Closed locked nailing is not a suitable procedure for polytrauma patients and patients having vertical crack fractures. Nutritional haemodynamics of bone is disturbed by nailing irrespective of its reamed or unreamed nature. 25 patients with diaphyseal fractures tibia had percutaneous plate fixation under image intensifier. Both ends of the plate were fixed to bone with two screws. The plates were locally fabricated. Patients were given PTB caliper and no plaster. The weight bearing was delayed. Two patients had superficial infection. Two patients required iliac bone grafting as a secondary procedure. Union occurred in 6 to 8 months time. The procedure was well tolerated by patients. The timing of surgery is an important factor. Inflamatory response of local soft tissues must settle before the procedure is undertaken.

Experience with 20 fractures (18 closed, 2 Grade-I open) proved that closed intramedullary nailing of tibia with Kuntscher nail using conventional x-ray without the help of image intensifier was effective. The mean time for clinical union in 16 cases was 13 weeks. The major complication was delayed union (4 cases) and varus deformity more than 5° (one case).

The present series consists of 104 cases of severe fractures of tibial shaft which were treated by a hybrid system of external fixation and functional cast bracing. Bone marrow transfer was bone in 40 patients who reported to us after ten weeks. The bone marrow graft was taken from the upper end of contralateral tibia. Overall the results were excellent in 35%, good in 45%, fair in 13% and poor in 7% as per the criteria laid down by Johner et.al., 1983.

Forty-five cases of fracture lower third tibia were included in this study. The effect of fracture configuration, grade of compounding and modalities of treatment on the healing time and final outcome as per Johner and Wruh’s criteria were studied. In our study we found that tissue injury in lower third tibia and various modalities of treatment (closed interlocking nailing, open medial plating, External Fixator and Plaster of Paris) had no significant effect on the healing time or final outcome. However, fracture configuration especially comminution had a delaying effect on the healing time proportional with the severity. This is in accordance with previous series of Ellis (1958), Leach (1964), Nicoll (1984), Allum & Mowbray (1980). This study confirms the findings of the above series, which found no significant effect of site on the healing time in tibial fractures. This study further suggests that union in lower third tibial fractures solely depends on regeneration of intramedullary vessels and the contribution of peripheral blood supply is minimal.

A total of sixty patients with infected diaphyseal non union of tibia and femur were subjected to Ilizarov’s external ring fixator. Forty-seven cases were of infected non union or infected defect non union requiring bone transport or soft tissue reconstruction while thirteen were of infected non union not requiring bone transport or soft tissue reconstruction. In the 1st group twenty-seven males and six females under went metaphyseal cortitocomy while in the remaining it could not be done due to poor bone or skin condition and diaphyseal corticotomy was performed and controlled distraction was begun within seven days. Normotrophic regenerate was observed in all the cases of metaphyseal corticotomy while hypotrophic or atrophic regenerate was observed in cases of diaphyseal corticotomy. The later requiring reinforcement by cancellous iliac bone grafting. In second group there were 7 cases of infected tibia and 6 infected femur requiring only radical debridement and acute compression at the fracture site. Failure of union was seen only in nine cases (19.75%). All these were cases of diaphyseal corticotomy with atrophic regenerate. The remaining fifty-one patients showed union clinically and radiologically with a success rate of (85%). Equines contracture and toe drop were seen in 20 cases of group A and 12 cases of group B respectively as a result of disuse atrophy.

Twenty-eight cases of displaced ankle fracture treated by open reduction and internal fixation were studied over a period of 1½ years. Early mobilisation was started. Nineteen cases were closed and 9 were open fractures. Injury was most commonly due to road traffic accident coming in emergency hours. All fractures united well and the complications were minimal. Assessment of the result was made following Lindsjo scoring system by clinico-functional & radiological assessment. Excellent and good results were achieved in 75% cases and poor result in 10.7% cases. It is a safe and simple procedure, acceptable to the patient.

Russian Assault Rifle AK-47, even today after the disintegration of Soviet Union remains the most lethal of all. This article brings into light the current trends of high velocity skeleto muscular injuries by the AK-47 and AK-74U bullets and their treatment. The article tries to throw light on the different aspects of wounds such as larger exit than entry wound. Projectile yaw inside the body, deviation of center of mass of the bullet and its effect on extent of injury and the use of Ilizarov apparatus in the treatment.

A new technique of locked nailing of humeral fractures was used in 20 cases of diaphyseal fractures of the humerus with Indian implants by two different approaches. In 10 cases antegrade approach and in 10 cases retrograde approach was used. The details of the techniques have been mentioned and the complication discussed. There were 75-80% excellent to good results. The complications, particularly iatrogenic comminution, were comparatively more with the retrograde method of fixation.

