Background: Trauma is globally associated with significant mortality with developing countries bearing a disproportionately high burden. It represents a major epidemic of non – communicable disease. The aim of this study is to evaluate the incidence of various fracture and dislocation patterns in patients with extremity injuries and their 1- year mortality rate. Materials and Methods: An observational, prospective study was undertaken to analyse the incidence of fracture and dislocation patterns in patients coming to the Orthopaedics OPD and emergency medicine department in a tertiary hospital during a period of two years from 1^st, October 2017 to 30^th, September 2019. Overall, 1182 patients were enrolled for the study with a mean age of 43 yrs. Results: Age group 21 – 30 years was most common (17.1%) age to suffer injuries with a male preponderance (67.5%). The most common mode of injury was by road traffic accident (43%). 97.9% of the injuries had unilateral involvement with the lower extremity (57.2%) and the femur (21.2%) being most frequently fractured. Dislocations/fracture-dislocations constituted only 5.5% cases with shoulder dislocation being the most frequently involved joint. Plain radiographs were used in 96.9% cases for final diagnosis. Forty cases (3.4%) were found to not survive in the 1-year follow up after fracture. Conclusion: The present study shows that most of the causes of trauma are preventable. This study could assist in raising the profile of RTI as a public health problem which needs to be addressed as a preventable cause of mortality and morbidity, and planning appropriate interventions for this major challenge.

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Introduction: The growing trend toward the use of pedicle screws for the operative treatment of patients with idiopathic scoliosis is to provide a three-dimensional (3D) deformity correction using a three-column fixation was observed. Reports have variable recommendations regarding the implant density as well as the configuration of the pedicle screws. This study re-evaluated implant density and curve correction currently based on the 3D correction strategy by comparing it to side-bending correction (SBC). Materials and Methods: Seventy-six adolescent idiopathic scoliosis (AIS) patients who had undergone posterior spinal fusion from 2017 to 2019 visited our specialized center were recruited. Demographic variables and radiological measurements were collected. Patients filled out the Scoliosis Research Society (SRS-22) questionnaire from a mobile device, of which the SRS-22 was digitally adopted using mobile technology and cloud computation. Results: In the 76 AIS patients, 28 (37%) were rigid curves and 48 (63%) were flexible curves. Of the 28 rigid curves (SBC <30%), 13 (46%) patients had low pedicle screw density (PSD), while 15 (54%) had high PSD. Of the 48 flexible curves, 26 (55%) patients had low PSD, while 22 (45%) patients had high PSD. SBC index for the high PSD group (172) is almost the same compared to the low PSD group (174). Conclusions: Using high or low PSD makes the same amount of spinal correction for this group and additional screws do not make significant improvement on spinal correction. Higher screw density instrumentation is associated with the same amount of correction rate, whether in rigid or flexible curves, leading us to postulate that scoliosis correction relates more to intrinsic curve flexibility rather than instrument density.

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Objective: The objective of the study to compare the relative effectiveness of intralesional steroid versus platelet-rich plasma (PRP) injection among 80 patients in plantar fasciitis. Materials and Methods: A total number of 80 patients with plantar fasciitis were divided into two groups. Group A with 30 patients received intralesional PRP and Group B received intralesional methylprednisolone acetate injection. Pre- and post-intervention visual analogue scale (VAS), the Foot and Ankle Ability Measure (FAAM) score, and Plantar Fascia (PF) thickness for the assessment of pain relief in two groups were recorded at 6 months. Results: The mean VAS scores for heel pain measured after 6 months of treatment were 1.460 ± 0.6911 in PRP group and 3.024 ± 0.9572 in steroid group. The decrease in mean VAS score in both the groups was statistically significant when compared with pretreatment values (8.38 ± 0.6820 in PRP group and 8.44 ± 0.6021 in steroid group). The mean FAAM score measured after 6 months of treatment increased in both the groups (83.43 ± 5.661 in PRP group and 69.12 ± 5.795 in steroid group) when compared with pretreatment value (29.97 ± 5.997 in PRP group and 31.68 ± 6.297 in steroid group), and it was statistically significant. There was 35.90% reduction in mean PF thickness in PRP group and 28.67% reduction in steroid group as compared to baseline values after 6 months of injection. Conclusion: Intralesional injections of both the PRP and steroid are effective and safe modalities of treatment for plantar fasciitis. A steroid is better for short-term treatment of plantar fasciitis, but in long-term follow-up, PRP therapy is better than steroid. Both the treatment methods have caused a significant reduction in PF thickness.

