Multifocal skeletal involvement is exceptional, constituting <5% of all bony tuberculosis (TB), even in countries where TB is endemic. Multifocal skeletal TB is defined as osteoarticular lesions that occur simultaneously at two or more locations. We describe an immunocompetent patient with multifocal skeletal TB involving multiple vertebrae, ribs, and pelvis with empyema necessitans who also had atypical imaging features to make the readers aware of such unusual presentations of TB.

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Background: Management of bicondylar tibial plateau fracture dislocations is a serious challenge in terms of soft-tissue complications, fracture morphology, early mobilization, and maintenance of alignment and reduction postoperatively. We have conducted a prospective study to evaluate the necessity of dual plating in these fractures to achieve articular reduction, early mobilization, and maintenance of alignment on long-term follow-up. Materials and Methods: A prospective study including 24 patients with bicondylar tibial plateau fracture dislocations were operated with dual plating through dual-incision approach. Patients were evaluated clinically and radiologically for a minimum period of 24 months. All patients were operated after a minimum period of 7 days, to prevent soft-tissue complications. Functional evaluation was done using Oxford knee score. Results: A total of 24 patients were operated with dual plating, including 20 males and 4 females with the mean age of 36 years. All cases united with mean healing time of 15.2 weeks, malunion was seen in one case. Functional outcome was assessed using Oxford knee score which was excellent in 21 cases (87.5%) and good in 3 cases (12.5%). Conclusion: Dual plating for bicondylar tibial plateau fracture dislocations is necessary to achieve articular congruity, stable fixation, early mobilization, and maintenance of limb alignment on long-term follow-up. The only concern is soft-tissue complications which can be minimized by waiting for adequate time preoperatively and meticulous surgical technique.

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Panner's disease also known as osteochondrosis of capitellum, is a rare disorder. We present a case of Panner's disease in an 11-year-old male child who was misdiagnosed as tuberculosis on clinical and radiological findings. The duration of symptoms was over 5 months, yet the child retained most of the elbow range of motion. He reported a sharp pain over the lateral condyle during end range of pronation and deep palpation. Plain radiograph findings were contour irregularities and flattening of the articular surface in humeral capitellum. Magnetic resonance imaging T2 images showed decreased signal intensity in capitellum as well as a high signal in joint space consistent with joint effusion. The joint aspirated clear synovial fluid with no culture growth. The outcome of Panner's disease was good with conservative treatment. Panner's disease is often misdiagnosed in our tubercular endemic regions and thus, awareness on the part of the clinician is must.

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Purpose: The purpose of this study is to assess the outcome of debridement and Ilizarov ring fixator (IRF) in the management of infected nonunion of tibia. Materials and Methods: Sixteen patients with infected nonunions of the tibia were managed by debridement and resection of infected portion and stabilization by IRF. In six patients shortening was <2.5 cm managed by accordion maneuver and in rest of the 10 patients had postdebridement shortening of >2.5 cm managed by corticotomy and distraction osteogenesis. The results were analyzed radiologically, skeletal, and functional results using Association for the Study and Application of Methods of Ilizarov (ASAMI) scoring system. Results: All fractures united and infection eradicated completely. According to ASAMI classification, bone results were excellent in 9, good in 5, fair in 2, and no poor. Functional results were excellent in 9, good in 5, fair in 2, and no poor. The most common complication was pin site infection. Out of 16 patients, 10 had Grade II, 4 had Grade III, and 2 had Grade IV infection which was managed accordingly. There were no major complications or neurovascular complications. Conclusion: We conclude that for management of infected nonunion of tibia, radical debridement with IRF give satisfactory bone results and functional results. Thus, Ilizarov technique is a most versatile and promising technique in the management of infected nonunion of tibia.

