Articular cartilage damage in the young adult knee, if left untreated, it may proceed to degenerative osteoarthritis and is a serious cause of disability and loss of function. Surgical cartilage repair of an osteochondral defect can give the patient significant relief from symptoms and preserve the functional life of the joint. Several techniques including bone marrow stimulation, cartilage tissue based therapy, cartilage cell seeded therapies and osteotomies have been described in the literature with varying results. Established techniques rely mainly on the formation of fibro-cartilage, which has been shown to degenerate over time due to shear forces. The implantation of autologous cultured chondrocytes into an osteochondral defect, may replace damaged cartilage with hyaline or hyaline-like cartilage. This clinical review assesses current surgical techniques and makes recommendations on the most appropriate method of cartilage repair when managing symptomatic osteochondral defects of the knee. We also discuss the experience with the technique of autologous chondrocyte implantation at our institution over the past 11 years.

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Background: Giant cell tumor (GCT) of the distal radius poses problems for reconstruction after resection. Several reconstructive procedures like vascularized and non-vascularized fibular graft, osteo-articular allograft, ceramic prosthesis and megaprosthesis are in use for substitution of the defect in the distal radius following resection. Most authors advocate wrist arthrodesis following resection of distal radius and non vascularized fibular graft. Here we have analyzed the results of aggressive benign GCTs of the distal radius treated by resection and reconstruction arthroplasty using autogenous non-vascularized fibular graft. Materials and Methods: Twenty-four cases of giant cell tumor of the distal radius (mean age 32 years, mean follow-up 6.6 years) treated by en-bloc resection and reconstruction arthroplasty using autogenous non-vascularized ipsilateral fibular graft with a minimum followup of two years have been included in this retrospective study. Nineteen cases were of Campanacci grade III and five were of Grade II recurrence. The mean resected length of the radius was 9.5 (8-12) cm. Routine radiographs and clinical assessments regarding pain, instability, recurrence, hand grip strength and functional status were done at regular intervals and functional results were assessed using (musculoskeletal tumor society) MSTS-87 scoring. Results: Early radiological union at host-graft junction was achieved at mean 12.5 weeks, (range 12-14 weeks) and solid incorporation with callus formation was observed in mean 29 weeks (range 28-32 weeks) in all the cases. Satisfactory range of motion (mean 63%, range 52-78%) of the wrist was achieved in 18 cases. Grip strength compared to the contralateral hand was found to be 67% (range 58-74%). Functional results were excellent in six cases (25%), good in 14 cases (58.3%) and four (16.7%) cases had fair results. Soft tissue recurrence was seen in one patient. The most commonly encountered complication was fibulo-carpal subluxation (10 cases, 41.7%). Conclusion: Resection of the distal radius and reconstruction arthroplasty with non-vascularized proximal fibular graft is useful in preserving the functional movement and stability of the wrist as well as achieving satisfactory range of movement and grip strength.

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Osseous involvement occurs in 5-10% of patients with disseminated cryptococcosis. We are reporting an unusual case of disseminated cryptococcosis involving the sternum and lumbar vertebra with the formation of psoas abscess with pulmonary tuberculosis. The patient presented with fever for 3 months. A diagnosis of pulmonary tuberculosis was made on thoracic contrast-enhanced computerized tomography and she was put on antituberculosis treatment. She was immunocompetent with negative human immunodeficiency virus. She conceived subsequently and had complaints of backache and swelling over the sternum. Magnetic resonance imaging showed destruction of L5 vertebra with psoas abscess. Vertebral cryptococcosis may mimic tuberculosis and malignancy. She had a bad obstetric history and experienced five, first-trimester spontaneous abortions in each successive year since 2001. This pregnancy again resulted in spontaneous abortion. Cryptococcus neoformans was isolated from two different sites: pus-involving the sternum and ultrasound-guided psoas abscess aspirate. Serum latex agglutination test for cryptococcal capsular polysaccharide antigen was positive. The diagnosis of cryptococcosis was delayed because the patient was diagnosed as a case of pulmonary tuberculosis, wherein clinical signs, symptoms and radiological findings in both the conditions are similar. Amphotericin B was started but she developed varicella infection and expired due to cardiac failure.

