Percutaneous elevation of proximal tibia depressed fractures using modified new instrument.

Proximal tibia depression fracture often occur isolated or in conjunction with complex fracture presentations and elevation of such depression is required to retard arthritis in long term. Conventional open reduction by sub meniscal approach has many percutaneous alternatives from arthroscopy assisted reduction to balloon tibioplasty. Few authors even reported usage of PCL jig and percutaneous pins to elevate, while the primary author has previously described an instrument to elevate the depressed fragment percutaneously. With the shortcomings of the same instrument, authors have designed modifications in the same to address anterior and posterior extensions of depression without widening the metaphyseal window. In this article, we describe the size and concept of the modified design and its efficacy to address depression injuries.

The Masquelet technique in an extruded talus injury after open peri-talar dislocation-A case report.

Extruded talus is a rare injury pattern that occurs following a high velocity injury loading on a supinated and plantar flexed foot. Treatment for such rare presentation varies from talectomy to arthrodesis. Reimplantation than excision has been favoured in literature, but it carries its own subset of issues to tackle from avascular necrosis to infection. Masquelet technique has been a saviour for open injuries most of the time in tackling both bone defects and infections. We present a case of open ankle injury with talar extrusion and assosciated talar bone loss along with calcaneum fracture, treated by masquelet technique.

Menopause-Related Quality of Life among Urban Women of Hyderabad, India.

BACKGROUND: Menopause is regarded as the marker for various symptoms such as physical, psychological, vasomotor, and sexual impairing the quality of life (QOL). OBJECTIVES: To assess the menopause-related QOL and determine associated factors among postmenopausal women. MATERIALS AND METHODS: A cross-sectional study was conducted among 378 postmenopausal women attending the obstetrics and gynecology department of a tertiary care hospital using a standardized menopause-specific QOL (MENQOL) questionnaire consisting of physical, vasomotor, psychosocial, and sexual domains. RESULTS: The study included 378 women aged above 40 years, with majority belonging to the age group of 46-50 years. The total MENQOL mean score was found to be 19.35 ± 16.20, with physical domain score the highest 14.89 ± 11.85, followed by vasomotor 1.98 ± 3.83, psychosocial 1.82 ± 3.29, and the least as sexual domain with score of 0.624 ± 2.21. Post menopausal women with age less than 50 years, No formal education, High socio-economic status, Home makers and duration of menopause less than 5 years was found to have statistical significant association with higher vasomotor domain score; No formal education, higher socio economic status and duration of menopause with greater than 5 years was found to be significant with higher sexual domain scores. CONCLUSIONS: Menopause may be associated with a decrease in QOL. Certain sociodemographic variables showed a statistically significant association with the vasomotor and sexual domains. Awareness and interventions that affect the modifiable factors may help in increasing the QOL at menopause.

A Case Report of Osteomyelitis of Lower End of Tibia and Fibula as a Complication of Elastic Rubber Band Syndrome (Dhaga Syndrome).

INTRODUCTION: Rubber band syndrome is a rare acquired condition poorly discussed in literature, when neglected can lead to devastating complications of compartment syndrome and infection of soft tissue and bone as seen in the present case. Rubber band or Dhaga (sacred thread) when worn for prolonged duration can bury into the skin and soft tissue. CASE REPORT: A 12-month-old girl developed osteomyelitis of tibia and fibula as sequelae of misdiagnosis and treatment for this syndrome. Assuming it to be a simple constriction band, incisions were given on medial and lateral aspect of the ankle, later she developed osteomyelitis of the tibia and fibula with in buried rubber band, which was removed and thorough curettage done and achieved good healing of the bones. CONCLUSION: Rubber band syndrome in not an uncommon condition, but when neglected or misdiagnosed can lead to complications such as compartment syndrome and osteomyelitis of the bones in involved limb as seen in this case. In suspected cases, imaging with sonography and X-ray of involved helps in diagnosis.

Articular disimpaction in acetabular fractures.

Acetabular impaction fractures when not adequately addressed leads to early arthritis. Dome impaction injuries and marginal impaction injuries have to be properly planned pre-operatively with respect to surgical approach, disimpaction techniques and fixation strategies. CT scan is the best modality to analyse the site, extent of impaction and plan strategies to reduce. Emphasis of early mobilisation should not drive the surgeon towards the motive of rigid fixation of columns alone, as the inadequate reduction of acetabular impaction leads to loss of mechanical support on weight bearing and thereby cause loss of reduction. Bone grafting either by auto or allograft or graft substitutes in the void after disimpaction helps in reducing anatomically and provide mechanical support adequately. In cases of severe comminution, reconstruction of the wall defect with autologous graft is a better treatment option. In this article we reviewed the characteristics of impaction injuries of acetabulum exploring surgical procedures, approaches and techniques for achieving open reduction and internal fixation.

Management of subtrochanteric fractures by nail osteosynthesis: a review of tips and tricks.

INTRODUCTION: Subtrochanteric fractures of femur remain most challenging injuries faced by orthopaedic surgeons. The implant choice shifted from extra medullary to intramedullary nails over the last two decades. Effort to achieve anatomical reduction before nail insertion for better outcomes has been emphasized well in literature. We reviewed various surgical techniques for reduction of fracture in more biological way that can be used to overcome the deforming forces of the muscles acting on fracture fragments. CONCLUSION: Regardless of the closed vs open reduction for subtrochanteric fracture fixation, the key point to reduce the risk of complications is quality of reduction of fracture. This article highlights specific strategies to achieve reliable, efficient and desired outcomes when using intramedullary nails for subtrochanteric fractures.

Medial femoral condyle fracture following traumatic allogenic bone transfer - A case report.

Open fractures can cause an "out-in" injury, wherein a foreign body can penetrate the skin causing fracture. There are few reports of allogenic bone getting embedded in soft tissue, but one causing fracture to the host bone has not been reported till date. We present a case, wherein a large cortical bony fragment from one individual penetrated the thigh of another person causing fracture of medial femoral condyle during a head-on collision involving two motorbikes.