The Musculoskeletal Manifestations of Type 2 Diabetes Mellitus in a Kashmiri Population.

Objectives: Diabetes mellitus (DM), is affecting an ever increasing number of people worldwide. Diabetes is associated with several musculoskeletal manifestations. These may involve, the upper as well as the lower limb.

Transmalleolar approach to a tubercular lytic lesion of the talar body: a case report.

Tuberculosis of the talus is a rare condition, and the diagnosis can be difficult to make because of inconclusive laboratory and ancillary testing. In such cases, accurate diagnosis and appropriate treatment may require the use of a transmalleolar osteotomy to gain access to the involved portion of the talar body. In the case described in this article, a transmalleolar approach was used to gain access to a lytic lesion of the talar body so as to obtain microbiological and histopathological specimens for diagnostic purposes, and to thoroughly debride the lesion.

Stable relocation of the radial head without annular ligament reconstruction using the Ilizarov technique to treat neglected Monteggia fracture: two case reports.

Introduction: A Monteggia facture dislocation is not an uncommon injury, and the diagnosis can often be missed. Long-term follow-up of untreated Monteggia fracture dislocations reveals development of premature arthritis, pain, instability, and loss of pronation and supination. Methods involving annular ligament reconstruction require post-operative immobilization and use of transcapitellar pinning for maintenance of reduction, and thus a delay in rehabilitation.

A reciprocating ledge technique in closing wedge osteotomy for genu valgum in adolescents.

Purpose: To describe a technique that preserves anterior and posterior alternate ledges in a closing wedge osteotomy.

Methods: Five patients aged 14 to 19 years underwent a closing wedge osteotomy for genu valgum in 8 limbs using a reciprocating ledge technique. A unicortical wedge of bone was removed, with the anterior and posterior cortices spared.

The role of composite technique in managing peri implant re-fractures in a case with supracondylar fracture of the femur: a case report.

Introduction: Osteoporosis of the long bones challenges the orthopaedician in several ways. Amongst the difficulties encountered are the reduced bone mass, increased bone brittleness and medullary expansion, which must be factored in when deciding the type of surgical method to be used. One of the commoner complications of fixation of fractures in such bone is the occurrence of peri implant fractures with subsequent management requiring significant surgical acumen and judgment.

Treatment of ipsilateral high energy tibial plateau and calcaneal fractures by a circular wire fixator: a case report.

Introduction: High energy tibial plateau fractures along with calcaneal fractures individually produce several challenges for the orthopaedic surgeon. The principles of bony reconstruction include anatomic reduction and rigid internal fixation of intra-articular fractures and accurate restoration of the coronal, sagittal and transverse mechanical axes. Due to the tenuous nature of the soft tissue and devitalisation of the comminuted fragments with open reduction, external fixation of type 6 tibial plateau fractures is recommended.

Delayed fixation of the transcervical fracture of the neck of the femur in the pediatric population: results and complications.

Purpose: To determine the impact of a substantial delay in providing surgical treatment on the final outcome in transcervical femoral neck fractures in children.

Methods: Data on all pediatric patients with transcervical fractures of the femoral neck that were fixed by reduction and internal fixation after a delay of ≥7 days in our department between 2000 and 2008 were collected both retrospectively and prospectively.

Results: The medical records of 14 patients (15 fractures) were analyzed.

Delayed manifestations of the "Nail-Slipper injury".

Penetrating injuries of the foot are a common presenting complaint in the emergency department. The residents of the underdeveloped world are especially prone to suffer such injuries as barefoot walking is still common. However, a relatively common injury that occurs in the shod feet is the "Nail-Slipper injury".

Draining infected non union of the distal third of the tibia. The use of invaginating docking over short distances in older patients.

Background: The distal third of the tibia is unique in the sense that it has a minimal muscle cover and consequently the blood supply is easily compromised after a fracture in this area. Infected non union in this area provides a challenge to the orthopaedic surgeon. These difficulties are especially profound in the geriatric age group.

Delayed union of an operated fracture of the femoral neck.

Fracture of the femoral neck continues to be a vexing clinical and therapeutic challenge for the orthopedic surgeon. The fracture has a propensity for non-union and avascular necrosis. It is a challenge for the orthopedic surgeon to decide when to intervene in a case with non-union where the implant continues to be in place.

Differentiating mass disasters. The barzullah classification.

Background: To assess the pattern of mass casualty incidents managed at our hospital over the last eight years, and evolve a differentiating classification based on this pattern. A combination of retrospective and prospective assessment was made.

