Twenty six cases of old neglected unreduced dislocations (twenty three anterior and three posterior) were treated by open reduction with or without internal fixation. Duration of dislocation varied from 4 to 36 (average 9.4) weeks. Ten dislocations were associated with fracture either of greater tuberosity or neck of humerus. Their follow up period varied from 2 to 12 (average 7.1) years. Sixteen had good, six fair and four poor results. Several complications like injury to axillary artery in one, superficial wound infection in four, avascular necrosis of humeral head in five and painful stiff shoulder in four cases were encountered. Recovery of good shoulder function was obtained in 16 (61.5%) cases.

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Concern about the safety of blood available for transfusion has paved the way for autologous transfusion in the Western countries. Autologous deposition of blood units prior to elective surgery accounted for 5% of the blood supply in the USA in 1989 and this figure is on the rise. Data regarding this procedure is not available in our country where the need to protect the population from transmission of infectious diseases is greater than in the West. Autologous blood transfusion was attempted in some orthopaedic patients undergoing planned surgeries to assess the feasibility of this form of transfusion. The procedure was simple to perform and safe for the donor-patient. The only disadvantage of the procedure was overcollection of blood units by almost 45%.

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The efficacy and tolerability profile of nimesulide was assessed in a double blind piroxicam controlled trial in 71 (nimesulide 32 and piroxicam 39) patients with osteorthritis of the knee joint. Nimesulide was administered orally as 100 mg twice daily and piroxicam was administered as 20 mg orally in the morning and placebo in the evening. All patients were followed for 8 weeks with clinical assessment every 2 weeks. The principal efficacy parameters were improvement in osteoarthritis severity index (OSI), joint tenderness, swelling and functional capacity of the patients. Nimesulide improved all primary and secondary efficacy parameters with an activity comparable with piroxicam. No difference in OSI was observed between 6 and 8 weeks in piroxicam group. Significant reduction in swelling and tenderness was observed as early as 2 weeks in the nimesulide groups, whereas it became evident at 6 weeks in piroxicam group. There was no significant difference in scoring between 6 & 8 weeks in the two treatment groups. Mild adverse effects mainly gastrointestinal were recorded in 6 patients treated with nimesulide and in 9 patients with piroxicam.

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Results of twenty five intra-articular fractures of the distal humerus, managed by early operative reduction and internal fixation through transolecranon approach are presented. The fractures were classified according to the system of Muller et al., (1979). Each case was followed upto two years and more. The factors leading to good result were early anatomical and internal fixation of the fracture and early elbow mobilisation. At a mean follow-up of two years, 12 cases had excellent results, nine had good, two had fair and two cases had poor result. No non union and hetrotopic ossification was observed. Non union at the olecranon osteotomy site was observed in three cases and superficial sepsis was observed in two cases.

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A prospective study done over a 14 months period revealed an 8% incidence of proximal deep vein thrombosis after major orthopaedic surgical procedures. All patients were analysed by compression ultrasound, which was found to be a good modality to pick up this complication. This is a significant incidence of a potentially disastraous complication, and is contrary to the common view that DVT is rare in Asian populations. Routine prophylaxis is therefore recommended after major lower limb surgery.

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Brucellosis is a multi-system disease and is endemic in the rural population of Saudi Arabia. A study of 41 patients suffering from brucella induced joint pain and low back pain treated in the Orthopaedic unit of King Khalid Hospital Najran, is presented. There were 30 males (73.17%) and 11 females (26.82%). All responded to a six weeks course of antibrucella treatment with complete resolution of symptoms.

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From August 1993 to September 1996, 74 patients with Ipsilateral fractures of femur & Tibia were evaluated. Majority were caused by roadside accidents & males in the 3rd decade of life were predominantly affected. Closed factures, both tibial and femoral were treated by DCP. Open fractures were initially stabilized with external fixators followed by ORIF with DCP later. Average healing time for femoral fractures was 16 weeks and that for tibial fractures 13.5 weeks. Excellent to good results were achieved in 85.7% of cases while acceptable to poor results in 14.3% cases. High velocity trauma sustained in road side accidents resulting in Floating Knee is more often seen (Angus et al 1974). There are no accepted guidelines for treating these fractures. But all relevant reports in the literature emphasize early mobilization of the patient to facilitate rapid recovery of the patient. The recommended methods of treatment vary widely (Ratliff 1965, Karistom et al, 1977, Hojer et al 1977, Winston 1972, DeLee 1978, Fraser et al, 1978, Anastopaulos et al, 1992). The purpose of this paper is to report our method of managing these fractures and the final functional result of this treatment in our series of patients.

