Twenty five patients of synovitis knee were examined arthroscopically. Synovial biopsy taken through the arthroscope was adequate in all but one case. 11 cases where traurna was the cause of synovitis were included in the study. Histopathology and arthroscopy made an important contribution in the further management of these cases and changed the provisional diagnosis in four out of 25 cases.

Twenty active young males underwent combined reconstruction of anterior cruciate ligament (ACL) using middle one third of bone patellar tendon graft unit for intra-articular reconstruction with extra-articular augmentation laterally by iliotibial band and medially by pesplasty. Due to severe degree of instability, medial and lateral augmentation was done in all cases to protect the intra-articularly reconstructed ligament during its critical early months of strengthening. The patients were followed up post-operatively for varying periods from 6 months to 32 months. There were 4 excellent, 10 good, 4 fair and 2 poor results.

It has been proven beyond doubt that meniscus is absolutely necessary for the 'total knee health'. Therefore, surgeons the world over are becoming more aggressive in retaining the meniscus tissue than performing menisectomy. We present here a review of literature about meniscus repair and describe the technique of inside out type of meniscus repair used by the author. The duration of follow up is from 12 months to 3 years. Preliminary reports of results of these cases are presented. Indications and the technique used for meniscus repair are discussed. We repair only longitudinal tears in the vascular zone or in the junction of vascular and avascular zones. Proper patient and tear selection will result in good success of the meniscus repair.

Forty five patients with knee problems attending the out patient clinics of the Central Institute of Orthopaedics, Safdarjang Hospital, New Delhi, with suspected internal derangements between August 93 - July 94 were subjected to an arthroscopic examination in order to confirm/alter the diagnosis and simultaneously correct the pathology detected. Mal-aligned knees were excluded from this study as no therapeutic benefit was expected. The superiority of an arthroscopic diagnosis and its attendant advantages were proved beyond doubt. However, certain problems of the knee can be detected equally well clinically.

14 cases with 15 deformities around the knee joint were treated by Ilizarov's technique. The mean age was 16.7 years, 10 were males and 4 females. 7 deformities were of left side, 6 of right side and one bilateral. Seven knees had genu valgum, 3 had genu varum, 3 had anterolateral angulation of shaft of femur, one had lateral angulation of shaft of tibia and one patient had anterior bowing of femur (Femur Procurvaturn). Average magnitude of deformity was 27.2o and average pre-operative shortening was 3.6 cms. Average duration of fixator was 3.2 months. Translational hinge was applied in 8 cases, open wedge hinge in 5 cases and translational distraction hinge in one case. Incidence of complications was minimal and wherever present the complications were adequately treated. The results were compared with other methods of treatment of deformities. We conclude that llizarov method was significantly better particularly in multi-level and multi-planar deformities with limb-length discrepancy.

Silicone oil is well established as a good lubricant with no adverse effects. Intra-articular injections have a definite role in the management of arthritic knee. Presently it is accepted that intra-articular hydrocortisone may lead to further deterioration of the joints. We have injected silicone. oil in 56 arthritic knees in 50 patients and followed them between 5 to 36 weeks. Seventy-nine percent patients obtained good relief with no deleterious effects. We recommend the use of silicone oil in the conservative management of knee joint arthritis.

Osteochondral fracture of patella is a painful disabling condition. Astute clinical appreciation and precise radiological evaluation is mandatory to arrive at a correct diagnosis. The treatment in the face of severe disabling pain, remains surgery. Here lies the controversy, what surgery? We try to suggest a simple yet effective surgical technique as yet unreported. A case of undisplaced Ostcochondral fracture involving medial articular facet of Patella is reported which remained symptomatic despite adequate conservative management. Partial medial patellectomy was very rewarding.

The results of application of Pulsed Electro-Magnetic Field (PEMF) therapy on 48 osteo-arthritis (OA) patients are described in the paper. The patients underwent various treatment-modalities prior to this therapy without any steady improvement in their symptomatologies of pain, tenderness, joint functional disability and joint spasm plus stiffness (with deformity). Patients show considerable improvement at the end of the therapy with minimum deterioration at five-year follow-up. Differential progress characteristics of improvements in relation to big and small joints are also presented. These are analysed in the light of OA-pathology, to focus on the possible effects of PEMF on the physiological processes.

Serum Copper & Zinc concentrations were estimated in 95 patients suffering from rheumatoid arthritis, ankylosing spondylitis, tubercular arthritis and osteoarthritis. It was observed that estimation of serum copper and zinc do not provide clue to the diagnosis of any type of arthritis, however they are an indicator of the severity of the underlying inflammatory process. The role of zinc supplementation in addition to specific anti-arthritic therapy has also been emphasized.

