Results of Dorsal Closing Wedge Osteotomy in Freiberg’s Disease

Introduction: Freiberg’s disease, the osteochondrosis of themetatarsal seen in our part of the world, usually at late stages,are refractory to the conservative treatment. Objective:Thepurpose of this study was to evaluate the results of dorsalclosing wedge osteotomy and pin fixation besides debridementand synovectomy.Material and Methods: Twenty patients (14 females,6 Males), mean age 19.3 years; range 14 to 26 years wereevaluated and teated by dorsal closing wedge osteotomy andpin fixation besides debridement and synovectomy, betweenseptember 2016 to 2018 at our institution. The presentingsymptoms were pain on walking or sports, limitation of dailyroutine activities, footwear problems, cosmetic deformitiesof forefoot and failed conservative treatment. Three patientshad a history of trauma. According to Smillies’s classificationtwelve patients were type IV and eight were Type V.Meanfollow-up period was 14.85 months(range 6 months to 24months).Results: Patients were assessed by the lessermetatarsophalangeal interphalangeal (LMPI) scale bykitaokaetal. At the final follow-up, scoring had changed from(44-66) with an average 54.65 to (76-100) with an average85.3. There was no case of infection, avascular necrosis,arthritis or pseudoarthrosis.Conclusion: Treatment of freiberg's disease with dorsalclosing-wedge osteotomy shows satisfactory pain relief andimprovement in quality of life

Observations on AVN Development in Patients of Fracture Neck of Femur Treated with Delayed Fixation

Introduction: Incidence of displaced fracture neck of femuris high and there is lack of consensus over the definitivetreatment of such fractures as the incidence of complicationsespecially avascular necrosis remains very high. Objective ofthe study was to evaluate the incidence of avasular necrosisand its pattern in displaced fracture neck of femur managedwith osteosynthesisMaterial and methods: This study was a prospective studyconducted in Bone & Joint Hospital, Srinagar from 2003 to2018 on patients with displaced fracture neck of femur. Closereduction was done on traction table using Whitman’s Methodand reduction was confirmed under C Arm and was labelledsatisfactory using Lowell’s S Method and fixation was doneusing 3 Cannulated Screws of 6.5mm.Results: 118 patients {70 males and 48 females} with meanage 42.5 years {range 18 to 55 years} presented late in ourhospital which resulted in a delay in fixation from 24 hrs to7 days post trauma. Patients were followed till 2018 for aminimum period of 10 years.Conclusion: Our study suggest same AVN rates as of otherstudies if fixation is done within a period of one week.