Material And Methods: All patients receiving injuries in mass casualty incidents and managed at our hospital.

Use of the Ilizarov apparatus to improve alignment in proximal humeral fractures treated initially by a unilateral external fixator.

One of the recommended methods for the management of displaced unstable proximal humeral fractures is the unilateral external fixator. In polytrauma cases this method may be especially useful for the stabilisation of these fractures. However, problems may arise if the fracture is fixed in a malaligned or distracted position.

Operative management of a subtrochanteric fracture in severe osteoporosis. a case report.

Background: Fractures of the subtrochanteric region of the femur provide several challenges to the operating surgeon due to anatomic and biomechanical peculiarities inherent to this region. These challenges are compounded several times in a severely porotic bone.

Case Presentation: We report a case with severe osteoporosis who sustained a subtrochanteric fracture and was managed with a Dynamic condylar screw DCS.

Unforeseen difficulties faced by a hospital in dealing with mass disaster victims.

Every major mass disaster challenges the health care services, especially in the third world. These challenges include the expected situations mainly pertaining to the overload of patients and the stretching of hospital facilities. We report our experiences about several unforseen challenges faced by our hospital in the 2005 earthquake that struck the Kashmir region.

More than two years delay in the union of fracture neck of femur after primary intervention.

Introduction: More than two years delay in the union of fracture neck of femur is a very rare entity.The treatment of an established non union depends on numerous factors including age of the patient, vascularity of the femoral head and other factors. It is timing of intervention that is not clearly defined in the literature.

Management of lower limb fractures in polytrauma patients with delayed referral in a mass disaster. The role of the Ilizarov method in conversion osteosynthesis.

Polytrauma cases in mass disasters present several challenges to the orthopaedic surgeon. Delayed referral, multisystem involvement and the requirement to manage coexisting injuries by interhospital transfer often make infection an inevitable risk. 28 patients with polytrauma were studied after being referred after being recovered from the debris of their homes in the Kashmir earthquake.

Open reduction and internal fixation in a case with transscaphoid perilunate dislocation 8 months after the injury: a patient with a 5-year follow-up.

The management of perilunate dislocations diagnosed later than three months continue to elicit debate with literature being scarce. We report a 22-year-old male with transscaphoid perilunate dislocation who reported to our hospital 8 months after sustaining the injury. Open reduction was done along with bone grafting.

The dynamic condylar screw in the management of subtrochanteric fractures: does judicious use of biological fixation enhance overall results?

Subtrochanteric fractures are fraught with certain anatomic, biologic and biomechanical challenges. Evolution of implants like the Gamma nail, fixed-angle nail plates, compression hip screws and dynamic hip screws with trochanteric stabilization plates underlines a persistent quest for a better implant. We studied the dynamic condylar screw DCS as an implant on a series of 30 consecutive patients with subtrochanteric fractures.

'Damage control orthopaedics' in patients with delayed referral to a tertiary care center: experience from a place where Composite Trauma Centers do not exist.

Background: Management of orthopaedic injuries in polytrauma cases continues to challenge the orthopaedic traumatologist. Mass disasters compound this challenge further due to delayed referral. Recently there has been increasing evidence showing that damage control surgery has advantages that are absent in the early total care modality.

Pattern of orthopaedic injuries in bear attacks: report from a tertiary care centre in Kashmir.

Interaction between humans and wild animals has increased in recent times, because of overlap of habitats. A proportion of this interaction is violent. Most of the literature describing the injuries sustained by humans in such contact pertains to the involvement of soft tissues.

Retrospective analysis of the occurrence of radiologically detectable surgical error in cases of failed pedicle screw implants.

Pedicle screw instrumentation is an important tool in an orthopaedic surgeon's armamentarium in the management of spinal fractures. Complications with this system have been studied extensively. Due to the exacting technique the possibility of surgical error exists while using this modality.

In situ instrumented posterolateral fusion without decompression in symptomatic low-grade isthmic spondylolisthesis in adults.

Forty patients with an average age of 26.5 years were treated for symptomatic low-grade isthmic spondylolisthesis with in situ instrumented posterolateral fusion. All patients had failed previous conservative treatment.

Acute peg in hole docking in the management of infected non-union of long bones.

The Ilizarov method has been studied extensively in the management of non-union of long bones. In most cases this involves filling of defects present primarily or after débridement by bone transport. Acute docking over gaps longer than 2 cm has not been adequately studied, however.