A study of marketing strategies used by Indian artisans during the Covid-19 crisis

70% of the population lives in villages in India. Time and again, we have underestimated this part of our population while thinking about our country’s economic growth. However, the true spirit and skills of Indian crafts live in rural areas that are self-sufficient and self-reliant. Indian crafts have evolved from the Vedic Era to Indus Valley civilization to Mauryan Era to the Mughal Era, and currently the Modern Indian Era. However, with industrialization and the informal nature of the sector, Indian crafts had started losing relevance. Though 90% population is uneducated, Indian crafts are highly skill-based. Today with the advent of technology, awareness among the new generation of artisans, emerging sectors of the economy, Indian crafts are being revived with the help of craft activists and platforms created for uplifting the community. Slowly as this sector started reviving itself and generated awareness and business, a novel coronavirus pandemic has affected their livelihood. Most artisans have an informal setup. The uncertainty of the situation, ruptured supply chain, canceled orders, and customers’ non-engagement in buying the products; have blurred their future. With no raw materials, no business, no demand, and a huge inventory of canceled orders, various platforms are being created to market their products and generate funds. A study of the marketing strategy is important to know the way forward.

OUR EXPERINCE OF A CASE OF TERRIBLE TRIAD OF ELBOW

Dislocation of the elbow joint in association with fracture of radial head and fracture of coronoid process, is referred to as “terrible triad” of the elbow, the treatment of which provides a challenge to treating surgeon due to its complicated outcomes. The understanding of the elbow kinematics, the usage of various implants and surgical techniques in the recent years has led to the development of standard treatment protocols. The 'terrible triad' of the elbow is a severe injury that is difficult to treat and has a poor prognosis in the medium-tolong term. It is characterised most often by instability of the elbow, development of arthrosis and joint stiffness.

A 43 year old lady presented to us after a fall on outstretched dominant hand with severe pain and swelling around elbow. She had sustained a fracture of the radial neck and coronoid process with posterolateral dislocation of elbow. Immediate Closed reduction of the dislocation was performed under GA and elbow was immobilised in a plaster of paris slab for 3 weeks. She underwent operative procedure of open reduction and internal fixation of the radial head with a titanium plate and the coronoid process with a 4mm screw and washer after 10 days.After 3 weeks elbow rehabilitation was begun and at one year post surgery there was signs of fracture healing with full range of motion of the elbow.

CAVERNOUS HAEMANGIOMA IN THE GASTROCNEMIUS MUSCLE: A RARE PRESENTATION IN THE GERIATRIC AGE GROUP

Intramuscular haemangiomas are believed to be hamartomatous and are a distinctive type of haemangioma occurring within skeletal muscle. They account for less than 1% of all haemangiomas. They occur more often in trunk and extremity muscles.

A sixty five year old lady presented with swelling and pain from the back of the left knee for two years.

On clinical examination, a mass of about 10X10 cms in size was noted in the left popliteal fossa. The swelling was tender with well defined borders but fixed to the muscle. She had a flexion deformity of knee of ten degrees.

MRI revealed a large encapsulated cystic lesion in the posterior aspect of the muscular compartment of the knee.

She underwent excision of the mass, intraoperatively the mass was noted to be arising from the gastrocnemius. Histopathology revealed large cavernous filled spaces filled with blood which indicated a cavernous haemangioma.

Most of the literature suggest the occurance of capillary haemangioma to be a commoner one. Occurance of a cavernous haemangioma is usually before the third decade and is congenital in most times. Most of the authors emphasize that radiological methods are generally insufficient for the correct diagnosis of intramuscular hemangiomas, and surgery is the treatment of choice to exclude malignancy and for adequate treatment of these lesions.

Hence, the present case which we are reporting here is a rare occurance of a cavernous haemangioma of the gastrocnemius in a 65 year old lady, which was managed by surgical methods.

