Introduction: One of the major causes of loosening of cementless acetabular cup implants is insufficient initial stability. A technical proposal to decrease the risk of suboptimal first stability is a circumferential finned design of the cup. This design aims to improve periacetabular bone contact and prevent rotational micromotion of the cup when optimal press-fit cannot be obtained. Materials and Methods: We retrospectively reviewed a group of 712 consecutive patients who underwent total hip arthroplasty from June 2006 to June 2014. In all patients, a titanium cup, characterized by three anti-rotational circumferential fins at the superior pole, was implanted. Results: Five hundred and ninety-two patients, for a total of 685 hips, were evaluated at a mean follow-up of 58 months (range 12-96 months). At 1-year follow-up, the average score increased to 82.90 (range 100-70) and at the final follow-up (58 months, range 12-96 months), it was 80.12 (range 100-66). In 22 cases (3%), screws to obtain a secure primary stability of the cup were used. Nineteen complications (2.6%) needing revision surgery were observed. Survivorship at 10 years was 98.7% (95% confidence interval [CI], 98.7-99.7%) with revision for aseptic cup loosening as an endpoint and 96.7% (95% CI, 98.3-95.1%) with revision for all causes of revision as the second endpoint. Discussion: In our group of patients, we did not observe the cases of very early cup loosening. The only two-cup revision, do to loosening of osteolysis, was observed 26 and 32 months before surgery. Conclusion: Our very low rate of additional screws represents an indirect sign of finned cup first stability. Three-finned cup design clinically confirmed to improve initial cup stability.

Background: Trochanteric fractures of femur like intertrochanteric and subtrochanteric fractures are a leading cause of hospital admissions in elderly people. Conservative methods of treatment results in malunion with shortening and limitation of hip movement as well as complications of prolonged immobilizations such as bed sores, deep vein thrombosis, and respiratory infections. This study is done to analyze the surgical management of trochanteric fractures of the femur using a proximal femoral nail (PFN). Methodology: This is a prospective study of 40 cases of trochanteric and subtrochanteric fractures admitted to Government General Hospital, Vijayawada, Andhra Pradesh. Cases were taken according to inclusion and exclusion criteria, i.e., patients with trochanteric fractures femur above the age of 20 years. Medically unsuitable, open fractures and patients not willing for surgery were excluded from the study. Results: Forty percentage of cases were admitted due to slip and fall and with a slight predominance of the right side. Out of 40 cases, 26 were trochanteric, and 14 were subtrochanteric. In trochanteric class, 37.5% were body and griffin Type 2, in subtrochanteric class 12.5% were sinsheimer Type 3a and 10% were 2b. Out of 30 remaining cases, 25 were trochanteric, and 05 were subtrochanteric. Good to excellent results are seen in 100% cases of trochanteric fractures and 90% cases in subtrochanteric fractures. Conclusion: From this sample study, we consider that PFN is an excellent implant for the treatment of pertrochanteric fractures. The terms of successful outcome include a good understanding of fracture biomechanics, proper patient selection, good preoperative planning, accurate instrumentation, good image intensifier, and exactly performed osteosynthesis.

Background: Hip fracture is a severe health burden in the elderly population. In order to prevent, it is to evaluate the bone strength by establishing the relation between bone mineral density (BMD), neck strength, and geometry. Materials and Methods: The subjects under study were 100 postmenopausal women who visited bone clinic of Bharat Scan Centre. After recording general profile such as age, body mass index (BMI), geometric measures such as hip axis length (HAL), neck shaft angle (NSA), and neck width (NW) were measured from digital X-ray. For the same individuals, BMD was measured using dual energy X-ray absorptiometry (DXA) scan. From the DXA print out neck strength was calculated using the formula = sectional modulus/HAL. Results: The correlation test was analyzed among BMD, neck strength, anthropometric, and geometric factors using Statistical packages for social services (SPSS) software. BMD is inversely related with age and positively correlated with height, weight, and BMI. HAL, NSA, and NW had a weaker association with BMD. Age, BMD, and NSA had a negative relation with neck strength. HAL and NW had a positive relation with neck strength. Conclusion: Noninvasive means of associating neck strength with BMD and geometry will provide improved estimates for fracture risk beyond any other invasive method of assessing bone mineral properties.

Introduction: Intertrochanteric femur fracture incidence has increased due to increased life expectancy and osteoporosis. Management of these fractures in elderly is challenging due to difficult anatomical reduction, poor bone quality and osteoporosis. Internal fixation in these cases usually involves prolonged bed rest to prevent implant failure which leads higher complication such as deep vein thrombosis, pneumonia pulmonary embolism, bed sores, increased morbidity. Materials and Methods: We have done a prospective study in 18 cases of unstable intertrochanteric fracture where 12 (not associated hip arthritis) patients are operated by bipolar hemiarthroplasty and 6 (associated hip arthritis) patients operated by total hip arthroplasty (THA). Results: Patients were followed for an average of 12 months duration (9-15 months). Patients treated by bipolar hemiarthroplasty group (Group 1) have an average surgery duration of 95 min and blood loss of 315 ml. While patients treated with THA (Group 2) has average surgery duration of 152 min, blood loss of 565 ml. About 91% of 1 ^st group and 100% of 2 ^nd group has an excellent to fair outcome. Conclusion: Bipolar hemiarthroplasty for unstable intertrochanteric fracture femur without hip arthritis, and THA for intertrochanteric fracture with hip arthritis in elderly patient results in early ambulation and good functional outcome. However, as our study group is small, so further large randomized trail required before reaching conclusion.

