Background: Intertrochanteric fracture is a common orthopedic injury sustained in the elderly population because of osteoporosis and trivial fall. Life-threatening systemic complications occur mainly due to immobility. Materials and Methods: We included 62 patients (40 males and 22 females) of unstable intertrochanteric fracture (AO 31 A2 and A3) attending Department of Orthopedics. They were all subjected to surgical treatment with proximal femoral locking plate (PFLP). Patients were followed up at 3rd, 6th, and 12th month for outcome variables, i.e., functional (Harris hip score, Palmer and Parker mobility score) and radiological outcomes (neck shaft angle, loss of reduction, union, and implant-related complications). Statistical analysis was done using Friedman’s test after calculating the data in terms of mean and median using SPSS 20 software. Results: Mean age of our patients was 64 years; 40 were males and 22 females. Fifty patients sustained fracture due to trivial fall and 12 due to road traffic accidents. Thirty-five out of 62 patients had medical comorbidities. Twenty-six patients needed open reduction of fracture and 36 were close reduced. Twenty-two patients had severe comminution (AO A3 III type). Mean degree of loss of reduction was 5° in 6th month and 4° in 12th month. Union was achieved in 48 out of 50 patients at 12th month. Most of the patients achieved fair-to-good functional outcome scores at 12th month of follow-up. We noticed difficulties in fracture reduction as well as complications related to implant. Conclusion: PFLP is an effective implant in comminuted intertrochanteric fractures with broken lateral wall. Complications can be minimized by following the principles of locking plate meticulously.

Introduction: Soft tissue with skeletal infections remains a big problem for orthopaedic surgeons. Bone provides a unique milieu for bacteria, with low vascularity and turnover rate. Biofilm-forming bacteria cause most orthopaedic trauma infections. When biofilm is formed, it protects the microorganism from antimicrobial treatment thus leading to chronic infections. Antibiotic-coated interlocking nail locally releases gentamycin + PDLLA at initial high concentrations followed by a period of constant release. The biodegradable polymer (PDLLA) is excreted from the body through the tricorboxylic acid cycle cycle, combined with gentamycin for sustained release. Materials and Methods: This was a prospective interventional study conducted between September 2018 and August 2020. In this period, we analyzed the hospital records to find out the cases treated by antibiotic-coated intramedullary locking nails. A total of 30 cases of compound tibia fracture were included in our study. Patients were routinely followed at definite intervals and specifically assessed for radiographic and functional evaluation by using the RUST score. Results: Out of 30 patients, radiological union at 6 months using the RUST score was 4 in 10.00% patients, 8 in 13.33% patients, 10 in 23.33% patients and 12 in 53.33% patients and final functional outcome was “excellent” in 53.33% patients, “good” in 23.33% patients, “fair” in13.33 % patients and “poor” in 10.00% patients. Conclusion: Antibiotic-coated tibia interlocking nail yields good functional outcomes with fewer complications in these fractures. Antibiotic tibia interlocking nail is a good treatment option and should be used whenever indicated.

Introduction: Total hip replacement (THR) currently uses a various size of head and bearing. These days the most common head diameter used in the THR is 32 mm. The purpose of our study is to compare the functional and radiographic evaluation of outcomes of two groups of patients undergoing the THR, received either small diameter (≤28 mm) or large diameter (≥32 mm) femoral head prosthesis. Materials and Methods: This was an interventional prospective study done between September 2018 and August 2020. The diameter of femoral head sizes 32 mm and 28 mm was used in this study. At definite intervals, patients were regularly followed and specifically assessed for functional and radiographic evaluation. Results: During follow-up of patients with 32-mm femoral head diameter excellent functional results were achieved as graded by Harris hip score (P < 0.0001). No patients showed any complications in the large diameter femoral head group. Conclusions: Large femoral head diameter prosthesis may lead to more stability, range of motion, wear rate, and reducing the complications of revision surgery, but with small diameter femoral head, there is an increased chance of dislocation, impingement, and more complications.

Anterior knee pain (AKP) is one of the most common clinical conditions related to knee pathology among the athletes and young adults. The identification of pain provoking factor is crucial for the better outcome of the treatment. Many patients with AKP have disabling pain and significant disability, but the physical signs and radiological findings are unremarkable. Its aetiology is still not fully understood, but there are some major factors that can be attributed to its aetiology. Accurate diagnosis of the condition is needed before any decision regarding its management is undertaken. Diagnosis is usually suspected clinically and is confirmed by imaging. Although, radiography, ultrasonography, computed tomography scan and magnetic resonance imaging (MRI) are the available modalities for the evaluation of AKP, MRI is considered the gold standard for pain imaging and can provide important information regarding individually tailored treatment. The present study is a prospective descriptive compilation of the role of available imaging modalities, particularly MRI in the evaluation of different pathological conditions related to AKP. The present study demonstrated that patellofemoral instability was a major cause for origin of AKP.

Anterior cruciate ligament (ACL) injury is more common in men than women. Variable loop cortical suspensory fixation is an excellent graft fixation device, which provides an option for further tightening the graft even after the tibial end fixation is done if the surgeon feels it is needed. At 3-month follow-up, ACL reconstruction using the novel variable loop cortical suspensory fixation device granted an improvement in mean LYSHOLM score from 19.91 preoperatively to 85.59 at 3-month follow-up, which is a statistically very significant clinical and functional outcome. The principal advantage of the ACL reconstruction using variable loop cortical suspensory fixation is that it uses the ability to re-tension the graft after tibial fixation. A taut ACL construct is crucial during postoperative rehabilitation to reduce the risk of knee instability and re-rupture of the ACL graft. We conclude that the technique described here is a simple, robust, and effective approach to minimize graft laxity, and thereby leave a snug ACL construct. In addition, re-tensioning of the graft after tibial fixation eliminates the need for a posterior drawer on the knee, as the resulting laxity will be removed with re-tensioning.

