Introduction and purpose: Total knee replacement (TKR) is a common surgical procedure done for severe knee joint degeneration and arthritis. The deviations of mechanical axis (MA) greater than 3× from the normal neutral alignment have been correlated with worsening of clinical outcomes, abnormal wear, premature loosening, and early implant failure. The failure of conventional total knee replacement (CTKR) to achieve within 3° of the MA accounts for 30% of the TKR being unable to produce the desirable results. This study intended to compare the alignment outcome of accelerometer-based portable navigation system (orthoalign) with CTKR. Materials and methods: This is a prospective study with 68 cases divided into two groups of 34 each in conventional and navigation. Study period is from July 2019 to July 2021 where patients underwent TKR procedure in Kovai Medical Center and Hospital, Coimbatore. Preoperative evaluation data include age, sex, BMI, diagnosis, side of pathology, and knee range of motion (ROM). Radiological evaluation was done by X-rays includes full-length standing scanogram, anteroposterior (AP) and lateral view. Functional outcome was assessed by Knee Society Score (KSS) interval of 1 month, 6 months, 1 year, and 2 years. Results and discussion: Navigation (orthoalign system) based TKR group showed improved mechanical alignment outcome compared to CTKR group but functional outcome was almost similar in both the groups which needs longer study duration and follow-up. Main objective of this study is to show improving mechanical alignment through navigation so that we can prevent abnormal wear, premature implant loosening, and failure.

Background: Degenerative lumbar canal stenosis (LCS) is one of the frequently encountered problems in elderly. The long-term outcomes of posterior spinal decompression (PSD) on relief of neurogenic claudication (NC) due to LCS remain unclear. The aim of our study is to assess the functional outcomes of posterior decompression in patients with NC due to lumbar canal stenosis eliminating various heterogeneous factors. Materials and methods: A longitudinal prospective study conducted in 20 patients of homogenous group of age 60–80 years and other medical conditions who had undergone PSD from June 2018 to May 2020 at Rex Ortho Hospital adhering to inclusion and exclusion criteria with stable spine. Patients were assessed with Neurogenic Claudication Outcome Score (NCOS) and Japanese Orthopedic Association Score (JOAS) at preoperative and postoperative period. Results: At the end of the first year 85% had excellent outcome, 10% had good outcome, and 5% had fair outcome based on NCOS and JOAS. No patients had poor outcome or resurgery. Delayed wound healing was in one patient, and no radiological changes such as instability or further degenerative changes were identified. Conclusion: Posterior spinal decompression in patients with NC due to isolated lumbar canal stenosis yields excellent results based on NCOS and JOAS. Selection of patient is very important and careful assessment of other associated local or general problem may influence the outcome.

Background: Nonunion tibia is not uncommon due to various deleterious factors. We came across a significant number of cases of nonunion owing to fallacy in primary treatment modalities. This study is to analyze and identify the preventable causes of nonunion and their outcomes after our treatment with refixation and bone grafting. Materials and methods: It is a retrospective study of 53 patients of failed fixation resulting in nonunion tibia treated in our center between June 2018 and May 2020. All patients were treated with internal fixation and bone grafting after implant removal. The surgery was done by a single surgeon for all patients with inclusion and exclusion criteria excluding open fractures. Results: All 53 cases of nonunion united at 3 months. As per the functional outcomes concerned using short form (SF-36) score, we found 52 cases had excellent outcomes and three had late infection necessitating implant removal. We could delineate certain preventable reasons for nonunion from this study, mostly due to treatment modalities. Conclusion: We conclude that certain technical factors play a major role in nonunion, which could be easily averted by paying meticulous attention to surgical techniques and details.

Aim: Among the disabilities in India, locomotor disability ranks the highest among others due to a growing number of road traffic accidents, diabetic foot, peripheral vascular disease, and cancers that have led to the loss of one or the other limb; the primary aim is to study about how an idea of an orthopedic surgeon Professor S Vetrivel Chezian of creating an artificial limb production center at Coimbatore Medical College and Hospital has changed the lives of locomotor disabled persons and also provided monetary benefit to the government. Background: The idea of an orthopedic surgeon Professor S Vetrivel Chezian at Coimbatore Medical College and Hospital to start a lightweight artificial limb prosthesis production center with Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Tamil Nadu Chief Minister's Comprehensive Health Insurance Scheme (TNCMCHIS) funds without expenditure to the government but creating revenue to the government at the Institute of Orthopaedics and Traumatology, Coimbatore Medical College and Hospital to benefit locomotor disabled persons. Results: Lightweight artificial limb prosthesis production center started at the Institute of Orthopaedics and Traumatology, Coimbatore Medical College and Hospital, benefiting about 101 locomotor disabled persons to lead their life independently within 2 years of its establishment without any expenditure to the government rather making monetary benefit to the government under AB-PMJAY-TNCMCHIS. Discussion: An innovative idea of Professor S Vetrivel Chezian in using AB-PMJAY and TNCMCHIS fund generated by the Institute of Orthopaedics and Traumatology, Coimbatore, Tamil Nadu, India to establish a lightweight artificial limb prosthesis production center at Coimbatore Medical College and Hospital which gave not only new lives to locomotor disabled persons of very low socioeconomic status but also generated monetary benefit to the government for the infrastructure development of the institution. Conclusion: An idea by orthopedic surgeon Professor S Vetrivel Chezian is to be followed in all government institutions in India, which will lead locomotor disabled persons of the country to lead their life independently with confidence and also generate monetary benefit to the institution to improve health care in India.

