Of all the birth injuries in general and the brachial plexus injuries in particular, Duchenne-Erb’s palsy is the commonest in new borns. If this is recognized immediately after the birth and treated properly all new borns would recover fully without terminal disability, within a period of three months. A simple method is described. The results in 12 new borns with Duchenne-Erb’s palsy are presented.

Assessment of rotational malalignment in the management of fracture both bones forearm in children and adolescents is important because there is essentially no remodelling potential for rotational malalignment. In the present study assessment was done based on Evan's and Creasman's method. Sixteen out of sixty children with displaced diaphyseal fracture both bones forearm were found to have rotational malalignment of various degrees after reduction and, required another manipulation to prevent rotational mismatch.

Twenty one patients with cubitus varus deformity were treated by external fixation of corrective osteotomy. A new method of fixation was used to stabilize the osteotomy and produce compression across the osteotomy site. Thus plaster immobilization was avoided. Elbow mobilization could be started from the 2nd postoperative day. Removal of implant was easy and period of hospitalization was shortened.

Twenty two cases of spinal tuberculosis with atypical presentation were analysed. There were intraspinal tuberculous granuloma (5 cases), single vertebral disease (7), large paravertebral abscess with little or no demonstrable bony focus (1), isolated involvement of neural arch and appendages (3 cases), sclerotic lesions and intervertebral bony bridging (2), multifocal (Skipped) lesion (4). The atypical presentation relatively uncommon was difficult to suspect and diagnose clinico-mdiologically.

A total of 45 bacterial isolates were obtained from 71 cases of chronic Osteomyelitis and Septic arthritis. Only aerobes were isolated in 19 (26.76%), anaerobes in 12 (16.90%) and mixed isolates in 14 (19.71%) cases. Aerobic bacteriology showed the predominance of Staphylococcusaureus (19.5%) and Pseudomonas aeruginosa (14.63%) in chronic Osteonlyelitis. From septic arthritis Beta-haemolytic streptococci (16.66%) , Proteus species (16.16%) and Citrobacter species (16.66%) were commonly isolated. The common anaerobes isolated from both types of cases were Peptostrepotococci (15.90%) and Bacteroides fragilis (11.26%). Anaerobes were more frequently observed in chronic Osteomyelitis. Metronidazole, Rifampin and Chloromycetin were found effective against anaerobes, and Gentamicin and Cloxacillia against aerobes.

The results of a minimally invasive technique of prevention of nonunion was reported. Percutaneous bone marrow injection was given at the fracture site in nineteen patients with delayed union. All showed improvement in the healing pattern and united in 32 weeks. The procedure is simple. It is an excellent substitute for bone grafting and could be used to prevent nonunion.

Thirty five cases of established non-unions following fixation of diaphyseal fractures of long bones in all age groups were treated by percutaneous autologous bone marrow grafting as a substitute for the standard procedure of implant removal and cancellous bone grafting. Twenty seven non-unions united strongly after 4 sittings of bone marrow grafting at intervals of 3 weeks. The procedure is simple, cost effective and without any complications.

A review of 29 cases (30 hips) of CDH seen over a 3 year period is presented. Only 3 cases could be treated non operatively. All others were reduced by open reduction, with femoral osteotomy in 11 cases, and additional Salter’s osteotomy in 7 cases. Two hips developed AVN, and 2 redisolacated: cases with Salter’s osteotomy developed some ROM restrictions. The biggest problem was diagnostic delay, leading to surgical intervention.

Sixty cases of recalcitrant shoulder Impingement syndrome are analysed, and classified according to their presenting pathology and occupation. All these patients have been given trial of physiotherapy and local injection of steroid, over a period of 3 months. Cases of rotator cuff tears arid adhesive capsulitis are not included in this study. Intra-articular evaluation with shoulder arthroscopy & decompression of the sub- acromial space were undertaken through mini-open deltoid splitting approach. The results are rated according to the Constant shoulder functional score, which takes into consideration pain, activities of daily living, range of movement and power.

Twenty five cases of neglected elbow dislocation were seen over a 6 year period, with myositis ossificans in 20 cases. All cases were operated without waiting for myositis maturity. In 5 cases with no myositis, the triceps was not cut and the elbow was approached though two posteromedial and posterolateral incisions. At average follow up 2.3years, an average flexion of 850 had been achieved in the functional are. There was no significant recurrence of myositis but residual stiffness was a problem in the cases where the triceps had not been cut. Some ROM will always be achieved irrespective of recurrence of myositis and stability will not be compromised. Relatively early open reduction, with a triceps splitting approach, and early supervised ROM are the key to getting good function.

Fifteen patients presented themselves for functional disability in Activities of Daily living (ADL). Some complained of unacceptable appearance, especially the females. Clinically they all had contructure of the Deltoid muscle. All patients were subjected to release of contracted part of the deltoid muscle. Immediate restoration of full mobility of shoulder with realignment of Gleno-humoral joint was restored. During the follow-up none of them had residual deformity or recurrence of the deformity. All results were cosmetically and functionally acceptable.

Fourteen patients with acute fractures of humeral shaft were treated by closed intramedullary K-nail using the antegrade technique. Their records and radiographs were reviewed for this study. This report presents the complications of interlocking K-nail in the management of fractures of humeral shaft.

A total of 88 cases of pelvic fractures seen over a period of one year at Osmania general hospital were studied to find out the mode and severity of violence, type of fracture and assosiated visceral injuries and their relationship to mortality, in a view to reduce the mortality. Forty seven of the injuries were due to high velocity and crushing type and 38 of them were associated with visceral injuries. Of the 21 single pubic rami fractures 20% had urethral injuries and of the 28 bilateral pubic rami fractures 97.5% were associated with visceral injuries.

Primary neoplasms derived from the melanocytes of leptomeninges are very uncommon & most cases reported are malignant. Pappenheim & Bhattarcharji (1962) lissted 45 cases from American & European literature. Balasubramanium & Ramamurthi (1964), Deshpande et al (1970) reported meningeal melanomas associated with cautaneous naevi. Most of these case reports (Haffman 1967) showed direct co-relationship between melanoma of leptomeninges and giant cutaneous pigmented naevus and also were confined to melanomas involving brain. This is a case report of primary melanoma causing compressive rnyelopathy in a 40 yrs. old individual with no evidence of any giant cutaneous naevus and the related literature is discussed.

Hume's variant of the Monteggia fracture dislocation is a rare and an unsual entity. Only 8 such cases have so far been reported in literature (Hume 1957, Wiley et al 1985), since the initial report. The diagnosis is frequently missed precluding a satisfactory functional result. We present 2 such cases, with particular emphasis on pitfalls in diagnosis and modes of treatment.