The purpose of this study was to evaluate the utility of magnetic resonance imaging (MRI) as the diagnostic tool in children with hip pain, without any diagnostic clue on routine investigations. Thirty-five patients with hip pain with no definite radiographic or laboratory findings were investigated with MRI. Four patients had bilateral symptoms. Out of 39 hips, diagnosis of transient synovitis was made in 35 patients. Out of the other four hips, 2 hips showed reversible ischemic changes in the proximal femur. In one hip MRI showed inflammation of the ipsi-lateral sacro-iliac joint and in one hip MRI showed infection of the ilium. The sensitivity of MRI in detecting the joint fluid and early changes in the bone and joint was confirmed. The MRI was found to be of value in the patients with prolonged and recurrent symptoms for early detection of underlying disorder.

Twenty cases of bone grafts in humans were studied by fine needle aspiration cytology from the perigraft area at intervals of 10, 20, 30 and 40 days. Ten patients received autogenous bone grafts while the other ten were recipients of allogenic bone implants (0.6M HCI treated partially decalcified bone). The paramenters observed were: mean lymphocyte counts, CD4+ / CD8+ cell counts and CD4+ / CD8+ cell ratios. There was a gradual increase in the relative lymphocyte count and CD8+ lymphocytes while decrease in the CD4+ / CD8+ lymphocyte ratios from 10th to 40th day. A similar trend was observed in fresh autogenous bone graft and allografts. The CD4+ / CD8+ ratios were higher in allografts as compared to autografts on all the days. The partially decalcified alloimplants seen to excite immunocellular response almost similar to that of fresh autogenous grafts. Thus partially decalcified allografts are a good substitute of autogenous bone grafts in clinical practice.

We evaluated pulmonary functions in 27 patients with idiopathic adolescent scoliosis (AIS). In 21 patients the pulmonary functions were done before and after surgery whereas 6 patients who had refused surgery the readings of last follow-up were taken. The mean age was 14.79 years (SD ± 1.65) in the operated group with mean Cobb angle of 76.74° (SD ± 15.49) and the average correction was 53°. The mean follow-up was 58 months (14 – 132 months). Forced Vital Capacity (FVC), Forced Expiratory Volume (FEVI) Forced Expiratory Flow (FEF) (25-75%) were actually lower than predicted values by 15-25%. Post surgery this improved but a deficit of 2.8 to 7.3% remained. There was no statistical significance. In the non-operated patients the follow-up was 54 months and the pulmonary flow decreased by 56% of the cumulated value of FVC/FEVI and FEF from the first reading a p Value between <.0000 and <.0001. Pulmonary volumes were lower in patients with Cobb angle of >81° than in <80°. Statistical significance was observed in FEVI and FEF a P Value <.0001. Our findings suggest that after surgical correction and fusion in scoliosis patients pulmonary flow improves but remains marginally impaired in comparison, whereas in patients who were not operated pulmonary flow reduced between 53-61% indicating progressive deterioration.

Failure of implants is a common Orthopaedic problem today. The reasons for failure may be varied and complex. Excessive motion at the implant-bone interface, stress concentration within the implant and stress shielding of bone are a few reasons implicated in implant failure. With a view to screen the intensity of the problem in our set up, we have conducted a survey of fourteen senior practicing Orthopaedic Surgeons in our District. These surgeons have rated the specific causes of implant failure on a scale of one to ten, depending upon their own experiences. It is concluded that the causes of implant failure are related to the competence of surgeon and working conditions including the approach towards fracture fixation, availability and quality of implants, quality of fixation and possibilities of alternative internal fixation procedures during surgery, resulting ultimately into implant failure.

One hundred cases of fractures of the shaft of femur, ages ranging between 15-70 years, were managed by Intramedullary open (50 cases) or closed (50 cases) Kuntscher’s nailing with the follow-up of 6-32 months. Closed Intramedullary nailing was better in transverse and short oblique fractures and also in upper and middle third femoral shaft fractures, while open nailing could be done in moderately comminuted and spiral fractures. Knee movements returned to normal earlier. Callus was seen early and post-operating complications were less in closed nailing. Radiation hazards to the operating team has to be taken into account over the advantages of closed nailing.

We carried out tetracycline double labeling with a definite dosage protocol in 21 patients, mean age 45 (10-65) years, with displaced intracapsular fracture neck of femur who were admitted untreated later than 3(3-39) weeks after injury. Undecalcified sections of bone samples from the femoral head were studied under fluorescent microscope and compared with findings of avascular necrosis on conventional radiographs. The presence of bands of fluorescence along the trabeculae were taken as evidence of viability of the head of femur. The radiographical criteria used were according to those laid down by Cohen et al (1990). Eleven femoral heads showed evidence of avascular necrosis in the initial radiographs and nine of these did not take up the tetracycline label. The sensitivity of the radiographs of avascular necrosis was 82 percent while the specificity was 80 percent. The conventional radiograph offers an economical yet sensitive method of diagnosis of avascular necrosis of the femoral head following fracture neck of femur in patients who report later than 3 weeks of injury.

Anatomical reduction and rigid internal fixation is the prerequisite for successful outcome of treatment in a fresh fracture of neck femur. This study was carried out in 30 such patients who were treated with closed reduction and percutaneous cancellous cannulated screw fixation meeting above mentioned goals. Patient’s age varied from 15 years to 75 years (Avg.43 years) who were operated at an interval of 3 to 40 days after injury (Avg. 13.5 days). In all 72% patients showed excellent to good results according to Askin and Bryan functional scoring.

