The aim of this study is to explore the effect of extracorporeal shock wave therapy (ESWT) in patients with chronic planter faciitis. In this prospective study 70 heels in 62 patients with chronic planter faciitis in whom conventional conservative treatment consisting of nonsteroidal anti-inflammatory drugs, heel cup, orthoses and/or shoe modifications, local steroid injections have failed, were treated with low energy ESWT. Patients were reviewed at 6, 12 and 24 weeks post treatment. At follow-up there was significant decrease in pain on the visual analog scale (VAS) (p=0.27), with significant improvement in pain score (p=0.009) and in functional score (p< 0.001). The comfortable walking distance has increased significantly. There were no reported side effects. This study indicates that in patients with chronic plantar fasciitis, the ESWT provide a good pain relief and a satisfactory clinical outcome.

Introduction: Although the application of low-energy Extracorporeal shock waves application (ESWA) to treat musculoskeletal disorders is controversial, there has been some limited, short-term evidence of its effectiveness for the treatment of chronic plantar fasciitis. Objective: The aim of this prospective study is to explore the effect of Extracorporal shock waves in patients with chronic planter faciitis. Methodology & results: In this prospective study 70 heels in 62 patients with chronic planter faciitis in whom conventional conservative treatment consisting of nonsteroidal anti-inßammatory drugs, heel cup, orthoses and/or shoe modiþcations, local steroid injections have failed, were treated with low energy ESWA. Standard radiographs of the affected heels were obtained before ESWA to document the existence of a calcaneal heel spur. Pre and post therapy subjective and objective scoring systems are being used to know the functional outcome (SF36 Health Survey score, Short Form McGill Pain Questionaire, American Orthopaedic foot and ankle society Hindfoot Scale, Visual analogue Pain score). Patients were reviewed at 6 and 12 weeks post treatment. At followup pain was decreased by 70% to 90% on the visual analog scale (VAS) and the comfortable walking time had increased signiþcantly. There were no reported side effects. Conclusion: This study indicates that in patients with chronic plantar fasciitis, the ESWA.provide a good pain relief and a satisfactory clinical outcome

Introduction: The management of young adults with severe osteoarthritis of the hip still remains a problem because of the increased failure rates of total hip arthroplasty in this active high demanding individuals. Hip arthrodesis if done with proper patient selection and proper arthrodesis position provide a viable alternative with good functional results. Objective: The objective of our study was to review the functional outcome after hip arthrodesis and to review its implications on patientñs general life. Material & methods: In our retrospective study we reviewed thirteen patients (5 males,8 females) who had hip arthrodesis at an average age of 30 years. Indications include Septic arthritis, T.B, A.V.N and osteoarthritis secondary to trauma. Cobra Head plate Technique was used. The mean follow up was 15.2 years. All cases had union at the time of followup. SF 36 and Modiþed Harris hip score was used to assess the functional outcome. Isokinetic muscle strength was measured using Cybex machine. Results: Solid arthrodesis was noted in all cases at follow-up. 50% of cases complained of back pain and only one patient complained about ipsilateral knee pain. The average Haris hip score was 76.

The average deþcit in extension torque in the involved leg was 46% and average deþcit in ßexion torque was 4%. The differences in torque were compared using a t-test and extension difference was found to be statistically signiþcant (p< 0.0001). Female patients did well as well as male patients with 70% having no major difþculties in sexual relationship. Ten out of 13 were satisþed with the operation but 7 of 13 would undergo it again given the alternative of total joint arthroplasty. Conclusion:We conclude that hip arthrodesis is still a viable alternative procedure in carefully selected patients.

Material and Methods: In our study the results of a consecutive series of symptomatic non unions of scaphoid fractures treated with Herbert screw and bone graft during period between July 1996 and June 2000 are studied. Out of a total of 66 patients (one bilateral), 61(91.04%) cases who had symptomatic non unions (type D) were treated with Herbert Screw plus iliac crest bone graft while 6(8.95%) cases were treated for acute unstable fractures (type B)with Herbert screw only (these are excluded from the study). The time interval between injury and surgery was 12.2 months (range 2–72 months) Patients were followed up for radiological evidence of union and clinically for range of movement of wrist, grip strength and outcome score. Results:Total No 61, Union 47 (77.1%), Persistent non-union 14 (22.9%). The site of fracture (p=.044), type (p=.028), screw placement (p=.019) were found to be significant factors infl uencing outcome. No statistically significant influence on outcome was found with patient’s age (p=0.983) and also with time interval to non union surgery (p=0.749). Using the scaphoid outcome score, an assessment scale based on pain, occupation, wrist motion, strength and patient satisfaction, functional results were graded as excellent in 19 cases, good in 12 cases, fair in 10 cases and poor in 5 cases. Conclusion: We recommend axial placement of Herbert screw with bone grafting via Russe approach and for difficult proximal pole non unions dorsal approach is recommended.

