Spastic paralysis is one of the frequently seen conditions in orthopaedic outpatient departments. It results due to a variety of causes like cerebral palsy, encephalitis, cerebral thrombosis, multiple sclerosis, transverse myelitis, injuries of brain or spinal cord, various causes of compression of cervical or dorsal spine, e.g., tuberculosis, fluorosis etc. Orthopaedic surgeons are called upon to treat these cases because of the deformities and disabilities produced in the limbs. Management of these cases has been largely neglected in the past due to the complex pathophysiology of muscle imbalance and spasticity in these cases. As a lot perseverance is required in the management of these cases and hence they are generally left to their fate. This wave of pessimism does not seem to be justified because with their fate. This wave of pessimism does not seem to be justified because with proper care in treatment and rehabilitation, majority of these cases can be made serviceable to themselves and to the society. It is with this aim in view that this study was undertaken. The literature is full of reports on surgical management of spastic paralysis with new methods coming up every day claiming superiority over the old ones. The old procedures like resection of posterior nerve roots, radicotomy, local alcohol injections, and selective nerve resection (Heyman 1939) have been largely abandoned. The surgical trend in recent years has been on procedures like tenotomy, tendon lengthening, tendon transfer, arthrodesis etc. Eggers (1952) described hamstring transplant into femoral condyles to improve flexion deformity at the hip was well as the knee. Pollock (1953) described gastrocnemius tendon lengthening to correct the equines deformity when the deformity was in this component. Bleck and Holstein (1964) perfumed iliopsoas tenotomy for correcting flexion deformity of hip. In the upper limb, surgery has been recommended for pronation deformity of forearm and flexion of wrist. Mccarroll and Schwartzmann (1943) advocated correction of the adduction contracture of the thumb by adductor release.

Quadriceps paralysis is a major disability in patients afflicted with poliomyelitis. While many so affected develop various trick mechanisms to lock the knee, the locking mechanism usually remains weak, and running climbing stairs or walking over uneven ground very often results in instability of the joint. Others who can not develop trick mechanisms or have associated weak muscles in the same limb particularly of hip extensors or triceps surae can only manage to walk either with a hand on knee gait or with the help of a full length walking caliper which is expensive and cumbersome. For increasing the strength of the knee extensors various muscle transfers have been described in the literature. These are sartorius to patella (Goldthwait 1895), tensor fascia lata and sartorius to patella (Ober 1933), biceps femoris and semitendinosus to patella (Crego et al.1931), biceps femoris transfer to patella rerouting it medial to the femur (Caldwell 1955), opposite external oblique abdominis to greater trochanter (Saha and Dutta1959), obturator externus to the front of the femur to internally rotate the femur for locking the knee (Saha and Paul 1965). Of all the procedures mentioned possibly the transfer of biceps femoris and semitendinosus to patella is the most popular one. However, in the English literature the results of these procedures are scarcely described and due to control of poliomyelitis in the developed countries, future reports are unlikely to be many. The present paper is therefore, intended to present the result of 40 cases of hamstring transfer to patella for quadriceps weakness following poliomyelitis.

Lambrindudi’s modification of triple arthrodesis is a well known procedure, being practiced since 1929. Though the efficacy of subtalar fusion has never been questioned, it certainly diminishes the capability of the foot to adopt to uneven ground. Most Indians walk on uneven terrain and their difficulties after a subtalar fusion have not been adequately ascertained. It was considered worthwhile reporting analysis of result of this operation in the background of Indian conditions

Blount (1955) pointed out that the occurrence of fracture of the neck of femur in children was a rare condition and one had too great an experience in their management. The trochanteric and cervico-trochanteric fractures untied easily because of their broad fracture and ample blood supply. Trans-epiphyseal and transcervical fractures were notorious for complications of non union, avascular necrosis, premature epiphyseal fusion and coax vara. A study of 21 cases of fractures of the neck of femur in children was considered wroth reporting to highlight problems of its management.

Intracapsular fracture of neck of the femur is still an unsolved problem. Many types of operations have been devised for it. On one hand there are internal fixations by Smith-Petersen nail and other methods which aim at restoring normal anatomy and normal function but which result in about 30 per cent failures. On the other hand we have replacement arthroplasty and total hip replacement which eliminate chances of occurrence of avascular necrosis or non-union, but have their own limitations. McMurray’s intertrochanteric displacement osteotomy was in early stages used for old ununited fracture of neck of femur, however, later many surgeons used it as primary treatment for fresh fractures (McMurray 1938, King 1950, Allende and Lezama1951, Gupta and Atri 1963, Chaturvedi and Gupta 1969, Rallan and Shrivastava 1976, and Mishra 1979). We are presenting here an evaluation of this procedure in fresh and old intracapsular fractures of femoral neck.