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Background: Polymethyl methacrylate (PMMA) antibiotic beads though have proved their utility as a local antibiotic delivery system, however, there are limitations. Decalcified bone matrix (DBM) as a vehicle of antibiotics can serve the purpose, provided a minimum inhibitory concentration is sustained. Healing of the defect and avoiding the second surgery is another advantage. We studied the DBM as the delivery vehicle for vancomycin in controlling the methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis as well as healing of the cavity simultaneously in an experimental study. Materials and Methods: An in vitro study was conducted to optimize vancomycin impregnation in the DBM. For the in vivo study, a unicortical defect was created in the metaphysis of the distal femur in 18 rabbits. After contaminating the defect with MRSA, rabbits were divided into three groups. Group I (eight limbs) received no graft. Defects in group II (11 limbs) were filled with plain DBM chips and in group III (14 limbs), cavities were implanted with vancomycin-impregnated decal bone chips. Rabbits were assessed by clinical, radiological, histological, gross examination and bacterial load assay. High Performance Liquid Chromatography HPLC analysis of vancomycin in group III was done to assess the concentration in DBM chips. Results: In group I, the infection persisted throughout the period of the study. Group II showed the fulminated infection at the grafted site with DBM chips sequestrating out. Vancomycin-impregnated decal chips in group III did not show any sign of infection and eventually incorporated. The bacterial load study showed a progressive load change and HPLC revealed an effective antibiotic concentration up to 3 weeks in both in vitro and in vivo. Conclusion: Decal bone chips were effective as the local antibiotic delivery vehicle in preventing the MRSA osteomyelitis model. It eluted vancomycin significantly and the graft uptake was also excellent. Allogeneic decal grafts eliminated the need for second surgery and acted as an excellent delivery vehicle for antibiotics.

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Background: Abnormal femoral neck anteversion (FNA) and/or acetabulum anteversion (AA) have long been implicated in the etiogenesis of hip osteoarthritis (OA), developmental dysplasia of the hip (DDH), and impingement, instability and wear in total hip arthroplasty (THA). Since studies on the Indian population are sparse on this topic, the purpose of this study was to report the normal values of FNA, AA and the combined anteversion (CA= FNA+ AA) in Indian adults. Materials and Methods: FNA, AA and CA were prospectively measured in 172 normal hips in 86 Indian adults using standardized computed tomographic (CT) methods and this data was compared with the established Western values. Results: The median values and interquartile ranges were 8 ^o (6.5-10.0 ^o ) for FNA, 19 ^o (16.0-22.0 ^o ) for AA and 27 ^o (23.5-30.0 ^o ) for CA. AA and CA values were significantly (P<0.05) lower in males, and there was also a trend towards lower FNA in males. Although a negative correlation was observed between the FNA and AA, this was not strong and may not be clinically relevant. Conclusion: When compared with the Western data, the FNA values were 3-12 ^o lower and the CA values were 3-5 ^o lower in Indian adults. The AA values were comparable, but were skewed towards the higher side. Further studies are needed to assess the clinical relevance of our basic science data in pathogenesis of OA, and to validate it in relation to hip surgeries like corrective osteotomies and THA.

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Background: Lumbar disc prolapse is one of the common causes of low back pain seen in the working population ¹³ . There are contradictorty reports regarding the clinical significance of various magnetic resonance imaging (MRI) findings observed in these patients. The study was conducted to correlate the abnormalities observed on MRI and clinical features of lumbar disc prolapse. Materials and Methods: 119 clinically diagnosed patients with lumbar disc prolapse were included in the study. Clinical evaluation included pain distribution, neurological symptoms and signs. MR evaluation included grades of disc degeneration, type of herniation, neural foramen compromise, nerve root compression, and miscellaneous findings. These MRI findings were tested for inter- and intraobserver variability. The MRI findings were then correlated with clinical symptoms and the level of disc prolapse as well as neurological signs and symptoms. Statistical analysis included the Kappa coefficient, Odd's ratio, and logistic regression analysis. Results: There were no significant inter- or intraobserver variations for most of MRI findings (Kappa value more than 0.5) except for type of disc herniation which showed a interobserver variation of 0.46 (Kappa value). The clinical level of pain distribution correlated well with the MRI level (Kappa 0.8), but not all disc bulges produced symptoms. Central bulges and disc protrusions with thecal sac compression were mostly asymptomatic, while centrolateral protrusions and extrusions with neural foramen compromise correlated well with the dermatomal distribution of pain. Root compression observed in MRI did not produce neurological symptoms or deficits in all patients but when deficits were present, they correlated well with the presence of root compression in MRI. Multiple level disc herniations with foramen compromise were strongly associated with the presence of neurological signs. Conclusions: The presence of centrolateral protrusion or extrusion with gross foramen compromise correlates with clinical signs and symptoms very well, while central bulges and disc protrusions correlate poorly with clinical signs and symptoms. The presence of neural foramen compromise is more important in determining the clinical signs and symptoms while type of disc herniation (bulge, protrusion, or extrusion) correlates poorly with clinical signs and symptoms.