A Study to Assess the Functional Outcome of Decompression and Posterior Lumbar Interbody Fusion of Low Grade Spondylolisthesis of Lumbar Vertebra

INTRODUCTION

Spondylolisthesis is defined as the forward displacement of one vertebra over the vertebra below. It is often accompanied by spinal canal stenosis and compression, which is the cause of all the symptoms.

AIM

To assess and study the functional outcome after decompression and Posterior Lumbar Interbody Fusion (PLIF) of isthmic spondylolisthesis of lower lumbar vertebra and to study the complications occurring with this technique.

MATERIALS AND METHODS

A prospective study was conducted in the Department of Orthopaedics in Justice KS Hegde Charitable Hospital, Mangalore, Karnataka, India from March 2015 to August 2016. A total of 15 diagnosed patients with Grade I and II spondylolisthesis of L4-L5 and L5-S1 vertebrae with no neurological deficits, between the age group of 25-50 were included in the study. An initial two months of conservative treatment of back physiotherapy and flexion exercises was tried. Patients who did not improve with the conservative therapy were taken up for surgery with consent. Decompression and PLIF with bone grafting with interbody cage placement and pedicle screw instrumentation was performed. The patients were discharged on postoperative day 10 after suture removal. They were reviewed at postoperative day 10, week six and week 24. The scoring of the functional outcome of the back was done as per the Modified Oswestry low back pain Disability Questionnaire. The statistical analyses were done using the repeated measures ANOVA, SPSS version 20.

RESULTS

The mean Modified Oswestry low back pain Disability score preoperatively was noted to be 42.87+/- 3.46 points. The mean Modified Oswestry low back pain Disability score at postoperative day 10 was noted to be 36.93±3.75 points. The mean Modified Oswestry low back pain Disability score at postoperative week six was noted to be 28.47±3.70 points. The mean Modified Oswestry low back pain Disability score at postoperative week 24 was noted to be 24.27±3.01 points. Improvement in the Modified Oswestry low back pain Disability scores was noted during the follow ups. Foot drop was noted in two cases postoperatively which improved during the final follow up with physiotherapy.

CONCLUSION

Decompression and PLIF is noted to produce good to satisfactory functional results in cases of isthmic spondylolisthesis of lower lumbar vertebra.

Open Reduction and Volar Plate Fixation of Dorsally Displaced Distal Radius Fractures: A Prospective Study of Functional and Radiological Outcomes

INTRODUCTION

The fractures of the distal radius have always posed a unique challenge to the orthopaedic fraternity. The complex ligamentous and bony anatomy offers a wide variety of fractures to be dealt with around this zone. Over the years these injuries have become common especially in the elderly age group as well as the implants and surgical techniques have improved.

AIM

To assess the radiological and functional outcome after fixation of intra-articular dorsally displaced distal radius fractures with open reduction and volar Locking Compression Plate fixation (LCP). To study the complications occurring with this technique.

MATERIALS AND METHODS

A prospective study was conducted in the Department of Orthopaedics at ARS Hospital, Tirupur, Tamil Nadu, from June 2015 to June 2016. A total of 20 skeletally mature patients with Lidstrom class 2D and 2E fresh closed distal radius fractures were enrolled in the study. All the patients underwent open reduction with locking compression plating with titanium LCPs using the volar approach. The patients were reviewed regularly at three, six, 12 and 24 weeks. Final assessment of radiographic fracture union was done and scored as per the 'Radiographic Scoring System to Evaluate Union of Distal Radius Fractures {Radius Union Scoring System (RUSS)}' and the functional assessment of the wrist was done using the Mayo wrist score. The final results were tabulated and calculated statistically using 'frequency and proportions' and 'Chi-square tests' were used to assess the test of association.

