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Atypical presentation of tuberculosis is not uncommon in developing countries. Among extra-pulmonary sites, tendons are very rarely involved. Compound palmar ganglion associated with tuberculosis is an uncommon condition in which a swelling is present across the wrist joint on either side of the flexor retinaculum. Very rarely such lesion can compress over neural structures and may present as Carpal Tunnel Syndrome. A therapeutic challenge consists of treating disease and its associated presentation. Treatment of choice for such conditions include complete excision of the mass along with the radical synovectomy of the wrist joint and associated flexor tendon sheaths followed by anti-tubercular medications. With early diagnosis and treatment good recovery can be achieved. We present a Case of a large compound tubercular palmar ganglion who presented to us with symptoms of carpal tunnel syndrome which was treated surgically with excision and carpal tunnel release.

Though distal end radius fractures are one of the commonest fractures to occur, their nonunions are extremely uncommon. Out of these, post-septic defect nonunions with acquired radial clubhand deformity are even more rare and pose unique problems in management. We present a case series of 4 patients of post-septic radius nonunion with acquired radial clubhand deformity successfully treated with a novel technique of using Ulna Strut grafting for radius defect after ulnar shortening. All 4 patients have a good functional and cosmetic outcomes with radiological union at the cost of minimal limb length discrepancy of the forearm.

This is a case series of 4 patients with a retrospective study design and study duration of 3 years from August 2016 till March 2019.4 patients presenting to us with post-septic defect nonunions of radius with an acquired radial clubhand deformity were selected with a mean age of 19.75 years which included 2 males and 2 females.

The mean time for radiological union was 3.125 monthstional training, with no additional morbidity of iliac crest or fibula bone grafting and had a minimum complication rate. The technique looks promising in the future, though a study on a larger population would further strengthen the predictability of this unique technique.

Infected wounds pose a great financial burden on our healthcare system. Negative pressure wound therapy (NPWT) has brought a paradigm shift in the management of these wounds. However, availability and high cost of a conventional NPWT system remains a challenge. We carried out this study to assess whether we can replicate functioning of the conventional NPWT system using resources which are easily available in most hospitals and determine the clinical efficacy and cost effectiveness of the same.

A prospective study was conducted in the orthopaedic department at our tertiary care institute from January 2018 to December 2019. Fifty six patients with contaminated or infected orthopaedic wounds were included in the study. Wound dressings were carried out by modified negative pressure therapy and their results were studied.

The study group consisted of 41 males and 15 females. Duration of stay in hospital ranged from 6 to 37 days, with average duration of 14.05 days. Wound closure was achieved by secondary suturing in 18 (32.2%) of the cases and split thickness skin grafting in 38 (67.8%) of the cases. Wound assessment done using the revised Photographic wound assessment tool revealed an average of 60% reduction in scores, post procedure. The average cost of the dressing could be considerably reduced during the study by the use of available material.

Through our study we describe a simple and effective method of application of negative pressure dressings which may be beneficial in low resource settings. Our method is easily reproducible and does not require expertise for its application, at the same time it is cost effective and efficient in wound care.

Through our study we describe a simple and effective method of application of negative pressure dressings which may be beneficial in low resource settings. Our method is easily reproducible and does not require expertise for its application, at the same time it is cost effective and efficient in wound care.

A very few flaps would be described as versatile as the Keystone Flap. There is an increasing demand for coverage of defects in lower limb due to traumatic defects as well as other parts of the body. Keystone flap is one of its kind, which is simple and easy to perform. It is a safe option for conditions where microsurgery may not be a viable option. The relative simplicity of this flap makes it a to go option at many places.

A prospective study was developed from October 2017 to December 2019at SMS Hospital, Jaipur. We assessed the size of the flap, operation time, average hospital stay and the complications. Perforators over the leg were Doppler marked preoperatively over which the flap was raised.

50 patients were taken into the study. 30 key stone flaps were done to cover lower limb defects, 10 flaps were done for upper limb defects and the remaining 10 were for trunk defects. The average intraoperative time from skin incision to final suture was 50min (range 20-90min). The largest defect covered bye flap allows reconstruction in a single stage and is a relatively easy and fast technique for the beginner as well as the experienced surgeon. We believe it should be incorporated more into a surgeons practice.

In-growing toenails commonly affect young men hampering the quality of life. There are many methods to treat in-growing toe nail but most of them have high recurrence rates and poor patient satisfaction. We describe our results of segmental matrix excision for correction of ingrowing toe nails.

It is a retrospective study over a period of 2 years. Patients with symptomatic in-growing toe nails with stage II and III were operated by technique of segmental matrix excision. All patients were available for follow-up at ∼1 year.