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Background: There has been a recent interest in the double row repair method for arthroscopic rotator cuff repair following favourable biomechanical results reported by some studies. The purpose of this study was to compare the clinical results of arthroscopic single row and double row repair methods in the full-thickness rotator cuff tears. Materials and Methods: 22 patients of arthroscopic single row repair (group I) and 25 patients who underwent double row repair (group II) from March 2003 to March 2005 were retrospectively evaluated and compared for the clinical outcomes. The mean age was 58 years and 56 years respectively for group I and II. The average follow-up in the two groups was 24 months. The evaluation was done by using the University of California Los Angeles (UCLA) rating scale and the shoulder index of the American Shoulder and Elbow Surgeons (ASES). Results: In Group I, the mean ASES score increased from 30.48 to 87.40 and the mean ASES score increased from 32.00 to 91.45 in the Group II. The mean UCLA score increased from the preoperative 12.23 to 30.82 in Group I and from 12.20 to 32.40 in Group II. Each method has shown no statistical clinical differences between two methods, but based on the sub scores of UCLA score, the double row repair method yields better results for the strength, and it gives more satisfaction to the patients than the single row repair method. Conclusions: Comparing the two methods, double row repair group showed better clinical results in recovering strength and gave more satisfaction to the patients but no statistical clinical difference was found between 2 methods.

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Background: Unstable spinal lesions in patients with ankylosing spondylitis are common and have a high incidence of associated neurological deficit. The evolution and presentation of these lesions is unclear and the management strategies can be confusing. We present retrospective analysis of the cases of ankylosing spondylitis developing spinal instability either due to spondylodiscitis or fractures for mechanisms of injury, presentations, management strategies and outcome. Materials and Methods: In a retrospective analysis of 16 cases of ankylosing spondylitis, treated surgically for unstable spinal lesions over a period of 12 years (1995-2007); 87.5% (n=14) patients had low energy (no obvious/trivial) trauma while 12.5% (n=2) patients sustained high energy trauma. The most common presentation was pain associated with neurological deficit. The surgical indications included neurological deficit, chronic pain due to instability and progressive deformity. All patients were treated surgically with anterior surgery in 18.8% (n=3) patients, posterior in 56.2% (n=9) patients and combined approach in 25% (n=4) patients. Instrumented fusion was carried out in 87.5% (n=14) patients. Average surgical duration was 3.84 (Range 2-7.5) hours, blood loss 765.6 (± 472.5) ml and follow-up 54.5 (Range 18-54) months. The patients were evaluated for pain score, Frankel neurological grading, deformity progression and radiological fusion. One patient died of medical complications a week following surgery. Results: Intra-operative adverse events like dural tears and inadequate deformity correction occurred in 18.7% (n=3) patients (Cases 6, 7 and 8) which could be managed conservatively. There was a significant improvement in the Visual analogue score for pain from a pre-surgical median of 8 to post-surgical median of 2 (P=0.001), while the neurological status improved in 90% (n=9) patients among those with preoperative neurological deficit who could be followed-up (n =10). Frankel grading improved from C to E in 31.25% (n=5) patients, D to E in 12.5% (n=2) and B to D in 12.5% (n=2), while it remained unchanged in the remaining - E in 31.25% (n=5), B in 6.25% (n=1) and D in 6.25% (n=1). Fusion occurred in 11 (68.7%) patients, while 12.5% (n=2) had pseudoarthrosis and 12.5% (n=2) patients had evidence of inadequate fusion. 68.7% (n=11) patients regained their pre-injury functional status, with no spine related complaints and 25% (n=4) patients had complaints like chronic back pain and deformity progression. In one patient (6.2%) who died of medical complications a week following surgery, the neurological function remained unchanged (Frankel grade D). Persistent back pain attributed to inadequate fusion/ pseudoarthrosis could be managed conservatively in 12.5% (n=2) patients. Progression of deformity and pain secondary to pseudoarthrosis, requiring revision surgery was noted in one patient (6.2%). One patient (6.2%) had no neurological recovery following the surgery and continued to have nonfunctional neurological status. Conclusion: In ankylosing spondylitis, the diagnosis of unstable spinal lesions needs high index of suspicion and extensive radiological evaluation Surgery is indicated if neurological deficit, two/three column injury, significant pain and progressive deformity are present. Long segment instrumentation and fusion is ideal.