Alkaptonuria is a rare autosomal recessive disorder caused by defective metabolism of homogentisic acid (HGA) which on accumulation in the connective tissues causes arthritis, darkening of urine and connective tissue pigmentation. Knee is most commonly affected joint whereas pigment deposition is seen in entire body causing cardiovascular, genitourinary, ocular, cutaneous, and musculoskeletal complications. We here report such a case of bilateral ochronotic arthropathy, who was diagnosed to be alkaptonuric only during joint exploration. He sustained a cardiac catastrophic stroke on 3 ^rd post operative day of the left knee replacement which was done one week after the right knee replacement. With prompt treatment and good hospital care, the patient was revived successfully, without valvulotomy or valvular replacement. The spectrum of clinical manifestations are discussed in the report with emphasis on thorough history and clinical examination of the patient, before taking the patient to the total knee replacement to make accurate diagnosis before hand and be prepared for the complications or catastrophic by a multidisciplinary approach.

Literature suggests that vascular damage occurring with orthopedic injury of the lower extremity is rare and uncommon. We present a case of a young adult male who presented to the emergency room with a history of road traffic accident with complaints of pain in the right ankle diagnosed as medial malleolus fracture and pain in the left knee diagnosed as undisplaced lateral tibial condyle fracture. At the time of presentation, the left leg appeared normal and was stabilized with a knee brace, which on the next day developed severe swelling with absence of distal pulses. Doppler revealed no blood flow distal to popliteal artery with severe soft tissue edema. The patient was posted for emergency basis vascular exploration where popliteal artery was surprisingly found transected and was repaired followed by timely fasciotomy. This case report has also been prepared to stress the importance of secondary survey in patients after high energy trauma as it can prevent the important injuries from being missed.

Isolated fracture of the scaphoid with the dislocation of the proximal bony component is a rare abnormality, usually encountered in a high-energy injury. Prompt diagnosis is essential for preferentially considering open reduction and fixation. Careful image analysis is necessary to exclude more frequent injuries such as lunate dislocation and establish encroachment of carpal tunnel or injury to median nerve. This presentation presents imaging and management consideration of the patient with the scaphoid fracture with dislocation of proximal component encountered in association with polytrauma.

Myositis ossificans progressiva/fibrodysplasia ossificans progressiva (MOP), is an autosomal dominant mesodermal tissue disorder, characterized by an initial period of inflammation and subsequent proliferation of fibrous tissue with the formation of ectopic bone tissue. The incidence of MOP is one case per two million people. The ectopic bone tissue formed is located in soft tissue mainly in the connective tissue of striated musculature. We report MOP in an 18-year old female who presented with multiple tender, hard swelling in various parts of the body associated with stiffness and limitations of movements. A literature review of the subject showed few similar case reports in the literature. We revisit the criteria for diagnosis and the essentials of management and treatment of MOP as it is rare being a rare condition, and treatment guidelines are not clear.

Epidermoid cysts are a rare benign neoplasm of spine. They account for only 1% of all benign spinal tumors. These cysts are either congenital or acquired, like after repeated lumbar puncture. They can present anywhere in the spinal cord, and are intradural. They can be intra- or extra-medullary. As the cysts are slow growing, they are mostly reported after some sensorimotor or in some cases after bowel and bladder involvement. Typical magnetic resonance imaging (MRI) findings are a hyperintense signal on T2-weighted (T2W) and hypointense T2W images. Diagnosis is confirmed on histopathologic examination. The treatment is complete excision and if not then maximum debulking of the tumor. We present a case of 27-year-old male with only tingling and mild weakness in the left lower limb. He was diagnosed with intradural tumor with MRI findings showing hyperintense signal on T1-W and isointense signal on T2W images. This is an uncommon presentation. It was enmeshing around rootlets so had to be debulked. The diagnosis was confirmed on histopathologic examination. Postoperatively recovery was excellent with no neurological deficit.

Rapidly destructive hip disease (RDHD) is a rare syndrome of unknown etiology, resulting in rapid deterioration of both the femoral and acetabular aspects of the hip joint with disappearance of the femoral head. Differential diagnosis should include those conditions known to potentially lead to rapid hip destruction, such as septic arthritis, metabolic bone diseases, autoimmune inflammatory arthritis, malignancy, and classical osteonecrosis. Sequential X-rays in patients with fast worsening of hip symptoms and a high degree of clinical suspicion seem mandatory to avoid extensive joint destruction and facilitate better arthroplasty outcomes in these patients. Because of the degree of joint deformity and the patient's level of disability, the typical treatment of rapidly destructive arthropathy is total hip arthroplasty. In this report, we present a clinical case of left RDHD offering a useful review for the diagnosis and management of this condition.

In high-energy accidents, even exceptional multifragmentary fractures can be found in young and healthy individuals. We hereby report a case of a traumatic proximal femur fracture with dislocation of the femoral head and neck fragment to the scrotum. Although the blood supply to the fragment must have been destroyed during the displacement to the scrotum, there were no radiologic signs of femoral head necrosis. Initial open reduction and internal fixation failed within 7 weeks. The revision with a proximal femur nail was stable. A fast progressing osteoarthritis due to accompanying acetabular fracture urges for a total hip replacement.