Background : Mobile bearings in total knee arthroplasty reduce wear of polyethelene and mechanical loosening of components. Method : Non-cemented Low Contact Stress (LCS) femoral implant and cemented LCS rotating platform tibial tray and polyethylene insert was used in 100 knees. Pre-operative diagnosis was osteoarthritis (OA) in 85 and rheumatoid arthritis (RA) in 15 knees. Results : Ninetyeight knees were available for follow-up at a mean interval of 38 months. Minimum of 90° flexion was achieved in all the cases. All patients were females with a mean age of 67 years. Non progressive radiolucent lines of 1-2mm were seen in 6 femoral components. Twelve tibial components also showed similar radiolucent lines in 2 or less zones. Knee Society Knee Score improved from 32 to 93 and function score from 47 to 79. Results were good to excellent in 95 knees. There was no case for bearing spin out or revision. Conclusion : Results of this study suggest that the hybrid fixation can reliably provide excellent or good results in selected patients. Key-words: Mobile bearing knee; Arthroplasty; Porocoat; Hybrid.

Background : Treatment of fracture neck femur with three cannulated cancellous screws in an apex proximal configuration is practised in many parts of the world. Methods : Dimensions of femoral neck at the middle of transcervical neck using CT scan (live neck) and vernier caliper (dry cadeveric neck) in 20 subjects respectively were measured. Results : Inferior half of the neck is narrower than superior half. Conclusion : Biogeometry of the neck of femur does not accomodate two inferior screws and thus fixation of fracture neck femur with three canulated cancellous screws in an apex distal configuration is recommended.

Background : Femoral neck fractures in children are an uncommon but difficult situation. The aim of our study was to evaluate clinical results of closed reduction internal fixation and primary valgus osteotomy fixed with a tension band wire loop in high angled pediatric femoral neck fractures. Methods : In a prospective nonrandomized study conducted at 2 centres, sixteen children and adolescents with a Pauwel type 2/3 fracture neck femur were taken as participants. The femoral neck fractures were stabilized using closed reduction and internal fixation (6.5 mm noncannulated screw) and a primary valgus osteotomy fixed with a tension band wire loop preferably within 24-36 hours of injury. Patients were evaluated to determine complications, clinical and radiological outcome. Results : At a mean post operative follow up of 5 years, union was achieved in all cases. Three patients had AVN and one developed coxavara. Results were evaluated using IOWA hip scores. Thirteen patients had an excellent result while 3 patients had a good result. Conclusion : Use of this technique holds promise in treating these difficult unstable fractures. Although results from a larger series are still awaited yet the use of this technique can safely be extended to stable fractures also, to minimize the incidence of complications as nonunion and AVN.

Background : Delayed presentation of femoral neck fracture poses problem of management. Methods: Sixteen patients of fracture neck femur were treated with repositioning osteotomy and osteosynthesis with a 120 ^o double angle blade plate. Ten patients had Pauwel's type II and 6 had type III fracture. Results : The average period for fracture healing was 14.87 weeks. No patient developed avascular necrosis. The average duration of follow up was 25 months. A new scoring system has been described. The results were excellent in four; good in nine; satisfactory in two and poor in one case. Conclusion : Reposition osteotomy provides stability and union in femoral neck fractures.

Background : The dynamic hip screw has appeared to be a reliable answer for intertrochanteric fractures. Intertrochanteric fractures are composed of different anatomic patterns that vary in their degree of stability. However insufficient impaction allowed by the implant may have an adverse effect on fracture healing. Methods : One hundred and four patients were divided in two groups and followed up for one year, mean age was 78.2 years. The ninety patients in group I were fixed with short barrel plate and screws of 75mm or less while fourteen patients in group II were treated with standard barrel plate and screws of 80mm or more. Results : In patients treated with short barrel DHS four out of 90 fractures in group 1 did not heal while in group 2 one out of fourteen did not heal due to failure of standard barrel plate to accommodate the collapse of the fracture fragments. We observed a healing rate of 100% at 3 months. Conclusion : The DHS is reliable for intertrochanteric fractures. However the results of our study support the use of short barrel plates rather than standard barrel plates in Indian population with shorter femoral head and neck length to allow sufficient slide when using dynamic screws of 75 mm or less.

Background : Ipsilateral fractures of hip and shaft femur are a complex problem. High rate of complications are inherent with this injury. To choose from wide variety operative techniques and hardware available makes a life further difficult for an average orthopedic surgeon. Method : We present a series of 25 cases with ipsilateral hip and shaft femur fractures treated by intramedullary reconstruction nail. Intraoperative complications and postoperative results were critically analyzed. Results : Difficulty in reduction was observed in thirteen patients, improper placement of cervical screws in eleven patients and there was postoperative distraction present at fracture site in seven patients. Seven patients had malunion at hip and three at shaft femur. Nonunion was present in three patients with fracture shaft femur and one patient with fracture neck of femur requiring secondary surgical procedures. Conclusion : Though reconstruction nail is a good option for undisplaced or minimally displaced fractures at hip. In patients with marked displacement and comminution at fracture site its results are good only in experienced hands and needs further evaluation. Experience of the surgeon in managing these kinds of complex injuries cannot be over emphasized.

