Background: Fracture of the proximal humerus is the commonest fracture affecting the shoulder girdle in adults. Neer's 2, 3, and 4 part fractures are managed by operative fixation. Proximal humeral internal locking osteosynthesis (PHILOS) plate fixation is the treatment nowadays. However, accurate reduction of greater and lesser tuberosities may not be possible with a plate alone, which may lead to avascular necrosis of the humeral head. Transosseous suture fixation can accurately reduce the greater and lesser tuberosity fragments to shaft and head, but cannot maintain the reduction. A combination of transosseous suture fixation with PHILOS plate may be a viable option. Objective of Study: Our study was to evaluate functional outcome of transosseous sutures along with PHILOS plating for patients with proximal humerus fractures. Materials and Methods: The study was done as a prospective observational study of 40 consecutive patients with proximal humerus fractures, managed with transosseous suturing aided PHILOS plating. They were followed up for 6 months and evaluated using Constant Murley Scoring system. Results: The mean age of our patients was 52.86 years. The mechanism of injury was due to road traffic accident in 42.5% (17) and domestic falls in 57.5% (23). There were 20% two-part, 52.5% three-part, and 27.5% four-part fractures. Overall functional outcome was found to be good to excellent in 77.5% of our patients. The mean Constant Murley score achieved was 80.35. We found that patients with Neer's two-part and three-part fractures had the highest Constant scores (88.1 and 79.7. respectively) while patients with four-part had the lowest Constant scores (76). Patients <60 years showed better results. Conclusion: Transosseous suturing-aided PHILOS plating can be an excellent treatment option for osteosynthesis of complex proximal humerus fractures allowing early mobilization and good functional outcome. Transosseous suturing along with PHILOS plate can counteract the varus forces which can reduce complications such as late fracture displacement and avascular necrosis. There is no need for additional hardware, fibular graft, or exposure for the combined procedure to achieve a good outcome. Thorough knowledge of anatomy, proper fracture reduction and proper placement of locking plate are equally important for a superior outcome in these difficult fractures.

Study Design: Observational study. Objectives: To investigate the correlation of Short Form Health Survey (SF-36) score with various relevant clinical scoring systems, in patients with degenerative lumbar spinal stenosis (LSS). Materials and Methods: Eighty-two patients aged more than 40 years with clinicoradiological features suggestive of degenerative LSS were enrolled. All patients completed 10 clinical scoring questionnaires, which included SF-36, Oswestry Disability Index, Swiss Spinal Stenosis (SSS) Questionnaire, Quebec Pain Disability, Visual Analog Scale (VAS) (back pain), Modified Japanese Orthopaedic Association (mJOA), Pain Disability Index (PDI), Self-paced Walking Test (SPWT), VAS (leg pain), and Neurogenic Claudication Outcome Score. A comparison of 8 health concepts of SF-36 and health change was done with other 9 clinical scores and they were statistically analyzed and correlated. Results: The mean age was 53.02 years and included 51 females (62.2%) and 31 (37.8%) males. Out of 8 health concepts, 3 of them, pain, emotional well-being, and energy/fatigue, showed a statistically significant moderate correlation with 6 clinical scores (SSS, QPD, VAS back pain, mJOA, PDI, and SPWT) (P < 0.05, r > 0.3). The mJOA scale showed a moderate negative correlation with 4 other components also namely, role limitations due to physical health, role limitations due to emotional problems, social functioning, physical functioning as well as health change (P < 0.05, r > 0.3). Role limitations due to physical health had a moderate negative correlation with QPD scale also (P < 0.05, r > 0.3). Conclusions: Pain, emotional well-being, and energy/fatigue showed a moderate correlation with maximum number of scores and mJOA scale had a moderate negative correlation with 7 out of 8 components of SF-36 as well as Health change.

