Objective: Total knee arthroplasty and unicompartmental knee arthroplasty (UKA) are frequently done procedures for the treatment of various forms of arthritis and knee injuries. The knee prosthesis, which is used for these procedures requires adequate sizing specific to the population. Hence, the aim of the present study is to measure various parameters of the proximal end of the tibia in south Indian population. Materials and Methods: Fifty (26 left and 24 right) adult fully ossified dry tibia were taken, and various parameters of the proximal end of the tibia were measured using a Vernier caliper. Statistical analysis of the parameters was done. Comparison between various parameters of right and left side was done using paired t-test. Results: In our study, the mean transverse, the anteroposterior diameter of total, medial and lateral condyles of the tibia are 6.83, 4.57, 2.73, 4.45 and 2.79, 4.07 cm. The area of medial, lateral and total tibial condyle is 12.2, 11.42 and 31.39 cm ² . The mean length between the upper end of the tibia and tibial tuberosity and the mean circumference of the upper end of the tibia is 5.15 and 19.02 cm. Groove for ligamentum patellae was found in 100% of cases. Conclusion: The results of this study will be helpful for anatomists, anthropologists, and orthopedics in cases of UKA, complete knee arthroplasty procedures, and meniscal transplantation.

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Aims: To determine the efficacy of Proprioceptive neuromuscular facilitation (PNF) technique and muscle energy technique (MET) in limiting pain and disability among subjects with adhesive capsulitis of shoulder. Settings and Study Design: A single centre experimental design study was done. A total 132 male subjects were screened. After fulfilling inclusion and exclusion criteria, with convenient sampling 60 subjects were selected for the study. Mean age of Groups A and B subjects were 46 and 50 years respectively. Double blinded baseline and post interventional (after 2 weeks) assessment was performed. Intervention includes Proprioceptive neuromuscular facilitation technique for group A and Muscle energy technique for group B. Outcome measures were recorded using University of Pennsylvania shoulder score (1st subset) and shoulder flexion, abduction, external rotation and internal rotation range of motion using an universal goniometer. Results: Inter group comparison were analyzed using Independent t test and one way analysis of variance was used to analyze pre intervention, and post interventional results after 1 and 2 weeks respectively. The level of significance will be set at P < 0.05. Proprioceptive neuromuscular facilitation technique achieved significance in improving ROM and showed satisfactory results in university of Pennsylvania shoulder score when compared with muscle energy technique. Conclusion: Proprioceptive neuromuscular facilitation technique was effective in relieving pain, restoring ROM and restoring function among subjects with adhesive capsulitis.

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Background: There have been controversies regarding the ideal method of treatment of displaced supracondylar fractures of the humerus in children. Aims: The aim was to treat displaced supracondylar fractures of the humerus in children by conservative method and if results are not acceptable then by operative method and evolve a management protocol which will provide minimum complications with available facilities. Materials and Methods: This prospective study was conducted in a tertiary care hospital in a time span of 1-year. Ninety patients with Gartland's Type II and Type III fractures were initially subjected to closed manipulative reduction, of which acceptable reduction could be achieved only in 27 patients. Sixty-three patients who had unacceptable results were subjected to operative treatment. The final results of the treatment were assessed using the criteria of Flynn et al. Results: Among the Gartland's Type II fracture patients, acceptable reduction was achieved in 9 patients. Among Type III fracture, acceptable reduction was achieved in 18 patients (25%). The conservative treatment yielded excellent results for 9 patient and good for 9 patients. Of the 63 patients subjected to operative treatment, 15 patients had excellent result (23.81%), 24 good (38. 10%), 15 fair (23.81%), and 9 poor (14.29%). Satisfactory result was achieved in 39 patients (61.90%). Conclusion: Closed reduction in case of supracondylar displaced fracture of the humerus in children still remains an option in a developing country. It may be, followed by closed operating techniques when results are not acceptable as this delay does not affect functional outcome.