In 29 albino rabbits a circumscribed bone defect was produced in the femur. The periosteum around the defect was a) removed on the control side and b) autogenously grafted on the other side. In few experiments on one side the periosteum was removed and on the other the periosteum was reposited back. The results were analysed on the basis of a) radiographic b) macroscopic and c) histological examination. Free periosteal grafting was successful and produced abundant bone trabeculae.

We reviewed 20 cementless total hip arthroplasties. The mean age of the patient at operation was 34.8 years (22 to 55 years). They were followed up for an average of 23.4 months (6 to 48). The diagnosis was avascular necrosis of femoral head in 25%, secondary osteo-arthritis in 40%, rheumatoid arthritis in 15%, miscellaneous 20%.The average Charnley’s modification of Merle D. Aubigne and Postel preoperative score for pain was 3.6, for function 1.7 and for function 2.9. The average post-operative score till latest follow up for pain was 5.4, for function 5.3 and for motion 4.8. Two hips had intraoperative fractures of greater trochanter. One screw which secured acetabular cup was broken during implantation. One patient had femoral and sciatic nerve palsy who was operated for neglected congenital dislocation of hip. There was no cases of deep infection, deep vein thrombosis or pulmonary embolism. Six patient experienced thigh pain, of which four had mild occasional pain with activity and two had occasional severe pain with activity and they took analgesic to control it. There were two cases of heterotropic ossification (Brooker et al grade I) till latest follow-up. One stem showed aseptic loosening. One hip showed definite wear of polyethylene. Our study demonstrated that cementless total hip arthroplasty is an excellent option for young patients suffering from painful dysfunctioning hips, not responding to conservative methods.

In this study thirty cases of thoracolumbar spine injuries with neurological involvement were treated by posterior spinal fixation using the variable screw placement system (VSP system) introduced by Dr. Arthur Steffe. Thirty patients with similar injuries were taken as controls. Study was done regarding the neurological recovery and incidence of complications. Most of the patients (60%) were in the age group of 26-35 years with mean age of 29.3 years. Commonest mode (60%) of injury was a fall from height, leading to Flexion compression type of injury. None of the patients in the operated group had any neurological deterioration as compared to the control group where two patients were deteriorated. Forty percent cases showed an improvement in neurological status in the operated group with the percentage going up to 53.3% in the patients with incomplete neurological damage. This compared significantly with the control group where only twenty percent of the patients showed neurological recovery. In the operated group 20%, of the patients developed Bed Sores, 12.3% developed urinary tract infection and respiratory tract infection each. In contrast, with the control group all these complications were insignificantly higher percentage e.g. Bed sores in 66%, urinary tract infection 46.6% and respiratory tract infection in 33.3%. Screw loosening and misplacement of screwswere noted in 20% cases which may be controlled by using the image intensifier. Post-operatively two patients developed deep infection where implant had to be removed.

The voluminous literature and the host of new instruments and techniques used, in cases with deformed or unstable spines, all emphasize the fact that the ideal corrective technique and instrument is still elusive. In part, this is because in the spine, the same fixator may be called upon for contradictory physical force vectors such as compression and distraction, at the same time or at different times. Also, a fixator which is an ideal load distribution system at rest may become inadequate on bending or rotation. Hence a spinal fixator should be adaptable and capable of being tailored to suit the needs. A review of the current literature has been done to highlight such problems in spinal instrumentation. A preliminary report is also made on an indigenously developed adaptable spinal fixator.

In the present study, 76 club feet were included out of which 15 cases were treated with JESS, 20 cases were treated with surgical procedures like posteromedial soft tissue release with or without bony surgery and the rest 41 cases were treated with manipulation and repeated corrective casts. On an average 3 weeks of distraction is required to correct the deformity, following which the assembly was held in static position for 4 to 6 weeks and then after removal of the assembly, B/K pop cast was given for 6 weeks. Correction thus achieved was maintained with orthotic device. Out of 15 cases treated, 9 had excellent results, 3 had good results and in rest of the 3 cases, correction could not be achieved; later on they required additional surgical procedures.

Eight cases of Cleidocranial dysplasia occuring in four generations exhibiting autosomal dominat inheritance has been presented probably for the first time from our country. The dysplasia involves clavicles, skull, midline bones of body and that of hands occuring all over world. Sporadic cases had also been documented from India.

Twenty-four hour urinary calcium and hydroxyproline excretion were measured in 24 cases of osteoporosis (12M, 12F). A significantly increased (p < 0.001) urinary hydroxyproline excretion per mg of creatinine was observed in Type I osteoporosis. No significant difference in urinary calcium excretion per mg of creatinine was observed in any case.