Introduction: Lumbar stenosis is a common disorder, commonly occurring at L4-5, with up to 91% of patients having neural compression at this level. Degenerative spinal stenosis with or without instability requiring multilevel spine surgery is associated with large blood loss. Tranexamic acid (TXA), a synthetic antifibrinolytic drug, has been reported to reduce blood loss in orthopedic surgery, but there have been few reports of its use in spine surgery. The objectives of the study were to assess the efficacy of TXA in reducing perioperative blood loss and assess the complications associated with its administration and need for blood transfusion during posterior lumbar spine surgery for lumbar canal stenosis (LCS). Methodology: Between November 2018 and August 2020, 130 adult patients (age 18–70 years) with LCS undergoing posterior lumbar instrumented spinal fusions at our institution were divided into TXA and control groups. Outcomes assessed are intraoperative blood loss (IOBL) and postoperative blood loss (POBL), hematocrit, need for allogeneic blood transfusion, and complications such as deep vein thrombosis, myocardial infarction, stroke, and seizures postoperatively. Results: There was a statistically highly significant reduction in the mean IOBL, POBL, mean postoperative hemoglobin, and postoperative packed cell volume in the tranexamic group compared to the control group. There was no significant statistical difference in need for blood transfusion among the two groups. No complications were observed in either group associated with administration of TXA. Conclusion: Prophylactic use of low-dose TXA provides an effective and safe method for reduction of blood loss during and after LCS surgeries. Low-dose TXA does not significantly affect the duration of surgery or need for blood transfusion. Higher-level multicentric studies are required to evaluate the safety of TXA in multilevel lumbar spine surgeries.

Background: Proximal humeral fracture, whether caused by trauma or osteoporosis, requires meticulously planned individual treatment. The technique and devices used are determined by the quality of bone and soft tissue, age, and reliability of the patients. The purpose of this study is to evaluate the functional outcomes and complications of surgical neck humerus fractures (two part and three part) treated by percutaneous K-wire fixation and PHILOS plating. Methodology: The study includes patients with proximal neck humerus fractures (two-part and three-part) according to Neer's classification who underwent open reduction and internal fixation with a PHILOS locking plate and percutaneous K-wire fixation. Functional outcomes and complications were evaluated by the Shoulder Constant score (SCS). Patients were followed up at 1, 3, and 6 month intervals until fracture union. In this study, a total of 76 patients were chosen and divided into two groups, i.e., Group A and Group B, each comprising 38 patients. Patients of Group A were treated with ORIF PHILOS plating and patients of Group B were treated with closed reduction and internal fixation (CRIF) percutaneous K-wire fixation. Results: ORIF PHILOS plating was used on 20 (26%) of patients who had an excellent SCS. 10 (13%) patients exhibited a good grade, 5 (6%) patients had a fair grade, and the remaining 3 (4%) patients displayed a poor grade. In Group B, 12 (16%) of patients treated with closed reduction with K-wire fixation had excellent grades, 7 (9%) patients had good grades, 16 (21%) received fair grades, and the remaining 3 (4%) received poor grades. After comparing both treatments, a P value was found to be 0.0403, which shows Group A was more efficient than Group B. Conclusion: The results of our study concluded that, as compared to ORIFPHILOS plating treatment with the CRIF K-wire fixation treatment has poor functional outcomes and a high failure rate. In addition, the surgical treatment of proximal neck humerus fractures (two part and three part) in both groups showed that the PHILOS plating provides an excellent way to achieve the goal, including time of union, fewer complications, and good functional outcomes as compared to percutaneous K-wire.

