Study of relationship of posterior tibial slope in anterior cruciate ligament injury.

OBJECTIVE: To determine the relationship between Posterior Tibial slope in terms of medial and lateral in Anterior cruciate ligament deficient patients. METHODS: Magnetic resonance images (MRI) of the knee of 100 ACL injured patients and 100 ACL intact patients were studied. Their medial and lateral posterior tibial slopes were measured using MRI. Of 200 subjects, 100 (Male- 63, Female- 37) were controls, other 100 (Male - 68, Female-32) were ACL injured cases. Using DIACOM viewer software,the slopes of both medial and lateral slopes were measured. Range of Variation, mean value and standard deviation of medial tibial plateau slope (MTS), lateral tibia plateau slope (LTS) of controls and ACL injured patients were measured. The data collected were entered into Microsoft excel worksheet and analysed using statistical package for social sciences, Version 15.0 (SPSS Inc. Chicago, IL, USA). Distribution of data was confirmed using Shapiro's Wilk Test and appropriate parametric statistics were applied. For all analysis p value < 0.05 was set to be significant. RESULTS: In control (ACL uninjured) population mean MTS was 5.95° with SD 3.09°, mean LTS was 6.08° with SD 3.48°. In ACL injured population mean MTS 6.41° with SD 2.66°, mean LTS was 8.12° with SD 3.65°. So ACL injured population had MTS steeper than control population with no statistical significance (p value < 0.27) and LTS was steeper than control population with statistical significance (p value < 0.001),where as there were comparable results between male and females. CONCLUSION: Our current results indicate that lateral PTS is a risk factor for patients with primary ACL tears as compared with ligament-intact controls. Therefore,PTS should be considered as independent modifiable risk factors in ACL injury.

Vascularised fibular graft in the management of non-union of fracture shaft of radius: a less ventured entity.

INTRODUCTION: Non-union of the radius and ulna is a major complication of forearm fractures, accounting upto 10% of all forearm fractures. Multiple modalities are available for the treatment of non-union. Vascular grafts are a less sought-after surgical choice owing to the need of expertise and skills of surgeons. We discuss a case of gap non-union of fracture shaft radius treated with vascular fibula graft. CASE REPORT: We describe a case of 45yr old lady with closed fracture of both bones of left forearm.She underwent open reduction and internal fixation with 3.5 small DCP (6 hole) two days following trauma. On subsequent follow up in 6 months the radius fracture showed signs of infected non-union with osteolysis at screw sites while the ulnar side showed signs of satisfactory union. The patient underwent debridement with implant removal and osteosynthesis with vascularised fibula for gap non-union as second stage. 3 and 6 months follow up showed improvement in DASH score as well as VAS score and fair return of regular activity. CONCLUSION: In management of gap non-union of Shaft radius with gap (>6cm) vascularised fibular graft provides excellent functional outcome with far less donor site complications. FUNDING: None declared.

Bilateral discoid medial menisci: a rare phenomenon.

Discoid medial meniscus is a relatively rare pathology of the knee joint, with bilateral cases even rarer. Herein, we report the case of a 25-year-old man diagnosed with discoid medial meniscus in the right knee with a horizontal tear. Increased cupping of the medial condyle of the tibia, widening of the medial joint space and the presence of discoid meniscus in the right knee prompted investigation of the asymptomatic left knee with magnetic resonance imaging. The contralateral asymptomatic knee also showed evidence of discoid medial meniscus. The symptomatic knee was successfully treated by arthroscopic partial meniscectomy, with excellent functional outcome.