A total number of 39 cases, during the period of May ' 96 to April ' 98, formed the basis of this Rewa experience. The cases consisted of open fractures of tibia Gustilo’s type III & II (18), non-union 9 [tibia (6) femur, (3)], mail-union 6 [tibia (3) femur, (3)], tubercular arthritis of knee & post polio residual equines deformity 3 each. The age of patients ranged from 17 to 60 years. Gustilo’s type IIIA accounted for 67% of fractures resulting from road traffic accident. In non-union & mal-union cases corticotomy was done with/without the aim of opening wedge. The average limb length discrepancy was 4.3cm ranging from 1.0cm to 15cm. The total complication rate was 97% of which the commonest was wire tract infection 20%. No cases of vascular or neural injury were encountered. We achieved ASAMI based excellent bony union in 55%, good in 33%, poor in 12% cases. The functional result was excellent in 33%, good in 33%, fair in 22% & poor in 11% cases.

This is a prospective study, comprising of 35 cases (24 cases of total patellectomy and 11 cases of patellectomy). The patients were evaluated for subjective complaints and objective physical findings. The results of the two procedures were compared. Patients with partial patellectomy were found to have better overall results. The loss of quadriceps strength, quadriceps atrophy and degree of extension lag was found to be significantly lesser in cases with partial patellectomy as compared to total patellectomy. Loss of knee flexion and amount of knee pain were also slightly less in cases of partial patellectomy.

Intercondylar T-Y fracture of the lower end of the humerus is not as rate as reported in western literature. There is general agreement that this fracture is very difficult to treat. Conservation treatment in the form of traction gave way to high-tech methods of fracture fixation. We present here a method of skeletal traction through olecranon, keeping the patient ambulatory throughout the period of treatment. A specially designed splint was used for that purpose. The NRS Splint was developed in 1986. In all 73 cases of T-Y fracture were treated between 1986 and 1998 but only 58 cases were fully followed up. Risenborough classification was used to categorise the patients. A rigid criteria of assessment of results was developed. Categorized result has been presented in the text. Average follow up period was 7.48 years.

Elderly patients with osteoarthrosis of the knee have occasionally a stress fractures of tibia. A series of 18 such patients have been reviewed. In the majority of these patients, the diagnosis was initially missed. In 16 patients conservative treatment with NSAIDS and immobilisation with a splint or plaster was successful. Two cases needed bone grafting and internal fixation.

Proximal femoral fractures have always been a challenge to the orhopaedic surgeon. Whether femoral neck fracture, trochanteric fracture or subtrochanteric fracture per se, these three entities pose unique problems specified to each. A rare subgroup compounds the different problem of classifying and treating these fractures. Fifteen cases of segmental fractures (Double-level fractures) of proximal femur are being reported.

Blind unreamed intramedullary osteosynthesis by V/K nail for tibial fractures was undertaken in 100 cases of tibial shaft fractures. In 89 percent the results were good. It is a very simple method, can be done in places without C-arm facility.

This study presents observations based upon three cases of long bone fractures treated by internal fixation. These patients recovered without any complications, but soon after trivial fall resulted in a fracture at a different site than the previous one. This study tries of explore the possible reasons for such a happening. The probable causes include damage to the vascular supply of the long bone due to initial fracture, soft tissue injury due to initial trauma, surgical intervention and internal fixation with implants. This triggers a remodeling phase in the Haversian system thereby weakening the bone resulting in decreased critical strain of the involved bone. The implants and the screw holes in bone act as stress risers. This alters the even load distribution mechanism of the long bone. Trivial falls sustained by the patient during recovery period after fixation results in loads exceeding the critical strain causing fracture of the already operated long bone. Preventive measures like minimal damage to soft tissues during surgery and implant fixation, use of LCDCP type plates to preserve maximum blood supply of bone, adequate splinting during recovery phase of bone healing, and once bony union is adequate implant removal to restore the even load distribution mechanism in long bones are suggested.

