 6 females) were recruited from Emergency and outpatient department having closed and open Salter-Harris types III fracture of the medial femoral condyle of the distal femur. All patients were operated under general or spinal anesthesia. The mean follow-up period was 28 months. Results: All children achieved union in a mean time of 10 weeks (range from 6 to 16 weeks) depending on the type of fracture pattern. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The mean follow-up period was 28 months (17-48 months). Complications were recorded in 3 (13.64%) patients and included 2 Cases of insignificant limb shortening of 1 cm and 1.5 cm and 1 case of significant shortening of 2 cm. The results were excellent in 86.36 and good in 13.64% patients. Conclusion: Early anatomical reduction and fixation with screws provide satisfactory results and minimal complications.

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Human pelvis is a very stable structure. It achieves its stability from the surrounding musculature and ligaments. Hence, pelvic disruption requires high energy trauma specifically in young people. It is usually associated with multisystem injuries due to its close proximity to the vital structures. Mortality in pelvic injuries is mostly due to the uncontrolled hemorrhage and the late mortality due to associated multisystem injuries, multiorgan failure, and sepsis. Acute management focus on the complex pelvic trauma it includes the systemic control of hemorrhage, pelvic stabilization with external pelvic binder or external fixator, use of pelvic angiography, and embolization and preperitoneal packing. Every institute should develop its own protocol depending on facilities available.

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Introduction: Intertrochanteric fractures are common in the elderly especially with the increase in the incidence of osteoporosis. Various studies have shown good results when treated with intramedullary devices such as the proximal femoral nail (PFN) while other studies have shown high rates of complications. Aim: To study the outcome of intertrochanteric fractures treated with proximal femoral nailing by using Kyle's criteria. Materials and Methods: The study involved fifty cases of intertrochanteric fractures of femur that were treated with PFN. Fractures were classified using Orthopaedic Trauma Association classification. Patients were followed up at 4 weeks, 3 months, and 6 months and results were evaluated using Kyle's criteria. Results: The study included fifty patients, 32 males and 18 females of age 38-94 years with an average of 57 years. Excellent and good results were found in 44 patients (88%). Intra- and post-operative complications were found in 12 patients (24%). Conclusion: Good fracture reduction is critical in the management intertrochanteric fractures with PFN. Proximal femoral nailing is an excellent treatment option for unstable intertrochanteric fractures.

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Despite numerous advancement in surgical techniques and better understanding on pelvic injuries, it is not uncommon to see neglected pelvic fractures in India. The pelvic injuries are either neglected by the patients themselves by late presentation or poor compliance to treatment or sometimes even neglected by the surgeons by inadequate treatment. The usual manifestations of neglected pelvic fractures are either a nonunion or a malunion. Pelvic nonunion or malunion results in huge disability to the patients. These disabilities manifest in the form of pain, leg length discrepancy, sitting or standing imbalance and even sexual or excretory dysfunction. Treatment of such old injuries is extremely difficult. Correction of malunion may be performed in stage wise procedure with multiple osteotomy. The nonunion may be treated with bone grafting and plate stabilization. This literature review focused on the manifestations, treatment and residual problem of such pelvic malunions and nonunions

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Clawing, partial or total due to leprosy affects greatly, hand's ability for fine movements, grip and skilful use along with loss of tactile sensation of hand, which usually precedes the motor weakness. We reviewed and evaluated the functional results of Modified Bunnel's procedure in management of 20 patient of leprosy with 28 claw hand deformity. After mean followup of 18 months (range 12-38 months) results were excellent in 10 (35%) cases, good in 12 (42.8%), fair in 4 (14.2%) and poor in 2 (7.1%). 97% of the patients (27/28) had improvement in the grip except one case (3%). Swan-neck deformity, flexion contracture, check-rein deformity and insufficient finger flexion was seen in none of the cases whereas superficial minus deformity of ring finger was seen in only 1 case. Modified Bunnel's procedure is simple to perform and gives superior results as it gives least possible adhesions, provides straight course for the tendon and good leverage with normal angle, with better cosmetic results and patient satisfaction.

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Acute spinal cord injury primarily affects young otherwise healthy people and is a major cause of patient morbidity and a source of significant health care expenditure. The priority in the management of spinal injury in a patient with polytrauma is to minimize secondary mechanical or physiological insults to the spinal cord. Identification of spinal injuries during initial trauma evaluation is challenging, as patients often have a reduced level of consciousness due to other injuries or are under the influence of sedative and/or analgesic medication. The management of suspected spinal cord injury in patients with polytrauma involves early immobilization of the whole spine and the institution of measures to prevent secondary injury from hypoxia, hypoperfusion or further mechanical disturbance. All spinal injuries should be considered unstable and incomplete until proven otherwise. Careful and informed neurological assessment, together with appropriate plain radiography, will identify the majority of spinal injuries. Early surgical decompression should be considered. Improvements in motor vehicle safety and traffic regulations can result in a marked reduction in spinal cord injury due to motor vehicle accidents with significant reduction in mortality attributable to spinal injury. A robust system of care is the best assurance of good health outcomes and reasonable health for people with spinal cord Injury.

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Aim: To evaluate the role of dorsalis pedis artery flap in the coverage of distal lower leg defect. Materials and Methods: a retrospective review of patients who underwent soft tissue coverage over distal lower leg with dorsalis pedis artery flap was performed. A total of 16 patients were identified and included in this study. Soft tissue defects ranged in size from 3 × 7 cm to 6 × 10 cm were located over lower one-third of leg either, anteriorly (n = 8), posteriorly (n = 4), laterally (n = 2), or medially (n = 2). Associated injuries included open fractures of only tibia (n = 5), fibula (n = 2), both tibia and fibula (n = 3), or calcaneum (n = 2). Results: all flaps survived uneventfully except in three cases there was mild venous congestion in the distal part of the flap, two resolved within 4 days without further surgical intervention but one required skin grafting. Three patients developed donor site problems. Wound coverage was achieved in a mean duration of 14 days (range: 11 to 30 days). Conclusion: The dorsalis pedis artery flap is a reliable procedure to cover difficult wound such as distal lower leg.

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