Background: Degenerative spondylolisthesis is one of the most common causes for low back ache and radiculopathy and causes disability. Various surgical procedures have been described to achieve fusion. Intertransverse fusion (ITF) is the simplest of all with very less rates of complications. Objectives: The objective of this study was to analyze the outcomes of posterior instrumentation with pedicle screws, decompression, and ITF in degenerative lumbar spondylolisthesis based on the clinical outcome with Oswestry Disability Index (ODI) questionnaire and also to assess the fusion rates. Materials and Methods: A single-grouped, prospective interventional study was conducted from June 2015 to June 2019 in a tertiary care hospital. A total of 44 patients with Grades I and II degenerative lumbar spondylolisthesis of the Meyerding radiological grading system were included in the study. Posterior instrumentation with pedicle screws, decompression, and ITF was performed in all these patients. Patients were assessed preoperatively and postoperatively using ODI-based questionnaire. Results: The mean preoperative Oswestry score was 58.33 ± 10.66 and the mean postoperative score was 24.26 ± 12.80 at 1-year follow-up. Fifty percent had excellent and another 50% had better results with overall 100% satisfactory results, with a mean preoperative and postoperative difference of 34.07 ± 18.00 for ODI. All patients achieved radiological fusion. Conclusion: The study observed that ITF for Grades I and II degenerative lumbar spondylolistheses is a safe and simple fusion procedure with lesser rates of complications and higher rates of radiological fusion.

Background: With increasing road traffic accidents, cervical spine injuries are a major health hazard in the developed as well as the developing world. Over the years, the National Emergency X-radiography Utilization Study (NEXUS) low-risk criteria and the Canadian cervical spine rules (CCRs) have acted as primary guidelines in emergency departments around the world to decide on the need for cervical spine X-ray in emergency settings. The aim of this study was to retrospectively analyze the efficiency of both the NEXUS low-risk criteria and CCR in confirming positive cervical spine injuries in emergency department settings. Aims and Objectives: The aim was to retrospectively analyze the efficiency of both the NEXUS low-risk criteria and CCR in confirming positive cervical spine injuries. Methods: A retrospective study involving 631 patients for 4 years aged above 18 years, who underwent a cervical spine X-ray from June 2018 to June 2022, were included in the study. From the eligible case records, the data pertaining to the NEXUS low-risk criteria and CCR were recorded. Along with this, the final diagnosis regarding the cervical spine injury, confirmed by subsequent computed tomography (CT) scan or magnetic resonance imaging (MRI), was also recorded. Results: The NEXUS low-risk criteria and CCR were met in 92.7% and 98.6% of the patients, respectively. The cervical spine X-rays were normal in 87.8% of the patients, fractures were recorded in 9.5% of the patients, and in 2.7% of the patients, doubtful lesions were present, which needed additional investigations in the form of CT scan or MRI or both. Conclusion: Both the Nexus and CCR guidelines act as a good guiding light in deciding about the need for the cervical spine X-ray in the emergency setup. Both guidelines are effective in ruling out cervical spine injuries in the majority of cases.

Context: Vertebral compression fractures are the most common osteoporotic fracture in old age group causing incapacitating pain and producing significant disability. Approximately one-third of these patients do not respond to traditional conservative treatments. Percutaneous vertebroplasty (PV) is a minimally invasive treatment option being increasingly used and traditionally being done using polymethyl methacrylate (PMMA), but it has some disadvantages. Calcium phosphate cement (CPC) is a new entity with many benefits over PMMA such as it being biodegradable, little or no heat generation during polymerization, and remodeling into healthy bone. Aims: The aim of this study was to analyze the functional outcome, restoration of wedge angle, and vertebral height after vertebroplasty in osteoporotic vertebral wedge compression fractures. Subjects and Methods: In our study, a total of 21 symptomatic patients (between 55 and 80 years of age), refractory to conservative treatment, having kyphosis and vertebral wedge collapse were included in the study. Pre- and postoperative comparisons were done clinically (Oswestry Disability Index and Visual Analog Scale [VAS] score) and radiologically. Statistical Analysis Used: SPSS software version 22.0 was used for statistical analysis. Results: Preoperatively in all patients, Oswestry disability score was >60% and VAS score >7 indicating severe disability. On subsequent follow-ups at 15 days, 1 month, 3 months, 6 months, and 9 months, we found a significantly reduced VAS score (<2) and Oswestry disability score (<20%) in 19/21 (90%) patients indicating very minimal residual disability in majority of the patients. Conclusions: Our study shows that PV using CPC is a promising new procedure with the benefits of quick improvement in mobility, decreased pain-related doctor visits, decreased nonsteroidal anti-inflammatory drugs usage postoperatively, and overall increased quality of life.

