Posterolateral rotatory instability (PLRI) of the knee is a complex diagnostic and therapeutic problem. Although isolated PLRI of the knee is an uncommon injury pattern, it may result in significant degrees of functional impairment. It is usually associated with an injury to the anterior or posterior cruciate ligament, and it is often difficult to isolate the effect of a posterolateral injury on instability of the knee when these combined instability patterns are present. Accurate diagnosis of PLRI depends not only on a thorough knowledge of posterolateral corner (PLC) anatomy, but also an astute clinical assessment. Often these injuries are missed in the acute stage, resulting in chronic PLRI. In combined ligamentous injury, all components of instability must be surgically addressed to achieve the best opportunity for success. Numerous surgical techniques have been described for both repair and reconstruction of the injured posterolateral structures. Early diagnosis and reconstruction of posterolateral knee injuries is more successful than late reconstruction.

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A case of congenital pseudoarthrosis of humerus in a female infant is reported. The histopathological examination of fibrous tissue excised was suggestive of neurofibroma. It was treated by plating and bone grafting resulting in a sound clinical and radiological union at six months.

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Charcot’s arthropathy is relatively rare, but an important and potentially devastating disorder. Diabetes mellitus, syphilis, and syringomelia are the most commonly associated clinical entities but it particularly affects patients with long-standing diabetes. Charcot’s arthropathy is a chronic, progressive degenerative disorder affecting one or more peripheral or vertebral articulations, which develops as the result of a disturbance in the normal sensory innervations of joints. It results in massive osseous destruction and malposition of the articular constituents. These patients have one of the highest likelihood of having to undergo lower extremity amputation. With increasing number of diabetics in our country these complications are more likely to be encountered in day to day practice. A careful examination of the foot for injuries, neuropathy and early deformity along with timely intervention with save many a limbs from getting amputated.

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In a prospective study 56 cases of comminuted/segmental fractures of long bones were treated in accordance with the principle of indirect reduction and biological osteosynthesis technique. Fifty patients were adult males. Twenty-six fractures were of tibial diaphysis, 12 were of femoral diaphysis, 9 patients were of subtrochanteric fracture femur and remaining 9 were of supracondylar fracture of femur. Bypass/Bridge plating was done. Patients were followed up at 4 weekly intervals till fracture union. All fractures united on an average of 5 months period. Complications noted were of superficial infection; delayed union and two cases of implant failure. The mean time for healing was 20.4 weeks.

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The diagnosis of compartment syndrome is sometimes missed and adequate treatment if not started promptly leads to catastrophic results. A retrospective study was carried out on 80 patients who were diagnosed to have compartment syndrome on clinical symptoms and compartment pressure measurement to see if they respond to conservative treatment, if fasciotomy is beneficial, if so when should it be done and what are its limitations and complications. Deterioration in clinical signs and increase in compartment pressure above 40 cm of saline was taken as an indication for fasciotomy. Sixtynine patients had excellent results, 7 unacceptable and 4 Amputations. Even though fasciotomy has been described as the treatment of choice, there are situations where decompression fails to give desired results.

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Resection of distal femur or proximal tibia enbloc creates a wide bone gap at knee joint in case of bone tumours. The gap created after en block resection was fitted with autogenous bone grafts taken from opposite fibula an ilium stabilized with long Kuntscher rod for internal fixation to bring about arthrodesis of the knee. Among twenty patients operated, fifteen had union; three had non-union and two amputations.

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Bone is living and continuously remodelling tissue consisting of bone cells in an organic osteoid matrix largely impregnated with hydroxyapatite crystals. At the cellular level bone cells of the osteoblast and osteoclast lineage play a major role in the synthesis and degradation of osteoid and in its mineralization and demineralization. The steady state of bone density results from the balance of anabolic osteoblasts and catabolic osteoclasts. It is becoming clear that a class of regulatory proteins governs the celluar and molecular biology of osteogenesis.1-5 Frequently orthopaedic and trauma surgeons are faced with the problem of treating fractures in which a substantial amount of bone material has been lost. Similar problems arise following tumour resection. The conventional method to repair such defects is the use of autologous bone as optimal grafting material, which provides the essential features such as mechanical strength, temporary living osteoblasts, inductive matrix and conductive scaffold. Autograft is recognized as the gold standard in bone grafting material for most, if not all, implant indications. There are a lot of disadvantages and risks with autologous grafts such as pain, blood loss, risk of infection due to the harvesting procedure and last but not least possible cosmetic and functional defects. As an alternative to autografts, allogenic bone preparations offer obvious advantages. Their advantage over autografts lies in better availability of supply and their ability to be used for reconstructing large segments of bone. The major disadvantage of allogenic bone include disease transmission and the grafts tendency to elicit an immune response, which can lead to high failure rates.

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A case of Hydatid disease in ankle and subtalar joint in a 62-year-old male is reported. Patient presented with pain and swelling of left ankle and foot for two years. Subtalar joint movements were painfully restricted and radiograph of the ankle joint showed joint sclerosis. Open biopsy and subtotal synovectomy of ankle and subtalar arthrodesis was performed. Diagnosis of hydatidosis was made by histopathological examination. The patient was put on oral albendazole postoperatively for six months. Patient is aysmptomatic 2 years after surgery.

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Eighty cases of grade II and grade III A compound tibial shaft fractures were randomly divided into two groups of 40 each. Group I patients were treated by external fixation of tibia and in group II patients fibular plating was added as an adjunct to external fixation of tibia to study benefits of fixing the fibular fracture as an adjunct to external fixation. It was observed that plating the fibular fractures decreases the overall complication rate. Although plating of fibular fractures as an adjunct to external fixation gives enough rigidity at the fracture site, delayed union and malunion can still occur in comminuted and segmental fractures. Hence early posterolateral bone grafting is necessary to prevent the above complications.

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Aretrospective review of socket fixation in 34 hips of 28 patients with an average follow-up of 9 years 3 months has been reported. Thirty out of 34 sockets remain well fixed with excellent clinical outcome in 17, satisfactory in 7 patients. The cement pressuriser does not seem to alter the outcome of socket fixation. We conclude that revised surgical techniques and flanged socket design will improve socket survival in long term.

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