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Objective: Prosthetic joint dislocation remains a significant cause of revision following total hip replacement (THR). To prevent this complication, emphasis has been on choosing the optimum surgical approach, accurate implant alignment, bigger femoral head size, and implementing postoperative hip precautions. In the last decade, a newer acetabular design concept; the “Dual Mobility cup” (DM cup) was introduced to reduce the prosthetic dislocation. Although the concept of the use of such a device is well accepted, there remains apprehension regarding its precise indications, the outcome in terms of wear and ability to decrease the incidence of prosthetic dislocation. We reviewed the early results of a particular DM cup design. Materials and Methods: This study shares a single center experience of using a monoblock DM cup (Captiv DM, Evolutis, Briennon, France) in THR. It is a prospective cohort study that looked at indications, handling issues, complications including prosthetic dislocations at 24 months follow-up. Results: We followed up results of uncemented and cemented DM cup used in 129 patients who underwent primary THR or revision THR (RTHR). There was one (1.6%) prosthetic dislocation amongst primary THR and 2 (3%) in the RTHR group. There were handling issues with monoblock uncemented DM cups of occasional improper seating and acetabular rim fracture. Three cases in which revision was performed, were due to component to component impingement and resulted due to inappropriate acetabular version. Conclusion: The use of DM cups while performing THR or RTHR significantly decreased the incidence of instability. While placing DM cups an attempt should be made to maintain the native version of the acetabular cup to decrease the risk of component impingement and instability. Level of Evidence: Level III, therapeutic study.

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Introduction: More recent advances are about the incision technique for intramedullary interlocking (IMIL) nailing, a 3 cm stab incision is sufficient for the procedure of IMIL nailing as compared to commonly used suprapatellar incision of 5–7 cm with splitting of patellar tendon which might result in chronic knee pain restricted range of movement, risk of infection, longer duration of postoperative rehabilitation, and poor wound healing. Objective: A retrospective study and analysis of three stitch technique in posttraumatic shaft tibia fractures to assess the range of motion. Background: Tibial shaft fractures have peaked in incidence in the past decade with sky rocketing amount of road traffic accidents. With the mainstay of making any patient of such traumatic incident being early mobilisation, IMIL nailing for tibia remains one of the finest treatment modalities among plating or external fixator applications. With the increased demands in the field of cosmetology and minimally invasive scar techniques, the 3-stitch technique would have a major impact not only on the early healing of surgical scar but also reduced chances of acquired infections along with advancements in weight-bearing exercises. Materials and Methods: A retrospective analysis of midshaft tibia fractures who were treated with IMIL nailing with 3-stitch technique with a sample size of post op 100 patients. A study was held at a tertiary care hospital and research center. Results: Sample size of postoperative 100 patients out of which 76 showed conclusive results and 24 were lost at follow-up. Conclusion: Good to excellent outcome with a small healed scar was observed in patients who underwent 3-stitch technique IMIL nailing for shaft tibia fractures.

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Background: Arthroscopic Bankart repair is now the standard procedure for shoulder stabilization in patients with recurrent anterior shoulder instability with Bankart lesion with minimum glenoid bone loss. Aims: The aim of this study is to evaluate the postoperative shoulder motion and functional outcome following arthroscopic repair of Bankart lesion with suture anchors with or without remplissage. Materials and Methods: This is a prospective study done between May 2019 and April 2021. A total of 20 patients with recurrent anterior shoulder instability were stabilized arthroscopically by the same surgical team over time. All patients met the inclusion criteria and were assessed with the American Shoulder and Elbow Surgeons (ASES) and Rowe scoring systems. The range of motion, postoperative function, recurrence rate, and return to preinjury activities were evaluated. Results: In our study, all 20 patients were followed up for a minimum period of 1 year. All patients had a good range of motion. The two shoulder scores (ASES and Rowe) significantly improved after surgery (P < 0.05). There was only one recurrence (5%). Patients were able to return to their previous activities or physically demanding jobs. Conclusions: Arthroscopic Bankart repair for traumatic anterior shoulder instability is a good procedure with less postoperative morbidity and excellent functional outcome. It allows return of patients to previous activities without any restriction.