Background : Fracture shaft femur is one of the most common fracture treated at tertiary level centre's requiring adequate radiological assistance. Providing distal locking zig arm support in the nail has made it possible to treat fracture shaft femur at primary level with acceptable locking, without the additional support of IITV with added benefits on surgeons part of less expertise, less surgery time, and good to excellent union rates and at the same time on patients part, avoidance of radiological exposure, being economical availability at the next door itself Methods : One hundred and eight fractures of shaft of femora in 104 patients were treated at tertiary level with interlocking nails. Open nailing without IITV was done in 62 and closed nailing under IITV using proximal and distal locking zigs was done in 46 patients). All cases were operated within 24-48 hrs of injury. Results: The union rate at 12 months period was 93% in closed nails and 87.87% in open nails locked with distal zig averaging to 87% overall. Complications were the same as seen with closed interlocking nail involving limb length discrepancy malrotoation infection with added complication failure to lock distal end in few cases. Conclusion : Benefits so derived from open interlocking of fracture long bones can be applied at the very basic level of Indian health infrastructure where the facilities of IITV and surgical expertise are still lacking. Considering the over increasing load of fracture long bones, the results are comparable to that of closed nailing and has benefits on surgeon and patients more suiting to the Indian health infrastructure

Background : In management of fracture of both tibia and fibula, intact fibula may delay union of tibial fractures. Method : Twenty five cases of ununited fractures of tibia were managed between 1997 and 2004, by partial fibulectomy done after 20 weeks after fracture and a POP cast given for 4 weeks which was changed to a PTB cast and weight bearing encouraged at the earliest. Result : All fractures united at an average time of 14 weeks (range 6 to 20 weeks) after partial fibulectomy with acceptable alignment in coronal and sagittal planes. There was no neurovascular complication, limitation of joint motion or problem at the osteotomy site. Conclusion : Partial fibulectomy is a viable option in the management of tibial delayed and non-union.

Background : Scaphoid, among all carpal bones, is very vulnerable for fracture due to its unique shape and situation with greater articular surface. All scaphoid fractures are being treated with below elbow POP thumb spica casts keeping hand in ball throwing position. A few scaphoid fractures through the waist take longer time to unite, if not end in nonunion. These fractures were found to be displaced unimpacted trans-scaphoid fractures through the waist. Method : The effect of various positions of hand, wrist and forearm over unimpacted displaced scaphoid fractures through the waist were studied on dissected hand specimens and in patients with skiagrams. It was observed that possible radial deviation of hand over neutrally held wrist and forearm would result in anatomical reduction with impaction between the fragments. Added compression effect at site of fracture, necessary for early fracture healing, is produced by passively abducting the first metacarpal bone. Results : Of 68 scaphoid fractures under study, 24 and 41 were displaced and undisplaced ones through the waist respectively. All of them united in eight to ten weeks time as any fracture, when immobilised undisturbed with anatomic reduction and added compression between the fragments except one displaced fracture which took eight more weeks of immobilization for union and revascularilization of proximal fragment. Conclusion : This study showed that all scaphoid fractures in particular those through waist when rigidly immobilized unite as any fracture in eight to ten weeks provided the proximal fragment maintains proper blood supply. Otherwise it would further eight week of immobilization for the proximal fragment to get revascularize following union.

Background : Conservative management of fracture scaphoid with cast is still the most common modality of management, but the results following this protocol are not always satisfactory. Methods : Twenty five patients with fracture scaphoid were treated with a below elbow scaphoid cast and were followed up for minimum duration of one year. On follow up patients were examined clinicoradiologically and functional results were evaluated using the modification of the Mayo wrist scoring chart. Results : Nineteen fractures showed union, two were malunited and five went for nonunion. Two fractures developed avascular necrosis and three patients had wrist arthritis on follow up. Nineteen patients had excellent functional results, one had good results and six patients had poor results. Patients with delayed diagnosis had nonunion and poor functional results. Patients with premature removal of cast had comparatively inferior results Conclusion : For displaced unstable fracture, open reduction and internal fixation should be the preferred modality of treatment as cast treatment gives unacceptably high rate of malunion and nonunion with poor functional results.

Background : Poly trauma is a major killer. Team work is essential for better management. Method : Survey was undertaken to collect baseline data in polytrauma patient. Result : Two thousand patients were studied. Cause was fall in 904, vehicular accident in 776 and assault in 320 patients. Conclusion : There should be good prehospital emergency service and quick transport to equipped hospital.

Background : Late presentation of cut injury of tendo achilles is common in our country. Management of these cases poses a problem. Method : We present 16 patients of different age groups and both sexes with tear of tendo achilles treated by primary anastomosis of the tendon by muscle slide. Results : In all patients we had excellent to good results. Conclusion : This method gives excellent physio- anatomical correction of such defects.

Background : Tuberculosis is a serious disease of global importance with a rising incidence worldwide. Available investigations like AFB stain, culture have low sensitivity and specificity, so there is need for a diagnostic test which is more sensitive and specific and less time consuming to provide final result. PCR is said to provide result within 36-48 hrs with high specificity and sensitivity. Method : Forty one cases showing clinicoradiological features of osteoarticular tuberculosis were studied with 20 cases taken in negative control group. Samples for PCR included synovial fluid and tissue Biopsy. PCR was used to amplify IS6110 genomic sequence of M. tuberculosis in the sample material to provide diagnosis. Results : The sensitivity of PCR was found to be 73.17%; and specificity 100%. The report of PCR was available within 36-48 hrs. Conclusion : By our study we conclude that PCR is a rapid highly sensitive and specific modality for detecting osteoarticular tuberculosis.