Dr (Professor) Bishnupada Mukhopadhaya (1916-2003): A visionary surgeon and leader of Indian orthopaedics.

Dr (Professor) Bishnupada Mukhopadhaya's life story is a testament to his dedication, exceptional skill, and unwavering commitment to advancing the field of orthopaedics in India. His impact transcends his surgical skills. He leaves behind a legacy of excellence, not just through the numerous awards he received but through the countless lives he touched, the institutions he built, and the unwavering spirit of continuous learning he instilled in generations of orthopaedic surgeons in India. His biography highlights the key contributions across various aspects of the field, serving as a source of motivation and encouragement for all those who strive for continuous learning in the field of orthopaedics.

A Unique Upside-down Flip-lid Type of Lateral Tibial Plateau Fracture Fragment in a Bicondylar Tibial Plateau Fracture Managed with Dual Plates and Raft Screws.

Introduction: Bicondylar fractures are relatively common, yet those involving an elevated lateral tibial condyle fragment pose a unique challenge due to their atypical presentation. Existing classification systems inadequately describe this elevation, leading to varied terminology like "flip lid" or "reverse-Schatzker type" fractures in the literature. Case Report: We present a case where the anterolateral osteochondral fragment was elevated and inverted, resulting from a rare mechanism where the left knee was crushed between two vehicles without axial force. This unusual mechanism spared typical signs of condylar widening or depression, with the fragment elevating but remaining submeniscal. This presented a challenge for fixation. The rotated fragment was accessed through an anterolateral approach with submeniscal arthrotomy, reduced, and fixed using raft screws of the lateral locking plate. The medial plateau fracture was stabilized through a posteromedial approach using an antiglide plate. Follow-up at 14 months showed satisfactory outcomes. Conclusion: Unique injury mechanisms can give rise to distinct fracture types. When X-rays depict an elevated rather than depressed articular surface, suspicion should arise for an elevated, "popped up," or flip lid type fragment. Such cases require a high index of suspicion and a thorough preoperative evaluation using both X-rays and CT scans. Submeniscal arthrotomy is essential to assess meniscus integrity and allow direct visualization of the fracture fragment. Successful outcomes in managing these fractures are based on accurate diagnosis, thorough preoperative planning, and adherence to internal fixation principles.

Hemodynamic Effects of Bone Cement Implantation in Hip Arthroplasty: Insights from a Prospective Study in Eastern India.

Introduction: Bone cementation has various effects on hemodynamics including potentially fatal bone cement implantation syndrome (BCIS). Most of the studies on BCIS are from developed countries. We have studied the effect of bone cement on hemodynamics in hip arthroplasty in the eastern Indian population and compared it with the available literature. Materials and Methods: This prospective study was done by a team of orthopedic surgeons and anesthesiologists in a tertiary center in eastern India between March 2020 and December 2022. Result: Seventy-two patients (Male 38: and Female 34) of age between 25 and 100 years fulfilling the inclusion criteria were included. In 43 patients (43/72, 59.72%) systolic and diastolic blood pressure fell in the range of 10 mmHg, in 22 patients (22/72, 30.56%) fall in blood pressure was in the range of 10-20 mmHg, and more than 20 mmHg fall in blood pressure were seen in seven patients (7/72, 9.72%). SPO2 decreased from 97-100% to 94-96% in 28 patients and 90-93% in six patients, which began to rise after 5 min of cementing and returned to normal after 10 min. Arrhythmias were seen in 16 patients with multiple comorbidity. Two patients had a cardiac arrest and one patient died after 6 h in the intensive care unit. Conclusion: Pre-operative evaluation, perioperative monitoring of hemodynamic parameters during cementing especially in high-risk patients with multiple comorbidities, and taking essential precautions during cemented arthroplasty are the key to preventing complications like BCIS.

Comprehensive Evaluation and Arthroscopic Management of Circumferential Labral Tears Following Traumatic First Time Shoulder Dislocation: A Case Report and Review.

