INTRODUCTION: In the quest for better alternatives for open transforaminal lumbar interbody fusion (TLIF), minimally invasive surgery-TLIF (MIS-TLIF) has evolved, and feasibility studies of transforaminal endoscopic fusion are also getting reported in western literature. However, the cost of instrumented expandable cage may make it non-feasible for Indian setup whenever it will be commercially available. METHODS: This is a retrospective study of 13 patients of single-level percutaneous transforaminal endoscopic decompression and cageless percutaneous bone graft TLIF with percutaneous pedicle screw fixation under combined local with epidural anesthesia. The results of all patients as measured by validated tools of visual analogue score-Back and Leg, Oswestry Disability Index, patient satisfaction index, and fusion. The operating time, Estimated Blood Loss, Length of hospital stay and tolerance of patient for procedure was also scored. RESULTS: All the outcome measures were significant (P < 0.05) and fusion achieved in all with a mean follow-up period was 39 ± 6.36 months. Operating room time was 250.23 ± 52.90 min (187–327). Postoperative LOH hospital stay was 29.92 ± 4.94 h (24–39). The tolerance score was 2.30 ± 0.85 (1–3). One superficial bone graft site infection resolved with antibiotics. CONCLUSION: It not appealing to be recommendable to general population inspite of it being low cost and with negligible complications. Further research and engineered tools are needed to reduce the operating time.

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Context: It has been well-established now that intravenous (IV) tranexamic acid (TXA) is a potent agent to control postoperative blood loss following total knee arthroplasty (TKA). Recently, intraarticular administration of this agent has also shown good efficacy for the same. Aims: Comparison of postoperative blood loss between IV and topical administration of TXA in TKAs. Materials and Design: Eighty-six TKAs on knees were included in this study. Randomization was done so that 40 TKA received 1 g of IV TXA, while 46 had intraarticular administration of 1 g TXA. Subjets and Methods: We compared the postoperative blood loss by calculating the difference in pre- and postop hemoglobin and need for blood transfusion. Functional assessment was done on basis of Western Ontario McMaster Osteo-Arthritis Index (WOMAC) scores and complications like postoperative infection, oozing from the wound site and thromboembolic manifestations. Results: Blood loss was significantly less in the intraarticular administration group as compared to the IV injection group. Total blood loss, blood transfusion group, and drain output was also less but the difference was not significant. The functional assessment (WOMAC) scores were equivocal and so were the complications including thromboembolic manifestations (two cases each of deep vein thrombosis (DVT) and no cases of pulmonary embolism (PE)). Conclusion: Intraarticular administration of TXA to prevent postoperative blood loss in TKA is a safe and effective alternative/adjunct to its IV administration.

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Fat embolism syndrome (FES) is a life-threatening situation, which warrants greater emphasis than it receives in the literature. FE occurs following various medical and surgical conditions leading to a cascade of systemic inflammatory process affecting multiple organs of the body, which may lead to end-organ failure. It has high mortality and morbidity. Despite advancement in science and technology, diagnosis of this fatal syndrome is mainly based on clinical symptoms and signs and no major definitive diagnostic tool and treatment method is available. At present, treatment of this disastrous medical condition is only supportive. In this review, we summarize the incidence, etiology, pathophysiology, and management of FES.

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Spondylodiscitis is on rise due to increasing elderly population and immunocompromised people and now gets early detected due to early imaging. Percutaneous Transforaminal Endoscopic Discectomy and Drainage (PTELDD), is simple procedure that yields high culture wihich helps in specific targeted antimicrobial bombardment. Dr. Satishchandra Gore has been pioneer in introducing transforaminal endoscopy in India way back in 1999. His persistent efforts has made inroads into traditional spine care treatments and endoscopy bandwagon is flying high and many surgeons are able to give results with the technique all over India. The available english literature of transforaminal endoscopy in spondylodiscitis is reviewed here with technical note of this simplistic procedure. The reported outcome in literature is excellent in majority of cases. Authors unpublished report of 16 cases is also comparable with literature. PTELDD is a simplistic most minimalist minimally invasive procedure that gives very positive outcome in early cases of spondylodiscitis.