90 patients, 59 males and 31females with ingrowing nail of great toe (108 toes and 120 surgical sites) that underwent correction of by segmental matrix excision. Patient's age ranged from 19 to 59 years. There was involvement of right great toe in 42 patients, left great toe in 30 patients and bilateral toes in 18 patients. 12 great toes were affected on both sides (74 lateral sides and 46 medial sides of toes). 15/90 (16.6%) patients had history of previous failed surgery by nail plate avulsion. Complications include bleeding (n=1), infection (n=2). On average follow up of ∼1 year, there was only 1 recurrence. There was no loss of cutaneous innervation or osteomyelitis. All patients went back to their normal activity on 10th day.

Segmental matrix excision should be considered as the treatment of choice for ingrowing toe nail because of high cure rate, less pain, low risk of postoperative infection, and results in good cosmetic result.

Segmental matrix excision should be considered as the treatment of choice for ingrowing toe nail because of high cure rate, less pain, low risk of postoperative infection, and results in good cosmetic result.Non-healing neuropathic heel ulcer provides a challenge to salvage the limb from a below-knee amputation. Total calcanectomy can prove a reliable option for limb salvage. Given a well-designed orthosis, patients with total calcanectomy do well at any age. We present two case examples of non-healing neuropathic heel ulcers with chronic osteomyelitis of the calcaneus, which were salvaged with total calcanectomy and returned to all activities of daily living.

Osteoporosis is defined as a systemic skeletal disease characterized by reduced bone mass and degeneration of bone tissue microarchitecture which leads to bone fragility and fracture risk. Annually, 100 to 200 million people around the world are at risk for osteoporotic fractures. One way to prevent osteoporosis fracture is by using medications such as bisphosphonates. Alendronate is the most prescribed bisphosphonate in the world. The objective of this article is to evaluate the effect of alendronate on bone fracture healing.

15 adult male rats that were 60 days old were used, divided into three groups A or Control, B (non-osteoporotic bones plus alendronate application) and C (osteoporotic bones plus alendronate application). Osteoporotic bones were compared with non-osteoporotic bones that underwent bone window creation and administration of alendronate sodium. These bones were submitted to radiographic and histological analysis.

All of Group A had complete bone healing, reaching the phase of bone remodeling. While in groups B and C, the rats were in the repair phase.

The drug alendronate interferes with delayed fracture healing and delayed bone remodeling. The article advises that studies in humans are needed in order to assess whether the alendronate interferes with bone healing.

The drug alendronate interferes with delayed fracture healing and delayed bone remodeling. The article advises that studies in humans are needed in order to assess whether the alendronate interferes with bone healing.Metabolic syndrome (MS) has become one of the top major health burdens for over three decades not only due to its effects on cardiovascular health but also its implications in orthopedics. Extensive research has shown that MS is tightly linked to osteoarthritis and inflammation, a process which appears to primarily occur in the subchondral bone via the incidence of bone-marrow lesions (BMLs). Numerous studies identify obesity, dyslipidemia, insulin resistance and hypertension as the top metabolic risk factors, the so-called "deadly quartet". These factors are responsible for the disruptive physiological processes that culminate in detrimental alterations within the subchondral bone, cartilage damage and, overall, the predominant pro-inflammatory joint microenvironment. Although it has long been thought that osteoarthritis was limited to the cartilage component of the joint, other studies indicate that the disease may originate from the harmful alterations that occur primarily in the subchondral bone, especialadly Quartet (metabolic syndrome), dysregulation of both pro- and anti-inflammatory biomarkers, and osteoarthritic progression arising from unbridled systemic inflammation.

With increasing concerns regarding the newer emerging pathogens, alternatives to allogeneic blood transfusion are being explored and acute normovolemic hemodilution (ANH) is one of them.

A prospective study was conducted in patients aged 18-65 years with preoperative hemoglobin >12g/dl undergoing total knee replacement or total hip replacement. check details Patients in whom hemodilution was performed were included in the ANH group whereas patients undergoing treatment as per the routine hospital protocol were included in the control group.

Preoperative hemoglobin was similar in both ANH and control groups (12.7±0.7 vs 12.6±0.6, p=0.56). Allogeneic blood requirement was significantly less in the ANH group as compared to the control group (4 vs 15, p=0.001). Postoperative complications were significantly lower in ANH group as compared to control group (7 vs 16, p=0.01).

ANH can be an alternative approach to meet the need of safe blood especially in resource constrained countries, like India where risk of transfusion transmitted infections are still high and where there is high demand of blood and acute shortage of blood in hospitals.