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Considerable debate exists regarding the pathogenesis, natural history and treatment of Scheuermann's kyphosis. Surgical correction is indicated in the presence of severe kyphosis which carries the risk of neurological complications, persistent back pain and significant cosmetic deformity. This can be achieved through a posterior-only or an anteroposterior approach. Spontaneous fusion in association with Scheuermann's kyphosis has not been previously described. This is an important consideration if surgical correction of the kyphosis is planned. Two patients with severe thoracolumbar Scheuermann's kyphosis who developed spontaneous posterior and anteroposterior fusion across the apex of the deformity are presented. The surgical treatment and final outcome is discussed.

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Background: Limb length discrepancy and its effects on patient function have been discussed in depth in the literature with respect to hip arthroplasty but there are few studies that have examined the effect on function of limb length discrepency following total knee arthroplasty (TKA). The aim of this study was to determine whether limb length discrepancy after TKA in patients with bilateral osteoarthritis of knee with varus deformity affects functional outcome. Materials and Methods: Fifty-four patients with bilateral osteoarthritis of knee with varus deformity, who were operated for total knee arthroplasty from 1996 to 2008, were reviewed retrospectively. The patients were divided into two groups. Thirty patients (mean age 64 years) were operated for unilateral TKA and thirty patients (mean age 65.8 years) were operated for bilateral total knee arthroplasty. Six patients underwent staged surgery and were included in both groups as the time interval between the two surgeries was more than the minimum 6-month follow-up period specified for inclusion in the study. The limb length discrepancy was measured and statistically correlated with the functional component of the Knee Society Score. Result: In the unilateral group (n=30), the mean limb length discrepancy was 1.53 cm (range: 0-3 cm) and the mean functional score was 73 (range: 45-100). In the bilateral group (n=30), the mean limb length discrepancy was 0.5 cm (range: 0-2 cm) and the mean functional score was 80.67 (range: 0-100). A statistically significant negative correlation was found between limb length discrepancy and functional score in the unilateral group (Spearman correlation coefficient, r = −0.52, P=0.006), while no statistically significant correlation was found in the bilateral group (Spearman correlation coefficient, r = −0.141, P=0.458). Conclusion: Limb length discrepancy affects functional outcome after total knee arthroplasty, especially so in patients of bilateral osteoarthritis with varus deformity undergoing surgery of only one knee.

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Background: The traditional recommendation for displaced comminuted inferior pole fractures is excision of the comminuted pole followed by reattachment of the patellar tendon with transosseous suture. To the best of our knowledge there has been no previous published study mentioning the use of suture anchors for fracture inferior pole of patella. We present a retrospective analysis of five cases of patients doing well at final follow-up of two years. Materials and Methods: Five patients treated at our institute using suture anchors for repair of comminuted inferior pole fractures of patella between January 2007 to March 2007. (range 28 years-55 years). There were three males and two females. Results: The average follow-up was 25 months (range 24 months-26 months). The patients were evaluated for range of motion, strength, patellofemoral scores and any alteration of patellar height. The outcome of the procedure was assessed with use of the patellofemoral scoring system of Noyes et al, ⁵ as adapted by Saltzman et al. ⁶ The final patellofemoral score (maximum 100 points) was 94.6 (range 93-96). Conclusion: We believe it is a novel extended indication of the use of suture anchors and should be in the armament of every trauma surgeon.