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Background: Management of tibial plate fracture represents a challenging problem in developing countries. Aims: To compare the results of treatment of tibial plateau fractures with conventional nonlocking buttress plates (BP group) and locking compression plates (LCPs). Materials and Methods: The study was conducted on 30 patients with intra-articular closed fractures of the proximal tibia who were alternately assigned to two different treatment protocol, conventional nonlocking BP group or locking plates (LP group). Results : Schatzker Type II fracture was found to be the commonest fracture type with 13 patients. Only lateral plating was done in 24 patients, and dual plating was done in 6 patients. In 8 patients, corticocancellous bone graft were used. On follow-up complications like superficial skin necrosis (two cases), infection (two cases), varus collapse (three cases) developed. Sixty percent in LCP group, 66.6% in buttress group fractures clinically united in the time period of 7-9 weeks and 73.3% in LCP group and 80% in buttress group radiological union occurred in a period of 12-15 weeks. The results were graded in accordance with Poul S. Rasmussen's grading system. During the follow-up, 73.3% in LCP group and 66.6% in buttress group had no pain after clinical union. 66.6% patients in LCP group and 73.3% in buttress group could perform normal walking. About 86.6%in each group had no lack of extension. Nine patients (60%) in LCP group and 10 patients (66.6%) had flexion of up to at least 140°. About 86.6% in LCP group and 80% in buttress group had a stable joint in extension. Conclusion: Considering its high cost, LP group should only be used, where it is more advantageous than conventional plate.

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Background: Several techniques and tools are available for achieving fracture reduction during antegrade intramedullary nailing of femur fractures. Aims: To compare results of femoral shaft fracture treatment with nailing through the greater trochanter to nailing through the piriformis fossa (PF). Materials and Methods: The present pilot project was conducted in a time span of 1-year. The patients admitted with femoral diaphyseal fractures were alternately selected for antegrade nailing through PF group and greater trochanter entry (GTE group) approach. Total number of patient in each group was 15 (n = 15). Results: Complications of nailing: PE group - 6.7% infection, 20% malunion, 20% delayed union, 20% restriction of hip range of motion (ROM), 6.7% restriction of knee ROM, 13.3% limb length discrepancy, 13.3% hardware prominence. GTE group - 13.3% malunion, 13.3% delayed union, 33.3% Restriction of hip ROM, 6.7% restriction of knee ROM, 20% limb length discrepancy, 26.7% hardware prominence. Radiological union time in PE was 12-15 weeks in 5 patients, 16-19 weeks in 8 patients, 20-23 weeks in 1 and >24 weeks in 1 patient. Radiological union time in GTE was 12-15 weeks in 4 patients, 16-19 weeks in 9 patients, 20-23 weeks in 2 patients. Need for dynamization was 20% in the PE group and 13.3% in GTE group. Thoresen's scoring system showed no significant difference between the two groups. Conclusion: Femoral nailing through the greater trochanter with specifically designed nails and with attention to specific techniques for such insertion should be considered a rational alternative to femoral nailing through the PF with the benefit of reduced requirement for fluoroscopy and decreased operative time.

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To review recent literature regarding evidences for best possible exercises and methods that are proposed for preferential vastus medialis oblique (VMO) activation and effectiveness of preferential VMO activation in patellofemoral pain syndrome (PFPS) patients. The review of recent literature supports preferential VMO activation as one of the efficient management protocols in PFPS patients. Although there is quite heterogeneity in the available research, a majority of research suggests close kinetic chain (CKC) exercises to be more beneficial also the CKC squatting exercise with full maximum voluntary isometric contraction hip adduction has been an exercise quite supported by the recent researches for preferential VMO activation. It can be augmented via other methods like taping, biofeedback, motor imagery, unstable surface to enhance the VMO activation. In accordance with the review of recent literature, preferential VMO activation also has been very well correlated with a reduction in pain, enhancement in function in PFPS patients.