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Paralytic calcaneus deformity due to weak planter flexors of ankle is difficult to manage conservatively. Tendon transfers with or without foot stabilisation have been in practice to regain muscle balance and correct deformity. Release of plantar fascia, osteotomy of vertically inclined calcaneum with displacement of posterior fragment posterosuperiorly alone or in combination with tendon transfer to heel or translocation of peroneus longus gives immediate correction of calcaneocavus deformity with varying degree of increase in power of plantar flexors. It preserves the mobility of the foot, and increases the length or shorter foot. In this series of 23 patients, 5(21.73%) had excellent results,13(56.52%) had good results and 4(17.40%) had fair results. One (4.35%) had proof results. It appears to be procedure of choice in selected cases of post-polio calcaneocavus deformity for improvement of shape and function of foot with mobility.

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A comprehensive study of intraosseous and extraosseous blood supply of scaphoid utilizing newer techniques as has been applied to study the anatomy of blood supply of tibia, the talus and the head of femur in man, is undertaken. The exact relationship between blood supply of scaphoid and non union or avascular necrosis of scaphoid in Indian population was compared with the western population. It is concluded the scaphoid in Indians has a better vascularity of the proximal pole, leading to less incidence of non-union or avacular necrosis.

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A prospective study to assess the role of undreamed interlocking humeral nail (UHN) in the treatment of 22 adult patients with fractures of shaft of humerus is presented. Results are evaluated in terms of clinical function and radiological union. Eighteen patients (90.9%) regained full ROM of shoulder at an average of 7.17 weeks and full range of elbow motion at 17.1 days. Fifteen patients (71%) achieved radiological union by 8 weeks while 21 patients (95.45%) achieved by 16 weeks. (average time of union, 8.38 weeks). No case of wound infection or refracture occurred. UHN compared favourably in terms of rate of union, surgical exposure time and functional results with DCP plating and may prove to be a better alternative.

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Thirty cases of trochanteric fractures were treated by close reduction internal fixation with a dynamic compression hip screw and side barrel plate. In one and half year of average follow up 95% cases showed excellent to good results with early mobilization. Prolonged recumbency and long hospital stay were thus eliminated.

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Ninety four clubfeet deformities in sixty three patients of age group from three days to thirteen years were treated in Orthopaedic department in last one and half years. Sixty three clubfeet were treated by repeated manipulation and cast, 9 with posteromedial tissue relase, 7 by triple arthrodesis and 15 by Joshi’s external stabilization system (JESS). Link joints are the basic holding units in the external fixator frame. Each component deformities were sequentially distracted. The fractional distraction was done for 3-6 weeks followed by static phase of 3-4 weeks with post fixator plaster maintenance given for 8-12 weeks. Results were graded as excellent in 8 feet, good in 4 feet and fair in 2 feet. In one case JESS was discontinued on 3rd postoperative day.

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Two cases of Monostotic fibrous dysplasia of the femur who were treated by inter-locking nailing are presented. One of them had a refracture after curettage, bone grafting and Jewett nail-plate fixation, whereas the other had a severe shepherd’s crook deformity. Intramedullary devices with proximal and distal locking in the case of fibrous dysplasia where the medullay canal is quite wide maintain proper alignment and prevent rotational instability at the osteotomy / fracture site. It prevents further deformity in a bone that is weak and being a load sharing device bone formation is superior.

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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. Patients showed considerable improvement at the end of the PEMF therapy with minimum deteriorations 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.

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One hundred and thirty six patients with skeletal Tuberculosis were studied at Assam Medical College, Dibrugarh during 1996-98. Age of occurrence varied from 3½ years to 75 years. Young male adults had a higher incidence of the disease. The spine was the commonest site of involvement, with 79, cases, followed by Hip and Knee joints. The socioeconmically backward were the commonest victims. A.T.T. with some sort of external support were needed in 120 cases, and surgical intervention was needed in 16 cases. Anti tubercular treatment upto 16 months gave satisfactory results.

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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 (1month 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 (159) and 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.

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