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Background: The functional outcome of a flexor tendon injury after repair depends on multiple factors. The postoperative management of tendon injuries has paved a sea through many mobilization protocols. The improved understanding of splinting techniques has promoted the understanding and implication of these mobilization protocols. We conducted a study to observe and record the results of early active mobilization of repaired flexor tendons in zones II-V. Materials and Methods: 25 cases with 75 digits involving 129 flexor tendons including 8 flexor pollicis longus (FPL) tendons in zones II-V of thumb were subjected to the early active mobilization protocol. Eighteen (72%) patients were below 30 years of age. Twenty-four cases (96%) sustained injury by sharp instrument either accidentally or by assault. Ring and little finger were involved in 50% instances. In all digits, either a primary repair (n=26) or a delayed primary repair (n=49) was done. The repair was done with the modified Kessler core suture technique with locking epitendinous sutures with a knot inside the repair site, using polypropylene 3-0/4-0 sutures. An end-to-end repair of the cut nerves was done under loupe magnification using a 6-0/8-0 polyamide suture. The rehabilitation program adopted was a modification of Kleinert's regimen, and Silfverskiold regimen. The final assessment was done at 14 weeks post repair using the Louisville system of Lister et al. Results: Eighteen of excellent results were attributed to ring and little fingers where there was a flexion lag of <1 cm and an extension lag of <15^o. FPL showed 75% (n=6) excellent flexion. 63% (n=47) digits showed excellent results whereas good results were seen in 19% (n=14) digits. Nine percent (n=7) digits showed fair and the same number showed poor results. The cases where the median (n=4) or ulnar nerve (n=6) or both (n=3) were involved led to some deformity (clawing/ape thumb) at 6 months postoperatively. The cases with digital or common digital nerve involvement (n=7 with 17 digits) showed five excellent, two good, four fair, and six poor results. Complications included tendon ruptures in 2 (3%) cases (one thumb and one ring finger) and contracture in 2 (3%) cases whereas superficial infection and flap necrosis was seen in 1 case each. Conclusion: The early active mobilization of cut flexor tendons in zones II-V using the modified mobilization protocol has given good results, with minimal complications.

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Bizarre parosteal osteochondromatous proliferation, otherwise known as Nora's lesion, is surface tumor of bone with high probability of local recurrence. The author reports a case of Nora's lesion of the proximal phalanx of the second toe, successfully managed by en bloc excision of the swelling. At four-year follow-up there was no evidence of recurrence.

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Transstyloid, transscaphoid, transtriquetral perilunate dislocations are extremely rare carpal dislocations. We report a 24-year-old male who presented with this rare injury pattern four weeks after sustaining trauma. The patient underwent open reduction and internal fixation via dorsal approach. Reduction was assisted by the use of Joshi's Distraction System. Scaphoid fracture healed by 16 weeks. At 2 years follow-up patient has good range of motion around wrist without any discomfort.

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Background: Mini-subvastus approach for Total Knee Arthropalsty allows a faster recovery. It is traditionally not utilized for obese patients because of difficulty in exposure of the knee and eversion of the patella. We hypothesized that obesity should not really cause a problem for patients undergoing a TKA with the mini-subvastus approach as the anatomy of the quadriceps in the obese and the nonobese patient population is the same. We present an analysis of the use of mini-subvastus approach in obese patients. Materials and Methods : 97 obese patients (109 knees) 81 females + 16 males with mean age 64 years underwent total knee arthroplasty (TKA) by mini-subvastus approach between January 2006 to July 2007. 16 patients (18 kness) were morbidly obese. All patients were prospectively evaluated by pre- and postoperative Knee Society and function score. The average follow-up was 18 months (range from 1 to 3 years) with minimum 1 year follow-up. Results: The approach provided adequate exposure in all knees, with an average surgical time of 90 minutes. The patella could be everted easily after the tibial and femoral cuts. The average Knee Society score improved from 42 to 89 and the function score from 48 to 65. The complications included medial collateral ligament injury (one case) and patellar tendon avulsion (one case). Conclusion: Our results compare favorably with other reported series in obese patients. The mini-subvastus approach can be considered in obese patients.

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Background: Primary cemented total hip arthroplasty is a procedure for non-traumatic and traumatic affections of the hip. Long term follow-up is required to assess the longevity of the implant and establish the procedure. Indo-Asian literature on long term result of total hip arthroplasty is sparse. We present a 10-year follow-up of our patients of primary cemented total hip arthroplasty. Materials and Methods: We operated 31 hips in 30 patients with primary cemented total hip arthroplasty. We followed the cases for a minimum period of 10 years with a mean follow-up period of 12.7 years. The mean age of the patients was 60.7 years (range 37-82 yrs) male to female ratio was 2:1. The clinical diagnoses included - avascular necrosis of femoral head (n=15), sero positive rheumatoid arthritis (n=5), seronegative spondylo-arthropathy (n=4), neglected femoral neck fractures (n=3), healed tubercular arthritis (n=2) and post traumatic osteoarthritis of hip (n=2). The prostheses used were cemented Charnley's total hip (n=12) and cemented modular prosthesis (n=19). The results were assessed according to Harris hip score and radiographs taken at yearly intervals. Results: The mean follow-up is 12.7 yrs (range 11-16 yrs) Results in all operated patients showed marked improvement in Harris hip score from preoperative mean 29.2 to 79.9 at 10 years or more followup. However, the non-inflammatory group showed more sustained long term improvement as compared to the inflammatory group, as revealed by the Harris hip score. Mean blood loss was 450ml (±3.7 ml), mean transfusion rate was 1.2 units (±.3). The complications were hypotension (n=7), shortening >1.5 cm (n=9), superficial infection (n=2) and malposition of prosthesis (n=1). Conclusion: The needs of Indian Asian patients, vary from what is discussed in literature. The pain tolerance is greater than western population and financial constraints are high. Thus revision surgery among Indian-Asian patients is less compared to western yard sticks.