Introduction: Thromboangiitis obliterans (TAO), also known as Buerger's disease, is a disease of unknown etiology affecting small- and medium-sized blood vessels, mainly seen in heavy smokers. The characteristic features of this disease are distal ischemia, with patients having claudication, rest pain, and toe ulcers. The proper management of TAO is still a challenging problem. Various medical and surgical treatments have been tried with a variable success. Since it is a disease characterized by chronic ischemia, achieving neoangiogenesis could have a beneficial effect. Ilizarov has shown that corticotomy and distraction of bony fragments can increase the blood supply to the entire limb. TAO can be managed using this principle of distraction osteogenesis to induce neoangiogenesis. We conducted this study to evaluate the clinical outcomes of longitudinal tibial corticotomy and horizontal distraction with Ilizarov's fixator in Buerger's disease of the lower limb. Materials and Methods: Ten patients with clinically and radiologically proven Buerger's disease admitted to our hospital between 2019 and 2021 who had failed the conservative pharmacological modalities of treatment were included. A lateral tibial corticotomy and distraction was performed by the use of olive wires and two-ring frame with horizontal distraction mechanism. Lateral distraction was started after 10 days at the rate of 0.25 mm 6 h for 25 days to achieve a distraction of 2.5 cm. The frame was removed after consolidation of regenerate. Results: Of the 10 cases, eight patients became pain free, while one had a partial relief of pain and one patient worsened on treatment and underwent below-knee amputation. Three patients had at least one episode of pin site infection which improved with oral antibiotics and dressings. One patient had delayed consolidation of regenerate. The claudication distance improved at each follow-up for all but one patient. Conclusion: Neoangiogenesis by corticotomy and distraction offers a relatively simple and cost-effective surgical option to salvage ischemic limbs from amputations and provide pain relief, ischemic ulcer healing, and improved claudication distance, thus improving the quality of life.

Background: Lateral epicondylitis is the most common chronic disabling painful condition affecting 1% to 3% of the population predominantly those between 35 and 55 years of age. Elbow pain with tenderness and restricted wrist extension is its common manifestations. Although a few conservative methods of treatment are available, recent studies have suggested platelet-rich plasma (PRP) to be a safe and effective therapy in relieving pain and improving function for tennis elbow. Aim: This study aims to study the efficacy of autologous PRP in tennis elbow. Materials and Methods: A prospective observational study was conducted in our hospital. Fifty patients with chronic lateral epicondylitis aged above 18 years were included in the study. All the patients had a minimum of 3 months of symptoms, were selected based on the inclusion and exclusion criteria and underwent the same method of treatment. All patients had a baseline assessment of numerical pain score and were repeated at 2 weeks, 4 weeks, 8 weeks, 3 months, and 6 months posttreatment. The PRP was prepared from venous whole blood. All patients had a single-dose injection of autologous PRP in their extensor tendons at the elbow through a peppering needling technique. Results: The patients were more often successfully treated. When baseline numerical pain scores were compared with those at 8 weeks, 12 weeks, and 24 weeks follow-up, they showed improvement over time. There were no complications observed related to the use of PRP. The difference between 1-, 2-, 4-, and 6-month pain reduction was tested for significance by Friedman's test and found that there was no significant difference in pain reduction between 2 months and 3 months, 2 months and 6 months, and 3 months and 6 months scores. However, there was a statistically significant difference in pain score in 1 and 2 months. Duration of symptoms suggests the chronic nature of disease. In this study, analysis was done based on the duration of symptoms. Thirty-two out of the 50 patients had pain for <6 months, 16 out of 50 patients between 6 and 12 months, and 2 out of 50 had symptoms of >1 year. In our study, it was found that mean pain score at the end of 6 months for patients with symptoms <6 months was 0.59, whereas the mean pain score of patients with symptoms from 6 to 12 months was 1.81. This indicates that duration of symptoms had a significant correlation with the clinical outcome after injection. Conclusion: Autologous PRP injection is a safe and useful modality of treatment in the treatment of tennis elbow. Maximum benefit after PRP injection was observed at 2 months and had sustained for at least 6 months. More trials are required to optimize the technique for separating PRP. These improvements were maintained over in our follow-up period without any significant complications. Long-term follow-up with more number of patients is needed to evaluate the lasting benefits of pain relief and functional improvement in lateral epicondylitis.

