There are numerous classification systems for fracture neck of femur in adults. A fracture classification is proposed either for taxonomical purpose, characterization, guiding intervention, or predicting outcomes of intervention. The classifications described in this chapter are needed to decide on choice of implant, stability, acceptability of reduction, vascularity and long term prognosis.

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Distal radius fractures are increasingly managed by operative means now. Hence the anatomy and surgical approaches are of utmost importance. Distal end of radius articulates with carpal bones forming radiocarpal joint and distal ulna forming distal radio ulnar joint. Presence of multiple tendons and neurovascular structure makes the dissection of this area difficult. Authors have reviewed the anatomy and surgical approaches of this area.

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Introduction: Cubitus varus (gunstock deformity) is the most common complication of supracondylar fracture of the humerus. Several osteotomies and various fixation techniques are described for its correction. The most commonly used is the lateral closing-wedge osteotomy, also known as French osteotomy with variable results. Persistent lateral condyle prominence leads to cosmetically unacceptable appearance and poor patient satisfaction. To avoid this problem, dome osteotomy is performed. We have evaluated results of dome osteotomy in our population. Material and Methods: This was a retrospective study carried out in our institute. Ten patients with cubitus varus treated by dome osteotomy were evaluated at 24 months. All patients were operated by triceps-splitting approach. Pre- and postoperative carrying angle of elbow, range of motion, and lateral condyle prominence index were compared according to Banerjee criteria. Results: Ten patients with average age of 9.1 years were followed up for 2 years. Mean gap between injury and surgery was 15 months. Postoperative improvement in carrying angle and lateral condylar prominence index was significant. One case developed ulnar neuropraxia, which recovered fully within 2 weeks. Pin tract infection was seen in three cases and skin infections in two cases. Conclusion: Dome osteotomy is a technically demanding surgery. The functional and cosmetic correction is better compared to that for French osteotomy.

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Fracture neck of femur continues to be neglected in rural India. Several salvage options tried in the past are now out of local interest in favor of some sort of arthroplasty. Although the long-term viability of this policy is not known, only the future will guide to a definite path.

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Coccydynia is disabling painful condition resulting from various factors and often not given serious importance. The chronic or recurrent pain affects activities of daily living and overall quality of life. Not only it is a poorly understood disorder with newer findings related to its anatomy, radiology, and the management periodically supplementing the medical literature but also it is managed in casual manner in clinical settings. There are various treatment options in both conservative and operative methods of its treatment and knowledge of which is important for its optimal management. A relevant topical review of recent advances on its management is presented here as handy guide for busy practitioners.

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Nonunion and osteonecrosis are two major problems that lead to revision surgery after treatment of intracapsular femoral neck fractures. Fixation failure and nonunion are the main modes of failure following fixation of displaced or undisplaced femoral neck fractures. The two problems are difficult to distinguish as most displaced fractures take a long time to heal after fixation, which increases the risk of fixation failure. Avascular necrosis of the femoral head occurs in 9%–18% of patients, between 2 and 8 years postfracture. Risk factors include the degree of fracture displacement, patient age, and delay in surgical treatment.

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Undisplaced distal end radius fracture is traditionally managed with conservative treatment, that is, closed reduction and immobilization. This approach has excellent result in undisplaced distal radial fractures and in displaced fractures where stable reduction can be achieved after closed reduction. Subjective results of conservative treatment are as good as the results of operative treatment in patients aged > 65 years at 1-year follow-up. Closed reduction is done mainly with two methods – direct reduction by manipulation and by ligamentotaxis. Immobilization is done mainly by a cylindrical plaster cast. Immobilization of the wrist in neutral radial-ulnar deviation and neutral or slight extension is recommended. Rehabilitation is a very important part of conservative treatment and is started from the day of the first visit in the form of mobilization of adjacent joints and limb elevation. The goal of rehabilitation is to achieve maximum range of motion and strength in the extremity with good fracture healing.