G.C.T. is a relatively uncommon and peculiar lesion occurring mostly in young adults, around the knee and in the lower end of radius (Fig. 1). We present a series of 14 cases of G.C.T. of bone treated in Burdwan Medical College Hospital from 1991-94. Age of patients ranged from 14-35 years. 10 patients were treated by excision and all were followed up more than two years. There was no recurrence. Functional recovery occured within 1 year. There was no relation of outcome of the tumour to histologic grading or clinical staging.

A Case of synovial hemangioma of shoulder with gross destruction of the joint is presented for its rarity.

Haemangioma of bone is rare benign bony lesion. Haemangiomas are of two types viz, the cavernous and the capillary forms. The capillary type is found to be rarer than the cavernous one. Very few cases of capillary haemangiomas have been reported. A rare case of capillary haemangioma of the patella is reported with review of the literature.

A patient with multifocal “Histiocytosi-X�-Litterer Sieve Syndrome is discussed with respect to clinical, radiologic, pathologic, diagnostic biases and discrepancies employing illustrative case material. This case is reviewed with emphasis on features that may serve as a valuable resource in evaluating initial patient presentation.

Dermal inclusion tumour is of rare occurrence. It is known to involve tibia, fibula and possibly some other bones. Involvement of rib has not been known so far. This case is being reported because of rare site and unusual presentation.

A total of 10 Giant Cell Tumors of long bones treated with resection and reconstruction, followed up for an average of eighteen months, were studied to indicate factors predicting recurrence. Out of 10, 8 tumors were classified clinico-radiologically as aggressive and non-aggressive. Out of 3 aggressive tumors, 2 recurred and none of the 5 non-aggressive tumors showed recurrence.

Limb Salvage surgery with custom prosthesis has now been well established. This paper analyses our experience with the largers series from a single centre in Madras, India. 100 cases have undergone prosthetic replacement surgery in 6 years. The average follow up was 27 months. 50% of cases were osteosarcomas. 45 cases were in the distal femur. CT scan, MRI and DSA were done preoperatively. The prosthesis were made of stainless steel or titanium. The functional results were 8% excellent, 50% good and 30% fair. Complications were biological, mechanical and oncological.

Developed countries have been able to institutionalise all aspects of total care of Spinal Cord injury like prevention, identification, safe carriage, hospital treatment and post hospital care. For developing country like India, we cannot afford to follow them due to high cost involved with it. 'Patna Medical College Model' is an ingenious concept where relatives of patients have been trained in all aspects of Spinal Cord injury in a planned way so that they not only takeover the load of paramedical staff, but manage all sectors of total care of Spinal Cord Injury and have produced a comparable result.

The present study was undertaken to evaluate association of HLA class-I antigens in Indians at Varanasi to understand Rheumatoid-SSA overlap. A total of thirty five cases of seronegative spondyloarthritides (SSA),. ninty cases of Rheumatoid Arthritis (RA) and one hundred random unrelated healthy controls were analysed. A highly significant increase in risk for developing SSA was observed in HLA-B27 positive cases (RR-80.83, P<0.0001). It was absent in RA patients. Thus this study brings out that the clinically difficult RA-SSA overlap cases can be clarified by HLA-B27 typing along with other investigations.

The human immunoglobulin (lgG) has been used in various other kinds of infections therapeutically and prophylactically. A trial of over 150 cases was done to observe the immune response in the open fracture patients. The results of prophylactically used human immunoglobulin were found to be excellent.

Trachanteric fracture femur with ipsilateral nonunion neck femur is a rare injury. This report describes a case in which the patient developed trochanteric fracture of the right femur despite having a twenty-five-year old nonunion neck femur in the same bone. The fresh fracture was managed conservatively.

In this study we have treated two groups of 50 patients each by narrow DCP and SFS'DCP. Fractures were commonly seen in middle 1/3rd of forearm. We used narrow DCP commonly with 6 holes, or SFS'DCP having 8 holes for fixation of these fractures. It was found that the operative wound, periosteal stripping, operation time were less with SFS'DCP. Though both these provided good anatomical alignment in both the groups but, we observed that following SFS'DCP fixation, functional results were excellent in 86% of cases as compared to 80% after narrow DCP fixation. Average time of union after narrow DCP and SFS'DCP was 13.36 weeks and 12.80 weeks respectively. SFS'DCP was well accepted by the female forearm bones as it gave a nicer fit over slender bones. Post-operative complications were less with SFS'DCP than with narrow DCP.

Histopathology and special staining techniques were used to study the interface tissue removed at the time of implant extraction. Seventy eight such cases were studied spread over a period of twenty years. Fibrous tissue at interface was the most common finding in the most of the uncomplicated cases. Granulation tissue and neutrophils at the interface were hall marks of infection. Different type of metal debris are found in varying amounts in different cases. Special stains were found to be very useful in highlighting various histopathological changes.

