Introduction:Treatment of infected nonunion is a serious challenge. The bone transport technique using an external fixator(EF) is the answer to bridge the defect. However, these fixators don’t come without complications. We aimed to evaluate the results and complications among two types of EF. Methods:A retrospective cohort study, where 60 cases with infected non-union identified from the hospital record of the institute in northern India, over the period 2010-2016. Allotted group-A and group-B on basis of treatment with Ilizarov and LRS(limb reconstruction system) with minimum of 1-year follow-up. Results:The total number of complication 78 in group A and 84 in group B. Incidence of complication - 2.6 & 2.83 in groupA & B. 100% union rate achieved. ASAMI bone results - excellent in 12 (40%), good in 11 (36.67%), fair in 1 (3.33%), poor in 6 (20%) in Group A whereas in group B were excellent in 15 (50%), good in 7 (23.33%), fair in 2 (6.67%), poor in 6 (20%)cases. Clinical result in group A & B were excellent in 9 (30%) & 6 (20%), good in 13 (43.33%) & 17 (56.67%), fair in 6 (20%) & 4 (13.33%) and poor in 2 (6.67%) & 3 (10%) respectively. Conclusion:Ilizarov and LRS application are both excellent methods to achieve union, even in presence of infection Although each method has its own pros & cons. But final outcome with specific reference to complications is more or less similar. However, it has been observed that compliance is more in LRS.

Background: In this study, we aimed to compare the Taylor Spatial frame, Orthex frame and TrueLok hexapod frame in lower limb deformity correction. We used Sawbones models with femoral and tibial deformities. We compared the following: 1) The software accuracy in estimating the deformity 2) The accuracy of initial correction. 3) The frequency of re-programming, struts changes and re-adjustments. Methods: This is a biomechanical study comparing the above 3 different types of circular frames to correct similar deformities in Sawbones models. The deformities that are compared were: 1) 30 ° Valgus deformity of the distal femur. 2) 30 ° Varus deformity of the proximal tibia. Each frame was applied to the deformed bone in the standard way that we apply to normal bone. X-rays were taken before the deformity correction was started. The frame software’s were used to estimate the deformities. The variations between the software’s estimations and the known bone deformities were compared between the frames. Residual deformity after initial correction and the number of re-programming was compared among these 3 frames. The least residual deformity and re-programming is the favourable outcomes. Conclusion: The three frames were comparable in terms of accurate correction of the two deformities, the strut changes and strut adjustments. The TL-HEX frame software was superior to other frames in terms of analysing the deformity but the difference, although statistically different, clinically was not.

Introduction: Fracture site healing can be linked to patient, biological and mechanical factors. Great advances have been made in fracture management through improved understanding of biomechanics, biology and importance of soft tissue preservation. Intramedullary fixation presents us with reduced soft tissue dissection, less blood loss, shorter operative time and decreased complication rate. This clinical study focuses on identifying influential factors in bone healing after reamed tibial nailing, to improve comprehension and crucial surgical factors. Methods: Thirty-three diaphyseal tibial fractures (AO 42) treated with reamed intramedullary nails, over a five-year period were reviewed, consisting of 16 AO type-A, 8 AO type-B and 9 AO type-C. Delayed union (DU) was defined as lack of union at 26 weeks, whereas non-union (NU) was defined as no healing within 39 weeks. Six variables where analyzed. Results: Global mean time to union was 22,06 weeks. There were four delayed unions and one non-union. Smoking habits, mechanism of trauma, fracture pattern and existence of fracture site gap showed influence in union, the difference was statistically significant (p<0,01). Age, sex and alcohol consumption showed no significant influence. Conclusions: Complex fracture patterns and high-energy trauma have a negatively affect healing, requiring excellent surgical technique and choice of implant. It is crucial to avoid fracture site gap. Smoking cessation is important, and cessation programs could be instituted. One problem may arise in what concerns differences in age, due that the majority of young patients suffered high energy trauma making up for the tendency for their shorter healing time.