RESULTS

Of the 20 patients reviewed, one patient had excellent Mayo wrist score, five had good scores, 12 had satisfactory and two patients had poor results. Seven patients had a RUSS score less than five points and four patients had RUSS score of five points, four patients had six points, two patients had seven points and three patients had eight points. One patient was noted to have dorsal collapse of the fracture during the final review. But, no evident of cosmetic deformity or any diminution in functional outcome of wrist was noted.

CONCLUSION

Open reduction and internal fixation with volar plating of dorsally displaced intra-articular distal radius fractures is an excellent technique with acceptable radiological fracture union and satisfactory functional outcome of the wrist.

Excision Versus Fixation of the Radial Head: A Comparative Study of the Functional Outcomes of the Two Techniques

INTRODUCTION

The management of displaced and comminuted radial head fractures has been a matter of debate amongst surgeons for many years. Radial head excision formed the mainstay of surgical management of these injuries. Over the years, there have been improvements in the surgical techniques and availability of better implants and instrumentation techniques, hence, open reduction and internal fixation of these fractures is gaining popularity.

AIM

To compare the outcome of elbow function between radial head excision and open reduction and internal fixation of the radial head with mini screws of Mason Type II and Type III radial head fractures and to assess the complications that occur in both techniques.

MATERIALS AND METHODS

A prospective study was conducted in the Department of Orthopaedic Surgery of Justice K.S.Hegde Charitable hospital. A total of 40 patients between the age group of 30-50 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. Group I consisted of 20 patients who underwent radial head excision and Group II consisted of 20 patients who underwent open reduction and internal fixation with mini screws. Patients were reviewed at postoperative week 3, 6 and 24. Radiographs were taken and functional outcome assessment of the elbow was done during all the follow ups. Elbow physiotherapy was started on postoperative week three. Scoring of elbow function was done as per the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system. Results were tabulated, compared and analysed statistically using the 'chi-square test'.

RESULTS

At the end of six months, the patients of the open reduction and internal fixation group had lower DASH scores (4.82±2.73 points) than the radial head excision group (14.23±5.60 points). This inferred that patients who underwent open reduction and internal fixation had better functional outcomes than the excision group. Complications of proximal radial migration was noted in three patients, elbow osteoarthritis was noted in two and periarticular ossification was noted in six patients who underwent radial head excision.

CONCLUSION

Open reduction and internal fixation of Mason Type II and Type III radial head fractures is a better management technique as compared to radial head excision for management of Mason Type II and III radial head fractures.

To Operate or not to Operate the Mid-Shaft Fractures of the Clavicle: A Comparative Study of Functional Outcomes of the Two Methods of Management

INTRODUCTION

Fractures of the clavicle are some of the most common fractures which are seen in the adult population. Mid-shaft fractures of the clavicle are considered the most common form of clavicle fractures and about half of them are displaced fractures. They have been managed non-operatively over the years. However, severe displacement and comminution of these fractures have warranted the requirement of operative intervention, due to increased incidence of mal-union, worsening of shoulder functions etc., after conservative management. The introduction of locking compression plates, have increased the incidence of operative intervention in the management of these injuries.

AIM

To study and compare the functional outcome of the shoulder after open reduction and internal fixation versus non-operative management of mid-shaft clavicle fractures.

MATERIALS AND METHODS

A prospective study was conducted from June 2013-October 2015 in the Department of Orthopaedic Surgery, K.S. Hegde Medical Academy, Mangalore. A total of 30 skeletally mature patients between the age groups of 20-50 years with diagnosed fresh mid-shaft clavicle fractures, AO type A and B mild to moderate displacement, were enrolled into the study with. They were divided into two groups randomly. Group 1 consisted 16 patients who underwent open reduction and locking compression plate fixation and Group 2 consisted of 14 patients who were managed with application of a clavicle brace and arm pouch for three weeks. Reviews were done at three, six and 24 weeks postoperatively. The patients were assessed clinically and radiographs were taken during all the reviews. Scoring of shoulder function was done using the Disabilities of the Arm, Shoulder and Hand (DASH) score during all the reviews. The results were tabulated compared and analyzed statistically using the 'Independent t-test' and Chi-square test.