Two - hundred and thirty - six diaphyseal fractures of the femur in 230 children were studied retrospectively. There were 138 boys and 92 girls with a mean age of 5.59 years (1 month to 14 years). Majority of the children were below the age of 6 years. In 67.8% of children the cause of fracture was due to a road traffic accident. Forty-one of the children had associated injuries. The minimum hospital stay was 15 days and the maximum 62 days (mean 32.6 days). The commonest site of fracture was at middle third (N=159) and N=109 were transverse type. The mode of treatment was Balanced skin traction in 146, Skeletal traction in 72, Hip spica in 9, internal fixation in 6 and external fixators in 3. The average follow up was 6.8 years. Complications were few. Our experience indicates that with conservative mode of treatment there is no risk of overgrowth and rotational malalignment upto 20 corrects during growth. We believe that diaphyseal fractures of the femur in children can be safely managed non-operatively and economically, contrary to the present advocacy of operative treatment.

Intraosseous neurilemomas are very rare. Most of them were reported in the mandible. This could be due to long intraosseous course of the mandibular nerves. Vertebral lesions are very rare. A rare case of a big intraosseous neurilemoma of D7 vertebral body with paraplegia having recovered fully from surgery, is reported.

Sixty femoral shaft fractures were treated with interlocking intramedullary nail at Central Institute of Orthopaedics, Safdarjang Hospital, New Delhi. Nineteen fractures were transverse or short oblique, 12 were long-oblique or spiral and 29 were comminuted. Out of sixty, thirty fractures were located in middle third. 34 fractures were treated with static interlocking and 26 with dynamic interlocking. The average time of full weight bearing was 33 days. Radiographic consolidation was seen in all fractures at the average time of sixteen weeks. The minimum followup was 4 months, maximum 18 months. The results were excellent in forty two fractures, good in eight, fair in seven and poor in three. We conclude that interlocking nail is useful in treating patients with unstable fractures, multiple fractures, grade one compound fractures and fractures in osteoporotic bones where role of conventional I.M. nail is very limited. Dynamization does not enhance the rate of union. Wherever in doubt static nailing with optimum reaming should be the method of choice.

Two Hundred and fifty six patients with 264 fracture calcaneus were treated conservatively with and without close reduction and early motion at Govt. Rural Hospital Deogad and Kudal over a period of ten years. Long term follow up of two to six years conclude that only 27% patients of fracture calcaneus, had a total painless foot. Lateral residual pain was demonstrated in 28% of cases which was due to crowding of bone under fibula, limiting the action of peroneal tendons. Fifty percent of the patients are relatively symptom free and doing the same work as they had done prior to their injury. 13.28'% patients required some modification of their work and 10% patients were classified as failures. The incidence of osteo arthritis of sub talar joint with restriction of movements was seen in (31%) patients who have been followed up from two to six years from the time of their injury. Out of 28 patients with fracture calcancus seen in children, under ten age group, excellent to good results were noted in 16 children.

We report a 11-year-old male having a fracture of the lateral end of clavicle with Impalement into the trapezius muscle because of severely posterior displacement. Surgical reduction was required for the fractured clavicle.

Grip strength following open carpal tunnel release was studied over a year in 50 cases at Goa Medical College and analysed. A dynamometer was used to measure grip strength. A sample of 19 males & 31 females were tested using standardised positioning & instructions. Grip strength was found to be 15% of the pre-operative level at two weeks, 30% by four weeks, 70% by six weeks and returned to 99% of the pre-operative level by three months. At six months grip strength had increased to 110% of the pre-operative level & 115% at one year.

A 19 year old male worker in a transport company and engaged in manually lifting heavy bags for the past three years, presented to the Orthopaedic unit with recurrent pain in the right wrist. There was no past history of injury to either wrist. A three phase bone scan revealed increased vascularity and intense radiotracer uptake in the lunate bone. X-ray of the right wrist joint revealed a dense lunate bone suggestive of Kienbock's disease (Avascelar necrosis of lunate bane). This report highlights the role of three phase bone scan in the management of Kienbock's disease.

This study was conducted on fifty-six patients with sixty-five total hip arthroplasties. Aim of this study was to evaluate the role of three phase bone scan in early detection of aseptic\septic loosening following total hip arhtroplasty. In this study sensitivity and specificity of plain X-ray was 40% and 100 % respectively while in case of three phase bone scan it was 100% and 84.6% respectively for diagnosis of aseptic loosening. There was only one case of infection which was not detected on plain radiographs but infection was detected on three phase bone scan. This concludes that three phase bone scan is a useful investigation in early diagnosis of aseptic loosening and occult infection however a good clinical and radiological correlation is a must. Normal three phase bone scan should be weighed heavily against surgical exploration in an attempt to find the cause of pain.