Introduction: Osteoarthritis (OA) is the most common musculoskeletal disorder among the elderly population. Quadriceps muscle weakness is one of the biological factors that may contribute to knee pain. There was only limited evidence that higher quadriceps strength may improve knee pain. This study investigates whether quadriceps strengthening improves pain, joint stability, and quality of life (QOL) in OA patients. Materials and methodology: Prospective study was done among the outpatients visiting the orthopaedic department, Velammal Medical College Hospital & Research Institute, Madurai, Tamil Nadu, India. The study period is between 1^st October 2020 and 1^st January 2021. We had 340 OA knee patients in the age-group <65 years who met the inclusion criteria as the study participants. Patients were randomly assigned to two groups A and B by card method. Group A is the case group, and group B is the control group. The patients allocated in the case group underwent isometric exercise (isometric hip adduction, isometric quadriceps exercise, and straight leg raise exercise) along with pharmacotherapy and lifestyle modification advices. The control group only had pharmacotherapy and lifestyle modification advices. The Knee Injury and Osteoarthritis Outcome Scale (KOOS) scale was used to measure the outcome. Results: Unpaired t-test was used to compare between two groups, reduction in pain intensity (0.001**), improvement in QOL (0.001**), and improvement in joint stability (0.001**) in the isometric exercise group at the end of the 8th week were significantly greater than those of the control group (p < 0.05). Conclusion: The 8-week isometric quadriceps exercise program showed beneficial effects on pain, QOL, and joint stability in patients with OA of the knee.

Among the femoral neck fractures, unilateral injury is the most common presenting feature.¹ In the younger population, it is a result of high energy trauma from road traffic accidents or falls from height.^1,2 In the elderly population, a simple fall results in a fracture of the osteoporotic bone.³ But a patient sustaining a bilateral neck of femur fracture without any trauma is a rare occurrence.⁴ We recently received a 78-year-old male patient who sustained a nontraumatic bilateral neck of femur fracture following a single episode of a generalized tonic-clonic seizure. He is a known chronic obstructive pulmonary disease patient and recovered from COVID pneumonia 6 months back. The patient underwent modular cemented bipolar hemiarthroplasty for both hips as a staged procedure, and the patient was made for walking full weight-bearing from the second postoperative after the second hip was operated.

Background: Brachial plexus injury subsequent to an interscalene block (ISB) can be a difficult situation. Ultrasound-guided interscalene block (US-ISB) is currently the preferred technique; however, there is conflicting evidence in the existing literature about the elimination of this uncommon complication. Less is known about the nature and severity of the resulting neurological sequel as only few case studies are available in literature. Case description: A 28-year-old male underwent an elective removal of the dynamic compression plate and screws in a united fracture of humerus for constant pain with day-to-day activities. An ISB was performed under ultrasound guidance without any remarkable events during the procedure. Untowardly, the patient had experienced complete motor and sensory inactivity around shoulder and elbow in the postoperative period that persisted even at 3 weeks. Magnetic resonance imaging showed evidences of brachial plexus injury involving C5 and C6 roots extending to trunks. A conservative approach with rehabilitation and electrical muscle stimulation (EMS) was followed. Gradual recovery was observed and by 7 months he attained power to preinjury level. Conclusion: The practice of ISBs for upper limb surgeries does exhibit a rare risk of severe neuronal injury, even with established safe practices using ultrasound guidance. There are inconsistent evidences in the literature regarding permanent damage to brachial plexus following US-ISB and the resulting plexopathy shows complete recovery with conservative management. Clinical significance: Ultrasound guidance for ISBs may not be totally immune to neurological injury; however, the magnitude is of lesser severity and spontaneous recovery should be the rule.

Osteochondroma, the most common benign bone tumor, involves 10–15% of all bone tumors. It can occur frequently either as solitary osteocartilaginous exostosis or rarely as hereditary multiple lesions. The most common sites of occurrence are long bones of the lower arm (50%), usually the lower end of the femur and upper end of the tibia. However, involvement of the small hand and foot bones occurs in 10% of cases, pelvis in 5%, scapulae in 4%, and spine in 2%. Symptoms are not very specific. The authors present a case series of atypical sites of osteochondroma. In the present case series report, we describe a case series of osteochondroma arising from the talus, trochlea, and ribs, respectively.

Introduction: Euycetoma infection is a rare and debilitating progressive chronic granulomatous disease. It has serious economical, medical, and social impacts on the people. Case description: A 30-year-old gentleman came with complaints of swelling with blackish discoloration of his right foot for the past 10 years. He was clinically and through biopsy proven to be an eumycetoma infection of the foot. He underwent radical excision followed by vacuum dressing and split skin grafting of the foot. The wound healed completely and there was no recurrence over a follow-up period of 6 months. Conclusion: Early and appropriate diagnosis and management are necessary for optimal treatment and to prevent a recurrence. Clinical significance: Diagnosis of eumycetoma infection is predominantly through clinical examination and history. It has to be differentiated from actinomycetal infection. Chronic history, long incubation period, and painless swelling are its salient features.

Introduction: Irreducible metatarsophalangeal joint dislocations of lesser toes are not very common. Case description: We report a rare case of a 27-year-old male patient who was injured following a motorbike accident and dislocated his second, third, and fifth metatarsophalangeal joint (MTP) along with a fourth metatarsal neck fracture and same-side femur shaft fracture. The fifth MTP reduction was achieved by the closed method; however, the second and third MTP was not reducible despite multiple attempts at closed reduction. This called for open reduction and stabilization with K-wires. Clinical significance: This case report depicts the mechanism of injury, clinical signs, and structures preventing close and open reduction techniques through the dorsal approach is reviewed.