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Introduction: Trauma is the major cause of death and disability in developing country, is responsible for more years of life lost than most human diseases. This study aims to establish the value of a trauma registry by measuring, monitoring, and analyzing etiological factors of common musculoskeletal injuries caused due to several forms of trauma. Materials and Methods: This study has been conducted retrospectively. The patients attending the emergency department in tertiary care hospital were included in this study. Personal data and pattern of injuries sustained were extracted from the casualty admission register of emergency department and trauma unit, case records, and operation records. Results: A total of 6574 injured patients were seen in the emergency department. The most common injury was bony injury (65.38%, n = 4298) and soft-tissue injury 34.62% (n = 2276) and the most common sites were lower limbs in 41.39% of cases, amputation/crush injury in 7.82%, and 32.03% of cases (n = 1377) were of compound fractures. The most common soft-tissue injury was lacerated wound 45.21%. Most commonly associated injury was the head injury in 5.53% of cases. Maximum cases were in the age group of 30-59. Conclusion: Fractures were the most common pattern of injuries frequently associated with other injuries, especially head injuries, particular age group, and time period need special attention, and we need more such institutes near highways.

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Introduction: Platelet-rich plasma (PRP) is promoted nowadays as an ideal autologous biological blood-derived product. It enhances wound healing, bone healing, tendon healing and is currently being widely used. Aims and Objectives: A prospective cohort study was conducted to assess the efficacy of autologous PRP injection and to compare it with corticosteroid injection in the treatment of plantar fasciitis (PF). Materials and Methods: Fifty patients were included in the study and divided into two groups. Group I (25 patients) received PRP injection and Group II (25 patients) were given steroid injection. Patients were clinically assessed at different intervals. Functional outcome was evaluated on the basis of the visual analog scale (VAS) and foot and ankle ability measure (FAAM) scores. Plantar fascia thickness was assessed pre- and post-injection by ultrasound. Results: PRP and corticosteroid injection groups at the initial visit had VAS score of 8.86 and 8.60, respectively, which was reduced to 1.52 and 3.10 at the end of 6 months. The PRP and corticosteroid injection groups at the initial visit had FAAM score of 29.2 and 30.8, respectively, which increased to 84.2 and 68.3 at the end of 6 months. After injection, the PRP group had a significant reduction (34.80%) in the thickness of plantar fascia as compared to corticosteroid group (29.54%). Conclusion: Treatment of PF with PRP extract reduces pain and significantly increases function, exceeding the effect of steroid on long-term follow-up.

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Femoral neck fracture has an annual incidence of 1 per 1000 population; in young patients, functional prognosis is not good due to risk of osteonecrosis. Femoral head vascularity is mostly contributed by retinacular vessels and lateral epiphyseal artery. The vascular impact is due to displacement, interrupting retinacular vessel, interrupting ligament teres vascularization, and increased intracapsular pressure, producing a tamponade effect leading to osteonecrosis. This study reviewed the different methods of assessment of femoral head vascularity after femoral neck fractures. There are many techniques for the assessment of residual femoral head vascularity after femoral neck fractures and for the assessment of post-traumatic osteonecrosis risk. Some invasive techniques are superselective angiography, intraosseous oxygen pressure measurement, or Doppler-laser hemodynamic measurement; others are noninvasive scintigraphy and conventional or dynamic magnetic resonance imaging (MRI). The future seems to lie with dynamic MRI, which gives new classification of femoral neck fractures, based on a noninvasive assessment of femoral head vascularity.

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Failure of fixation is common complication of fracture neck of femur, more common in displaced fractures than in undisplaced fractures. Early diagnosis and treatment of fixation failure is very important for good outcome. Physiological age of patient, status of the hip joint, viability of the femoral head, and presence of occult infection are the factors that should be considered before deciding the suitable salvage procedure. In patients younger than 50 years, preservation of the femoral head is preferred as salvage treatment. Hemiarthroplasty or total hip arthroplasty is the choice of salvage for femoral neck fracture nonunions in physiologically older patients.