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Background: Treatment of tuberculosis of spine has various modalities ranging from medical to various surgical forms including just drainage of pus to only decompression and decompression with instrumentation. The goals of surgery include radical debridement of the infective focus. In some cases, when surgery causes mechanical spinal instability, the question arises whether the risk of recurrent infection outweighs the benefits of spinal instrumentation and stabilization. Instrumentation helps in preventing progression of kyphosis and helps in maintaining the achieved correction. Materials and Methods: Forty-three cases of both sexes with spinal tuberculosis treated with anterior decompression with instrumentation were reviewed retrospectively. Patients with medically managed disease and those who did not receive instrumentation were eliminated from this review. The mean age of patients was 42.3 years (20–72). The mean follow-up duration was 31.6 months (72 to 12 months). Results: Result was analyzed clinically and radiologically in the form of neurological improvement, correction of kyphosis, and maintenance of correction. All patients with wet lesion showed neurological improvement and showed no or very minimal progression of kyphosis. The mean preoperative kyphosis was 27.2° (50 to 16). The mean postoperative kyphosis was 9.0° (20 to 0) and the mean kyphosis at follow-up was 10.3°. None of the patients showed hardware failure, deep infection, and wound infection, and no patient required hardware revision. Conclusion: Instrumentation of the spine is safe and has an important role in stabilization of the tuberculosis of the spine. Despite the presence of active infection, instrumentation after radical debridement will not increase the risk of recurrent infection. In fact, greater benefit can be achieved through spinal stabilization, which can even promote accelerated healing and avoids progression of kyphosis. Level of Evidence: 2

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Introduction: Synovitis is one of the most common conditions affecting knee joint in present day practice. Common etiological factor for synovitis is non specific inflammation. Diagnosis of causative factor is by synovial biopsy, but material obtained by routine needle biopsy is insufficient and open procedures are associated with some morbidity. Arthroscopic biopsy is a safe and effective procedure. Materials and Methods: Arthroscopy assisted selective synovial biopsy was performed in 40 patients with chronic synovitis of knee presented to orthopaedic outpatient department, Government General Hospital , kurnool. Study was done over a period of 2years. Results: In our study 25 patients were male and 15 were female. Most common age group of our study was 41-50 years. Period of hospitalization ranged from 1 to 3 days. Most common finding in histopathology report was chronic non specific synovitis. Most common complication encountered was hemarthrosis. Conclusion: Arthroscopy assisted synovial biopsy enables surgeon to select site of biopsy, avoiding missing of lesion. And it's a simple and safe procedure, has advantage of early functional recovery.

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Background: Less attention has been focused on patient psychological status and quality of life (QoL) following maxillofacial and orthopedic trauma, especially in underdeveloped countries, hence need for such studies. Patients and Methods: This was a prospective, repeated measure design study of recruited participants in Obafemi Awolowo University teaching hospital, Ile-Ife, State of Osun, Nigeria. A total of 160 participants (80 with maxillofacial bone fracture and 80 with long bone fractures) had repeated review follow-ups within 1 week of arrival in the hospital (Time 1), 4–8 weeks after initial contact (Time 2), and 10–12 weeks thereafter (Time 3), using WHO HRQoL-Bref questionnaire. Results: Road traffic accident remained the main cause of injury in both groups of participants (85% in the maxillofacial fracture and 91.5% in long bone fracture patients). Most were male (80% in facial injured and 72% in long bone fracture patients). Majority of the patients were young adult (75% in the maxillofacial fracture and 55% in the long bone patient). QoL was poor in all domains in both groups. However, there were statistically significant differences between the two groups when compared in the physical health domain at Time 1 (P = 0.006), psychological health domain at Time 2 (P = 0.017), and both physical and psychological health domains at Time 3. Conclusions: Long bone fracture group had poorer QoL scores than the maxillofacial fracture group in some domains of the QoL instrument. Management of these injuries should integrate multidisciplinary care that will address QoL and psychological concerns of patients.