Introduction: Pan-labral tears, commonly associated with recurrent shoulder dislocations, are a well-documented pathology. However, circumferential pan-labral tears following a first-time shoulder dislocation represent a rare and scarcely reported entity in the literature. Accurate diagnosis requires a comprehensive clinical history, physical examination, and further evaluation, often involving MRI. Even with advanced imaging, the acute nature of the injury can lead to the oversight of pan-labral tears, necessitating arthroscopic assessment for definitive diagnosis. Repairing such extensive glenoid labral tears presents a challenging task, requiring skilled surgeons to utilize accessory portals and percutaneous techniques for optimal visualization and anchor placement trajectory. To the best of our knowledge, this case report represents the first documentation of a pan-labral tear associated with a 1st-time shoulder dislocation. Case Report: A 27-year-old Asian male presented with pain and limited range of motion in the left shoulder following a single episode of anterior shoulder dislocation during cricket. Initial X-rays were unremarkable, but subsequent MRI revealed an anteroinferior labral tear with intact rotator cuffs. Arthroscopic evaluation disclosed a pan-labral tear, prompting meticulous repair under general and locoregional anesthesia. The patient achieved full recovery postoperatively. Conclusion: While pan-labral tears are typically linked to recurrent dislocations, this case underscores their occurrence in a 1st-time traumatic shoulder dislocation without overt clinical signs or fractures. Arthroscopic repair demands careful intraoperative planning to achieve optimal tensioning and alignment of labral and capsular tissues. This report contributes to the limited literature on pan-labral tears associated with initial shoulder dislocations, emphasizing the importance of arthroscopic evaluation for accurate diagnosis and successful repair.

Outcome of Osteosynthesis of Late-Presenting Proximal Humerus Non-union: A Case Series.

Introduction: It can be challenging to treat proximal humeral non-union (PHN). The challenge gets compounded when they are presented either late or after previous surgery. The challenges are far greater due to small proximal fragments, scalloping of the head, medial bone defect, osteoporosis, soft tissue contractures, and problems related to the previous implants. Material and Methods: In this retro-prospective study (2007-2020), we report on six cases of PHN which were presented to us more than 5 years after the original injury and managed using an intra-medullary autologous fibular strut graft (FSG) along with fixation with a proximal humeral locking plate and cancellous bone grafting. We quantified shoulder function based on constant score and disabilities of the arm, shoulder and hand (DASH) score. Results: The mean age of patients is found to be 54.3 years (range, 22-74 years) with females dominating our study. The mean pre-operative constant score is 26.33 which improved to 71.83 in the post-operative period. The mean DASH score is 77.98 preoperatively, which improved to 19.5 postoperatively. The paired sample t-test compared the difference in mean of the pre-operative and post-operative scores, which shows significant improvement in outcome. Conclusion: Even in very late PHN in poor-quality bone, the additional use of intramedullary strut grafts provides structural support to the fixation and further enhances the ability to withstand the load-start early motion and have a satisfactory functional outcome. Keywords: Non-union, proximal humerus non-union, proximal humerus fracture, proximal humerus internal locking system, locking plate, autogenous fibular strut graft.

Traumatic bilateral neck of femur fracture in paediatric age: A case report and review of literature.

Bilateral femoral neck fractures are rare, and only a few cases have been reported following major trauma in children. An 8-year-old male patient presented with pain both hips and inability to bear weight on his lower limbs, four days after he fell through a roof while playing. The anteroposterior pelvic radiograph showed a displaced transcervical fracture of the right femoral neck and an undisplaced transcervical fracture of the left femoral neck. Operative fixation of both hips with cannulated cancellous screws done on the 5th day of injury led to a successful outcome. This case is presented due to its rarity and successful outcome despite a late presentation.

Outcomes of operative management in the delayed presenting neck of femur fractures in children: A case series.

Introduction: Fracture neck of femur in pediatric age group occurs due to high energy trauma and is an uncommon entity with high complication rate. No uniform guidelines are present to manage these fractures, especially in delayed presentation of fracture neck of femur as a smaller number of such cases were reported. Cases: Eight children (nine hips), five boys and three girls of age <15 years, were operated on. The mean delay in surgery time was 8.6 days (range: 5-22 days). The mean union time was 13.44 weeks. The mean follow-up was 20.88 months (range: 12-36 months). All the cases were managed with closed or open reduction followed by internal fixation with or without hip spica application and resulted in satisfactory outcomes in most of the cases. Conclusion: Anatomical reduction (open or closed) and fixation reduce the risk of complications even in delayed presentation if the orthopedic surgeon is familiar with the management.