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The incidence of hip fractures in children about 1% of total pediatric fractures. The most common cause is a high-energy trauma, such as motor vehicle accidents and falls from a height. In old cases, magnetic resonance imaging (MRI) may be needed to assess the vascularity of femoral head. Hip fractures can have deep impact on the development of hip. Vascularity of femoral head plays a vital role in the management of femoral neck fracture. The paper deals with the cited complications related to femoral neck fracture like avascular necrosis (AVN), nonunion, mal-union, and premature closure of the proximal femoral physis, leading to leg length discrepancy.

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Background: Drilling of the bone is common to produce holes for screws and pin insertion, to fix the fractured parts for immobilization. For this purpose, we need a power drill machine. Power drills used in orthopedic surgery can be categorized into two types: electrical and battery operated. Battery-operated drills could be orthopedic drills or hardware engineering drills. Commercial orthopedic battery drills (OBDs) are very costly. However, the same purpose can be subserved by hardware/engineering battery drill (HBD or EBD), with some additional practical advantages. Purpose: The purpose of this study is to aware the orthopedic surgeons who are working at resource constraint places about the advantages of EBD which is available at a very low price and serves the same purpose. Methods: We are using these battery operated hardware/engineering drills from quite a period of time and we have immense experiences with these EBD. The present article discusses in details about both the OBD and EBD. We assessed both drills by our own practical experience and compared both drills' specifications. Research Performance Place: The present study was conducted at Amandeep Hospital, G. T. Road, Model Town, Amritsar, Punjab, India. +91-98760-02746, 9876046778, E-mail: [email protected] It is a research institute with super specialty and multispecialty offering postgraduation courses and residency with national and international fellowships and observerships. Results: After comparing both the drills, we found that EBD is a very good substitute for OBD in orthopedic surgery in various aspects, namely availability, procurement, functionalities, servicing, and maintenance and is very cost-effective too. Conclusion: Hardware / engineering battery drills are very good and practical alternative to orthopedic drills in orthopedic surgeries. Hence, EBD is recommended for hospitals with limited resources and where treatment cost is an issue. Level of Evidence: 5.

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Femoral neck fracture is considered a medical emergency as an early fixation helps in getting an accurate reduction, preservation of blood supply, removal of tamponade within the capsule, and early mobilization. This article deals with the science of early management of femoral neck fractures.

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Treatment of displaced femoral neck fractures includes internal fixation with/without graft supplementation or internal fixation plus osteotomy or arthroplasty. The literature contains conflicting evidence regarding rates of mortality, revision surgery, major postoperative complications, and function in patients with displaced femoral neck fractures who present delayed, treated either by internal fixation or arthroplasty. The purpose of our study was to summarize the management protocol of fracture of neck of femur when they present at different duration and at different stage.

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Distal radius fractures are a very common fracture. They occur mostly due to fall on an outstretched hand. They represent around 17% of all adult fractures. They occur most commonly in young males due to high energy trauma and older females due to osteoporosis. There are various treatment options available for fracture fixation, such as close reduction and manipulation, followed by cast application, close reduction and external fixator application, close reduction with percutaneous K-wire fixation, and open reduction and internal fixation with distal radius plate. Displaced intra-articular fractures are mostly managed with open reduction and distal radius plate fixation. Different fracture patterns require different types of distal radius plates such as T-plate, buttress plate, and variable angle plate. This article outlines the role of plating in distal radius fractures.

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The fracture of distal radial was first described by Sir Abraham Colles in 1814. In last two centuries, the clinical features, investigative modalities, treatment modalities and complications have been explored extensively. To standardize the treatment, these fractures have been classified in several ways. Here in this article the author has tried to summarise the classifications of distal radius by various authors. It highlights the indications and implications of each classification modality.