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Background: The aim of this study was to identify the effects of smoking on bone healing and other complications encountered in the treatment and follow-up of distal femur fracture. Materials and Methods: A total of 54 patients with AO Type B and C distal femur fracture were included during the study. All the patients were treated with distal locking compression plating. Functional outcome was recorded on the basis of the American knee society scoring system. Results: The mean radiological union time and incidence of postoperative infection were significantly higher in smokers as compared to nonsmokers. Total American knee society score was similar in both the groups. Conclusion: Smoking cessation should be advised following fracture fixation.

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Objective: Knee osteoarthritis (OA) is a common problem in the elderly but often difficult to manage in primary care. In literature, traditional nonsurgical managements, consisting of physical therapy, lifestyle modification, and pharmacologic therapy such as nonsteroidal anti-inflammatory drugs, are often ineffective or do not alleviate symptoms adequately. Viscosupplementation is a newly available option for patients with symptomatic knee OA that involves a series of intra-articular (IA) injections of hyaluronic acid (HA). Materials and Methods: In our study, we included 300 patients with primary knee OA who did not have diabetes mellitus as comorbidity. We gave IA injections (HA, platelet-rich plasma (PRP), and corticosteroid) to all patients with both unilateral and bilateral knee OA, under strict aseptic conditions, and followed them up for 18 months. Results: The exact mechanisms of action are unclear although increasing the viscoelasticity of the synovial fluid appears to play an important role. IA corticosteroid injections reduce inflammation and that can give pain relief. About 95% of our patients got pain relief at the end of 3 injections and remained pain free or had bearable pain till 25 months of follow-up. Conclusion: Based on our study, we can conclude that the combined IA injections (HA along with PRP and corticosteroid) for knee OA and is an effective and safe nonoperative modality of treatment, at least in the short term. The results were promising for relieving pain, improving knee function and quality of life, especially in younger patients and in mild-to-moderate OA cases and especially in those who were unwilling or medically unfit to undergo total knee replacement arthroplasty.

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Background: Although tension-band wiring is the most widely used technique to treat patellar fractures, metal implant-related complications such as implant failure, palpable hardware are very common and additional procedures are often necessary to treat the complications. We are presenting a new technique of fixing transverse patellar fractures with endobuttons which has minimal hardware-related complications. Materials and Methods: A total of 25 patients with <3 weeks old closed displaced transverse fractures patella of age <60 years were treated by this technique. At the end of 1-year follow-up, Rasmussen's knee score, extension lag, range of flexion, and thigh circumference were measured. Results: At the end of mean follow-up of 13.44 ± 1.29 months, all the fractures attained union. In 80% of cases, there was no quadriceps wasting, 72% of cases had no extension lag and range of flexion was more than 120° in 64% of cases. The Rasmussen's knee score was excellent in 72%, good in 20%, and fair in 8% of cases. Mean knee score found to be 25.8 ± 4.5 (good). The values of extension lag and range of flexion at the end of 2 weeks and 1-year postoperatively were compared, and change in the values found to be statistically significant at P < 0.05. Conclusions: The transosseous suturing with endobuttons is a safe and effective fixation technique for the treatment of displaced transverse fracture patella. It allows for rapid recovery with minimal implant-related complications. Its use should be considered in the treatment of transverse fractures patella.

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Context: Antimicrobial prophylaxis has been accepted as a universal protocol for reducing postoperative complications related to infections in surgical practice. Controversy still exists regarding the type of antibiotic and duration of administration for various surgical maneuvers. Aims: This study was conducted to compare the efficacy of short course of perioperative antibiotic prophylaxis against the long-term administration of antibiotics for the prevention of surgical site infections (SSIs). Settings and Design: This was a prospective, randomized, two arm, and open-label study. Subjects and Methods: All patients of either sex, who were admitted in orthopedic wards and planned for elective orthopedic surgical procedures, were included in the study. This was a prospective study, conducted from June 2011 to December 2012. Patients were randomly allocated into two groups. Group A (n = 153) was given 3 doses of 1 g intravenous (IV) ceftriaxone in combination with amikacin (15 mg/kg) perioperatively at an interval of 12 h and Group B (n = 142) was given the usual regimen (5 days of IV antibiotics [ceftriaxone 50 mg/kg twice daily in combination with amikacin 15 mg/kg 12 hourly], accompanied by oral cefuroxime, till elimination of stitches). Statistical Analysis Used: Chi-square test and Student's t-test were used for calculating the difference in rates of infection with 95% confidence intervals. Results: Out of the 295 patients, 13 patients suffered SSI. In Group “A,” superficial infection rate was 3.27% and deep infection rate was 1.31%, while in Group “B,” superficial infection rate was 1.41% and deep infection rate was 2.82%. The difference in infection rates between the two groups was statistically insignificant. Conclusions: There is no role of continuing prophylactic antibiotics beyond 24 h in elective orthopedic surgery to prevent SSI, rather it increases morbidity, mortality, cost for the patients, and antibiotic resistance. Short-course antimicrobial prophylaxis is equally good and as effective as the long-term dosage.