Masquelet technique for infected distal radius fractures with gaps in paediatric age group.

The management of infected nonunion with bone loss is always challenging. The Masquelet technique is an excellent option available for us today. However, there are few reports of its use in the paediatric age group and no reports of its use especially in infected distal radius fractures or nonunion. We report on two children with infection and significant bone loss after open fractures of the distal radius which we have treated successfully using a modified Masquelet technique.

The Management of Aseptic Non-unions of Distal Femur Fractures with Anatomical Lateral Locking Plates.

Background: Distal femoral non-unions are challenging, and frequently associated with short distal fragments, poor bone stock, and with issues from previous implants. Materials and methods: A retrospective study of 31 patients admitted with distal femoral non-unions treated using anatomical lateral locking plates. Non-union scores were used. The Knee Society and Neer's scores were used for the comparison of results. The mean follow-up was 39.5 months (from 24 months to 60 months). Results: Stable union was accomplished in all. There was a significant improvement in the average Neer's score (24 preoperative to 82 post-operatively at final follow-up), the Part 1 Knee Society score from an average of 46 preoperatively to 84 post-operatively, and Part 2 Knee Society score from 36 preoperatively to 80 post-operatively. Conclusion: Optimal stability, good compression at the non-union site (either by lag screws or a compression device or both), maintaining the axial alignment strictly, freshening of bone ends, using an adequate amount of cortico-cancellous bone graft, respecting the biology along with the correct choice of the implant (including the size) are essential to achieve union at the fracture site. Clinical significance: Paying attention to the basic principles of management, good contact, stability and maintaining biology is essential in the treatment of non-union. How to cite this article: Mukhopadhaya J, Ranjan R, Sinha AK, et al. The Management of Aseptic Non-unions of Distal Femur Fractures with Anatomical Lateral Locking Plates. Strategies Trauma Limb Reconstr 2022;17(3):137-143.

A case report of extensive segmental defect of the humerus due to thermal necrosis treated with Masquelet technique.

Thermal necrosis due to over-reaming or blunt reamer may have devastating consequences. We present one such case of humerus shaft fracture referred to us at two and half months after primary surgery with active signs of infection and sequestrated segment of the humerus. The challenges were not only to achieve union, control of infection, but also the 10 cm bone gap created after removal of sequestrated part of humerus and preservation of reasonable function of adjacent joints. Emergency drainage of thick purulent material was done on day one because the patient was in excessive pain, the abscess was likely to burst and she was unfit for major surgery due to her toxic clinical state abnormal blood parameters. We had managed this case successfully using Masquelet technique. Masquelet technique is an excellent option for bone gap reconstruction compared to other techniques. It helped us to achieve good functional outcomes and to manage large bone loss in infected humeral non-union.

Functional Outcome of Pipkin Type III Fracture Managed by Osteosynthesis through Trochanteric Flip Osteotomy in a Young Patient after 5 Years Follow-Up - A Case Report and Literature Review.

INTRODUCTION: Femoral head fractures are uncommon. A femoral head fracture associated with an ipsilateral neck of femur fracture is classified as a Pipkin's Type III fracture and is exceedingly rare. It is a high-energy injury associated with an extremely poor prognosis. This has led some authors to advocate primary arthroplasty for these injuries. The aim of reporting this case is that in young patients even with severely displaced Pipkin's Type III injuries, it is reasonable to opt for internal fixation of these fractures. It is possible to obtain good function for a significant amount of time as evidenced by the 5-year follow-up in this case. CASE REPORT: A 25-year-old male presented 4 days after a motorbike accident. He was diagnosed as a femoral head fracture with neck fracture of the left side. This fracture is classified as type III Pipkin fracture or OTA type 31C.3. This case was managed with open reduction and internal fixation utilizing the trochanteric flip osteotomy and multiple screws. It is worth to report the first case of Pipkin type three fracture having satisfactory functional outcome after 5 years of follow-up. CONCLUSION: It is worth preserving the femoral head in young patients. Good pre-operative planning, meticulous reduction, tissue handling, and fixation could get satisfactory results. The outcome also depends on post-operative rehabilitation and compliance of patient.