March, 1993 onwards, we have been using Dynamic hip screw and sliding plate device for fixation of trochanteric fractures. First 44 cases are reported here. Trochanteric fractures usually occurred between age group of 28 to 84 years (Mean 62.45). Out of 44 cases, there were 20 stable and 24 unstable fractures. Follow up period varied from 26 to 70 (average being 50.80) months. At final follow up, only 38 patients (18 stable & 20 unstable) attended at follow up clinic. Out of other six cases, one died. Sixteen out of 18 stable trochanteric fractures (88.89 percent) achieved excellent and two (11.11 percent) good results whereas in 20 unstable trochanteric fractures, 8 (40 percent) showed excellent, 6(30 percent) good, 2 fair (10 percent) and four (20 percent) poor results. Several complications were encountered such as superficial infections in 4, transient sciatic nerve palsy in one, pedal oedema (mild) in majority, shortening 1-3cm, Coxa Vara in 3, due to cutting of implants through head and neck of femur (2 partial & one complete), proximal migration of DHS with avascular changes of femoral head in one case only.

Results of 75 cases of fracture subtrochanter are presented. The fractures were classified according to AO and Seinsheimer’s classifications. Shortcomings of Fielding’s classification were noted. Each case was followed for a long period. A new modified criteria for assessment of final results, suited to needs of Indian patients, was devised. All patients were assessed according to this criterias. Results were compared with other studies by other surgeons. Comparative study of fixation with DHS and DCS was also carried out. Satisfactory results were seen in 89% patients. Results of DHS fixation were marginally better over DCS fixation.

A prospective study of 88 cases of trochanteric fractures of femur was done with average follow up of 24 months. Patients were divided in 3 groups; conservative hospital conservative home; operative group. Pre designed proforma was filled for every patient and was analysed on basis of age, sex, rural/urban background, mode of injury, grade and stability of fracture, socio-economic status and hospital stay. The patients were followed up both clinically and radiologically. Final results were tabulated on basis of Kyle’s criteria of pain, limp, shortening, coxa vara, limitation of hip and knee movements, ability to sit cross legged and squatting and graded as excellent, good, fair, poor for each category. The study shows that those patients who were managed in hospital (whether operated or not) showed better results than those managed at home. In stable fractures conservative management gives equally comparable results to operative methods.

This study is an endeavour to assess the effectiveness of Ender’s nailing in trochanteric fractures in the elderly patients. Fifty eight patients with an average age of 66.3 years (range from 50 to 95 years) were operated. The follow-up period ranged from 9 months to 46 months, with an average of 30 months. There was no incidence of non-union, delayed union or deep would infection. Partial weight bearing could be started in the second week after operation in 86 percent and good to excellent functional results were obtained 84 percent of patients. The authors conclude that this method of limited operative trauma is ideally suited for the elderly and osteoporotic patients.

Seventy eight patients who sustained pelvic fractures, with an average age of 29,99 yrs. were analyzed clinically & radiologically to determine their morbidity profile. Road traffic accidents were responsible for 80% of injuries. All fractures were classified by the alphanumeric system of Tile (1988). High velocity injuries (RTA) resulted in more severe fractures (type B & C). Abdominal & urogenital injuries were more common in B1 & C fractures. The overall mortality rate was 8.97% but in only 2.6% could death be attributed directly to the pelvic fracture. Rapid stabilization of the pelvis by external fixation gave consistently good results. The amount of blood required for resuscitation was less, nursing was easier and early mobilization could be achieved.

The Exeter THA system, introduced in the early 1970s, has been modified into a modular design with a matt finish and a stronger stem. We reviewed our results in 61 hips implanted in 60 patients at an average 3.3 years after implantation. One patient died and no patient needed revision; the remaining 60 hips were examined clinically and radiographically. There were 33 excellent, 18 good and 9 fair results using our modified criteria for examination. All fair results were in either polyarticular rheumatoid cases or in elderly people after trochanteric fractures. Radiological deficiency of cement was detected at the distal stem in 4 cases; this was due to defective cement pressurization and was not seen in the later cases after technique modification. In our short term experience, the Exeter modular hip is a good implant for Indian patients.

Congenital anterolateral bowing of the tibia associated with dysplastic changes such as cortical tapering, formation of a cyst, or sclerosis that obliterates the medullary canal nearly always develops into a pseudarthrosis. Fracture usually occurs in these tibia following inconsequential trauma. Multiple procedures may be necessary to attain osseous union. Severe shortening and painful or stiff joints often result. Many authors have cautioned against doing a corrective osteotomy through the deformed part of tibia as this invariably results in pseudarthrosis. We treated two cases of prepseudarthrotic tibia with corrective osteotomy proximal to the pathological segment of tibia and allowed the bone to remodel according to the Heuter Volkmann principle. The follow-up at 52 months shows that this helps in correcting the deformity and preventing pseudarthrosis.

Osteoid osteoma in second sacral vertebra is reported here which is not common site. Young boy of 16 years had persistent pain and tenderness for last 8 months. Plain x-ray of sacrum could not diagnose it; but CT scan, specially 3-D image was very helpful to diagnose and decide the course of treatment. En bloc resection with laminectomy from posterior approach gave complete relief of pain. The prognosis is very good in this area after surgical resection.