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Introduction: Pathophysiology of vertigo in patients having neck pain is not well understood, and many theories have been postulated. Cervical spondylitis is one of the most common causes of neck pain, and these are the group of patients who often complain of vertigo. The role of vascular flow alteration in these patients in causing vertigo is under investigation. We intended to study the vascular flow pattern in the vertebral circulation using color Doppler ultrasound in these patients and compare it with controls. Material and Methods: Fifteen cases and 11 controls were evaluated using color Doppler ultrasound. All these patients were evaluated in detail by the Ear, Nose, Throat and the orthopedics department. The statistical analysis was done by IBP SPSS version 22 software. Independent t-test was performed to compare the case and control groups. Results: The mean intimal thickness of common carotid artery of cases was significantly less than the controls (0.35 mm vs. 0.51 mm for the right common carotid artery and 0.38 mm vs. 0.54 mm for the left common carotid artery, P < 0.05). The diameter of the right vertebral artery (VA) in neutral and left rotation positions was less in cases than in controls, but the difference was not significant, whereas the diameter in the right rotation position was the same both in cases and controls. The blood flow velocity in the right VA was less in the cases than controls, but this difference was not statistically significant. The diameter of the left VA in all the three positions (neutral, right rotation, and left rotation) was less in cases than in controls, and this was statistically significant (P < 0.05) for neutral and left rotation positions. The blood flow velocity in the left VA was less in the cases than controls for all the three positions, but this difference was not statistically significant. Conclusion: 1. Our study demonstrates the role of vascular compromise in the VA circulation in patients suffering from cervical spondylosis and vertigo. Narrowing of VA was present in cases and that too on the left side. The cause behind left-sided predilection could not be ascertained with certainty. Since the difference in blood flow was not significant in cases and controls, a definitive correlation is possible only if the sample size is more and results are replicated 2. Mild relief in symptoms after physiotherapy in the form of transcutaneous nerve stimulation and interferential therapy also points toward a possible role of nerve irritation in causing vertigo in patients of cervical spondylosis. The causation seems to be multifactorial in nature.

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Fat necrosis is an inflammatory process of fat folloing an insult to the adipose tissue. It is more common in the body region here there is high adipose tissue. It can present ith cellulitis, skin necrosis, discharging ounds, and mass. Carcinoma is one of the differential diagnoses of fat necrosis. Our case is presented ith a gluteal mass hich as diagnosed as a hydatid cyst, based on the imaging. Sometimes, imaging fails to identify traumatic fat necrosis, particularly if it is associated ith a capsule ith multiple fat lobules. Postoperative history confirms the encapsulated type of fat necrosis ith fat lobules. Encapsulated traumatic fat necrosis should be considered one of the differential diagnoses of hydatid cyst.

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Background: The aim was to validate the association between Vitamin D level and rheumatoid arthritis (RA); evaluate association of stages of disease activity with various parameters such as serum Vitamin D level, RA factor level, anti-cyclic citrullinated peptide (CCP), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels; and evaluate correlation of Vitamin D with various parameters and Disease Activity Score (DAS)-28 score with various parameters. Materials and Methods: This was a prospective comparative study. The sample size was of 100 patients with 50 each in case and control groups. Investigations such as ESR, CRP (quant), anti-CCP, and RA factor were undertaken for case group. Serum 25-hydroxyvitamin D concentration was analyzed for both case and control groups. Disease activity was measured in patients of RA using DAS-28. Mean of Vitamin D level in case and control groups were measured. Association of different stage of disease activity among cases was calculated with various laboratory parameters. Correlation coefficient of Vitamin D with various laboratory parameters and DAS-28 score with various laboratory parameters calculated. Results: The mean Vitamin D level in case group was 18.726 ng/ml, while in control group, it was 42.851 ng/ml. Association of various stages of disease activity was statistically highly significant for CRP and anti-CCP levels. Vitamin D was negatively correlated with serum ESR, while DAS-28 score was positively correlated with serum ESR, CRP, RA factor, and anti-CCP values. Conclusions: Vitamin D deficiency is more common in RA patients. CRP and anti-CCP markers are associated with disease activity. Moderate-to-strong positive linear correlation present between DAS 28 score & CRP and DAS 28 score & anti CCP values respectively.