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Background: Epidural steroid injection is a common intervention for symptomatic lumbar disc herniation. It is safe, but not absolutely free from complications. Visual complications and adverse intraocular events are sparse in the literature. This study is done to determine any intraocular complication after caudal epidural steroid injection for discogenic low back pain and radiculopathy. Materials and Methods: It was a prospective study, conducted from April 2018 to December 2019 by the orthopedics and ophthalmology departments of our institute. A total of 31 patients were recruited based on inclusion/exclusion criteria. All the patients presented to this institute with complaints of low back pain and sciatica were investigated. After proper diagnosis, the decision was made for caudal epidural steroid injection as per the standard principles of orthopedic surgery. Eye evaluations (intraocular pressure [IOP], visual acuity, and ocular examination) were done 1 day before, and 2–4 h, 1 week, and 2 weeks after epidural injection. The differences in eye evaluation values between time points were determined and discussed. Results: A total of 31 patients were recruited for this study, out of which the majority of the patients (27 patients) were between 41 and 60 years of age, and males (22 patients) outnumbered females (nine patients). Most of the patients (17 patients) had prolapsed IV disc of L5-S1. IOP was found to be raised after the intervention of epidural steroid injection which gradually came down to a preinjection level within 2 weeks. There was no change in visual acuity and no other intraocular complications, like hemorrhages. Conclusion: Epidural steroid injection for discogenic low backache (LBA) with radiculopathy did not adversely affect IOP, and neither had any ocular complication (in an ophthalmologically normal set of patients). A prudent approach should always be implemented.

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Rhabdomyosarcoma (RMS) is the most common soft sarcoma in kids, with alveolar and embryonal variants distinguishable by histopathology and, more significantly, molecular biology. RMS occurs intermittently in a substantial proportion of cases without a predisposing condition. Nevertheless, it is well established that certain hereditary factors enhance the likelihood of developing RMS. Beckwith–Wiedemann syndrome, Gorlin syndrome, Costello syndrome, neurofibromatosis type 1 (NF1), and Li-Fraumeni syndromes are some of them. These syndromes present with RMS during childhood. A 47-year-old female with NF1 discovered a lump in her right forearm 1 year before presentation. When the patient noticed ulceration on the swelling, she sought medical attention. A tumor was detected in the center of the right forearm through magnetic resonance imaging, and it was suspected to be a cystic or myxoid soft-tissue tumor, RMS, or a peripheral neural tumor. We classified the tumor as stage IV due to axillary lymph node involvement and lung metastasis. Histopathology confirmed RMS. The patient then received radiotherapy and chemotherapy, and her tumor went into remission. After confirming NF1 syndrome, we advise patients to adhere to the standard cancer screening protocol. The screening would assist in the earlier diagnosis of tumors, leading to a reduction in complications.

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Background: Treatment alternatives for patella fractures with the inferior pole are still being deliberated. In addition to tension-band wiring, metal implant-related complications are also not uncommon to occur in patellar fracture treatment. It is common to encounter implant-related complications such as implants failing, palpable hardware which require supplementary techniques to resolve. We evaluated participants with inferior poles of patella fracture treated with transosseous nonabsorbable sutures on functional outcomes. Methodology: This study encompasses observation of patients having transosseous suture fixation by no. 5 Ethibond for fixation of distal pole patella fractures. This was a longitudinal study piloted at a tertiary care center between January 2020 and June 2022. Patients' functional outcomes were assessed using the Bostman score. Results: The Bostman scoring system was used to evaluate the outcome at the final follow-up. In 19 patients, 7 (36.84%) patients showed outstanding and 11 (57.89%) patients showed good outcomes at the termination of 9 months follow-up. Only one patient established an unsatisfactory result. Conclusion: Distal pole patella fractures can be effectively fixed via transosseous suturing with unabsorbable sutures. Fast recovery and minimal implant-related complications are possible with this procedure. The resurgery rate is also significantly reduced.