RESULTS

The DASH scores at the end of 24 weeks were noted to be 8.57±6.073 points for the 14 patients in the conservative management group and 7.74±16.422 points for the 16 patients in the open reduction and internal fixation group. This indicated that there was no significant difference noted in terms of shoulder function between the two groups. Six of the 14 patients in the conservative management group were noted to have mal-union of the fracture. No non-unions were noted in the conservative or operative groups. No mal-union was noted in the open reduction and internal fixation group.

CONCLUSION

Though open reduction and internal fixation of mid-shaft clavicle fractures reduced the incidence of mal-union, no significant difference was noted in the functional outcome of shoulder function as compared to when the fracture was managed conservatively.

Dynamic Hip Screw with Trochanteric Stablization Plate Fixation of Unstable Inter-Trochanteric Fractures: A Prospective Study of Functional and Radiological Outcomes

INTRODUCTION

Management of unstable intertrochanteric fractures have posed a unique challenge to orthopaedicians over years. Several surgical techniques and implants have been developed for the same. Fractures of the lateral wall have been considered as the major cause of femoral medialization after fixation by Dynamic Hip Screw (DHS). Studies have shown that supplementation of trochanteric stabilization plate reduces the incidence of femoral medialization.

AIM

To assess the radiological union and hip function after fixation of unstable intertrochanteric fractures with DHS and Trochanteric Stabilization Plate (TSP).

MATERIALS AND METHODS

A prospective study was conducted with a total of 32 patients between age groups of 30-70 years with Evan Jensen unstable and very unstable type of intertrochanteric fractures, between August 2013 to March 2015 in the Department of Orthopaedics ARS Hospital, Tirupur, Tamil Nadu, India. They underwent open reduction and DHS and TSP fixation. They were started on full weight bearing mobilization on post op day three. They were reviewed at post-op weeks 3,6,12 and 24. Hip mobilization and rehabilitation exercises were instituted during course of reviews. Radiographs were taken to assess fracture union and hip function was evaluated during follow-ups. At the end of 24 weeks, degree of radiographic union was scored as per Radiological Union Score for Hip (RUSH). Hip function was scored with Harris hip score. Analyses were done using frequency and proportions. Chi-square tests were used to assess the test of association.

RESULTS

Fifteen patients had RUSH scores between 10-20 and 17 patients had scores between 20-30 points. RUSH score had mean of 21.03+/- 2.132 points. 9 of 32 patients had excellent results as per Harris hip score, 10 had good, nine had fair and four had poor. On comparison of Harris hip score with RUSH score: Interval between 10-20 points, of 15 patients; two had excellent results, five had good, five had fair and three had poor. Of 17 patients between 20-30 points, seven had excellent, five had good, four had fair and one had poor results.

CONCLUSION

DHS and TSP fixation of unstable intertrochanteric fractures is an effective technique with good radiological and functional outcome.

Solitary Fibrous Tumour of the Clavicle: A Rare Case Report

A Solitary Fibrous Tumour (SFT) is the preferred term by most of the pathologists than "haemangiopericytoma". SFT is a heterogeneous group of benign and malignant neoplasms along a morphologic continuum. Here we report a case of SFT of the clavicle in a 26-year-old male patient, who presented to us with complaints of pain and swelling over the dominant shoulder. No signs of metastasis were noted clinically and radiologically. He underwent surgical resection of swelling. At 6 months after resection and after 22 cycles of radiotherapy, he was noted to have excellent prognosis with satisfactory shoulder function.

Osteoid Osteoma of the Ankle Posing As a Distal Tibiofibular Syndesmosis: A Rare Case Report

Osteoid osteoma is a benign tumor of the bones. The adolescent males are the most commonly involved population. Pain of the affected site forms the common symptom during clinical presentation. The lower limbs are the most commonly affected site.