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Background: The lack of physical activity and sedentary lifestyles in the young generation have been a matter of concern in recent days, and about 3.3% of all deaths can be attributed to physical inactivity. Aims: To assess the effects of an exercise program on correlation of VO ₂ max and anthropometric parameters, Physical Fitness Index (PFI). Materials and Methods: This pilot project was carried in a time span of 2 years in a tertiary care hospital on 100 young adult male subjects. Untrained Group comprised of 100 healthy young adult males. History was recorded followed by anthropometry and clinical examination. Body mass index (BMI) was calculated. Resting pulse rate, blood pressure, heart rate variations during deep breathing, VO ₂ max, PFI were measured. These subjects were given training of aerobic exercises for a time span of 1 year. After completion of 1 year of training, all parameters were re-evaluated. Results: BMI, pulse rate and blood pressure, were significantly lower in trained individuals. Heart rate variations during deep breathing, VO ₂ max, PFI were significantly increased following training. A good negative correlation was seen between BMI and VO ₂ max amongst the untrained subjects (Pearson coefficient of −0.673), which was statistically significant at P < 0.0001. However, the correlation between VO ₂ max and BMI amongst the trained subjects was a weak negative correlation (Pearson's correlation coefficient of −0.202. The correlation between VO ₂ max and pulse amongst the trained subjects also showed a negative correlation with a Pearson's correlation coefficient of −0.271. The correlation between VO ₂ max and PFI amongst the trained subjects was strong with a Pearson's correlation coefficient of 0.792. Conclusions: Regular exercise training decrease resting pulse rate, blood pressure and increase VO ₂ max, heart rate variations during deep breathing, PFI. These positive physiological outcomes of exercise and training have important implications in the prevention of cardiovascular diseases and needs to be popularized among younger generations.

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Background: Disorders of the central nervous system cause a wide array of cardiovascular disorders. Aims: The present study was conducted to study the pattern of electrocardiogram (ECG) changes associated with acute stroke in recovery phase among patients without cardiovascular diseases in a rural population of a developing country. Materials and Methods: The present study was conducted in a tertiary care hospital of eastern India in a time span of 1 year. Study group consisted of hundred postcerebrovascular accident (CVA) patients during recovery stage and age and gender matched hundred subjects with no history of CVA or cardiac dysfunction in present or past were chosen as control. Results: Average heart rate of controls was 76.58 ± 6.31 per min and in stroke it was 69.74 ± 12.03 per min. The P value was significant (<0.01). Axis, P-R interval, ST segment, Q-Tc intervals were significantly worse in patients suffering from stroke as compared to normal. Average heart rate of ischemic stroke patients was 71.36 ± 12.17 per min and in the haemorrhagic stroke was 65.12 ± 10.52 per min. The P value was significant (0.02* < 0.05). There was no significant difference in other ECG parameters among the two groups of stroke patients. Conclusion: The major ECG abnormalities are S-T segment depression, prolonged corrected Q-T interval and abnormalities in heart rate and rhythm following CVA and are nearly identical in ischemic and haemorrhagic CVA. The patients of acute CVA in developing countries need to be treated with proper follow-up considering the neurological as well as cardiological complications.

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Background: Thyroid dysfunction has a great impact on lipid profile and other cardiovascular risk factors. Aims: This study was conducted to assess the association between electrocardiography (ECG) changes and lipid profile in newly diagnosed hypothyroid patients in a rural population of eastern India. Materials and Methods: This cross-sectional pilot project was conducted in a tertiary care hospital in a time span of 1-year on hundred newly diagnosed hypothyroid patients. Fasting blood samples were drawn for assessment of lipid profile followed by Anthropometric measurements. Basal heart rate and blood pressure were recorded, followed by ECG. Results: A total of 85 subjects were female and rest 15 were male. Eleven (73.33%) male hypothyroid patient and 41 (48.24%) female hypothyroid patient had thyroid-stimulating hormone (TSH) level >10. Four (26.67%) male hypothyroid patients and 44 (51.76%) female hypothyroid patients had TSH level ≤10. Fifty-seven hypothyroid patients showed cholesterol level ≤200. Eight (53.33%) male hypothyroid patients and 43 (50.89%) female hypothyroid patient had triglyceride level ≤150 mg/dl. Among 100 hypothyroid patients, 13 (15.29%) female hypothyroid patient had sinus bradycardia and 9 (10.59%) had poor progression of R wave. Two (13.33%) male hypothyroid patient and 19 (22.35%) female hypothyroid patients showed low voltage ECG. QRS complex of ECG showed statistically significant relationship (P < 0.000) with TSH level. All parameters of lipid profile except high-density lipoprotein had a significant negative co-relation with QRS complex. Conclusions: The present study shows that there are exit significant changes in ECG with increased TSH levels and dyslipidemia. Early diagnosis of these changes may help in proper management of these patients.

