Twenty one children aged 3 to 12 years (12 males, 9 females) with femoral shaft fractures were treated over a period of 3 years by applying 90o-90o lower femoral skeletal traction for 3 to 4 weeks till the fracture was sticky in good position, followed by one and a half spica immobilisation for the next 3 to 6 weeks, till fracture consolidation as evidenced by X-ray. The results were assessed in terms of the limb length discrepancy, angulation at the fracture site at the final followup, time period for union and complications. Nine (43%) patients had 'excellent results and Twelve (57%) had good results. No poor results were seen in this series. Complications included pressure sore in the heel in 2 patients, pin tract infection in 2 patients, placement of wire through lower femoral physis in one patient. We conclude that 90o-90o traction rnethod provides a reliable and excellent method of treating femoral shaft fracutes in children with good control of reduction and alignment of fracture fragments and union with negligible complications. This is a simple and proved methood that can be used at PIIC and Subdivisional level hospitals also, with safety.

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Recurrent dislocation of the shoulder is being treated right from the time of Hippocrates. Since the beginning of this century more than 150 surgical procedures were described in treating recurrent dislocation of the shoulder with varying results of success. The essential pathological lesions in recurrent dislocation of the shoulder viz., the detachment of the anterior glenoid labrum and the bony defect in the postero-superior aspect of the head of the humerus, were rightly described by Broca and Hartman (1890) long before these defects were described by Bankart (1938) and Hill and Sach (1940) respectively.

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We studied the efficacy of intra-articular injection of steroids and also the factors which affect the clinical response in management of OA Knee for relief of pain in 129 patients. The study was divided in 8 groups depending on the type of steroid which was injected, the type of local anaesthetic used in conjunction with the steroid and the total volume of injection used. So, 71 patients received Triamcinolone hexacetonide (THA) and 58 patients received Methylprednisolone acetate (MPA) injection. These two steroids were mixed with local anaesthetics (either bupivacaine or lignocaine) in small and large volumes. It was found that THA was quite effective in relieving knee pain of OA as compared to MPA. At 8 weeks, following intra-articular injection, THA was twice as effective as MPA, though at 6 months this effect was still more but not significantly different. Bupivacaine had a better response in pain relief as compared to Ligocaine when used with either THA or MPA. In patients who had large volume of injections and distension of the knee joint there was better relief of symptoms of OA Knee. For giving the knee injection, infero-lateral site was found to be the most appropriate site as localization of the joint was easy and needle placement was convenient.

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This is a study of total knee replacement evaluation done at Dayanand Medical College & Hospital from Aug. 1992 to Aug. 1996 with a follow up of 1½ -4 years. There were 35 knees operated in 25 patients. Age ranging from 33-79 years (mean 54.25 years) with osteoarthritis predominating. The analysis was done according to Hospital for special surgery scoring system. The average improvement in knee score was from 22.88 to 91.23 and functional score improvement was from 16.26 to 73.54. The average range of motion in the whole series improved from 64.4o to 110.7o. A comparison of total condylar and posterior stabilized prosthesis was performed and there was found to be no significant difference between the two series. There were no major complications. The minor complications of two haemarthrosis, one suture line infection and one superficial skin necrosis were managed and the patients had good results. There was no radiological and clinical evidence of loosening. All the patients were satisfied with the results. Thus we recommend total knee arthroplasty for the patients with painful tricompartmental degeneration of the knee with or without deformities whose symptoms could not be alleviated with conservative means. Further we recommend proper and meticulous surgical technique with utmost care to achieve soft tissue balancing and prosthetic alignment for better survival of arthroplasty.

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Encouraged by the results of external fixator in intertrochanteric fractures, this technique was used in 21 cases for fixation of proximal femoral osteotomy. The indication was neglected fracture neck femur. Tubular external fixator was applied with two or three Schanz screws passed from the base of trochanter and two Schanz screws passed in distal femur 3" above the superior pole of the patella, two rods mere applied to give the osteotomy a stable fixation. Non-weight bearing crutch walking and knee rnobilisation was started in the second week and partial weight bearing at 6th to 8th week depending on the stability achieved. Results evaluated on clinical and radiological grounds were found to be excellent in 71% cases, good 24% cases and poor in 5% cases. More common complications were superficial pin tract infection and knee stiffness in 68% and 30% cases.