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Background: Magnetic resonance myelography (MRM) after lumbar discectomy is all too often an unrewarding challenge. A constellation of findings are inevitable, and determining their significance is often difficult. MRM is a noninvasive technique that can provide anatomical information about the subarachnoid space. Until now, there is no study reported in literature showing any clinico-radiological correlation of post operative MRM. The objective of this study was to prospectively evaluate the diagnostic effectiveness of MRM for the demonstration of decompression in operated discectomy patients and its correlation with subjective and objective outcome (pain and SLR) in immediate postoperative period. Materials and Methods: Fifty three patients of single level lumbar disc herniation (LDH) justifying the inclusion criteria were operated for discectomy. All patients underwent MRM on second/third postoperative day. The pain relief and straight leg raise sign improvement was correlated with the postoperative MRM images to group the patients into: A- Subjective Pain relief, SLR improved and MRM image showing myelo regression; B- Subjective Pain relief, SLR improved and MRM image showing no myelo regression; C- No Subjective Pain relief, no SLR improved and MRM image showing myelo regression and; D- No Subjective Pain relief, no SLR improved and MRM image showing no myelo regression. Results: The result showed that Group A had 46 while Group B, C and Group D had 4, 2 and one patients respectively. Clinico-radiological correlation (Clinically diagnosed patient and findings with MRM correlation) was present in 47 patients (88.68%) which includes both A and D groups. The MRM specificity and sensitivity were 92% and 33.33% respectively. Conclusion: MRM is a non-invasive, efficient and reliable tool in confirming postoperative decompression in lumbar discectomy patients, especially when economic factors are to be considered and the required expertise to reliably read a complex confusing post-operative MRI is not available readily. Further, controlled double blinded multicentric study in operated and non operated LDH, with MRI comparison would give better evidence to justify its use in screening to detect persisting compression and to document decompression.

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Background: Spinal cord trauma is a major health problem with associated physical, social, economic and psychological sequelae. Despite many advances in research and treatment modalities, the pathophysiology of spinal cord injury remains unclear, and morbidity and mortality among these patients remain high. This experimental study investigates the regenerative cell proliferation effects of bone marrow supplemented with neurotransmitters combinations in the regeneration of spinal cord injury Materials and Methods: Ethical Committee Clearance was obtained for animal study. All animal care and procedures were in accordance with the CPCSEA and National Institute of Health guidelines. Thirty Wistar rats with monoplegia following surgical hemitransection of the spinal cord were used for the study. Half of them were randomly selected as the test group and the rest as the control group. Spinal cord injury model of Wistar rats in the test group were treated by infusing a combination of neurotransmitters and bone marrow at the site of injury using a special polythene tube and reservoir for 21 days. In the control group of rats with monoplegia, normal saline was infused at the site of injury for 21 days. The observations are recorded along with results. Results: The monoplegia in the test group of rats recovered significantly (P value < 0.01) with supplementation of the bone marrow cells and neurotransmitters combination. In the control group of rats, there was no recovery. The reward-seeking locomotor test and sensory recovery test confirmed recovery from spinal cord injury in the test group with significance. Conclusions: The neurotransmitters and bone marrow combination was responsible for functional recovery in the test group of rats with experimental spinal cord injury We believe that the combination of neurotransmitters along with bone marrow may be a scope of future research in patients with spinal cord injury.

