Background: The management of unsalvageable femoral head conditions in the young patient has remained an unresolved dilemma. Articular surface replacement of the hip has recently made some headway in terms of providing near-normal hip joint mechanics and function. However, this surgery has been limited to early stages of arthritis only with reasonable maintenance of head-neck congruity and morphology. Femoral neck fractures, osteonecrosis with large segment collapse, advanced arthritis with femoral incongruity, etc are traditional contraindications to the resurfacing technique. Methods: We present here a report on our series of 20 cases of unsalvageable femoral heads in young patients (age range, 27 to 52yrs), over a twelve month period (Aug 2004 to Jul 2005), treated with the unipolar ASR prosthesis. Fifteen patients (two had bilateral hip pathology) had primary or secondary arthritis (degenerative, post-traumatic, ankylosing spondylitis and post­avascular necrosis) while three had old operated femoral neck fractures. All patients underwent hip replacement surgery using the Unipolar ASR prosthesis. Results: Clinical and radiological results at 6-month follow up have been very encouraging and warrant further study. At an average of 4 months post-operatively, patients were able to squat, sit on the ground and perform light sporting activities. Conclusions: The Unipolar ASR prosthesis is an extension of the articular resurfacing technique employing similar principles (large size bearings, metal-on-metal interfaces), and has incorporated the advantages of the uncemented technique. We propose that this technique be more frequently used so as to brighten the prognosis of the young active patient with unsalvageable hip conditions, especially in the Asian scenario.

Background: Knee Arthritis in most patients begins and remains confined to medial compartment. Unicondylar knee replacement (UKR) can be better alternative in these selected patients. Methods: Eighty one consecutive unicondylar knee arthroplasties in 60 patients of isolated medial compartment arthritis were done using Allegrato unicondylar knee. Patients were followed up at 6­month interval with average follow up 1.8 yrs. Knee society score was used for comparative evaluation of these patients. Results: The mean pre operative knee society score of 62 improved to post op. score of 94. No complication reported so far except one case of tibial base plate dislocation requiring re fixation. Our short-term results are good to excellent with 100 % survival at avg. follow up of 1.8 years. Conclusion: UKA is better alternative with many advantages in selected patients of early symptomatic medial compartment arthritis. However proper patient selection improvised design, exacting surgical technique and experienced team with established center are must for uncompromising results.

Background: Spinal instrumentation may be used in tuberculosis of spine for prevention or correction of deformity. Methods: Thirty eight patients of caries spine underwent surgery with spinal instrumentation in the last 3 years. Out of these patients, 30 cases have completed a minimum follow-up of 9 months (Range 9 to 39 months, mean 12.8 months). The regional distribution was 1 in the craniocervical junction, 7 in the subaxial cervical spine, 3 in the cervicothoracic junction, 3 in the thoracic region, 4 in the thoracolumbar junction and 8 in the lumbar region and 1 in the lumbosacral junction. All the cases had anterior lesions except one, which had both anterior and posterior lesions. All of them had decompression, debridement of the lesion and instrumented fusion. Indication of surgery was caries spine with neurodeficit and /or osseous destruction and deformity, which was not responding to conservative treatment of one month. Results: Results were analyzed keeping in mind the clinical and radiological criteria. The former included recovery of pain, and neural deficit with a feeling of general well being. The latter included correction of deformity and evidence of fusion. There was no case which had wound healing/infection related problems. Complications included one case of implant failure and one case of transient neurological deterioration. Results were excellent in 20, good in 5, fair in one and poor in one patient. Majority of the patients were very satisfied with the surgery and all the patients had full anti-tubercular chemotherapy for one year. Conclusions: In properly selected patients, spinal instrumentation is justified because of its safety and efficacy in achieving deformity correction and solid fusion.

Background: The presence of vertebral lesion, whether symptomatic or not presents a diagnostic challenge. Open biopsy of spine is associated with considerable clinical morbidity. Hence it was decided to evaluate the efficacy of fluoroscopic guided fine needle aspiration biopsy (FGFNAB) in providing a definitive diagnosis in pathologies of the spine and to determine the degree of co-relation between the histopathological diagnosis and the presumptive clinicoradiological diagnosis. Methods: A prospective study of 103 patients in whom a presumptive diagnosis was made by available imaging techniques (including magnetic resonance imaging) was undertaken. All patients underwent histopathological /cytological examination for confirmation of the presumptive diagnosis, using material obtained through FGFNAB. Results: A definitive diagnosis was established, through FGFNAB, in 76 (73.8%) patients. Non concordant diagnosis was seen in 13(12%) of patients. In 27 (26.2%) patients the results of FGFNAB were inconclusive. Conclusion: FGFNAB is a minimally invasive, technically easy, quick and cost-effective procedure. It can be done on an outpatient basis, under local anaesthesia and often eliminates the need for an open biopsy. FGFNAB can clinch the diagnosis early and helps institute definitive therapy. Hence we strongly recommend FGFNAB as a basic investigation in all pathological lesions of the spine.