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Objective: The purpose of this study was to correlate clinical, MRI, and arthroscopic findings in diagnosing ligament and meniscus tears in knee joint injuries. Materials and Methods: Our study included 20 patients in the age range of 11-60 years who were referred to radiology department for MRI of knee joint following injury to the knee. Prior to MRI, a detailed history, clinical, and local examination was done in all the subjects. MRI was carried out on 1.5 Tesla MR Machine and the standard protocol consisted of fat-suppressed PD (TE 45, TR 2800) in axial, sagittal, and coronal planes, T2W (TE 80, TR 4000) in sagittal plane and T1W (TE 11, TR 495) in sagittal plane. All the patients underwent arthroscopy by an orthopedic surgeon. Results: MR had 100% sensitivity and NPV of diagnosing ACL tears in this study. Clinical examination had sensitivity of 88% and NPV 75% in diagnosing ACL injuries. There was high NPV of MR examination (96%) in diagnosing meniscus tear while the PPV of MR examination was low (71%). These values were low in case of clinical examination. Conclusions: MRI is a useful non-invasive modality having high diagnostic accuracy, sensitivity, and negative predictive value making it a very reliable screening test for diagnosing internal derangements.

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At one point or another in their lives, most people will experience some degree of shoulder pain. It may be secondary to a variety of underlying pathology. We report a case of shoulder pain caused by a granulocytic sarcoma (chloroma) in chronic myeloid leukemia (CML) patient misdiagnosed initially as synovitis. Although granulocytic sarcoma has many classic musculoskeletal manifestations, to our knowledge, a case of CML concurrent with chloroma of the shoulder joint has not been reported in the literature. We must not forget that the shoulder pain arising from granulocytic sarcoma may be the initial presenting feature of underlying hematological malignancy such as CML.

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Introduction: Rheumatoid arthritis (RA) affects 0.5-1% of population all over the world. As the duration of treatment is more in RA, patient's adherence to treatment is less. Controlling the number of patients lost to follow-up is essential for the successful completion of randomized clinical trials. Also, patient adherence is critical in clinical trial setting as it has impact on validity of clinical data and also it remains an issue of utmost importance to pharmaceutical manufacturers as well as scientific and regulatory community. The studies which show reasons for withdrawal from clinical trials are done for diseases like tuberculosis (TB). None of the study is available to find reasons for withdrawal from clinical trials in RA. Hence, this study is planned. Aims and Objectives: Find reasons and effect of age, sex, duration of therapy, and distance from home on withdrawal from clinical trial. Materials and Methods: This study is a retrospective observational data analysis. Primary outcome are to find reasons for withdrawal from trial. Results: Withdrawal from clinical trial in patients of RA is more in female. In this study, reasons for withdrawal from study are change in location, loss to follow-up, failure of therapy, concomitant illness, patient withdrew consent, and adverse effects is the common reason for withdrawal from clinical trial in both patient and investigator-related reason for withdrawal.

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Neurogenic fibrolipomatous hamartoma (FLH) is a benign lesion that can affect any of the peripheral nerves, causing significant enlargement. Though the pathology is a rare one, median nerve is the most common nerve in the body to be affected. The most common segment of the nerve to be affected is that around the wrist. We present a case of carpal tunnel syndrome caused by FLH of the median nerve associated with macrodactyly.

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Gluteal compartment is a rare site for compartment syndrome. Gluteal compartment syndrome has most commonly been described in the literature as occurring after prolonged immobility associated with substance abuse, improper operative positioning, sickle cell-induced infarct, post-traumatic and spontaneous superior gluteal artery rupture, exercise, and post-arterial embolization of the internal iliac artery prior to abdominal aortic aneurysm repair. Trauma is rarely associated with this syndrome. Gluteal compartment syndrome occurs in approximately 0.9% of trauma patients. Posttraumatic gluteal compartment syndrome develops because of edema with traumatic contusions, crush injuries and hematoma formation due to blunt superior or inferior gluteal artery injuries in all compartments of the gluteal region Only 6 previous cases have been reported in the literature. Two previous cases involved positioning for urological procedures, while the other cited causes of bilateral gluteal compartment syndrome include exercise-induced, trauma, and prolonged immobilization from substance abuse. One of the most immediately devastating results of a missed compartment syndrome is the risk of the development of rhabdomyolysis with the resulting squeal of myoglobinuria, hyperkalemia, and acidosis resulting in renal failure, shock, multiple organ failure, disseminated intravascular coagulation, and possibly death. Here we report a case of posttraumatic bilateral compartment syndrome which developed secondary to pressure due to patient being trapped under a vehicle following a vehicular accident. He was operated upon and a bilateral fasciotomy was done. Although he did not develop any renal complications, the sciatic nerve palsy on the left side did not recover. The patient is still under follow up.