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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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Multiple deformities of femur and tibia in a child are known to occur in various conditions such as multiple hereditary exostosis, polyostotic fibrous dysplasia, Osteogenesis imperfecta, achondroplasia, multiple epiphyseal dysplasia, and rickets. For severe deformities and hypophosphatemic rickets, surgical correction is invariably required. A 6-year-old female child presented with deformities in bilateral lower limbs (O Deformity), stunted growth, and a waddling gait. We discuss multiple osteotomies and fixation with locking compression plate's as an excellent surgical option for better outcome.

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Bizarre parosteal osteochondromatous proliferation (BPOP; Nora's lesion) is the most common benign osteocartilaginous lesion. It is most commonly seen in hands followed by the long bones, feet, and skull. The clinical and pathological feature's of Nora's Lesion mimick malignant lesions. The recurrence rate of lesion is 20%–50%. We present a case of BPOP of the middle phalanx of the middle finger. The importance of the case is that involvement of hand may not rare, but it's present in the proximal phalanges is very rare. In our case, it is present in the middle phalanx of the right middle finger.

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Traumatic hip dislocation in children is relatively rare, accounting for about 5% of all hip dislocations. Most of the hip dislocations seen in children are of the posterior type, but the much rarer anterior and anterior–inferior (obturator) types have also been described. We present the case of a 4-year-old boy with an anterior of hip dislocation following trauma. He was treated with closed reduction and immobilization in hip spica followed by skin traction. The aim of this study is to report the case of an anterior hip dislocation in a 4-year-old child, where it apparently appears normal in X-ray. The diagnosis of dislocation is suspected due to the abnormal attitude of the limb which is confirmed using computed tomography scan. The diagnosis of dislocation in children is difficult, and such trauma can lead to serious complications if missed.

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Introduction: Injuries of the proximal interphalangeal joint ranging from simple sprain to fracture dislocation, are most common injuries of the hand labelled as jammed finger. The management of these injuries are difficult and challenging to hand surgeon with potential long term sequelae of residual pain and stiffness. So our aim is to evaluate the result of volar plate advancement arthroplasty in these injuries. Materials and Methods: This is a retrospective study conducts between 2013 to 2017. In our study 10 cases (8 male and 2 female with average age 26.9y) of fracture dislocation of PIP joint with average 5.3 weeks after injury, operated by advancement of volar plate arthroplasty (in 3 case as a primary and in 7 cases as a secondary reconstructive procedure) with inclusive criteria of unstable joint and > 40% involvement of volar surface of middle phalanx. Results: The average follow up was 20.9 months with preoperative ROM was 15.70. The ROM improved to 910 in fresh and 720 in late cases . The result of over- all study shows good result with functional gain in range of movement. Discussion: The surgeon must choose an appropriate treatment based on fracture pattern, joint stability , duration. Stability of the joint is paramount in determining the appropriate treatment, which should aim to facilitate early mobilisation and restoration of function. Conclusion: volar plate arthroplasty gives stable joint and functional range of motion.

