A simplified system for grading the severity of osteomyelitis process into three grades, i.e. ‘mild’, ‘moderate’ and ‘severe’ has been developed based on a detailed study of osteomyelitis process in fifty three patients and on the experience gathered while treating such patients at the Central Institute of Orthopaedics in India. Only clinical data and plain radiographs in two planes have been used, taking care to minimize chances of subjective errors. The factors considered for the purpose were, length of the bone involved, number of sites involved, number and size of cavities if present, along with the amount of sclerosis around their margins, characteristics of the sequestrum seen, presence of any pathological fractures, number of sinuses, the amount of discharge at the time of active disease, and systemic involvement, if any.

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Osteoarticular tuberculosis remains a common problem in India. The clinical diagnosis is often delayed, by which time irreparable damage is done to the tissues. To determine the efficacy of Adenosine Deaminase levels as a diagnostic tool in suspect tuberculosis, 36 cases of synovial effusions of varied aetiology were studied. With a sensitivity of 95% and specificity of 81.25%, estimation of Adenosine Deaminase levels offer a simple, cheap method of diagnosing synovial effusion of ‘suspect’ tuberculosis aetiology.

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Sixty consecutive patients with fracture of the proximal femur (41 trochanteric 19 displaced fracture neck of the femur), were treated by Dynamic hip screw implant system using 135 degree plate. Age of the patients varied from 23-110 years. There was one death due to concomitant medical problem, unrelated to surgical procedure, and 2 superficial wound infections in the whole series. Union was achieved in all patients and there was no implant failure. Early mobilization and weight bearing contributed in achieving 88.1% excellent, 8.4% good and 3.4% poor, end results. By resorting the function of the injured hip, early DHS allows patient the freedom of sitting cross-legged and squatting postures which are essential part of daily activities of life of most of the Arabian and Asian countries. Further, it minimizes the hospital stay and follow up visits of the patients, thereby ensures substantial savings for both the patients and the orthopaedic service.

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Although congenital constriction bands are a well documented entity, acquired constriction bands have not been so far described or documented. We are presenting rare cases of constriction by a rubber hand embedded under the skin.

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Forty eight cases of nonunion of tibia were treated by Ilizarov’s method of fixation. Present article deals with 28 cases in which treatment has been completed. 2 cases were treated by monofocal, 25 by bifocal and 1 by trifocal osteosynthesis. The average age was 32.04 years, average duration of nonunion was 24.69 months. Average preoperative shortening bone gap and angulation were 1.11 cm, 1.45 cm 6.7 in AP and 4.86 in lateral plane respectively. Average duration of fixation was 7.9 months and 18 cases were initially infected. Infection got controlled in all the cases. Immediate postoperative weight bearing was started. Incidence of complications were minimal and were adequately treated. The results were compared with other methods of treatment of non-union. We conclude that Ilizarov method is significantly better particularly in infected non-union, gap non-union and those with multiplaner deformities.

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One hundred and fifty specimens from cases of osteomyelitis were cultured for isolation of anaerobic and aerobic bacteria. Positive culture was obtained in 95.3%; anaerobic bacterial alone were present in 4%, aerobic in 77.3% and a combination of both in 14%. The anaerobes isolated were Peptostreptococci 60.7%, Bacteroides fragilis 28.6%, Clostridium welchii 7.1% and anaerobic gram positive cocci 3.6%. Aerobic bacteriology showed the predominance of Staphyloccus aureus (48.3%) and Pseudomonas aeruginosa (20.9%). Other aerobes isolated were Proteus Sp 14% and Klebsiella Sp. & Escherichia coil 6.7% each. Clinidamycin was found to be the must effective drug against anaerobes and Ciprofloxacin against aerobes.

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A study was conducted in 60 patients to find out the feasibility, efficacy and safety of a local anesthesia technique (n=20) for knee-arthroscopy and compared it with general (n=20) and spinal (n=20) anaesthesia. Local anaesthetic technique consisted of local infiltration and continuous irrigation into the knee joint with 0.5% xylocine with adrenaline (1.25 microgram/ml). For general anaesthesia a conventional nitrous oxide, oxygen, narcotic and relaxant technique was used. For spinal anaesthesia we used 24G spinal needle and hyperbaric 0.5% Bupivacaine. The study showed that 80% patients under local anaesthesia were pain free. No intraoperative and postoperative complications or signs and symptoms of xylocaine toxicity were found in local anaesthesia group. Hospital stay was also short (1.35+0.47 hr). 25% patients of general anaesthesia group had postoperative complications but the intraoperative period was uneventful. Spinal anaesthesia group had maximum intraoperative (60%) and postoperative (45%) complications and had longest duration of hospital stay (30+12.86 hr). Therefore the study concludes that knee arthroscopy under local anaesthesia is a safe, effective and acceptable technique for ambulatory outpatients, with minimal morbidity, hospital stay and cost.

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We present a five year follow-up study of 30 patients with different orthopaedic conditions treated with formalin preserved allografts. Bony union was achieved in 93% patients in 8 to 10 weeks. With the results comparable to other methods, used to preserve bone grafts, we conclude that formalin preserved allografts are convenient, economical and are an effective alternative to other homografts.

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A case of intermediate form of osteopetrosis is reported here who received general anaesthesia for debridement of a mandihular sequestrum. The awareness of multiple systemic disorders in these patients, including severe anaemia, hepatosplenomegaly, repeated fractures and infections of the bones, goes a long way in preventing complications during anaesthesia and in the post-operative period.

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A rare case of Ewing’s sarcoma arising in the fourth metacarpal is presented which reveals variable and changing radiological features that must be remembered to avoid mistakes in diagnosis.

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A case of klippel – Trenaunay – Weber syndrome (Hemangiectatic hypertrophy and gigantism) is reported for its rarity. The relevant literature on the subject is reviewed.

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Idiopathic thoracolumbar scoliosis in an eighteen year old Down Syndrome female patients is reported for the first time, in India. Her angle of spinal deformity is 19o. She was treated with conservative measures.

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External fixation was used in 48 cases of intertrochanteric fractures of femur in geriatric age group (average age of patient being 70.2 years). Majority (75%) of cases were of unstable type (Tronzo’s type III & IV). Partial weight bearing was allowed in stable fractures within 1-2 weeks and by 4-6 weeks in unstable cases. Results were assessed by Clawson’s functional grading and grade IV results were achieved in all cases of stable type and 61.1% of unstable type. Rest of patients had grade III functional results. After a follow up of 20-46 months, there was 4-8o loss of neck shaft angle in only four unstable cases. Complications observed were minor and were adequately treated in all cases.

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Hydatid disease resulting in Echinococcus infestation is a rare endemic parasitic disease that infrequently involves the skeleton. It is located in certain isolated pockets in the world. Clinical diagnosis is many a times missed and is diagnosed after a biopsy. Here we are reporting a case of Osseous Hydatidosis involving the ischium and pubis – a rare site.

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