Ten cases of CTEV were treated by method of controlled differential fractional distraction with Joshi’s External Stabilization System (JESS) between Oct, 97 to July 99. We used JESS for either neglected, resistant or recurrent cases of CTEV. Patients were in the age group of 3 to 7 years. The patients were operated after thorough clinical and radiological assessment and post operative follow up was done at regular interval to evaluate correction. Average follow up period was 8 months. Our results were Excellent 1,Good 4, Fair 4, and Poor 1. The only complication encountered was pin tract infection in one case requiring early removal of assembly leading to partial correction of deformity thereby giving rise to poor results.

The etiology of club foot is unknown. Recently interest is shown in the frequency of arterial dysgenesis in limbs exhibiting congenital iodpathic club foot. Most of the authors demonstrated the absence or hypoplastic anterior tibial artery and medial plantar artery in 85% of club feet and stressed the need of protection of posterior tibial artery during operative correction. (Greider 1982, and Sodre et al 1990). The posterior tibial artery has been found normal and mostly a dominant vessel in all club feet. We report a case of absent posterior tibial artery and its replacement by an aberrant muscle in a case of club foot.

The effect of acetyl salicyclic acid on fracture healing was studied experimentally. Standard experimental fractures were produced in the femora of 18 rabbits of either sex and nearly equal weight. They were divided into two groups control and experimental of 9 each. Acetyl salicyclic acid was given to experimental group in dose of 14.2 mg/kg/day. Fracture healing was studied, after sacrificing animals on the 21st or 42nd day, under four parameters of clinical, radiological, mechanical and histological. The fracture line was found to be visible at 42nd day in experimental group while consolidation was observed in control groups. Bending strength was more in control group. Histologically also at 42nd day the control group showed abundance of newly formed bone with marked osteoblastic activity and remodeling as compared to the experimental group. This study established that acetyl salicyclic acid inhibited fracture healing.

The Q-Angle has been a subject of great debate. Its values have not been ascertained for the Indian population. A study of 500 limbs in 250 subjects was undertaken to establish normal values. The subjects included 140 males and 110 females. The measurements were done using standard clinical methods by a single examiner. The average Q-angle in our series was 13.070o with 12.364o in males and 13.968o in females. The average patella : patellar tendon ratio in our series was 0.9807. Q-angle was found to have a significant positive correlation with female sex, interspinous distance and intermallcolar distance. A negative correlation was found between Q-angle and length of lower limb, length of patellar tendon and vertical length of patella. However, the most significant factor to alter the Q-angle was the lateral placement of tibial tuberosity from the vertical axis of patella.

A prospective study was done on 100 post-menopausal women presenting with hip fracture, with the objective to measure the osteoporosis by the Singh Index. All women were more than 49 years of age. About 84% cases sustained fracture after trivial trauma, the commonest mode of trauma being fall from standing position (90%). There were seven cases of moderate type of osteoporosis (grade 4) and 93 cases of severe type of osteoporosis (grade1, 2,3). There were seven cases of non-concurrent fracture of both hips, following trivial trauma. None of the patients were aware of osteoporosis. There is strong need of aggressive treatment in established osteoporosis and comprehensive preventive measure is needed.

Preparedness status in mass casualty management in three regional hospitals i.e. PGIMER Chandigarh, IG Medical College Shimla, Command Hospital & Govt. Medical College Hospital, Chandigarh was evaluated using preparedness indicators. One such event was documented in each hospital in which 30 casualties reported simultaneously in emergency department requiring in-or-out-patient treatment. Twenty parameters for effective casualty management before, during and after occurrence of event were identified. Each parameter was given score of five thus making a total score of hundred. Hospital scoring more than 80% was rated as excellent between 60%-80% good, between 41-60% fair and below 40% poor. The outcome of the present study indicated the periodic review, update and implementation of existing plans for mass casualty management are mandatory so as to improve functioning of medical care organisations in hour of need in an organised way.

A small study of patients who had lacerated wounds of the limbs with skin loss following trauma or skin loss due to infections, with a follow up of 2 months to 2 years is presented. The wounds after they become healthy and granulating ready for skin grafting were covered with split thickness grafts larger than the size of the wound. The graft was anchored with a few drops of pedilite (Fevikwik). The economics, facilities and results are discussed.