Objective: This study is to evaluate the clinical and radiological outcome of unstable fracture neck of the femur in young adults treated with three cannulated cancellous screws augmented with medial buttress plate. Materials and methods: Fifteen patients of less than 60 years were operated from January 2017 to March 2018. Reduction was achieved by closed or open means to Garden's alignment index grade I. Internal fixation was done with three cannulated cancellous screws through mini lateral incision, and medial buttress plating was done through modified Smith–Peterson approach. All patients were mobilized from the immediate postoperative period and allowed toe-touch weight-bearing as tolerated. All patients were followed at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Results: Fracture united in 14 of 15 patients. Reduction loss and backing out of cancellous screws occurred in one patient. No cases of avascular necrosis was identified at a mean follow-up of 13.7 months. No significant femoral neck shortening was observed in all united fractures. Conclusion: Anatomical reduction by closed or open method; stable fixation with three cannulated cancellous screws augmented with medial buttress plate, increases fracture union rate compared to the historical series using closed reduction and cancellous screw fixation alone. Open reduction and medial antiglide plate fixation do not appear to increase morbidity.

Aim: Proximal fibular osteotomy (PFO) for osteoarthritis (OA) knee is an emerging concept with good early results. This short-term study aimed to analyze the usefulness of PFO in Indian patients with OA knee with regard to pain relief and correction of deformity. Materials and methods: This study involves a surgical technique where 2 cm of proximal fibular bone is resected, and patient is permitted full-weight-bearing walking as early as possible. Subjective and objective outcome analyses done using Lysholm knee scoring sheet and radiographs, respectively. Minimum follow-up time was 6 months. Results: We had a of total of 20 knees in 18 patients, with average age of 56.1 years. The average visual analog score reduced by 6.8 points, and the average Lysholm knee score improved by an average of 34 points at the end of follow-up. The mean alpha angle correction achieved was 3.738°. The calculation of Pearson's correlation coefficient between the amount of correction of alpha angle and reduction of visual analog scale during the immediate postoperative period was −0.186. Among the 20 knees, we had four cases of weakness of extensor hallucis longus. Conclusion: Through our short-term prospective cohort study, we conclude that PFO helps in improvement of pain and function, in patients suffering from medial compartment OA knee. The effectiveness of proximal tibiofibular joint mechanism in immediate pain relief is evident in our study by subjective and objective means. A proper selection of case with regard to severity and duration of disease and patellofemoral involvement is vital in getting good results. Clinical significance: Proximal fibular osteotomy is an emerging concept in the management of OA of knee and gives the patient, more years, with native knee to walk.

Introduction: Fracture dislocations of the ankle are rare injuries with often poor outcomes due to posttraumatic arthritis and instability of the ankle. A concomitant fracture of the posterior malleolus occurs in 7–44% of all ankle fractures. Aim of the study: To study the outcomes in operated cases of posterior malleolus fractures fixed using percutaneous anteroposterior (AP) screws vs posterior buttress plating and to study which is advantageous. Materials and methods: Our study was conducted between December 2013 and December 2015. All operated cases of posterior malleolus fractures in trimalleolar fracture dislocations of the ankle joint were included. Polytrauma cases and open injuries were excluded. Among 28 cases, 24 cases were available for final follow-up. The average age was 47.2 years, and road traffic accident was the predominant cause in 80% of the cases. In 9 cases, buttress plating, and in 15 cases, percutaneous AP screws were used as decided by senior surgeon. All cases were followed up at periodic intervals. Mean follow-up is 28.5 months. Results: Average union time is 14.2 weeks. Ankle fracture scoring system designed by Phillips et al. was used. The outcome is the sum of the clinical score (follow-up), the anatomical score (postoperative), and arthritis score (follow-up). A minimum score is 0, and the maximum score is 150. In posterior plating group, the average score was 128 out of 150. In AP screws group, the average score was 114 out of 150. Improper reduction and articular step were noticed in three cases and developed ankle arthritis in subsequent radiographs. There were no infections in our series. Conclusion: Posterior plating gave better results due to stable anatomical reduction and by early physiotherapy, while AP screws group had relatively moderate outcome due to articular step off and late arthritic changes.

