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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While operating on the hip joint, breaking of guide wire became a challenge for treating orthopedic surgeon. Here we report a simple method of removal, which requires limited resources and does not need sophisticated instrumentation. By using this method, we remove broken guide wire in a patient of sub-trochantric fracture of femur managed by close reduction and internal fixation by proximal femoral nail. During the removal of the guide wire, after placing distal screw in the neck the guide wire comes out with some difficulty in the final view on image intensifier - the guide wire broken and transfixes the hip joint but does not enter the pelvis. After removal of the distal screw, its cannulated drill bit was connected to a T-handle and introduced into the track of distal screw up to the broken distal end of guide wire and slow manual reaming done under C-arm image intensifier to prevent damage to the articular cartilage. This process was repeated three times after cleaning drill bit each time to clear the base of guide wire for grasping its distal end. With the help of Kerryson rounger/grasper, the distal end of the guide wire was grasped and easily removed. The distal screw was placed in its original track and the procedure was completed.

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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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Fibrous dysplasia (FD) is a benign disorder affecting one or more bones seen in all age groups and shows no geographical, racial and sex predilection. Fibrocartilaginous dysplasia (FCD) is a type of fibrous dysplasia where there is extensive cartilaginous differentiation. Our patient was a young girl with a 2 year history of pain in the right forearm and hip. Imaging studies showed multiple lucent lesions in the femur, humerus and radius. Microscopic examination of the curetted fragments from the lesion showed predominant cartilaginous components with focal fibro-osseous areas and areas of enchondral ossification. We present this case due to its rarity and the importance of distinguishing FCD from other benign and malignant cartilaginous tumors as it mimics these in clinical and histological features.

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Fibrous dysplasia is a benign tumor-like lesion of bone believed to be developmental in origin. Polyostotic fibrous dysplasia (FD) is a rare condition. Our case was further complicated by the presence of secondary aneurysmal bone cyst (ABC). This is the second reported case of polyostotic FD with secondary ABC.

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Isolated fracture of the trapezoid bone is due to axial loading on the outstretched palm and extended wrist, transmitted through the second metacarpal bone. Traumatic lesions of trapezoid bone are rare because of its well-protected position in the wrist and hence missed in the past. The modern diagnostic modalities have made its diagnosis more frequent. The ability of wrist to place the hand in 3-dimensional space is essential for normal daily function of the upper extremity. Some wrist injuries remain a diagnostic enigma, while others remain frustrating to treat either conservatively or with operative intervention. Isolated fractures of the trapezoid bone are rarely reported in the literature. We report a case of an isolated, non-displaced trapezoid bone fracture, which sustained injury by direct trauma and treated conservatively by a cast with return of normal functions.

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Chronic patellar tendon ruptures are rare. Diagnosis is usually made on clinical background. The ideal method of treatment is a matter of debate. The management of neglected, chronic patellar tendon must address four difficulties: The proximally retracted patella, reconstruction of the patellar tendon, temporary protection of repair, patello-femoral tracking, and active full range of knee movement. By presenting a case of chronic patellar tendon rupture, the advantages of reconstruction with a free semi-tendinosus and gracilis autograft from an early rehabilitation are described.

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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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Management of an open wound is a problem frequently encountered in the treatment of fractures. Skin grafting, rotational flaps, free flaps, and healing by secondary intention add a considerable amount of morbidity and cost to the patient. Therefore, it is ideal to obtain primary closure when possible. This communication describes a technique that uses 1-0 prolene suture material, skin stapler and the natural stretching ability of the skin to enable primary closure of wounds. The technique described uses dermatotraction to stretch the skin, is a cost-effective way to achieve primary closure of large wounds with supplies that are readily available in every operating room.

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Multiple joint replacements have been employed to treat joint problems in patients with Rheumatoid Arthritis (RA) and is frequently used to address Osteoarthritis too. Septic Arthritis after Arthroplasty is a difficult clinical problem. Polyarticular Septic Arthritis (PASA) in this patient population is an emerging and extremely difficult entity to manage. We describe two patients of RA with PASA and our line of management for this condition. Early recognition and appropriate intervention should help prevent catastrophic outcomes in these unfortunate patients.

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The aetio-pathogenesis as with most malignancies is not known. However, trauma has being proposed as a possible theory underlying the development of this malignancy, where it is believed that the reparative cells could undergo malignant transformation. There is however a paucity of data suggestive of this theory in our setting. Hence this case report in the above case report the question is whether the recurrent trauma and subsequent surgery is coincidental with the development of the malignancy. This report highlights the possibility of such occurrences.

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Background: Fractures of lateral condyle of humerus in pediatric age group, the most common being distal humerus epiphyseal injury, are commonly associated with delayed presentation to terminal health care providers. Reasons accounted might be at every level, right from the patient to the physician. In the backdrop of existing disputed treatment strategy operative v/s non-operative treatment of fractures having more than 3-week duration of injury, same were treated by open reduction and k wire fixation using ulnar peg graft. Final functional result was evaluated with longest follow up of over 1 year. Materials and Methods: Twenty children having fracture of lateral condyle of humerus with duration of trauma more than 3 week were included in the prospective study. Age ranged from 5 years to 15 years. Average age was 8 years. Among the 20 patients, 8 were male and 12 were female. Average time of presentation was after 5 weeks of injury. Seven patients had milch type 1 injury and 13 patients had milch type II injury. All patients were treated by open reduction and internal fixation using k wires and ulnar peg graft. The follow-up period was over 1 year. Result: Results were evaluated using radiograph, and functional results were evaluated using the Liverpool elbow scoring system. In the present series, all fractures united with 92% excellent, 5% good, and 3% poor results. Poor results were associated with greater displacement of fracture, prior repeated attempts of close reduction, and history of massage. Conclusion: Being an epiphyseal injury and a common occurrence, fracture of lateral condyle of humerus in pediatric age group are commonly maltreated, with error contributed right from parents to even physician. Common reasons of delayed presentation are ignorance on parents' side, malpractice by some bone-setters, poorly done radiograph, inaccurate radiographic interpretation by the physician, and poor selection of treatment methods.

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Injuries to pediatric athletes are becoming increasingly common as children compete in more physically demanding sports. These athletic injuries may be acute or as the result of chronic overuse. Acute trauma may lead to damage to tendons, ligaments, and muscles, as well as their bony attachment sites. Infections such as osteomyelitis must also be considered in the differential of pediatric patients presenting with hip or groin pain. This review will discuss the normal muscular attachments to hip physes and physeal equivalents, as well as common injuries and their management. These findings are important to help with the diagnosis and treatment of pediatric patients who present with hip pain.

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