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Lateral epicondylitis, or “tennis elbow,” is a symptomatic chronic degeneration of the wrist extensor tendons that involves their attachment to the lateral epicondyle of the humerus. Analgesic, percutaneous, and arthroscopic surgery techniques have been used with no significant difference in the outcome. We report four cases of patients suffering from lateral epicondylitis who received nerve stimulator-guided radial nerve block for pain management. The patients had substantial and extended reduction of pain.

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Purpose: The aim was to evaluate the functional outcome and dislocation rate at a minimum of 1-year follow-up following total hip replacement (THR) using Stryker modular dual mobility (MDM) X3 Mobile Bearing Hip System. Materials and Methods: This was a prospective study. The sample size was twenty patients who had secondary osteoarthritis hip with age <60 years; who had no debilitating disease, neurological motor disease, or any history of hip fracture or infection; and those who had underwent primary uncemented THR. They were evaluated clinically using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Oxford Hip Score (OHS) and radiologically using routine radiographs. Results: The mean OHS at a minimum of 1-year follow-up was 40.40 ± 6.253, whereas WOMAC score was 93.85 ± 3.511. Correlational analysis of OHS and WOMAC score revealed very weak relationship (r = 0.165), and P = 0.486 was considered statistically not significant. Conclusion: The present study demonstrates that short-term follow-up of MDM THR is not worse than what is routinely used in the market.

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Brodie's abscess is an uncommon condition presenting as a subacute type of bone infection leading to localized pus collection. The common clinical presentation ranges from mild pain to serious functional impairment. The judicious radiological investigation helps in early diagnosis in suspected cases. The presence of a well-defined lytic lesion surrounded by sclerotic margins is a typical radiological feature that after exclusion may lead to a provisional diagnosis. The use of magnetic resonance imaging may prove supportive in further characterization of lesions and exclusion of related disorders. Final confirmation requires culture or histopathological evaluation following aspiration or biopsy following surgical drainage. The overall outcome has been good, following the appropriate diagnosis and management. This article attempts to give readers an overview of the reported cases or small series in the last decade (2010 onwards) in PubMed. This shall serve as a recollection of the spectrum of the clinical presentation and management of Brodie's abscess for educative purposes.

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Purpose: The treatment of intra-articular fractures of the calcaneum remains controversial. There is no consensus in the current literature regarding the optimal treatment of intra-articular fractures of the calcaneum. In the current study, we intend to compare the outcome of operative and conservative management for intra-articular calcaneum fractures based on the objective criteria, i.e., restoration of Bohler's angle, subtalar range of motion, and subjective criteria such as pain, return to work, return to physical activity, and change in shoe wear. Materials and Methods: This retrospective cum prospective study was conducted in a government hospital at Patna, Bihar, during the period extending from April 2016 to March 2019. Twenty-four patients with 25 intra-articular calcaneum fractures were included in the study. The outcome of conservative and operative management was compared using the Creighton-Nebraska Health Foundation Assessment Score (C-N scoring system). Pretreatment and posttreatment (at follow-up) Bohler's angle were also compared. Results: Restoration of the Bohler's angle was better with operative management as compared to conservative management. In our study, the results of type I fractures managed conservatively had a better outcome than those of displaced fractures and the difference was statistically significant. Furthermore, type II and type III fractures had a better outcome with operative management, but the difference was not statistically significant. In type IV fractures, operative management was significantly better than conservative management. A significant correlation was seen between the posttreatment Bohler's angle and C-N scores. Conclusions: Conservative management has better functional outcome for undisplaced fractures. For displaced and comminuted fractures, anatomical reduction and restoration of Bohler's angle is very important. Bohler's angle has a prognostic importance and correlates well with the functional outcome.

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