Background : Lumbar disc herniation often causes sciatica. Many different techniques have been advocated with the aim of least possible damage to other structures while dealing with prolapsed disc surgically in the properly selected and indicated cases. Methods : Twenty six patients with clinical symptoms and signs of prolapsed lumbar intervertebral disc having radiological correlation by MRI study were subjected to disc excision by interlaminar fenestration method. Results : The assessment at follow-up showed excellent results in 17 patients, good in 6 patients, fair in 2 patients and poor in 1 patient. The mean preoperative and postoperative Visual Analogue Scores were 9.34 ±0.84 and 2.19 ±0.84 on scale of 0-10 respectively. These were statistically significant (p value<0.001, paired t test). No significant complications were recorded. Conclusion : Procedures of interlaminar fenestration and open disc excision under direct vision offers sufficient adequate exposure for lumbar disc excision with a smaller incision, lesser morbidity, shorter convalescence, early return to work and comparable overall results in the centers where recent laser and endoscopy facilities are not available.

Background: Ununited fracture neck of femur in young adults has been tackled in various ways. Methods: Twenty five patients of ununited fracture neck of femur in age group 21-55 years were treated by closed reduction, cancellous screw fixation and fibular strut graft and followed up for 2-6 years. Time gap between injury and operation was 6 weeks to 58 weeks. Five cases were previously fixed with various fixation devices. Results: Osseous union was achieved in 24 cases with average time of 18.16 weeks. Main complication encountered in follow-up was avascular necrosis of femoral head, others were joint stiffness and shortening. Functional end results were good to excellent in 24 cases. Conclusion: Closed reduction with internal fixation by cancellous screw and fibular strut grafting is easy and useful procedure.

Background: We reviewed the operative results of fibular bone graft with cannulated hip screw fixation in femoral neck fracture in young adults. Method: Sixteen young adults with femoral neck fracture were treated by fibular bone graft with cannulated hip screw fixation. All the fractures were more than 3 weeks old. Results: Results were assessed in 15 patients while one patient died due to complications not related to surgery. Union occurred in all 15 patients. One patient had intra-operative complication in the form of screw cut out with graft in the joint space. The average fallow up was 24.4 months. Out of 15 patients assessed clinico­radiologically 11 showed good results, 3 had fair while 1 had poor result. Conclusion: We conclude that this is a simple and cost effective procedure for late femoral fleck fracture in young adults with good results.

Background: Neglected fractures of femoral neck present a problem in management. Method: Twenty five cases of neglected femoral neck fracture in young and middle age were treated by closed reduction and internal fixation by three peripherally placed cannulated cancellous screws, with centrally placed free fibular bone graft. Results: Union occurred in all the 25 cases, one case had avascular necrosis. There was no residual disability at donor site. Twenty four cases had excellent and one case had satisfactory result. Conclusion: Free fibular bone graft with multiple cancellous screws gives good results in treatment of neglected intracapsular fracture neck femur.

Background : Trochanteric fractures unite invariably with conservative treatment. However the high rate of complications associated with this method makes stable reduction and rigid internal fixation the treatment of choice. Methods : Eighty fresh trochanteric fractures were subjected to internal fixation, 50 with the DHS and 30 with the DCS. Indirect reduction or open reduction with internal fixation using prophylactic antibiotics was done. Patients were followed up clinico-rediologically for 2 years. Results : Satisfactory fixation was achieved in 93.3% of the DCS group and 92% of the DHS group. Union was seen at 12 weeks and 16 weeks depending on the quality of reduction and fixation. Technical problems and complications were slightly higher in the DHS group. Conclusion : Although there were no significant difference in the number of good reductions and the time to bony union between the 2 groups, as regards handling and complication, the DCS was found a more versatile implant compared to the DHS.

