Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a rare skeletal disorder. A series of 118 cases seen during 1994-2000 is presented. There were 85 males and 33 females in the 40-80 years of age group. They presented with back pain, with or without sciatica and claudication. The duration of symptoms was from a few days to many years. Positive neurological signs were uncommon. Radiology showed characteristically flowing and undulating juxtra-articular ossification of ligaments of three or more vertebral segments, most notably in the dorsal region, often with large anteriorly pointed osteophytes. In 18 cases there were no back-related complaints. They had an extra-spinal involvement like calcaneal bumps, prominent acetabular margins, tibial tubercle prominence. OPLL was found in four patients in dorsal and lumbar regions. Treatment has been conservative with NSAID, Physiotherapy and age related problems. Decompressive surgery was preferred in three cases.

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Osteochondral lesions of the talar dome are a diagnostic and therapeutic problem. Various classifications and different surgical options have been proposed. The aim of our study was to evaluate the effectiveness of the microfracture technique to treat these lesions in young athletes. Ten cases of osteochondral lesions in talus treated arthroscopically from 1993 to 1996 were reviewed. There were 9 athletes with an average age of 24 years, 6 patients had previous trauma. All the patients had arthroscopic debridement and chondroplasty with perforations or microfractures. All data was retrospectively analysed and the patients were reevaluated four years after surgery with subjective and objective examination, X rays, CT scans or MRI, Loomer evaluation forms and functional tests. Seventy per cent of these patients showed excellent or good results, one patient resulted in fair and we had one poor result (bilateral lesion). We suggest arthroscopic treatment of osteochondral lesions of talus whenever it is possible, because of reduction of surgical trauma and morbidity, early hospital discharge and high percentage of good results.

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Thirty adults with intraarticular fractures of distal humerus were treated with open reduction and internal fixation. Fracture site was exposed through either transolecranon or posterior Campbell approach. Elbow movements were started as soon as patients were comfortable. Patients were followed for an average period of 4.2 years. At the final review all the fractures healed with only one showing delayed union. Post-operative complications were heterotrophic ossification in one, ulnar nerve neuropraxia in two, delayed union at the osteotomy site of olecranon in two and mild pain on moderate to heavy manual work in four patients. Average time taken for union was 12.5 weeks and average range of motion at the elbow joint was 116.5. The clinical results were graded as good to excellent in 80% and poor in 20%.

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In a prospective study of 96 knees (94 patients) with osteoarthrosis, 53 were treated conservatively as control groups. High tibial osteotomy was done in 43 knees, 22 were treated with closing wedge technique and 21 with barrel vault technique. Operated group as a whole had significantly better knee scores at 4 year follow up. There was no significant difference in results of two techniques with respect to knee scores. Lateral ligament laxity was not found to be a significant problem with either technique.

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Forty-eight cases of difficult nonunion of tibia with gap between the fragments were studied. The commonest cause of nonunion was open fractures of tibia leading to infected non-union. The mean gap was 4 cm (ranged 2 to 12 cm). They were treated by bifocal osteosynthesis with gradual distraction at the corticotomy site and compression at the nonunion site by bone transport. Cancellous bone grafts were used, wherever necessary and length of the limb was restored by distracting the fragment below the corticotomy at the proximal tibia. Follow-up ranged from one year to 3 years. Union was achieved in all the cases. The mean time to union was 10 months (range 7 to 23 months). The functional results were good in 30 patients, fair in 17 and poor in one patient. The complications observed were wire breakage, pin tract infection, equines deformity, transient common peroneal nerve palsy, re-fracture and amputation.

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In a retrospective study, 30 cases of radial head excision in 29 patients for fracture radial head were studied at an average follow-up of 4.2 years. There were 26 satisfactory and 4 unsatisfactory results. There was definite proximal migration of the radius averaging 2.9mm, cubitus valgus, peri-articular ossification, and terminal loss of extension. The associated injuries decide the final outcome and excision of head radius in these conditions may add to the inherent instability. It is in these cases that fixation of the head, prosthetic replacement or primary MCL repair may be beneficial. Early excision arthroplasty seems to be an excellent procedure for isolated fracture of the radial head.

