Our knowledge of the trabecular framework is restricted to a two dimensional study of trabecular framework of the proximal femur. The author has been studying the trabecular pattern of all bones of the lower limb, including the pelvis, for the past 25 years.

The material for the study included cadaveric bones: 10 innominate bones, three hundred femora, 50 tibia, 30 talus, 30 calcanei. 5mm, sections in coronal, sagittal, transverse, (and in proximal femur - oblique) plane were obtained of the cadaveric bones. These were studied by naked eye observation, with a magnifying glass, after obtaining high resolution photographs, and radiographs of sections.

The most constant feature has been the arcuate arrangement of trabeculae as a reflection of joint mobility. In the proximal femur this was observed in three planes while around the knee, and ankle + foot it was observed only in the sagittal plane. The trabeculae are aligned in a fashion similar to the Meyer - Cullmann model of a loaded beam fixed at one end. This reflects response to movements in three planes in the hip, and in sagittal plane around knee and ankle. It was also observed that trabeculae are continuous across joints indicating lines of stress at individual joints.

The author concludes that it is essential to study trabeculae in three dimensional perspective in order to design implants for various regions. This study will also help in designing of components for joint replacement.

This paper is based on the experience gained from three recent earthquakes in India. Lature (Maharashtra 1993), Jabalpur (M.P. 1997),and Kutch (Gujarat 2001).

The importance of such studies and lessons learnt from the management of casualties cannot be under stated as we have had at least 6 major earthquakes in various parts of the world in the first two months of the New Millenium.

The uniqueness of an earthquake lies in its unpredictability. There is no warning & no time to take preventive measures. The event is sudden, takes a heavy toll of human life, leaves a huge injured population and very many trapped under the debris of fallen buildings. It also results in great fear psychosis in the injured/uninjured population as well.

Success of relief operations in earthquakes depends on:-

Preparedness for such eventualities by a clear established protocol of action before hand in earthquake prone areas.

Establishment of immediate communication links between affected area and controlling authorities.

Establishing a clear line of command from higher authorities to the rescue teams.

Immediate Co-ordination between government agencies and Non-Government Organisations flooding the area with man power and relief supplies. An effective control centre should be established for this.

Immediate mobilization of resources from nearby areas:-

Medical services.

Relief teams for removing debris to rescue trapped people.

Supply of food/water/shelters/Medical supplies.

Mobilization of Ambulance services/Helicopters for evacuation of injured patients after proper triage.

Monitoring services to keep updated statistics of injured/trapped /dead, and to constantly advise change of strategies for more effective rescue operations.

Minimize panic and boost morale of the affected population as well as rescue teams by preventing rumours of fresh quakes from circulating.

Early rescue operations to evecuate trapped people from debris/early evacuation of casualties by trained personnel in properly organised ambulance services help in drastically reducing the death toll.

Proper early management of polytraumatised victims on ATLS principles helps in saving a lot of lives in the first week after the earthquake. Systematic establishment of camps/mobile hospitals especially in remote areas further helps minimize mortality and morbidity in the second phase of relief services after the initial 2–4 days of emergency operations.

Psychotherapy of not only the injured but also the whole population is extremely important to minimize permanent mental scars which may take a lifetime to disappear.

It is important to conclude by stating that relief services require enormous manpower which should have a very high degree of motivation to perform under extreme physically and mentally stressful conditions.

Leadership is required at various levels to provide this motivation & is the key to success.

It must also be constantly kept in mind by medical personnel that the victims do not have only medical problems but far greater socio-economic and psychological problems from death in the family requiring completion of last rites, collapse of their houses & loss of all belongings & fear psychosis of further tremours.

The problem of chronic, haematogenous osteomyelitis is still a major one in developing countries. There are several patients who report with multiple discharging sinuses and a history of several operative procedures. The persistence of sepsis and repeated operations takes its physical, mental and financial toll.

The use of local muscle pedicle for filling saucerized cavities in chronic osteomyelitis was described by Starr and later by Ger. However, it has somehow not caught the fancy of Orthopaedic Surgeons.

The paper is a report of 55 cases of chronic osteomyelitis of long bones treated by use of the method. Anterior 1/3rd of Deltoid was used for proximal end of Humerus & lateral _ of brachialis for lower 1/3rd by a double breasting technique. The femoral shaft was filled by vastus lateralis by the author’s double breasting technique. The Medial Head of Gastrocnemius, soleus and Flexor Hallucis longus were used separately or in combinations for proximal 2/3rd of Tibia. The Abductor Hallucis was used for medial malleolus and calcaneum. A thorough debridement of necrotic and infected tissues preceded the application of muscle pedicle which was done as a single stage procedure.

The age of patients ranged from 8 yrs to 54 yrs with male preponderance. The followup of cases ranges between 18 months to 13 years with an average of 5.8 years.

All cases except 2 in femur showed no recurrence of sepsis. Two patients in femur had fracture through saucerized area.

It is concluded that filling of saucerized cavities with muscle graft obliterates the dead space as well as improves local vascularity. It adds only 20 minutes of operative time on an average and the technique is simple. It gives uniformly good results.