Aim: The aim of the study was to analyse the long-term follow-up of patients who were treated with chemonucleolysis for single level disc prolapse. Method: In our retrospective study we reviewed 112 cases that underwent chemonucleolysis for single level lumber disc herniation during the period of 1988–1996. Mean follow up was 9.5 years. In order to estimate the functional outcome of chemonucleolysis Oswestry Disability Index questionnaire was used. Results: An excellent or good response occurred in 79 patients (70.5%); 12 patients (10.7%) showed moderate response with minimal disability. Treatment failed in 21 patients (18.5%) who showed poor response and 12 of these 21 patients went for surgery within a mean period of 6 months. One patient had surgery at different level than chemonucleolysis. There was only one incident of procedure termination because of epidural contrast leak. There was no case of anaphylaxis or discitis. Conclusion: We conclude on the basis of our results that chemonucleolysis is a safe and effective treatment modality for lumber disc herniation in carefully selected patients.

The management of three or four-part fractures of proximal Humerus remains difficult. Controversy still persists concerning the preferred treatment of these fractures. The aim of our study was to review the functional outcome and factors influencing the outcome after shoulder hemi arthroplasty in acute fractures of proximal humerus.

Material and Methods: Retrospective review of a consecutive series of 23 patients with three/four-part proximal humerus fractures, treated with shoulder hemi-arthroplasty between 1999 – 2002. Nineteen patients (one bilateral) were available for study. The mean follow-up period was 12 months. All fractures, 16 cases were Neer’s four-part fractures, while one case was fracture with posterior dislocation. Post operative pain, range of motion and function evaluated using Visual analogue score, Pain scale and UCLA functional score. The average age was 64 years (range 50–85).

Results: At follow-up pain relief was satisfactory in 15 of 20 cases. Patient’s satisfaction was 75%. Functional evaluation was good/fair in 14 cases. One patient developed chronic inferior subluxation post-operatively. We have found that age (75 years +) at the time of surgery, securing of tuberosities t the implant and compliance with the post-operative rehabilitation program are significant factors affecting the outcome.

Conclusion: We recommend careful patient selection, proper positioning of patient during surgery, use of x-ray screening of the implant prior to cementing and meticulous surgical technique to achieve optimal results.

The fact that a multitude of procedures exist for the correction of hallux valgus indicates that there is no ideal operation for this problem. Hallux valgus correction can be significantly improved by scarf first metatarsal osteotomy. The surgical technique is versatile and strong internal fixation allows early functional recovery. The aim of our study is to analyse the clinical, radiological and functional outcome after scarf osteotomy for hallux valgus correction.

Material and Methods: The scarf osteotomy was performed on 65 feet of 48 patients between 1996 and February 2001. The indication was a symptomatic hallux valgus with increased intermetatarsal angle (IMA). The osteotomy was fixed with one/two 2.3mm screws. Mobilisation was allowed with full weight bearing with forefoot orthesis. Fifty-one cases in 39 female patients (12 bilateral feet) were available for follow-up. The mean follow-up was 14 months (range 3–36 months). Patients were interviewed, clinically examined and standing radiographs of operated foot were taken. They were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalyngeal Inter-phalyngeal clinical rating system in which 100 point are used to compare preoperative and postoperative pain, function and range of motion, shoe wear comfort and activity level and alignment.

Results: All osteotomies healed at the time of follow-up. The average value of AOFAS scale was 92 points. Five patients had removal of screws. There were 4 cases of superficial wound infection. All patients have excellent cosmetic and functional results.

Conclusion: Our study has demonstrated that scarf osteotomy has proven to offer easy postoperative care and has excellent stable long-term results.

Treatment of scaphoid fractures continues to be a difficult problem for both acute unstable fractures and non-unions. In our study, the results of a consecutive series of symptomatic non-unions of scaphoid fractures treated with Herbert screw and bone graft during period between July 1996 and June 2000 are studied. Out of a total of 66 patients (one bilateral), 61 (91.04%) cases who had symptomatic non-unions (type D) were treated with Herbert screw plus iliac crest bone graft while 6 (8.95%) cases were treated for acute unstable fractures (type B) with Herbert screw only (these are excluded from the study). All fractures were classified according to Herbert classification. Russe approach was used in 50 patients while dorsal approach was used in 11 cases with proximal pole fracture non-union. The time interval between injury and surgery was 12.2 months (range 2–72 months). Patients were followed up for radiological evidence of union and clinically for range of movement of wrist, grip strength and outcome score. The site of fracture, type, screw placement, the time interval between the original injury and non-union surgery, and age of the patient, were investigated to assess whether they influenced outcome.

Results: Total No. 61 – union 47 (77.1%), persistent non-union 14 (22.9%). We found site of fracture (p=0.044), type of fracture (p=0.028) and screw placement (p=0.019) as statistically significant factors influencing outcome. No statistically significant influence on outcome was found with patient’s age (p=0.983) and also with time interval to non-union surgery (p=0.749). Forty-six (75%) patients were available for clinical follow-up. Seven (15.2%) had persistent non-unions of which four had proximal pole fracture non-unions. Using the scaphoid outcome score, an assessment scale based on pain, occupation, wrist motion, strength and patient satisfaction, functional results were graded as excellent in 19 cases, good in 12 cases, fair in 10 cases and poor in 5 cases. We recommend axial placement of Herbert screw with bone grafting via Russe approach and for difficult proximal pole non-unions dorsal approach is recommended.