We present here a case report of a middle aged gentleman who presented to us with complaints of pain and mass over the non-dominant ankle for four years. Clinical examination revealed a bony hard swelling proximal to the lateral malleolus. The radiographs and CT scan reports were consistent with features suggestive of an exostosis bridging the distal tibio-fibular syndesmosis. Surgical exploration revealed a mass with definite borders bridging the distal tibio-fibular syndesmosis. Excision biopsy was performed and the histopathology of the specimen reported features consistent with that of an osteoid osteoma. The patient was started on physiotherapy of the ankle and he was noted to have full range of ankle motion at six months. As no such case has been reported in earlier in literature we present it as a rare case report.

A Prospective Study of the Functional Outcome of Anterior Cervical Discectomy With Fusion in Single Level Degenerative Cervical Disc Prolapse

INTRODUCTION

Cervical spondylotic myelo-radiculopathy is a form of spinal cord dysfunction syndrome and usually accompanies age related degeneration of the spine.

AIM

To determine the functional outcome of anterior cervical discectomy with fusion and plating in single level degenerative cervical disc prolapse.

MATERIALS AND METHODS

A total of 20 patients diagnosed with degenerative single level cervical disc prolapse who presented to the Department of Orthopaedic Surgery, Justice KS Hegde Charitable Hospital, Mangalore from the period of November 2012 to May 2014 were enrolled in the study. Complete clinical and radiological evaluation of the patients was done. A trial of conservative management was tried in all these patients for a period of two months. They were taken up for surgery only when conservative management had failed. Scoring of neck function before the surgery was done as per the Modified Japanese Orthopaedic Association (MJOA) score. All patients underwent anterior cervical discectomy and fusion (ACDF) with tricortical iliac crest bone grafting. Fixation was performed with titanium locking cervical plates. All patients were reviewed at 6 weeks and 6 months postoperatively. Assessment of neck function was done as per the MJOA scoring during all the reviews. Radiographic assessment was also done during all the reviews. The complications noted were documented. The statistical analysis was done using percentages; the arithmetic mean was calculated using SPSS software (version 16.0).

RESULTS

Amongst the 20 patients included in the study, 1 patient died postoperatively due to oesophageal rupture. of the remaining 19 patients reviewed and followed up, all of them had improvement of symptoms and were reported to be in the 'mild category' as per the MJOA score. One patient developed dysphonia, in the immediate postoperative period due to recurrent laryngeal nerve palsy which recovered in a period of three months postoperative.

CONCLUSION

Single level anterior cervical discectomy with fusion and anterior cervical plating for degenerative cervical disc prolapse with or without myelo-radiculopathy is an effective and safe surgical procedure with minimal complication rate.

A Prospective Study on Functional Outcome of Internal Fixation of Tibial Pilon Fractures with Locking Plate using Minimally Invasive Plate Osteosynthesis Technique

INTRODUCTION

Managing pilon fractures is still a great challenge for surgeons in terms of reduction and fixation. The soft tissue anatomy and the bony configuration, results in angular and rotational instability and other bony and soft tissue complications.

AIM

To evaluate the results of minimally invasive plate osteosynthesis using locking plates in management of fractures of tibial pilon in terms of radiological fracture union, restoration of ankle function and complications.

MATERIALS AND METHODS

A total of 18 patients with Ruedi Allgower class I, II & III fresh pilon fractures were taken into this study. All the patients underwent ankle spanning external fixator application on the day of presentation as a first stage. Wound debridement was done in patients with open fractures. Associated distal fibula fractures were fixed in the first stage. The second stage comprised of a definitive plate fixation using the minimally invasive plate osteosynthesis technique. This employed minimal periosteal and soft tissue dissection through a medial approach to the ankle. Postoperatively, all patients were reviewed at week six and 12 when partial weight bearing and full weight bearing mobilization was started respectively. The final review was done at 24 weeks when the final assessment of function was done as per the Mazur's scoring criteria. Analyses were done using frequency and proportions. Chi-square tests were used to assess the test of association.