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Background: Ender and Simon Weidner popularized the concept of closed condylocephlic nailing for intertrochanteric fractures in 1970. The clinical experience of authors revealed that Ender nailing alone cannot provide secure fixation in elderly patients with osteoporosis. Hence we conducted a study to evaluate the efficacy of a combined fixation procedure using Ender nails and a cannulated compression screw for intertrochanteric fractures. Materials and Methods: 76 patients with intertrochanteric fractures were treated using intramedullary Ender nails and cannulated compression screw from January 2004 to December 2007. The mean age of the patients was 80 years (range 70-105 years).Using the Evan's system of classification 49 were stable and 27 unstable fractures. Inclusion criteria was high risk elderly patients (age > 70 years) with intertrochanteric fracture. The exclusion criteria included patients with pressure sores over the trochanteric region. Many patients had pre-existing co-morbidities like diabetes mellitus, hypertension, COPD, ischemic heart disease, CVA and coronary artery bypass surgery. The two Ender nails of 4.5mm each were passed across the fracture site into the proximal neck. This was reinforced with a 6.5 mm cannulated compression screw passed from the sub trochanteric region, across the fracture into the head. Results: The mean follow-up was 14 months (range 9-19 months) Average time to fracture union was 10 weeks (range 6-16 weeks). The mean knee ROM was 130^o (± 5^o). There was no case of nail penetration into hip joint. In five cases with advanced osteoporosis there was minimal migration of Ender nails distally. Conclusions: The Ender nailing combined with compression screw fixation in cases of intertrochanteric fractures in high risk elderly patients could achieve reliable fracture stability with minimal complications.

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Background: The skeletal age in short stature and in various other growth abnormalities is well documented. We lack the study pertaining to the analysis of the skeletal age in idiopathic short stature or analyzing the difference in skeletal age delay or advancement between the familial short stature (FSS) and non-familial short stature (non-FSS) groups, hence this study. Present retrospective study is designed to study the variation in patterns of skeletal age in ISS. Materials and Methods: One hundred and eighty six patients, 95 males and 91 females of idiopathic short stature were examined to assess the skeletal age deviation in relation to chronological age. The radiographs of the left hand and wrist were done. The skeletal age was assessed using Tanner and Whitehouse (TW3) method and Greulich and Pyle (GP) atlas. The patients were divided into two groups based on the parental heights. Group A (Familial Short Stature; FSS) with 100 patients (55 males, 45 females) included patients whose at least one parent was short and Group B (non-Familial Short Stature; non-FSS) with 86 patients (40 males, 46 females), included patients whose parental height was normal. The carpal scores, RUS (Radius, Ulna and Short bone) scores and GP age were determined and the respective delay or advances were calculated. Results: The skeletal age in Group A was delayed relative to chronological age by a mean of 1.9 years in males and 2.3 years in females (P<0.05) by RUS method, mean of 2.7 years in males and 2.6 years in females by Carpal score (P<0.05), 2.2 years in males and 2.7 years in females by GP atlas age (P<0.05). The skeletal age in Group B was advanced by a mean of 0.9 years in males and 1.4 years in females (P<0.05) by RUS method, mean of 0.4 years in males and 0.35 years in females by Carpal score (P<0.05), mean of 1.1 years in males and 0.2 years in females by GP atlas method (P<0.05). The Pearson's coefficient of correlation (P<.001) demonstrated good agreement association between all three scores. Conclusions: There is definite age delay in both males and females in the FSS group while the bone maturation is accelerated in the non-FSS group. Both RUS and GP show good correlation amongst both the genders in both the groups and there is good inter observer correlation for both the methods. We can hypothesize that while treatment protocols to accelerate bone age will be beneficial in the FSS group, these should be avoided in the non-FSS group. Our study also indicates that there definitely exists a difference in normal growth curves in both these groups and a detailed study is required to plot their respective normal growth lines so as to make proper adjustments in the assessment of the remaining growth and limb lengthening protocols.

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A 24-year-old male patient presented with cauda equina lesion symptoms. His clinicoradiological examination including X-rays, CT scan and MRI revealed destruction of L ₅ vertebral body, pedicle and a mass extending to lateral recess and left intervertebral foramina causing pressure over the thecal sac. A CT guided FNAC was inconclusive. Open biopsy and hemilaminectomy of L ₅ vertebra was performed. Histopathology and immunocytochemical analysis revealed it to be primitive neuroectodermal tumor. Patient was given chemotherapy and radiation therapy. His lower limb power improved by grade I post operatively and at 2 years follow-up bowel/bladder recovery was noticed. Patient died after 2.5 years of surgery because of pulmonary metastasis.

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