In the past two decades, prosthetic replacement in intracapsular fracture of neck of femur in elderly patients has become an accepted procedure. In our country most of the patients reach the hospital after having been primarily treated by indigenous methods. This paper is based on observations of 25 cases treated at Magadh Medical College Hospital in the year 1975 to 1979 for old neglected fractures of the neck of femur, where the neck was absorbed and greater trochanter was shifted upwards.

Post-operative wound infection has always posed various problems both for the patient and the orthopaedic surgeon. Prophylactic antibiotics were, therefore, used almost routinely by many orthopaedic surgeons to decrease the incidence of this complication. However, its use in clean orthopaedic operations has long been debated. Tachdjian and Compere (1957), Johnstone (1963) and O’Riordan et al. (1972) in their series concluded that prophylactic antibiotics serve no useful purpose. Forelberg et al. (1970), Boyd et al. (1973), Pavel et al. (1974) however, showed in their study to the contrary. The present study was therefore, undertaken to test the effectiveness of prophylactic antibiotics in clean orthopaedic procedures.

Bridging of osseous defects and filling of osseous cavities is a well known operative procedure in orthopaedic surgery. Wide ranging substances have been used for this purpose, with variable success rates. Autologous bone, however, is universally accepted as the most effective osseous graft material (Wilson and Lance 1965, Caroll 1966, Parrish 1966, Pintilie et al. 1966, Tuli 1972). Implants of bone, decalcified by 0.6 M HCL are reported to have an appreciable bone forming potential (Van de putte and Urist 1966, Urist et al. 1968, Chalmes, Gray and Rush 1975, Tuli and Singh 1978, Tuli and Chaudhury 1979). Peltier (1961), Mukopadhya and Mehta (1957), and Sachdev and Sharma (1976) reported osteogenesis with plaster of Paris also. The present experimental study was therefore, undertaken to compare the osteo-inductive property, each of decalcified bone matrix and plaster of Paris.

Recent studies on zinc metabolism are suggestive of the fact that zinc sulphate not only enhances the healing o f wounds but also promotes fracture healing (Mesrobian and Shklar 1969, Westmoreland and Hoekstra 1969, McCray et al. 1972, Battistone et al. 1972, Calhoun et al. 1975). The uptake of zinc by fractured bone is increased during fracture healing (Calhoun and Smith 1968). Similarly other drugs like methandienone (Singh and Udupa1964) and ascorbic acid were also found to effect the rate of fracture healing. Therefore it was considered worthwhile to do a comparative study in zinc sulphate supplemented animals and in zinc sulphante, ascorbic acid and methandienone supplemented animals with non-supplemented controls with a view to find the rationale and the efficacy of these drugs in the healing of fracture.

Infection has been criminated as a cause of delayed union and non-union of fractures. In some infected fractures, there is excess callus formation as compared to uninfected fractures due to the effect of low grade infection stimulating the reparative osteogenic cells to lay down more bone tissue. Similarly in case of chronic pyogenic osteomyelitis there is massive new bone formation probably due to some stimulus provided by the pyogenic organism, the nature of which is unknown. Starr (1947) has stated that “Infection is not all detriment and a certain amount of infection at the site of fracture stimulates new bone formation�. This has aroused interest in us to study the effect of local injection of staphylococcal vaccine at the fracture site. No relevant literature for a similar work done previously is available, expect of Sullivan (1961) who studied at effects of injection of live staphylococcus for obtaining interbody fusion of spine in dogs.

Various changes in serum proteins may occur due to joint disorders, while synovial fluid proteins are often affected by systemic diseases. Hunder and Gleich (1974) described the raised serum and synovial proteins in cases of rheumatoid arthritis. Inamdar et al. (1974) reported the changes in other fractions of glycoproteins in synovial fluid. The present study was carried out to observe the changes in proteins of serum and synovial fluid in different groups of chronic arthritis.

Congenital pseudathrosis of tibia is rare but perhaps the most difficult condition to treat. These tibiae are abnormal and as a result of this they become bowed anteriorly and develop pathological fractures which may occur before or after birth. It is because of the nature of the lesion that some of the authorities have even advocated an early amputation (Lloyd-Roberts and Shaw 1969, Hardings 1972). There are various types of surgical approaches to manage the congenital pseudarthrosis of tibia (Boyd 1941, Mcfarland 1951, Charnley 1956, Charnley 1956, Sofield and Millar 1959). However, the studies undertaken so far reveal that no single type of surgical approach assures uniformly successful results. The purpose of this paper is to record the author’s observations on fixation of the mother’s fibula as a graft between the proximal end of the tibia and the talus after excision of the defective bone in the management of these patients. A report of 5 such cases is being put forward.