RESULTS

Three patients had excellent inference, nine patients had good inference, five patients had fair and one patient had poor inference as per the Mazur's scoring criteria. Two patients had scar dehiscence as a complication and one patient had a fixed equines deformity of the ankle who was under RuediAllgower class III.

CONCLUSION

Minimally invasive plate osteosynthesis is an excellent method of treating pilon fractures with very good functional results and minimal complication rate.

A Prospective Study on Radiological and Functional Outcome of Displaced Tongue Type Intra-Articular Calcaneal Fractures Treated by Percutaneous Screw Fixation

INTRODUCTION

Calcaneal fractures have posed a challenge to orthopaedic surgeon for many years. The major problem is to reconstruct the fracture and improve healing of the fracture and also the surrounding tissues. Anatomic restoration of the three-dimensional anatomy of the calcaneum is the goal of surgical management of calcaneal fractures. Over the years, various techniques have been developed to accomplish this goal.

AIM

To determine the functional outcome in displaced tongue-type calcaneal fracture treated by percutaneous screw fixation.

MATERIALS AND METHODS

A prospective study was conducted from October 2012 and September 2014. A total of 23 patients with intra-articular 'tongue type' calcaneal fractures were included in the study. Complete clinical and radiological evaluation was done. The surgical procedure encompassed closed reduction and fixation with two criss-cross 6.5 mm cannulated cancellous across the fracture site under fluoroscopic guidance. Postoperatively, on day three ankle and toe mobilization was begun. Non-weight bearing crutch mobilization was begun on postoperative day three. Reviews were done at 6 weeks, 12 weeks and 24 weeks postoperatively. At 6 weeks partial weight bearing mobilization was started. Full weight bearing was begun at 12 weeks. The patient was finally reviewed at 24 weeks and assessment of ankle function was done as per the Maryland foot scoring system. Radiographs were compared and preoperative and postoperative Gissane's and Bohler's angles were also compared. The results were analysed as per descriptive statistics (frequency, percentage). The complications noted were documented.

RESULTS

Of the 23 patients under the study, three had excellent results with mean score of 90, 17 had good results with mean score of 82.94 and three had fair results with mean score of 74. Only one patient had subtalar arthritis as a complication. No other complications were seen.

CONCLUSION

Percutaneous screw fixation of tongue type calcaneal fractures is a very effective surgical technique.

A study of functional outcome of laminectomy and discectomy in lumbar intervertebral disc prolapse (a comparison of retrospective and prospective analysis)

Background: Back pain is considered as one of the most unrewarding problems in clinical medicine. There have existed several etiologies for the same and most of them do not have an ideal clinical presentation. Only those syndromes associated with neurologic compression of the cauda equina or nerve roots, have reasonably well understood clinical presentation.

Aims: The aim of the study was to analyse and compare the functional outcome of laminectomy and discectomy in lumbar intervertebral disc prolapse in short and long term follow up.

Materials and methods: Our study included a total of 50 diagnosed cases of lumbar intervertebral disc prolapse between age group of 40-70 years. The patients were subdivided into two groups. The first group was a retrospective group and included patients who had undergone laminectomy and discectomy between January 1993 and December 2003 with an average follow up of 3.68 years. Group two (prospective group) consisted of patients between January 2004 and December 2004 who underwent laminectomy and discectomy, with a follow up of 6 months.

The subjective assessment was done using the Oswestry disability index (O.D.I). the results obtained with assessment of group I and group II were tabulated compared. Statistical analysis was done using the chi square test.

Results: The results were noted to be 76% excellent, 8% good and 16% with poor scores in group I. 96% with excellent, no patients with good scores and 4% with poor scores in group II as per the O.D.I.