Aim: To study clinicoradiological outcome of subtrochanteric femur fractures following intramedullary nailing. Materials and methods: This was a prospective study of 22 cases of subtrochanteric fractures admitted and operated by intramedullary nailing at Southern Railway HQ Hospital, Chennai, between June 1, 2017, and May 31, 2018. Results: The mean age distribution was 65.09 ± 17.84 years with 12 females and 10 males. According to Seinsheimer classification, there were six cases of type II, seven cases of type III, three cases of type IV, and six cases of type V. Intraoperative reduction techniques included closed reduction in 25% of subjects, limited open reduction in 50% and open reduction, augmentation with cerclage wiring in remaining 25%. Radiographic examination using radiological union score of hip (RUSH) was done to evaluate fracture union at monthly follow-up. Our mean time for union was 13.86 ± 3.8 weeks. Functional recovery was evaluated by the Harris hip scoring (HHS) system at 1, 3, 6, and 12 months postoperatively. The mean HHS at 6 months and 12 months were 81.57 ± 12.39 and 87.33 ± 8.2, respectively. Excellent to good functional outcome was seen in 76% of cases. There were two patients with superficial infections, one case of foot drop, and another case of lag screw cut-out. The mean shortening noted at final follow-up was 1.548 ± 0.57 cm. Conclusion: An intramedullary nail is an efficient device for the treatment of subtrochanteric fractures with high rate of bony union provided optimal reduction of the fracture and good positioning of the nail and screws is achieved.

Background: The treatment of intertrochanteric fractures continues to be a challenge in orthopedic trauma, especially in geriatric population. Among the various generations of cephalomedullary nails, proximal femoral nail antirotation II (PFN A-II) is specifically designed for Asian population, with helical blade, modified proximal diameter, and modified mediolateral angle. Aim: The aim of this study was to analyze the functional outcome of patients treated with PFN A-II using Harris hip score, at our institution. The study included 20 patients (11 males and 9 females). Results: Among the 20 patients included in the study, outcome was excellent in 5, good in 11, fair in 4, and this is based on Harris hip score with the minimum follow-up period being 6 months. The average union time was 13 weeks, average Harris hip score was 82.3. An abductor lurch was reported in one patient, postoperative thigh pain in two patients, infection in three patients, and bedsore in three patients.

Introduction: Perioperative and postsurgical hemorrhage is common in invasive surgical procedures, including orthopedic surgery. Tranexamic acid (TXA) is a pharmacologic agent that acts through an antifibrinolytic mechanism to stabilize formed clots and to reduce active bleeding. It has been used successfully in orthopedics to reduce perioperative blood loss, particularly in total hip and knee arthroplasty and spine surgery. Ischemia increases fibrinolysis, related to the proteolytic action of plasmin, with a subsequent fibrinogen scission, which limits postoperative coagulation and favors bleeding. Tranexamic acid being antifibrinolytic acts to prevent this effect from taking place. This study was designed to assess the efficacy of TXA in reducing blood loss and postoperative blood transfusions following the fixation of fracture of both bones of leg with intramedullary interlocking nailing of tibia done by open method. Study design: Randomized, prospective, comparative study. Materials and methods: In this study, patients were randomly allocated into two groups of 25 each. Group I received inj. TXA and group II received inj. normal saline. Preoperative hemoglobin (Hb), postoperative Hb, total blood volume (BV), blood loss, and Hb loss were compared between two groups. Statistical analysis was done with Fisher's t test and Fisher's exact test. Results: The mean blood loss in TXA and placebo group was 249.02 ± 57.04 mL and 543 ± 83.64 mL, respectively, and found to be highly significant (p value < 0.001). A number of patients required blood transfusion were significantly low in TXA group than in placebo group (p < 0.01). Conclusion: This study indicated that TXA results in significant reduction in blood loss (nearly 60%) and amount of blood transfusion required in patients undergoing surgery. Routine administration of TXA may benefit patients undergoing surgery where significant blood loss is expected.

Debate continues in the current orthopedic literature regarding advantages of performing concurrent fibular stabilization in combined distal tibial and fibular fractures. In this case report, we present the correction of tibial malalignment, fibular fixation, and syndesmotic restoration in a 21-year-old male after a high-energy injury where he sustained a fracture of the tibia and fibula at the same level that was initially managed with tibial nailing alone. After initially having delayed union, valgus malalignment and resultant syndesmotic pain and instability following the index surgery, he underwent revision surgery resulting in favorable recovery with cessation of his pain and correction of his malalignment.

Patellar duplication is a rare asymptomatic condition. The diagnosis is often made following a traumatic event associated with an injury to the knee extensor mechanism. The treatment is often surgical and consists of removal of the smaller part of the patella with tendon reinsertion; the case presented here did not have a sleeve avulsion fracture of patella but still developed a osseous lesion resembling patella. The possible theory for this finding could be due to a hematoma formation in Hoffa's fat pad that could have been calcified, then later ossified. This case is being report due to its rare occurrence.

Outcomes of severe aplastic anemia (SAA) have drastically improved over the last decade with most patients being cured after an appropriate therapy. Long-term side effects are hence becoming increasingly important. Avascular necrosis (AVN) is one of such debilitating complications. We hereby report the unusual association of AVN of hip in two pediatric patients who were treated with immunosuppressive therapy (IST) with short course of low-dose steroids and discuss the existing literature.