Filling up segmental defects in the continuity of long bones still poses a great challenge to an orthopaedic surgeon such defects could be either due to resection of segment of diseased bone or due to non-union with segmental loss or may be due to absence of part of bone. Bridging a defect in a long bone, especially weight bearing bone like tibia is difficult technically and union afterwards is indolent. The fibula of the affected side is transplanted to bridge the gap in such a situation to reconstruct a single bone leg, which is also called tibialisation of fibula. This paper reviews the follow up of 4 cases of reconstruction of single bone leg.

The results of treatment of congenital talipes equino-varus remain unsatisfactory inspite of various methods of treatment available as advocated by different surgeons from time to time. Even in the best hands the outcome is not always certain. Factors responsible for such an outcome are primarily the soft tissue contracture and distortion of arrangement of bones of the foot. It is made still worse by bringing the child late for the treatment, particularly so in our country. Club foot can be treated by both conservative and operative methods. Success has been claimed equally for both. It is also a known fact that relapse of the deformity can occur in both forms of treatment. Conservative treatment is often time consuming and patients in our country due to economic reasons cannot afford to attend the hospital for a long time. In addition, there are some rigid feet which resist conservative treatment. The results of surgical treatment can also be unsatisfactory specially if it is done for late and neglected cases when the ligaments and bones remain no more pliable. Any form of treatment to be successful must be done early if proper correction is to be achieved. Hence, there have been more and more attempts at operating these feet as early as possible. In the present work the results of early surgery on 30 patients with talipes equino-varus deformity are reported.

Ischaemic contracture of muscles developing in limbs due to tight splinatage or an injury to major arterial trunk is a well known entity. However, the changes that concurrently occur in the bones of the involved extremity are not well documented. Hence, a comparative radiological study of bones of the normal and the involved extremity was carried out. In the developed countries, the treatment is so prompt and adequate that long standing cases of ischaemic contracture are not available to the clinician for study. In India where produced by tight splintage is fairly common, many patients seek help only years later.

Iliac crest is a common site for taking bone graft but hernia through the donor site is rare. Till now only 14 cases have been reported in the literature (Table) but the true incidence of this “land slide hernia� is not known.

Osteochondritis dissecans is a rare bit fairly well defined clinical and pathological entity characterized by the separation of a subchondral fragment of bone from the convex articular surface of a joint. It occurs most frequently in the knee, elbow, shoulder, ankle and hip. In the knee, the commonest site is the lateral aspect of the medial femoral condyle in an area close to the intercondylar fossa. The condition has also been reported in patella but rarely so in the lateral condyle of the femur. One of the cases reported by Hall and Hume (1970) had lateral condyle involvement but even that was on the inner aspect and followed renal transplantation. It is indeed rare to find osteochondritis dissecans affecting the postero-lateral aspect of the lateral femoral condyle. Not a single case has been found in the available World literature. Present case was, therefore, considered worth reporting.

Vegetable foreign body induced synovitis is a rare phenomenon and presents diagnostic andtherapeutic problems. Because of its close similarity with conditions like tubercular synovitis, monoarticular rheumatoid arthritis, sub-acute septic arthritis and acute septic arthritis inadequately treated by antibiotics, it assumes an important place in the differential diagnosis of these conditions. Recently, we had an opportunity to study such a case.

Wedge osteotomy of spine, a one stage operation, was first described by Smith-Petersen et al. (1945) for flexion deformity of spine in Marje-Strumpell’s arthritis. Goel (1968) used this procedure for correction of kyphosis in osteomalacia. Later on, vertebral osteotomy was reported in ochronotic spondylitis (Saxena and Sharma 1974), quiescent tuberculosis of lumbar spine (Saxena 1976,1978) and osteoporosis (Saxena 1976,1978). As the result of osteotomy of spine for correction of adolescent kyphosis till date have not been published in the available World literature, our experience with 2 such cases warrants report.

Survival of the patient with traumatic occipito-atlantal dislocation is rare, only 3 reports of patients who recovered from this injury were found in a review of the literature (Corner 1970, Blackwood 1908, Farthing 1948, Wholey et al. 1958, Garbielsen and Maxwell 1966, Yajnik and Doshi 1977). Most injuries of this type are instantly fatal but autopsy information on the anatomical lesion is sparse. In these cases either the medulla oblongata or the spinomedullary junction may be served. The occipito-atlanto-axial ligaments are strong, and fracture usually precedes ligamentous rupture. Spontaneous non-traumatic occipito-atlantal dislocations have been reported secondary to inflammatory diseases that include rheumatoid arthritis, ankylosing spondylitis, and acute tonsillitis and in these the atlantoid joints and synovial tissue are affected by the inflammation, and periariticular bone is resorbed causing occipito-atlantal instability. Here too, if the instability is severe, dislocation and death may occur. A case of traumatic occipito-atlantal subluxation is presented here.