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Introduction: Low serum Vitamin D levels are common in orthopedic patients in India. Low serum Vitamin D levels are implicated in COVID-19 worsening the illness. With this background, we assessed serum Vitamin D levels in COVID-19 patients presenting to us and correlated them with other markers of bone metabolism and systemic immune response. Materials and Methods: A cross-sectional analytical study was done on 107 COVID-19 patients. The sample was taken for serum calcium, serum Vitamin D, serum phosphate, bone-specific alkaline phosphatase (ALP), serum parathyroid hormone, creatine phosphokinase (CPK), CPK myocardial band (MB), serum protein, C-reactive protein, erythrocyte sedimentation rate, and hemoglobin in these patients. The levels were correlated with each other to assess their relations in COVID-19 patients. Results: One hundred out of 107 patients had low serum Vitamin D levels. In these patients, serum lactate dehydrogenase and serum ALP levels were high, and creatine kinase MB levels were low. The illness was found more in diabetic/hypertensive and rheumatoid arthritis patients. The values and findings correlate with increased disease activity and osteopenia with no obvious muscular injury. Conclusion: Managing Vitamin D deficiency (VDD) has been taken up as a major step in COVID-19 affection. The markers of bone metabolism and their correlation with serum Vitamin D were equivocal in COVID-19-affected and not affected Indian populations. The risk of infection has been more in diabetic, hypertensive, and rheumatoid arthritis patients, all of whom were also suffering from VDD.

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Hoffa fractures are distal coronal femoral fractures which are intra-articular and involve one or both of the condyles. The lateral condyle is three times more likely to sustain an injury than the medial condyle. Malunion is one of the late complications in neglected instances or following nonoperative management. Medial femoral condyle injuries are quite uncommon. In this case study, a 23-year-old male with a neglected medial Hoffa's malunion is discussed. The patient presented with pain, deformity, and restriction of movements in the left knee for 6 months. Pain aggravates walking and was affecting his daily activities. He allegedly had a past trauma 18 months back for which he took osteopathic treatment. On examination, fixed 10° varus knee deformity is noted, and there is a fixed flexion deformity of 10° with further flexion up to 100°, i.e., there is an extension block terminally. X-rays and computed tomography scan showed medial condyle Hoffa's malunion with obvious intra-articular step. Treatment aims to reduce the articular surface anatomically and provide rigid and stable fixation. Treatment's objectives included easing pain and addressing deformities and improving the range of movements and early mobilization. The patient was assessed clinically with a Knee Society Score. The primary method of treatment for Hoffa's malunion is surgical. Intra-articular osteotomy should be taken into consideration as a salvage option in the younger population to prevent arthritis. The use of an antiglide plate in conjunction with screws provides rigid and stable fixation.

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Introduction: The anterior cruciate ligament (ACL) has an important role in preserving the function and stability of the knee joint, and it prevents anterior translation of the tibia. The ACL is the most commonly injured structure of the knee following posttraumatic and sports-related injuries. The treatment of modality for ACL insufficiency was arthroscopic ACL reconstruction. In this study, we followed the transportal approach for ACL reconstruction using a Quadrupled Hamstring graft, and we reported the functional outcome of ACL reconstruction at a minimum follow-up of 6 months. Materials and Methods: This was a prospective outcome study conducted on 32 patients who met the inclusion and exclusion criteria. All patients in this study underwent arthroscopic reconstruction of ACL using quadrupled hamstring tendon graft through transportal technique. The graft was fixed with an endobutton on the femoral side and an interference screw on the tibial side. Patients were assessed for the functional outcome for a minimum of 6 months using the Tegner-Lysholm knee scoring system. Results: The mean age of the patient was 27 years. The majority of involved patients were males. The left side (77.14%) was involved more than the right side (22.86%). The most common cause of ACL injury in this study was road traffic accidents. Preoperative Tegner-Lysholm scores were 20 (62.5%) patients had poor and 12 (37.5%) patients had fair scores. Post-operatively, at 6 months follow-up, 27 patients had excellent, four patients had good scores, and one patient had a fair score. There was a significant improvement in the Tenger-Lysholm scoring system after 6 months of follow-up when compared to preoperatively. Three patients had knee pain and thigh muscle wasting (2 – 3 cm) during follow-up. Conclusions: Transportal arthroscopic ACL reconstruction using Quadrupled Hamstring graft gives excellent functional outcome and knee kinematics.

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