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Background: The wound management is a huge complex problem consuming billions of dollars. The standard treatment includes advance therapeutics with drugs (such as antibiotics), intense local dressings (such as negative pressure/antimicrobial) and multiple surgical interventions/reconstructions. Such intervention and modalities requires experts and large resources. Still the outcomes are unpredictable and associated with morbidities at donor (otherwise normal) sites. Materials and Methods: The "Sandeep's Technique's for Assisted Regeneration of Skin" (STARS) is therapy for complete healing of wounds with Autologous self activated Platelet Rich Plasma (PRP), imparted as local subcutaneous infiltrate in the wound margin, on every 4 ^th day, till complete repair takes place and local skin regenerates. The wounds are dressed daily/alternate day with only moist saline. It is a Pilot study of patients treated with STARS Therapy treated at Acharya Vinobha Bhave Rural Hospital, J.N.Medical College, Wardha, INDIA. The different types of wounds were acute wounds with exposed deep tissues such tendons and bones; compound fractures; infected wounds; necrotising post surgical flaps and chronic non healing ulcers including diabetic and pressure ulcers. Result: All the wounds healed aby PRP infiltration not requiring any further drugs, complex dressings and surgical reconstruction. Conclusion: It is safe, effective, efficient, and easily reproducible technique with predictable results for even complex wounds in which surgical reconstructions are not possible. This method of treatment is a huge step forward in preservation of resources and prevention of morbidity.

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CONTEXT: Anterior cruciate ligament (ACL) reconstruction has remained the gold standard for ACL injuries, especially for young individuals and athletes expose to high-level sporting activities aiming to return preinjury level of activity. Femoral cortical suspension devices have gained popularity. However, there are limited studies specifying a superior graft fixation technique. AIMS: To evaluate outcome of arthroscopic ACL reconstruction using fixed closed loop fixation (CLF) and adjustable loop fixation (ALF) techniques. SETTINGS AND DESIGN: Prospective case series. MATERIALS AND METHODS: 40 cases were included in the study, among of which 20 cases, underwent arthroscopic CLF and another group of 20, who were operated on using ALF. Clinical outcome was assessed using manual tests, i.e., Lachman and pivot shift, and results were graded using the International Knee Documentation Committee. Lysholm score was used to evaluate functional outcome up to 6 months. STATISTICAL ANALYSIS USED: Data were analyzed using SPSS version 21. RESULTS: There were no significant differences in manual Lachman and pivot shift grading in both groups. One case (5%) in CLF group and 15% in ALF group were showed Grade B clinically laxity by Lachman, and one case (5%) in CLF group and 10% in ALF group were showed Grade 2 + rotatory laxities by pivot shift. The study found no statistically significant differences in functional score between the groups (P = 0.245). CONCLUSIONS: In femoral fixation of ACL graft both CLF and ALF techniques may provide secure fixation, equal reduction of graft laxity, and similar functional outcome in ACL deficient knee.

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OBJECTIVES: Injuries are the leading cause of death in the first four decades of life and the third leading cause of death among all patients. Road traffic accidents (RTAs) is the most common cause of injury in India with varied reports of mortality ranging from 7% to 45%. There are several scoring systems to evaluate the severity of injury and predict mortality. However, the reliability of injury score as a mortality predictor is challenging. The purpose of this study was to assess the cause of trauma with its epidemiological correlates and to categorize patients of trauma using the New Injury Severity Score (NISS) and Injury Severity Score (ISS) with their comparison in terms of mortality prediction in the present scenario of trauma in India. MATERIALS AND METHODS: Between October 2015 and March 2017, 5122 injured patients meeting the inclusion criteria were enrolled in this prospective longitudinal study. Data of the patients were recorded as per the working pro forma; detailed description of injury, treatment given, ISS and NISS, and ultimate outcome (mortality occurring within 30 days) was documented at the time of arrival/admission and stay at the hospital. Patients were divided into the score groups of 0–8, 9–15, 16–25, 26–49, and ≥50. The patients who were discharged or referred to a higher center were also followed up to 30 days of admission and any mortality occurring was recorded. RESULTS: Totally 5122 patients were enrolled in the study, and injuries, NISS/ISS, and outcome as mortality were documented. The overall mortality was 525 (10.25%). RTA constituted 61.56% and mortality was two times higher than that in female. Patients arriving after 24 h had the highest mortality (16.22%) and time lag had a significant effect on outcome. Sensitivity and specificity of NISS/ISS in predicting mortality was 85.5%, 63% and 61.7%, 68.3%, respectively, and the sensitivity of NISS in predicting mortality is higher than ISS whereas the specificity of NISS is similar to ISS. CONCLUSION: The major cause of trauma in India is RTA and time lag has a significant effect on the prognosis of the patient, and NISS is a better scale and should be incorporated in management protocols and TRISS methodology.