This study was undertaken to compare the results of operative and non-operative treatment of thoracic and lumbar injuries. Two hundred and forty eight patients with thoracic and lumbar spine injuries treated between January 1992 and December 1994 were analysed. All 110 patients who did not have any neurological deficit were treated by non-operative methods. Out of 138 (55.6%) patient who had neurological deficit, 114 (84%) had unstable spines whereas 24(16%) were with stable spines. All the 24 patients with stable spines and 84 with unstable spines in whom fracture could be reduced by postural reduction, were treated non-operatively, while 30 patients of the later group were treated by operative means. The outcome of the treatment in the form of neurological recovery and the incidence of complications viz. urinary tract infection (UTI), pressure sores and residual kyphosis were studied. Of 84 patients with unstable spines and neurological recovery in patients with stable spines (24 treated non operatively) was slightly higher (54.6%). Recovery was seen in 78% of the cauda equina lesions and in 17% of cord lesions. The incidence of urinary tract infection and pressure sores was almost the same in both groups. However, better correction of the kyphotic deformity was seen in the operated group.

Fifty-six patients underwent total knee joint replacement (TKR) at this institute between April 93 and Dec.97.of these, 14 patients underwent bilateral knee joint replacement (total 70 cases). The main indication for TKR was OA (42 patients) followed by RA (14 patients). The follow up period ranged from 6 months to 4 years. Results of the operation were evaluated in terms of pain relief, range of motion & stability of the joint. Functional improvement in activities of daily living were also assessed. The results of the total knee Arthroplasty were good to excellent. The mean preoperative score was 40 which improved to 95 after operation. Complications included tourniquet sore in 2 cases, delayed wound healing in 6 cases, superficial would infection in 4 cases and deep wound infection in one case. Our results compared favourably with other series. Since the durability of components has not been fully determined, it is advisable to perform the arthroplasty only in older patients with a sedentary life style or in younger patients with multiple joint involvement.

Arthroscopic assisted arthrolysis of knee following injury, surgery or infection is an effective and safe method of treatment. The complications associated with the procedure are minimal and the rehabilitation is much faster. On an average about 100° of painfree flexion was achieved as compared to average preoperative range of 23° in the present series of 17 patients.

Neuralgic Amyotrophy is a condition marked by spontaneous onset of severe pain in the shoulder followed by profound weakness and atrophy of the involved shoulder muscles as the pain subsides gradually. Authors diagnosed and reviewed five male patients (average age 29 years) of this rare disease from 1991 to 1997. Two patients gave history of the antecedent influenza like symptoms. All patients had an acute onset of intense pain in the shoulder without prior trauma which subsided gradually. This was followed approximately 2 weeks later by weakness and atrophy of the muscles supplied by the brachial plexus namely supraspinatus infraspinatus, deltoid and teres minor. Movements most affected were abduction, external rotation and flexion at the shoulder. Prognosis is good in this self limiting disease with full or near normal recovery in around 2-3 years time.

Fifteen patients, who had undergone corticocancellous bone grafting, were studied using tetracycline double labelling technique to assess the incorporation of fresh autologous bone grafts in human beings. Positive fluorescence at the site of incorporation of bone grafts was demonstrated in a significant number of patients. Differential osteogenic activity in the bone graft could be appreciated as tetracycline was labelled at the mineralization front.

Seventy four femora were studied to analyze the differences in the endosteal and periosteal geometry between Indian and Western subjects. To determine if there is a need to alter the design of femoral component in relation to Indian patients. Standard extracortical and endosteal dimensions were determined by direct measurement of roentgenograms. To enable comparison, standard horizontal and vertical axis were established using the geometric center of lesser trochanter and the bisecting axis of the medullary canal at the isthmus. Significant statistical differences were obtained for the following dimensions: femoral head offset, width at lesser trochanter, width at lesser trochanter-20mm, proximal border of isthmus, and neck shaft angle. This study had brought out that there is a need to modify the femoral component and the range of available implants has to be increased so as to obtain a better proximal canal fit and fill in Indian patients.

Sixty-five cases of aggressive benign and low grade malignant musculoskeletal neoplasms involving the extremities treated by resection and autologous non vascularised bone grafts are analysed. The period of study is 20 years from 1978 to 1998. Skeletal reconstruction was accomplished in most cases either by fibular transplant or by resection arthrodesis. Excellent results were achieved with a low tumour recurrence rate, high limb salvage and patient survival rates and good graft incorporation. Most of the patient survival rates and good graft incorporation. Most of the patients had satisfactory functional results. There were a few complications like infection, non-union of the graft, and fracture of the graft, which however did not compromise the function of the limb. Hence in selected patients these procedures remain a viable alternative to limb salvage by custom-made endoprosthetic replacement and are clearly superior to the functionally and psychologically deforming limb ablative procedures.