Conclusion: We conclude saying that laminectomy and discectomy had excellent outcome in terms of pain relief in terms of long term and short term follow up.

DOUBLE JEOPARDY : PATHOLOGICAL FRACTURE AND NONUNION OF PROXIMAL HUMERUS DUE TO CHONDROCALCINOSIS

Fractures of the humerus constitute 5% to 8% of fractures and most have an uneventful healing, but occasionally non-unions of the fracture with joint stiffness of shoulder and/or elbow and prolonged debilitating pain may be encountered. Predisposing conditions usually are osteoporosis, obesity, alcoholism and smoking. Comminuted or segmental fractures, soft tissue interposition at the fracture site, improper fixation and infection may also result in non-union.

A fracture of neck of the right humerus (dominant limb) in a young lady failed to unite following internal fixation and lead to atrophic non-union with implant loosening, which initially was suspected to be due to poor fixation and or infection, but histopathological evaluation on two separate occasions of the fracture site revealed a picture of Chondrocalcinosis (CC). CC is a condition wherein deposition of calcium pyrophosphate dihydrate (CPPD) crystals occurs within articular cartilage and synovial tissue and is associated with joint pain leading to arthritis. The presence of these CPPD crystal has not been mentioned in the bone or at fracture sites in the literature, The histopathological evidence of CPPD at the fracture site in this case of humerus non-union did not establish whether the fracture was due to the pathology or the CPPD got deposited at the fracture site and was a cause of non-union.

Extractant mediated nano-aggregate formation in Triton X-114 aided cloud formation: structural insights from TEM and SANS studies

Nanoaggregate formation by self assembly was noticed during the cloud formation of Triton X-114 in the presence of dibenzoylmethane (DBM), thenoyltrifluoroacetone (HTTA) and 1-phenyl-3-methyl-4-benzoyl-5-pyrazolone (PMBP) and tributyl phosphate (TBP).

UNILATERAL BICONDYLAR HOFFA FRACTURE WITH A FRACTURE SHAFT AND DISLOCATED KNEE AND HIP IN A MIDDLE AGED ADULT: A RARE CASE REPORT

Fracture at the distal end of the femur usually occurs in the sagittal plane. Hoffa fracture, i.e., coronal slice fracture of the condyles of the femur, is rare in adults and even rarer in children.

In the case we wish to discuss here presented to our emergency room with an open knee injury due to a road traffic accident. Imaging of the right lower limb revealed an open Gustilo-Anderson type IIIB bicondylar Hoffa fracture with an anterior dislocation of knee with a comminuted patella and a shaft of femur fracture with a posteriorly dislocated hip.

He underwent a successful stabilization and cannulated cancellous screw fixation of the Hoffa fracture and fixation of other injuries.

MONOARTICULAR SYNOVITIS OF KNEE DUE TO UNRECOGNISED INTRA-ARTICULAR PLANT SPLINTER

Synovitis of a knee secondary to penetrating splinter injuries of plant origin aren't frequently reported. Historically, it is considered aseptic and treated with removal of the intraarticular foreign body and affected synovial lining.

We report a case of a 59-year-old healthy man whose left knee was injured while at work at a bamboo plantation site. He presented to us with pain and swelling of the knee for one month. He underwent diagnostic arthroscopy of the knee wherein a foreign body was identified, located and removed and near total synovectomy was done.

We present this patient's case and its management with a review of the relevant literature.

Regulation of potassium-dependent Kdp-ATPase expression in the nitrogen-fixing cyanobacterium Anabaena torulosa

The KdpB polypeptides in the cyanobacterium Anabaena torulosa were shown to be two membrane-bound proteins of about 78 kDa, expressed strictly under K(+) deficiency and repressed or degraded upon readdition of K(+). In both Anabaena and Escherichia coli strain MC4100, osmotic and ionic stresses caused no significant induction of steady-state KdpB levels during extreme potassium starvation.