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PURPOSE: To assess the interobserver reliability and intraobserver variability of the visual analog scale (VAS) for visualization in shoulder arthroscopy and compare it to a less variable, more objective novel grading scale, the shoulder arthroscopy grading scale (SAGS). METHODS: Twenty separate 30-s length video clips were created from a library of shoulder arthroscopies. Video clips were randomized and distributed to six sports medicine fellowship-trained surgeons at two time points with a 1-month interval. Each rated visualization according to an adapted VAS and a novel grading scale, the SAGS. RESULTS: The VAS and SAGS both showed an excellent degree of consistency with interobserver reliability among raters with intraclass correlation coefficients (ICCs) of 0.96 and 0.97, respectively. Five of six raters demonstrated strong intraobserver variability with the VAS and SAGS with ICC ranging from 0.87 to 0.97 and 0.61 to 0.93, respectively. CONCLUSION: Given the strong-to-excellent degree of consistency in using the VAS and the SAGS, either can be reliably used as a measurement of visualization in shoulder arthroscopy.

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Bone regeneration, reparative and restorative techniques of bone length discrepancies, correction of posttraumatic and congenital defects and deformities can be induced mesenchymal stem cells (MSCs) which is taken from the bone marrow. In this review article, we aimed to have a look at MSCs for bone and tissue regeneration. MEDLINE ^® , Embase™, the Science Citation Index, and Google™ Scholar were used to look for relevant articles which published in English since January 2000. Studies on bone regeneration using MSCs in the field of clinical orthopedics were retrieved. The bone graft can create a self-reliant mechanism to induce bone cellular environment that adapts to the whole skeletal nature. There are several factors contributory to deciding which approach to take. These include the type of bone deformities, defects, the biological setting of the patient, the nature of the reparative process desired, and surgical or orthopedic possibility of conducting all these processes. All these factors and several others should be taken into consideration and careful medical consultation. Orthopedics along with osteology made much headway in restoring bone and tissue in uniquely medical approach that is MSCs through the autologous cancellous bone taken from the bone marrow.

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Tarsal tunnel syndrome is generally a subacute condition that gradually develops and worsens with time. Urgent tarsal tunnel release to treat an acute onset of symptomatic neurocompression within the tarsal tunnel following a fracture repair has not been previously reported. We present a case of a pregnant woman who developed an acute tarsal tunnel syndrome following an open reduction internal fixation of an ankle fracture. The urgent release of the tarsal tunnel resulted in resolution of her symptoms.

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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.

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We report a case of transient osteoporosis of the hip (TOH) in a 50-year-old man including the clinical presentation, diagnostic studies, management, and clinical progress. TOH is a rare self-limiting condition that typically affects middle-aged men or, less frequently, women in the third trimester of pregnancy. Affected individuals present clinically with acute hip pain, limping gait, and limited ranges of hip motion. TOH may begin spontaneously or after a minor trauma. Radiographs are typically unremarkable but magnetic resonance (MR) imaging studies yield findings consistent with bone marrow edema. TOH is referred to as regional migratory osteoporosis (RMO) if it travels to other joints or the contralateral hip. TOH often resembles osteonecrosis but the two conditions must be differentiated due to different prognoses and management approaches. The term TOH is often used interchangeably and synonymously with transient bone marrow edema (TBME).

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Distraction osteogenesis is standard for bone lengthening. The use of Joshi's external stabilizing system (JESS) fixators are common for lengthening of metacarpals. However, being a uniaxial fixator, occurrence of angular deformity is possible. The use of strong dynamic fixators aid in prevention and correction of angular deformities of long bones. We report a simple method to correct angular deformity of metacarpal using JESS fixator, in a 14-year-old girl who presented with congenitally short 3 ^rd metacarpal.