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Twenty seven-cases of fracture shaft femur in children were treated by close reduction under image intensifier and fixation with K-wire. Precaution was taken so that tip of K-wire did not cross trochanteric epiphysis. Children were in age group of 4-12 years with 15 transverse, seven short oblique, two long oblique and three comminuted fractures. All fractures united, but five cases had mal-rotation of 5 to 12, three cases had angulations of 5 to 10 and three cases had shortening of 0.5 to 1.5cm. All cases had full knee and hip movements. No case had avascular necrosis of head to femur in follow-up period of 6 months to 3 years.

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Thirty patients with severely displaced Colles’ fractures were treated by closed reduction and two Kirschner –wires pinning. All the fractures healed within three months. Anatomical result was good or excellent in 24 cases (80%), but six patients (20%) developed malunion. Functional results were satisfactory in all the cases. At a mean follow up of 3 years after injury, none had wrist pain, grip strength was 95% of the opposite normal side, complications and complaints were few. Our result suggests this procedure as a good treatment option for severely displaced Colles’ fracture.

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Tetracycline is deposited in newly formed bone and emits fluorescence when exposed to ultraviolet light. In this study, double labeling with tetracycline was used to measure the amount and the rate of bone turnover in 66 patients with a minimal hospital stay of 21 days. Oxytetracycline (500mg tds) was given orally in two does schedules of 3 days each with a gap of 7 days in between, followed by an anterior iliac crest biopsy at least 48 hours after the last dose. A calibrated ocular micrometer was used to measure the width of the tetracycline fluorescent bands I& II, the interlabel interval and the width of the entire labeled period of 13 days. The average rate of bone formation for the entire period of the study was 1.374+0.236 pm/day. Our study showed that tetracycline double labeling is a good method for measuring the rate of bone turnover in human subjects using anterior iliac crest biopsies. In addition the model has evolved a statistically significant regression equation for the evaluation of rate of bone formation in patients of this region, that is Rf=1.8705_ 0.0147 Age (where Rf is the rate of bone formation in pm/day at any age). This model can be used to predict the rate of bone turnover at different ages and also to monitor response to treatment in various metabolic bone diseases.

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The study was carried to evaluate longevity of fixation of Harris-Galante acetabular component. Twenty-six consecutive primary acetabular reconstructions were performed in 20 patients with use of a Harris Galante porous coated acetabular component with screw fixation from July 1992 to August 1999. The average age of these patients at the time of operation was 40 years (Average 19 years to 55 years). No acetabular component migrated or was classified radiographically as loose or revised because of aseptic loosening. There was no evidence of fragmentation or disruption of the titanium porous mesh of any cup. There was no complication associated with the insertion of the acetabular fixation screws. No osteolytic lesion was identified adjacent to acetabular component at the time of most recent follow up. The average Harris hip score improved from 40 points (rang 10 to 65 points) preoperatively to 87 points (67 to 100 points) at the time of latest examination. Excellent to good results were seen in 23, fair in two and poor in one hip. All fair and poor results were observed in patients who had other factors such as nonunion of trochanteric sliver and intraoperative femoral shaft fractures. In the present study, Harris-Galante porous coated acetabular component continued to provide excellent fixation.

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Fibula is an uncommon site for bone sarcomas. Oncological and functional results in twenty patients who underwent enbloc resection for malignant tumours of the fibula were reviewed. The histopathological diagnosis was osteosarcoma in ten patients, Ewing’s sarcoma in five, chondrosarcoma in four and metastasis in one. All patients with osteosarcoma and Ewing’s sarcoma received adjuvant chemotherapy, preoperatively and post operatively. Radical resection was performed in three cases, a wide margin was achieved in 16 cases and marginal margin in one case. The follow-up Period ranged from 2 years to 11.7 years with a mean followup of 4.5 years. Sixteen patients had a disease free survival at the end of the study. Two patients died of disease while two patients developed local recurrence and underwent above knee amputation. The mean ISOLS score in 16 patients in whom successful limb salvage was achieved, was 82.4. Limb salvage surgery can be accomplished in majority of the patients with malignant tumours of the fibula with satisfactory oncological and functional outcome. The proposed classification system is simple, comprehensive and applicable for all types of fibular resections.

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