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Aim: The purpose of this study was to find any difference in general physical fitness between tobacco and nontobacco chewers. Materials and Methods: A total of 50 subjects were participated in this study in which 25 subjects with mean age 20.30 (±2.11) were nontobacco chewers and placed in Group A, whereas, other 25 subjects with mean age 21.25 (±2.17) were tobacco chewers and placed in Group B. All participants performed the international physical fitness test (IPFT) battery which contains five tests (50 m shuttle run, arm flexed hang, 10 m shuttle, back throw and 1000 m run) for determining speed, agility, strength, and power. Results: Statistically significant differences were seen in all the five components of IPFT between Group A and Group B. Conclusion: Therefore, it can be suggested that tobacco consumption may cause decrease in physical fitness as the finding of this study supported that nontobacco chewers have better physical fitness than tobacco chewers.

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Stress fractures are commonly seen in athletes. The lower extremities are more frequently involved than the upper extremities. Stress fractures usually occur after a recent increase in activity or repeated activity with limited rest. A high index of suspicion and timely diagnosis are crucial in order to avoid the severe secondary damage that can occur. Although stress fractures are significant for all patients, in athletic individuals they may bring about the end of their sporting careers. Treatment usually is conservative including activity modification and analgesics to relieve pain. Orthopedic surgeon consultation is indicated in patients with recurrent fractures, nonunion, or fractures in high-risk locations. This article reviews the latest scientific literature in reference to stress fractures in athletes. It goes some way to explaining the principles, approach and guidelines for the management.

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Retrolisthesis is the posterior displacement of one vertebral body with respect to the adjacent vertebrae, to a degree less than a dislocation. It is associated with increased by a degree, and thus impaired function of the spine. It is correlated with a reduction in lumbar lordosis, end plate inclination and segmental height. Retrolisthesis hyper loads at least one disc and puts shearing forces of the anterior longitudinal ligament, the annular rings, nucleus pulposus and cartilage end plate ligament. There is a paucity of literature on the effective treatment of retrolisthesis. This article presents an overview of the etiology and symptoms of retrolisthesis and highlights the conservative management for the same. This will assist the health care practitioners who are treating this condition.

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Synovial chondromatosis is an uncommon benign disorder that is most often occurring in adults. It is an exceedingly rare condition in children. We are describing an unreported cause of knee swelling in an infant. Clinical and radiological evaluation revealed that the symptoms were due to a synovial chondromatosis of the knee joint. To the best of our knowledge, this is the first report describing a knee synovial chondromatosis in an infant patient. Synovial chondromatosis should be included in the differential diagnosis of knee swelling during infancy. Greater physician awareness of such condition together with a high index of suspicion is crucial for diagnosis.

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Background: During Hajj and Umra the pilgrim will be exposed to tense exercise he/she may not be used to in daily life. This may lead to several musculoskeletal injuries often revealed by clinical and radiological examination however, in some patients further investigations such as bone scan may be required. Aims: The aim of this report is to highlight the potential value of bone scan in the work up of pilgrims with bony ache developed after performing Hajj and/or Umra and in whom routine clinical and radiological examination failed to reveal the cause of their symptoms. Materials and Methods: Twenty three Saudi patients, 18 females with age range 28-70 years (mean = 58 years) and 5 male patients with age range 36-75 years (mean = 49 years) were included in the study. All patients were referred for bone scan within 1-month after performing Hajj and/or Umra. Three phase bone scan is the standard procedure to be performed. The procedure is performed using 700 MBq (20 mCi) technetium-99m methylene diphosphonate and a dual head gamma camera (Bright view from Phillips) equipped with low energy general purpose collimator. Results: Different patterns of bone scan were identified for each type of injury. Seventeen patients (14 females and 3 males) had positive bone scan (74%) and bone scan was negative in 4 female and 2 male patients (26%). Conclusion: The percentage yield of bone scan in evaluating the Muslim pilgrim with bony ache after performing Hajj and/or Umra is quiet high and thus bone scan can be recommended in the work up of those patients in whom clinical and radiologic examination failed to reveal the cause of their symptoms. Dual energy X-ray absorptiometry scan is also advised in patients with suspected insufficiency and stress fractures.