Background: Many studies show a high prevalence of Vitamin D deficiency across various populations the world over. This cross-sectional study was carried out to assess the prevalence of Vitamin D deficiency in a district located in central Haryana. Aim: The aim is to study the prevalence of Vitamin D deficiency in a district of central Haryana across various population characteristics such as gender, education, locality, occupation, and dietary habits. Materials and Methods: Healthy volunteers (n = 300) of either sex were enrolled and their fasting plasma samples were tested for 25-hydroxy Vitamin D (25 [OH] D) levels. Data were compiled as percentages and means across different population characteristics. Statistical analysis was done using Chi-square test and Fisher's exact test. Results: A high overall prevalence (90%) of Vitamin D deficiency was observed in the study subjects. There was a significant difference in the prevalence of Vitamin D insufficiency between rural and urban subjects (P < 0.05) and among the subjects pursuing different occupations (P < 0.05). Conclusions: There seems to have a high prevalence of Vitamin D deficiency in the population of a small district located in central Haryana. Lower prevalence is displayed by those subjects who have greater opportunities for sunlight exposure, such as rural individuals, farmers, and housewives.

Introduction: Knee osteoarthritis (OA) degenerative condition causes progressive wear in the articular cartilage and rises pressure over the medial compartment of the knee joint which will end up as a varus deformity. High tibial osteotomy (HOT) is one of the surgical managements in treatment of OA. The goal of the treatment is to relieve medial compartment knee pain and slowdown the arthritic progression. Materials and Methods: This prospective observational study was done on 20 patients of all ages and both genders having medial compartment OA with varus deformity of all grades over 24-month duration. Functional evaluation was done by the Knee Society Score, functional score, and the Lysholm score, whereas radiological evaluation was done by calculating various angles in orthoroentgenogram. Results: All the function scores hold high statistical significance. Changes in hip knee axis (HKA), medial proximal tibial angle, and tibial joint angle were statistically significant. All osteotomy sites consolidated in 6 months with not a single case of nonunion. Conclusion: HOT is an effective technique and has excellent functional and radiological outcomes with minimal complications in the management of OA. Appropriate patient selection, proper osteotomy type, and precise surgical techniques are essential for the success of HOT.

Introduction: One of the important factors that promote wound site dryness is the dressing material used. Sanitary napkins have been tried in the past for dressing of wounds in the postoperative period to effectively absorb fluids and secretions. This study was conducted to compare the effectiveness of sterile sanitary napkins when used as dressing in the immediate postoperative period for hip region surgeries in terms of efficacy and cost effectiveness. Methodology: Adult patients aged 18 and above (male and female) undergoing surgeries in the hip region were included in the study and grouped into three groups based on the type of dressing applied in the postoperative period. Results: The total cost of dressings was found to be the highest (>250 rupees) in group receiving commercial dressing compared to the most economical in Group A (sanitary napkins). The presence of soakage was found to be the highest in group getting conventional dressing. Conclusion: Sanitary napkin is a novel innovative option for dressing, being very economical, readily available, easily sterilizable, and can be used in hospitals in remote areas too.