Introduction: Uncemented total hip arthroplasty is a time-tested remarkable surgical procedure that provides mobility, stability, and better quality of life for thousands of patients, especially young patients throughout the world. Thus, uncemented total hip arthroplasty today has become the main mode of hip replacement, especially in young patients. However, uncemented total hip arthroplasty has its own drawbacks such as inadequate initial fixation, excessive wear, and periprosthetic bone loss due to particle-induced lysis. Materials and Methods: This prospective study was conducted between September 2018 and August 2020. A total of 30 patients were selected from patients attending emergency department and outpatient department of orthopedics. For all prospective cases, a detailed history regarding mode and mechanism of injury (in case of trauma) was taken followed by clinical examination, and the patient was documented. Follow-up visits were made at 3 months, 6 months, 1 year, and periodically thereafter. Results: In our study, functional outcomes after uncemented total hip replacement were excellent in 30% of cases, good in 53.33% of cases, fair in 13.33% of cases, and poor in 3.33% of cases by using Harris Hip Score. No patients showed any radiographic signs of loosening. No patients showed any complications during follow-up. Conclusion: In our study, the results are fair to poor in noncompliant young patients with high functional demands. The results are fair to poor in patients with bilateral affections such as chronic arthritis and avascular necrosis in which the patient undergoes only unilateral total hip arthroplasty.

The ischial tuberosity and ischiopubic ramus represent one of the rarest sites of giant cell tumors of bone. A rare case is presented here. The unusual site and characteristic features of giant cell tumors and current treatment options are reviewed.

Quadriceps tendon rupture is an unusual injury, mostly occurring in the middle-aged population involved in athletic activities. Patients with such injuries present with a history of trauma, which may be direct or indirect, associated with swelling and inability to actively extend the knee. When associated with minor trauma, the concurrent presence of chronic diseases and the long-term use of certain medications should be looked for. Neglected traumatic quadriceps tendon rupture is very rare. Our patient presented with a neglected quadriceps tendon rupture of the left knee due to injury sustained 6 months. Consent was taken from him to be used as a case report. The patient had full recovery after surgery and physiotherapy. The index case report is important as the patient had delayed presentation in such a rare injury.

A 33-year-old male presented to our casualty department with pain and swelling accompanied by bony deformity over bilateral elbows post an episode of high-energy trauma. Plain radiographs and 3d-CT were done which showed Terrible Triad injuries to both the elbows. Different surgical managements were planned and executed in both elbows according to the fracture patterns. The postoperative period was uneventful and the patient was under continuous follow-up. At the 1-year follow-up patient showed good radiological and functional recovery.

Tramadol is a synthetic analgesic used for the treatment of moderate to severe pain with a dual mechanism of action. Although Tramadol-induced seizures are reported in the literature, however, the incidence is rare with its use in therapeutic dosage. Bilateral symmetrical anterior dislocation following a seizure is an unusual complication. We present a rare case of bilateral symmetrical anterior shoulder dislocation following Tramadol-induced epileptiform reaction in an otherwise healthy adult male. The dislocations were diagnosed early and reduced immediately with a satisfactory outcome. An awareness of this entity and a high index of suspicion are required to make an early diagnosis and offer prompt treatment in order to avoid unpleasant complications.

Background: Monteggia fracture-dislocation is a rare entity in adults with an incidence of less than 1%. However, a combination of fracture shaft humerus with distal intraarticular extension along with monteggia fracture-dislocation in an ipsilateral upper limb is very hard to find and manage, owing to its rare presentation. Materials and Methods: In this report, we detailed the surgical management of comminuted fracture(splinter) of shaft humerus with intercondylar extension AO C2 with typeII monteggia fracture-dislocation with the usage of proper implants in a 25year old male with a 3 year follow-up. Result: It shows that the fracture united well at the appropriate period and the elbow range of movements was satisfactorily ranging from 20° to 130° with no limitation in supination and pronation. Conclusion: Such complex elbow injuries are difficult to find in the literature. This study addresses the proper surgical management in terms of approach and usage of appropriate implants to improve the long-term functional outcome when dealing with such injuries.

A 12-year-old male patient came to our outpatient department with a complaint of pain in the left hip region after he slipped and fell on a wet floor while playing at school. The symptoms were pain left the hip region with functional impairment, difficulty in walking, tenderness on inguinal region palpation, and restricted hip movements. The X-ray and computed tomography scan showed an avulsion fracture of the left lesser trochanter. The treatment included rest, immobilization, analgesia, and non-weight bearing. After a 9-month follow-up, the patient had a completely normal range of motion and was fully able to do all his daily activities

In this case report, we present a young adult presenting with a traumatic elbow dislocation with an entrapped osteochondral fragment. An initial diagnosis of traumatic elbow dislocation with entrapped medial epicondyle was made but later on it was found to be an osteochondral fragment detached from the olecranon fragment. The patient required surgical intervention to restore a congruent and stable elbow joint. This case report is novel as the elbow dislocation with osteochondral fragment entrapment is occurring in an adult; at the same time, the fragment belongs to the olecranon, and cases of which have not been reported yet.