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Background: Osteosynthesis of unstable intertrochanteric (IT) fractures in geriatric population needs prolonged bed rest to prevent implant failure, which in turn results in complications such as pressure sore and pulmonary infection. In literature, a newer approach, such as prosthetic replacement for unstable intertrochanteric fractures, has been described to allow earlier restoration of postoperative weight bearing. Our study aimed to evaluate the effectiveness of coxofemoral bypass in comparison to proximal femoral nail in the treatment of unstable intertrochanteric fractures in the elderly. Materials and Methods: Forty-two elderly patients with unstable IT femur fractures were included in this study, of which 21 patients underwent coxofemoral bypass with remaining 21 patients treated with proximal femoral nail. Both the groups were comparable with regard to demographic data and injury variables. The clinicoradiological evaluation was done at regular follow-up visits at 6 weeks, 3 months, and 6 months postoperatively. The functional outcome between the two techniques was evaluated using Harris hip score. Results: The complications such as pressure sore and pulmonary infection were higher in proximal femoral nail group compared to coxofemoral bypass group. There was statistically significant difference in functional outcome between two groups at the end of 6 weeks (P = 0.048) but not significant at the end of 6 months (P = 0.357, better in coxofemoral bypass group). Conclusion: Coxofemoral bypass is a better option than proximal femoral nail in the treatment of unstable IT fractures in the elderly as it provides stable, pain-free, mobile joint with earlier restoration of walking ability, less complications, and good functional outcome.

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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: As many as 40% of the shoulder injuries involve acromioclavicular (AC) joint. AC joint injuries have been classified by Rockwood into six types. Treatment of Type 3 AC joint injuries has been controversial. We present a series of 15 cases of Rockwood Type 3 AC joint injuries treated surgically with a method that addresses both superior- inferior as well as anteroposterior AC joint instability. Materials and Methods: Fifteen cases of Rockwood Type 3 AC joint injuries presented to us between November 2011 and November 2015. There were 11 male and four female patients. All patients were treated surgically with the reconstruction of AC and coracoclavicular (CC) ligaments using autogenous semitendinosus graft. The patients were evaluated pre operatively and postoperatively by radiological and functional (using American Shoulder and Elbow Surgeons [ASES] and Constant-Murley scores) methods. Results: X-rays done immediate postoperatively and at 6 weeks, 6 months, and 12 months postoperatively showed good maintenance of the reduction of the AC joint. The ASES score improved from a preoperative score of 41 to a postoperative score of 81 and 95 at 6 and 12 months, respectively. Constant-Murley score improved from a preoperative score of 42 to a post operative score of 79 and 93 at 6 and 12 months, respectively. Conclusion: Surgical management of Rockwood Type 3 AC joint injuries by AC and CC ligament reconstructions using autogenous semitendinosus graft leads to good functional results.

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Context: Acromioclavicular (AC) joint dislocation is one of the common shoulder problems accounting for 9% of all shoulder injuries and occurs five times more frequently in men than in women. Aims: In the present study, we aim to assess the functional outcome of hook plate fixation for the treatment of acute Rockwood Type III–V AC joint dislocation and to know the complications associated with the implant. Settings and Design: This was a prospective study. Subjects and Methods: Twenty patients, both male and female, with a mean age of 42 years who had acute dislocation of the AC joint were included for the study. Nine patients had Type III, four patients had Type IV, and 7 patients had Type V dislocation according to Rockwood classification. Patients were followed up till 6 months and were evaluated using Constant–Murley score. Statistical Analysis used: For the statistical analysis, descriptive statistics were calculated with the objective of summarizing the set of data analyzed. Results: The mean Constant–Murley score was 82.5 at 6-month follow-up. Four patients had complications of which one had superficial infection, two had subacromial erosion, and one had osteoarthritis of AC joint. Conclusions: Radiographic outcome based on the maintenance of reduction indicates that hook plate fixation is a better treatment option and is an effective method for the treatment of AC joint dislocation. Osteoarthritis and osteolysis are two common complications, which are associated with impairment of shoulder function. Shoulder function will be improved after the removal of hook plate.

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