Context: Partial finger amputations are commonly encountered in the emergency room and are often inadequately treated. Aims: The aim of this study was to compare and evaluate the results of wound debridement, followed by primary wound closure with multiple percutaneous hypodermic needles versus closure with monofilament nonabsorbable sutures. Settings and Design: Comparative prospective study on the management of partial amputations of fingers was conducted in patients between 18 and 60 years at a tertiary care center. Subjects and Methods: We compared two different techniques of management of fingertip injuries. Group A comprised percutaneous hypodermic needling. Group B included suture technique using monofilament nonabsorbable suture. Patients not willing to participate, crush injuries, injuries involving more than 80% of digit circumference and digital arterial injury, complete amputation, and finger injuries with polytrauma were excluded from the study. Statistical Analysis Used: Data were analyzed using SPSS version 21. Results: The right hand (dominant side) was involved more commonly in both groups. Secondary procedures, infection rate, healing time, and the cost of the procedure from primary procedure to complete healing of the digit/s were all higher in Group B. Final appearance of the digit(s) based on skin color was better in Group A. Conclusion: Percutaneous hypodermic needling technique is a simple, novel technique which provides a better result in comparison to suture technique in terms of the requirement for secondary procedures, wound healing time, infection rate, cost of the overall procedure, and the final appearance of the digit on complete healing.

Introduction: Due to the shifting of weight more on the medial side of the knee, more cartilage destruction occurs medially, and subsequently, varus deformity occurs. A corrective osteotomy to alter the weight-bearing axis will be ideal to slow down the degenerative process. The success of an osteotomy around the knee depends on the biomechanics of the lower extremity, load distribution in the knee, and also on the mechanical properties of the implants used for osteotomy fixation. The aim of the study is to know the functional outcome of open-wedge high tibial osteotomy in medial compartmental osteoarthritis of the knee joint. Materials and Methods: This prospective study was done at the tertiary center of Bihar between May 2016 and September 2018. Bilateral weight-bearing anteroposterior view in full extension and standing scannogram was taken preoperatively. Patients were operated and evaluated at 3, 6, and 12 months by the Japanese Orthopaedic association knee score and Japanese Orthopaedic association system. Results: Medial opening-wedge osteotomy was performed in 26 knees of 24 in which there were 10 male and 14 female patients. Of the 26 knees operated, 16 were of the left side and 10 of the right side. Of the 26 knees operated, 6 (23%) had excellent outcome, 12 (47%) had good outcome, 4 (15%) had fair, and 4 (15%) had poor outcome. The poor result of three patients was correlated to superficial infection and the other patients due to inadequate correction. Five patients had superficial infection and one patient had hardware prominence causing pain and two patients had under correction of varus. Conclusion: From this prospective study, it can be concluded that medial open-wedge high tibial osteotomy is a useful option in medial compartmental osteoarthritis of the knee joint and relieves pain and improves functional outcomes in patients.

Introduction: In India, majority patients with musculoskeletal injuries are attended by traditional medicine treatment provider. Bone setting services data from Subcontinent is not available. Methods: Prospective epidemiological study across 10 cities. Objective: To document bonesetter's spectrum of services and work-based information; radiological services use, treatment methods, treatment cost, treatment duration, referral timing, complication incidence and success rates. Results: Study encompasses 915 Traditional Bone Setters working over area of 6725 km2. Meerut houses most bonesetters (n=130); industry dominated by men (98.5%). 55% bonesetters are of 51-70 years. Overall experience 53.75 years. 9.50 % Bonesetters have radiograph machines. 55.95% practicing bonesetters are 3rd generation lineage. 32.67% bonesetters prescribe allopathic medications. For treatment, Males visit more (55%) followed by Females (25%) and Third gender (15%) patients. Patients age group 5-94 years. 22.4 patients visit each bonesetter daily. An average treatment lasts 4-5 sessions; treatment cost 300-400 Indian Rupees per sitting (3.60-4.80 USD). Patient report 2.75 days post injury & treatment lasts 14.5 days. 90% Bonesetters take time till 3rd bandage (9-10days) to decide on referral. Patient's satisfaction is 64% and 45% complication rates. Discussion: Traditional Bone Setters form largest specialised group offering services for musculoskeletal injuries in India; attracting 25-40 patients per practitioner daily. High complication and referral rates are worrisome. Conclusion: Clientele visiting bonesetters form major chunk of patients that should be treated by Orthopaedic Surgeons. Policies should be made to integrate bonesetters into structured health services; to benefit community at larger scale with fewer complications and man hours lost to work.