Fifteen patients with painful hips due to various conditions were operated using a modification of the standard Girdlestone excision arthroplasty. Modifications included preservation of maximum neck length by doing subcapital osteotomy and careful resuturing of the anterior capsule; post operatively skeletal traction was employed for 6 weeks. By reposing the smoothened edge of the neck into the acetabulum along with other mentioned steps, we attempted to minimize proximal migration of the femur and the subsequent trochanteric impingement with the pelvis. Ten cases could stand unaided on the operated limb and 11 could sit cross legged post operatively. The overall mean Harris score after minimum 1 year follow up improved form 21 points pre-operatively to 64 points postoperatively. Most of the patients still depended upon walking aids and 93% patients were subjectively happy with the results of the operation. We recommend this modified operation in young adults with painful hip disorders who cannot afford THR or for delaying THR in cases who cannot exclude squatting sitting on the ground from their life style. The added advantage is that due to the preservation of the femoral neck subsequent THR is not difficult.

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Nonunion of intertrochanteric fractures of femur is rare. These fractures require surgical intervention and internal fixation with or without bone grafting. A proper pre-operative planning is mandatory before surgery. Eight patients with nonunion of intertrochanteric fractures treated at Government General Hospital, Chennai, between January 1995 to May 1996 are reported here. Open reduction and internal fixation was done in all patients. Bone grafting was done in five patients. Dynamic Hip screw was used in five patients. Dynamic condylar screw in three. Bony union was achieved in six out of eight patients. Satisfactory functional results were obtained in six out of eight patients (75%).

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Experience with specially designed interlocking Nails in the management of Tibial fractures in 354 patients since 1990, is presented. In an Indian set up these affordable nails and instruments, have produced good results. The elimination of ‘C’ arm is an added advantage.

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Documentation of Internal Rotation Deformity in malunited supracondylar fractures of Humerus is possible only by C. T. Scan or M.R.I In absence of this facility, a new method of photographic evaluation is described. Fifty seven consecutive superacondylar fractures of humerus were studied; 11 varus mal unions were identified. Isao Yamamoto method of clinical assessment was used for measurement of Internal mal rotation. Six cases were compared with New Photographic Method, and it was found that on an average photographic method showed 5 degrees more angle. C. T. Scan was used in two cases to find out which method was perfect. The excessive measurement may be due to bowing of Ulna developing on mal union of S. C. Fracture of Humerus. This deformation was noted by us in 9 cases of our 57 cases on follow up.

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Fifty cases of side swipe injuries of the elbow are studied. The bony injury varied from a simple fracture of the olecranon to multiple fractures involving all the long bones of the limb. The soft tissue injury varied from an abrasion to very large wound with loss of bone and muscles. These patients were managed by primary internal fixation of all the fractures, only initial stabilisation of the elbow and conservative treatment for all the associated fractures, and initial stabilisation of elbow and surgical stabilisation of other fractures at a later stage. All these patients were followed up for about 2-4 yrs. Elbow function was assessed at the end of the follow up.

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Fifty two fractures of the distal radius treated by unilateral single plane small external fixator were studied over a period of one and a half years - 46 cases were closed and 6 cases were open fractures. The mode of injury was mainly by fall on outstretched hand. Average duration of application of the fixator was 6.19 weeks. The average period of follow up was 6.5 months. All united well. The complications were minimal (9.60%). Assessment of results was made on the criteria laid by Gartland and Werley (1951) modified by Sarmiento (1986). Excellent results were achieved in 73% cases, good in 21%, fair in 4% and poor in 2%. Thus proving that external fixation of intra articular fractures of the distal radius is a stable fixation which permits movements of fingers, elbow and shoulder and is safe & simple procedure acceptable by the patient.

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Thirteen Total Knee Replacements, performed in 9 patients, were extensively analysed clinically and radiologically. Particular attention was paid to the results vis-a-vis the different requirements and expectations of the Indian patient. The Harvard Medical School Scoring System was employed to rate the surgeries along with conventional radiological alignment indices. Accordingly, 3 surgeries were rated excellent, 6 good, 1 fair, and 3 poor. While the scores largely reflected patient satisfaction with the surgery, certain deficiencies were also detected in the H. M. S scoring system. This study outlines a protocol suited to Indian conditions as well as suggests modifications in the H. M. S. scoring system, to make it more reflective of the success of surgery.

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