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K-Nailing in fracture shaft femur may pose Acute Bending as one of the complications. The Author has described a new operative method of dealing with this problem.

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Short term followup of twentytwo patients operated for knee arthroplasty using the total condylar design is presented. The population comprised of fifteen females and seven male patients with age ranging from forty to seventy years. The average duration of follow up was fiftysix months. The indication for the surgery was rheumatoid arthritis (RA) in thirteen knees and osteoarthritis (OA) in nine knees. majority of the patients belonged to category "C" of the Knee Society Scoring System. Post-operative functional and radiologic scoring indicated excellent results in sixty percent, good results in twentytwo percent, fair in nine percent and poor results in nine percent cases. The infection rate was 4.5 percent in our study which exceeds the acceptable international limit. Comparable functional outcome was seen in RA as well as OA. The continuous passive motion (CPM) machine helped achieve a better and faster range of motion (ROM) with no case requiring manipulation.

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It is difficult to achieve and maintain closed reduction after diaphyseal fracture of forearm bones in adults. In this study we have treated two groups of 50 patients each by Narrow DCP and SFS'DCP. Fractutes were commonly seen in middle 1/3rd of forearm. We used Narrow DCP plate commonly with 6 holes, or SFS'DCP plate 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 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 Narrow with DCP.

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Two hundred and sixty patiets of fracture calcaneus were treated conservatively with & without close reduction and early motion at Govt. Rural Hospital Deogad and Kudal over a period of ten years highlighting advantages ; 26 children below the age of 14 years who had sustained 28 calcanial fractures, are categorised as a separate group in this study. The long range follow up evaluation results are Excellent 18 (64.2), Good 8(28.5%), Fair 2(7.1%), Poor 0 (0%). Long term follow up of 2 to 6 years concluded that 92% children of fracture caleaneus had a total painless foot. Children below 10 years of age 22 (78.5%) who predominently had extra articular fracture patterns, illustrated that extra articular fractures are more characteristic feature of younger child – a possible reflection of less frequent mechanism of vertical compression loading in children and their ability to absorb compression loading. Initially unrecongnised calcanial fractures were frequent to the tune of 8 (28.5%) in the present series, suggesting that a high degree of suspicion should be present. In 7(25.8%) children the fracture was later revealed by healing callus radiologically. All (100%) children of unrecognised fractures were extra articular. Growth deformity was not seen in this series with long range follow up evaluation, as a sequel to the apophyseal injury. The mechanism of injury in this series of children 16 (57%) with that of adult series reiterated that the most common cause of injury was a fall from mango or coconut tree, in this south konkan west coast of Maharashtra. Associated other skeletal injuries were twice as frequent in children 14 (50%).

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A case of disseminated bone tuberculosis in a 45 years old male is presented. Atypical aspects of the illness in this case include, age at onset, absence of pulmonary and visceral involvement, wide spread bone involvement with paraparesis. Pertinent literature on the subject has been reviewed.

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Specificity of routine bone scan acquired at 3h is quite low because most bone lesions appear as “hot spots� irrespective of underlying pathology. By taking an additional view of lesions at 24 h and using dexamethasone intervention between the two acquisitions, the specificity can be increased appreciably since lesions can be segregated according to their osteoblastic activity. Quantification is possible by calculating 24/3h radio uptake ratio for each lesion. The technique appears capable of differentiating pathological osteoblastic lesions, physiological osteoblastic lesions and degenerative bony lesions and may be useful in assessing treatment response in Pott’s spine, osteomyelitis and rheumatoid arthritis.

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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 53 weeks and few upto 2 years. 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.

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Twenty five cases of intra-articular temperomandibular ankylosis have been operated and followed-up for an average period of five years. Trauma (fall on chin) was the commonest cause of ankylosis. Condylectomy (wide excision) with fascia lata graft (four fold) interposition gave 72 percent excellent/good results.

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