Back ground: Supracondylar fracture is the most common fracture around the elbow in children of the age group 5-10 yrs. The issue of open reduction in such fractures is always a matter of debate as even closed reduction gives satisfactory results. However the present study of 50 cases aims to highlight the benefits of open reduction over closed reduction in such cases. Methods: Patients were divided into two groups, 25 cases (group I) were treated by ORIF using K-wires while 25 cases (group II) were treated by closed reduction and P.O.P. splint in pronation. Group I patients were treated under G/A by two mini incisions medial and lateral and fragments fixed with K-wires. Post­operatively P.O.P. back splint was given. In both groups, the back splint was discarded after three weeks and active exercises encouraged. Results: Minor complications as superficial infections and pin tract infection were observed in group I patients. However variation of carrying angle (cubitus varus) was more in group II. Limitation of movement was more in group II due to mal-rotation and anterior ledge formation, not seen with open reduction group. Conclusion: We conclude from above series that ORIF of supracondylar fracture is better than closed reduction as incidence of malunion is less and range of motion near normal as compared to closed reduction.

Background: Reduction of supracondylar fracture in children is technically difficult and therefore numerous methods have been described in the past . Method: We present a modified technique of reduction of grade three extension type supracondylar fracture of the humerus in children . All fracture except one were stabilized with two crossed pins after reduction under image intensifier. Early mobilization at 3 to 4 weeks with the pins in situ and pin removal at 4-5 weeks produced good results . Results: Only three out of 38 patients treated by this method had poor results. No neurovascular complications were found in the patients treated by this technique, and indeed we found that this method worked well even in those cases who presented late or had a gross swelling over the elbow at the time of presentation. At the end of three weeks, Baumann's angle was found to range between 72-84 degrees. Conclusion: The authors found this method to be effective and without any complications in the treatment of the displaced extension type supracondylar fractures of the humerus.

Background: Intraarticular fractures of calcaneum are commenest type of calcaneal fractures. Lots of controversies exist about the ideal management for them. The focus is now shifting on operative management by open reduction and internal fixation for these fractures with or without the use of bone grafts. Method: Thirty intraarticular fractures classified by Essex Lopresti radiological classification, were treated by open reduction and fixation. The patients were followed over a mean period of 30 months (25-40 months). Results: All the fractures united at a mean duration of 14 weeks. 86% patients had excellent functional outcome with one patient having fair and one having poor functional outcome. Conclusion: Open reduction and internal fixation with plate is a good method for treatment of intraarticular fractures of calcaneum to achieve anatomical restoration of articular surface under vision, stable fixation, early mobilization and an option for primary subtalar arthrodesis if deemed necessary.

Background: Total or partial excision of the clavicle has been advocated for many neoplastic and non neoplastic conditions. But the functional outcome after claviculectomy for tumours, has not been clearly described. By this study, we aim to analyze the oncological and functional outcome after claviculectomy for tumours of the clavicle. Methods: Between 1991 and 1998, twelve patients underwent claviculectomy for various tumours. Histopathologically, Ewing's sarcoma was the commonest. These patients were followed up for a variable period ranging from 2 to 9 years with a mean follow up of 4.9 years. Results: Functional results were analyzed using AMSTS scoring system. Functional outcome was excellent in 5 cases and good in 7 cases. Two patients of Ewing's sarcoma died of disease and the rest were continuously disease - free at their latest follow up. Conclusion: Partial or total claviculectomy can be successfully employed for bone tumours with good oncological and functional results. A new classification system for claviculectomy is reported, based on the extent of resection

Background : Plantar pressure measurement during bipedal standing provides an important information of loading of human body on foot under various postural activities. Therefore, the objective of the present work was to monitor the plantar pressure during bipedal standing in normal and pathological conditions. Use of orthotics in attenuating the peak pressure to distribute it uniformly on plantar surface of the foot was also examined. Methods: The pedobarographs of 66 subjects were recorded using computer assisted indigenously developed optical pedobarograph. The pedobarographs were evaluated using Asha 3-D software developed during present study. Standard size universal orthotics (FootmaxxTM, Canada) was used to determine the effect in attenuating the peak pressure. Results: Results showed distribution of plantar pressure in the right and left foot of normal subject under the various regions was not equal. It was observed that among the normal subjects 17% experienced equal pressure on the both feet, 7% showed greater pressure on left foot and 76% found higher load on the right foot. Similarly the pathological subjects were analyzed and noticed the changes in the pedobarographs depending upon the type and location of pathology. It was found that orthotics improved the plantar pressure and distributed it uniformly to make the person standing comfortably. Conclusion: Plantar pressure measurement techniques are useful in the analysis and understanding of the biomechanics of human foot. It was found that orthotics attenuated the peak pressure and distributed it uniformly on the plantar area of the foot. The data seem to be useful in understanding the biomechanics of bipedal standing.