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A rare case of primary intraosseous meningioma of the calvarial bones presenting as solitary osteolytic lesion on the skull radiograph and correctly diagnosed pre-operatively on computed tomography (CT) and magnetic resonance imaging (MRI) by correlating the clinical and imaging findings is reported in this communication. The clinical, radiographic, CT and MR imaging features of the case and the difficulties in making a correct clinico –radiological diagnosis are highlighted in this communication.

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Objective Unstable intertrochanteric fractures continue to be a challenge for orthopedic surgeons due to the functional limitations it results in the postoperative period. Anatomical reconstruction of the posteromedial fragment becomes difficult through conventional lateral approach, leading to excessive fracture collapse and limping. Materials and Methods: prospective, nonrandomized study was done with 40 patients. They were operated in prone position through posterior approach. Cancellous screws or SS-wires were used to fix the greater or lesser trochanteric fragments and dynamic hip screw (DHS) or dynamic condylar screw (DCS) for the main two fragments. Bone grafts were used to pack cavities at the posterior trochanteric regions. Results: Fracture healing occurred earlier compared to conventional lateral approach without excessive fracture collapse in majority of cases (average time to achieve union was 13.8 weeks; range: 10–18 weeks). Good functional recovery was noted with 75% 'Good' or 'Excellent' Harris Hip Scores at 24 weeks. Conclusion: Anatomical reconstruction of unstable trochanteric fractures becomes easier through posterior approach with earlier and better functional recovery.

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BACKGROUND: Blood transfusion is the cornerstone of therapy for many serious ailments, surgical and trauma patients. Patients undergoing orthopedic surgeries as elective procedure or emergency orthopedic surgery for trauma often experience excessive blood loss- requiring transfusions. However, preoperative placement of blood requests frequently overshoots the actual need resulting in unnecessary crossmatching, which can be reduced by formulating maximum surgical blood ordering schedule (MSBOS). It is a table of elective surgical procedures, which lists the number of units of blood routinely cross-matched pre-operatively. OBJECTIVE: The objective of this study is to audit the blood utilization in orthopedic surgeries so that unnecessary cross-matching, wastage of blood bank resources, and financial losses to the patients could be reduced. MATERIALS AND METHODS: A retrospective study was carried out in our tertiary care hospital over a period of 6 months to determine the utilization of blood during different orthopedic procedures and to recommend an appropriate blood ordering schedule. The data collected include patient's requests, patient's transfused, type of surgical procedure, number of units crossmatched and transfused, crossmatch to transfusion ratio (CTR) and transfusion indices (TI's); according to them, MSBOS was proposed. RESULTS: A total of 478 units of blood were crossmatched for 273 patients and only 243 units were transfused to 183 patients. About 50.8% of the crossmatched units and 67% of the total patients were transfused. Seven out of the thirteen procedures had a CTR higher than 2, low TI ≤0.5 and blood utilization ≤50%. Fracture forearm and unilateral total knee replacement have the transfusion probability of ≤30%, so implementation of type and screen policy was recommended for these two procedures. CONCLUSIONS: MSBOS based on the past blood utilization records for different surgeries and keeping patients variables in consideration wherever required would provide an efficient way of blood utilization and appropriate management of blood bank resources.

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Introduction: Sacroiliac screw placement is one standard treatment option for stabilization of posterior pelvic ring injuries encountering high intra- and inter-individual variations of bone stock quality as well as a vast variety and prevalence of sacral dysmorphism. An individual, easy-to-use preoperative bone stock quality estimation would be of high value for the surgeon. Materials and Methods: We analyzed 36 standard computed tomography datasets with the uninjured pelvic ring. Using a two-plane cross-referencing technique, we assessed the Hounsfield unit (HU) mean values as well as standard deviation and minimum/maximum values within selected region of interests (ROIs) at five key areas: os ilium left and right, massa lateralis of os sacrum left and right, and central vertebral body on levels S1 and S2. Results: Results showed no difference in mean HU at any ROI when comparing male and female data. For all ROIs set on S1 and S2, there was an age-related decline of HU with a calculated slope significantly different from zero. There was no statistical difference of slopes when comparing S1- and S2-level with respect to any distinct ROI. Comparison of levels S1 and S2 revealed differences at the vertebral body and at the right os ilium. The right and left massa lateralis of os sacrum had lower bone density than the center of the vertebral body, the right, or left os ilium on S1; right and left massa lateralis density did not differ significantly. On level S2, results were comparable with no difference of massa lateralis density. Conclusion: With our easy-to-use preoperative assessment of bone density of five key areas of sacroiliac screw anchoring we were able to find the lowest bone density in both the left and right massa lateralis on levels S1 and S2 with high inter- and intra-individual variations. Significantly lower bone density was found in the center of the vertebral bodies S2 in comparison to S1, which both are crucial for iliosacral screw placement. We thus recommend priority use of level S1 in screw placement and careful consideration of sole massa lateralis short-screw anchoring.