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Purpose: Making the femoral tunnel through the anteromedial (AM) portal is believed to allow an unconstrained position compared with the traditional transtibial (TT) tunnel. Our aim was to compare the AM and TT portals during anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI) to identify the three-dimensional (3D) position of the ACL and compare it to the normal ACL. Materials and Methods: The literature was reviewed to identify the angles used for comparison. A case-control study was conducted with AM, TT and control groups. MRI was used to measure the sagittal ACL angle (angle A), the Blumensaat angle (angle B), and the coronal ACL angle (angle C) in the three groups. Results: The sum of squares and mean squares of the angles were used. A comparison of the AM and control groups (A vs. C) showed a P value of 0.417, whereas the P value for the control and TT groups (C vs. T) was 0.001. The P values for the two comparisons with angle C were significant (P = 0.0007 and < 0.0001). The P values for the third angle (angle B) were not significant (P = 0.047 and 0.086, respectively). Conclusion: The 3D position of the ACL for the AM group was closer to that of the control group compared to that of the TT group. Thus, the AM technique was superior to the TT technique in terms of restoring normal anatomy. So, reconstruction of ACL using the AM technique is expected to give better functional result than the TT technique.

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Background: Deposition of glycosaminoglycans in nerves and soft tissues surrounding them result in axonal degeneration and secondary segmental demyelination and forms the pathological basis of alterations in peripheral nerve function in thyroid hormone deficiency. Aims: To detect abnormalities in nerve conduction velocities (NCVs) in newly diagnosed hypothyroid subjects and find its correlation with free thyroxine (FT4) levels in a rural population of eastern India. Materials and Methods: This cross-sectional study was carried in a tertiary care hospital of eastern India on 50 newly diagnosed hypothyroid subjects, selected as study group and 50 healthy subjects as control. Screening tests for thyroid hormone (Serum thyroid-stimulating hormone [TSH] and FT4 were estimated) was done on 512 adults and among them 50 were hypothyroid. NCV analysis was performed. Results: TSH values were 50.04 μIU//ml ± 14.61 and FT4 values 0.56 ng/dl ± 0.15 in hypothyroids and TSH values were 2.17 μIU//ml ± 0.57 and FT4 values were 1.46 ng/dl ± 0.27 respectively in euthyroid subjects. Forty-one (82%) patients out of 50 hypothyroid patients had presented with symptoms of hypothyroidism. NCV parameters were higher in the Euthyroid group than the hypothyroid group. FT4 values were positively correlated with NCVs. Conclusions: Screening tests need to be implemented in Indian population for early detection of thyroid disorders and electrophysiological studies are to be conducted in hypothyroid subjects to detect peripheral neuropathy because early detection can reverse the condition by treatment.

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Microscopic hematuria in athletes is a frequent laboratory sign result from vigorous exercise after a period of rest, either in individual sports as running and swimming or in clash sports such as boxing and football. This could be due to renal trauma and/or bladder injury or vasoconstriction of the splanchnic and renal vessels also due to constriction of the efferent glomerular arteriole lead to release of red blood corpuscles and plasma proteins in urine. Such hematuria is a benign self-limited condition 48-72 h. However, other urinary tract problems should be excluded. It is estimated that microscopic hematuria was 18% in athletes immediately after and 3 days post race. This article presents an overview of the current knowledge of microscopic hematuria in athletes focusing on etiology, pathophysiology, diagnosis and treatment. This information should assist healthcare practitioners who treat patients with this disorder.

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Cervical proprioception is very important for optimal neck performance in sports. Cervical muscles have numerous connections with vestibular, visual and higher centres and interactions with these can produce effective proprioceptive input. Dysfunction of cervical proprioception because of different sports injuries need to be evaluated. Common tests used in the evaluation of cervical proprioception include head reposition accuracy (HRA) tests. HRA tests commonly undertaken are repositioning to the neutral head position and repositioning into target head position. Cervical range of motion device is an effective, easy and convenient tool to measure cervical proprioception. This information should assist sports physiotherapists and health care providers who deal with cervical injuries in sports or any neck conditions.

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