Background Treatment of distal tibia fractures represents a challenge due to the importance of soft tissue preservation. Minimally invasive treatment of these fractures has become increasingly popular due to good results. The limited number of biomechanical studies makes it difficult choosing the optimal implant. Objectives
The study objective is to ensure biomechanical assessment the effectiveness of two methods of fixation: medial locked plate and Xs-nail, in the treatment of complex articular distal tibia fractures. Study Design Ten Tibia (Sawbones®, Fourth Generation) with articular and metaphiseal segmental osteotomy in three different planes were reduced and plated with precontoured medial distal tibia plate or with 2 Xs-nail in „X” position and screws. The constructs were biomechanical tested for axial and torsional loading at 200N and 400N, using a LRX Plus machine (Lloyd Instruments Ltd –AMETEK). For data data collection and analysis we used NEXIGEN Data Analysis and IBM SPSS 18.0 software.
Results Construct optimal stiffness to axial compression was obtained with the plate located on the medial side (50.13% of the standard values to small forces and 39.58% from standard to high forces). These values are comparable (and better) than when applying XS-nail (32.65% and 29.68% at small forces at large forces) (p<0.05). In case of torsion testing there were no statistical differences between the two constructs. Conclusions This study showed the biomechanical advantage of medial plating complex articular distal tibia fractures. Due to the microinvasive character the XS nail, it can be used for the stable fixation in selected cases.

Background
Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contacts whilst maintaining patient safety.

Objectives To estabilish a service that can be safe for both the patients and Clinicans.

Methods robust protocols were developed by the MDT on how to manage common musculoskeletal presentations to A&E. Patients broadly triaged into 3 categories; discharge with advice, referral to VFC or discussion with on call team. Vfc initiated fully from 17/08/2020. The first 5 Months of data were analysed to assess types of injury seen and outcomes.

Results In total 1362 patients were referred to VFC. 400 patients were discharged and 132 patients were discharged for physiotherapy. 3 patients required admission with the remaining 87 patients booked for follow-up with an appropriate specialist. Regarding Followups 212 patients had a Vfc followup while 595 of patients would have a  face to face Fracture clinic followup. 10 patients were felt to have been referred inappropriately.

Conclusions
BOA guidelines suggest all patients need to be reviewed within 72 hours of their orthopaedic injury. Implementation of a VFC allows this target to be achieved and at the same time reduce patient contact. Almost half the patients were discharged following VFC review. This is especially relevant in the current pandemic where reducing unnecessary trips to hospital will benefit the patient as well as make the most of the resources available.

Introduction:The discussion in which a patient gives their consent for surgery is most commonly documented on a paper consent form. Paper consent forms are associated with errors of completion, legibility and omission. We aim to compare the quality of a new digital consent platform against paper consent forms and assess the perceived quality of shared decision-making (SDM) patients experience with each form. Methods:194 patients were included in this multi-site, single centre study. Patients were not randomised and were consented by either a paper consent form 1 or via a digital multimedia platform. Consent forms were assessed for errors of legibility, completion and accuracy of content. “Core risks” for 20 Orthopaedic operations were defined by a Delphi round of experts and forms analysed for omission of these risks. SDM was determined via the “collaboRATE Top Score” which is a validated measure for gold-standard SDM. Results:73% of paper consent forms contained ≥1 error compared to <1% of digital forms (P<0.0001). Less than 2% of digital consent forms omitted any risks whilst 63% of paper forms omitted core risks (P<0.0001). 68% of patients consented digitally achieved gold-standard SDM compared to 27% seen with paper consent (P<0.001). Conclusion:Implementation of a digital consent process has been shown to reduce error rate and omission of core risks on consent forms. Gold-standard SDM was achieved more frequently when digital rather than paper consent was used. A large scale trial is required, however, digital platforms offer a future solution to improve the quality of informed consent in Orthopaedics.

Introduction: There are limited studies on the prevalence and patterns of Modic changes in the cervical spine. Their association with spinal pain, disc level, age, the severity of disc degeneration and endplate damage, and sagittal parameters like presence or absence of kyphosis, T1 slope, and C2-C7 angle, L1-S1 angle, has not been analyzed so far. This study was primarily aimed to investigate the epidemiology of Modic changes in patients with neck pain.

Methods: The study sample was segregated into three groups- Patients primarily presenting to the outpatient department with chronic unresolved neck pain (Group-A) and back pain (Group-B) and control MRI was obtained from patients who were admitted for spinal trauma (Group-C). A case-control analysis was performed.

Results: The overall prevalence of Modic changes in the Lumbar spine (41%) was higher than the cervical spine (16%). Both Cervical and Lumbar Modic changes were more common in symptomatic than asymptomatic individuals. While C6-C7 was the most common disc level involved with Modic changes in symptomatic individuals, C5-C6 was the most common level in patients presenting with back pain. Patients with Modic changes had higher intensity of pain, higher grades of disc degeneration, and endplate damage compared to patients without Modic changes.

Conclusion: Modic changes are more common in the Lumbar spine than the cervical spine, and common in symptomatic individuals. Patients with Modic changes have a higher intensity of pain, higher grades of degeneration, and associated end plate damage and their presence is more common in non-kyphotic individuals than kyphotic individuals