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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.

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Introduction: The intertrochanteric fractures of femur are commonly fixed using dynamic hip screw using a conventional open Dynamic Hip Screw (CDHS). This is associated with a long incision, blood loss, considerable soft tissue trauma and pain. All these problems can be avoided using minimally invasive Dynamic Hip Screw (MIDHS), which has a theoretical advantage of less blood loss, soft tissue trauma, and early rehabilitation. Thus, we conducted a prospective comparative study of the two techniques. Materials and Methods: This is a prospective comparative study conducted over a period of 2 years at Department of Orthopedics GMC Bhopal. Fifty patients in the age group of 50-80 years who presented with intertrochanteric femur fracture and fulfilled inclusion criteria were divided into two groups of 25 each for fixation by CDHS or MIDHS. Patients in both the groups were matched. The data analysis was performed using SPSS package. Results: The patients in minimally invasive group had shorter operative time (45 min vs. 75 min). The average postoperative blood loss in drain in conventional group was 150 ml whereas no drain was used in minimally invasive group. Postoperatively need for analgesic was significantly lower in minimally invasive group (P < 0.05). Duration of hospital stay was significantly less with minimally invasive technique. The duration of bony union was similar in both techniques. Conclusion: Our study concludes that the minimally invasive technique of fixation of Intertrochanteric femur fractures is superior in terms of less operating time and less duration of hospital stay.

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Background: Fracture of the distal end radius constitutes one of the most common skeletal injuries treated by the orthopedic surgeon. Wide arrays of techniques have been described including closed reduction, percutaneous fixation and open methods of reduction, and stabilization. Displaced extra- or intra-articular distal radius fractures require accurate reduction to allow a good outcome. We assessed the outcome of volar plate osteosynthesis and compared its outcome with other methods of treatment to confirm satisfactory reduction and functional outcomes. Materials and Methods: Prospective study conducted in our medical institution between 2012 and 2013. Inclusion criteria included skeletally mature patients who presented to casualty with fractures of the distal radius. Closed reduction cast application/K-wire fixation/open reduction and internal fixation with a volar plate was done under general anesthesia in 60 patients (20 cases each). During the follow-up, radiological and functional parameters were assessed and Gartland and Werley scoring was done. Results: Patients with volar plate fixation had a better outcome than the K-wire fixation and cast application. Radiological parameters were well-maintained, and functional parameters showed a significant improvement during the follow-up period. The complication rate was less and insignificant. 
Conclusion: Primary volar plate fixation of unstable distal radius fracture provides a stable construct that helps in early mobilization, thereby better functional outcomes and minimizes chances of delayed/malunion and, thereby is an upcoming method of choice for fracture distal end of radius. The present study comprised of 60 patients of distal radius fractures in 20 patients treated by plating, 20 by cast application and 20 by K-wire application. The minimum follow-up was 8 weeks, and the maximum was 36 weeks. This study was undertaken to assess the functional outcome of operative management of distal radial fractures and the following conclusions were drawn - male patients predominated female patients (36 males to 24 females) and average age of patients is 46.01 years. Left sided fractures were more common (61.6%). Road traffic accident was the commonest cause of the trauma (73.3%). AO 23 A-2 was the most common type of fracture, accounting for (26.6%) with Associated injuries seen in 4 patients (6.6%). Functional outcome as per Gartland and Werley was 3.75 for plating, 8.6 for cast application, and 7.55 for K-wire fixation. About 90% excellent to good results were observed in plating group as compared to 55% in cast and 65% in K-wire fixation in demerit score. Complication such as irregular articular surface, wrist pain, finger stiffness, K-wire loosening was observed. Thus, based on this study, we conclude that volar plating has relatively better outcome for distal end fractures of radius particularly volar Barton fractures, with minimum chance of loosening of implant even in highly comminuted cases and cases having osteoporosis.

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