International Archives of BioMedical and Clinical Research <p style="text-align: justify;">International Archives of Biomedical and Clinical Research (IABCR) is an open access, international, peer-reviewed, quarterly multidisciplinary medical research journal that focuses on communicating high quality research articles, reviews, Short communications, case reports, Letter to Editor, Drug News and updates in the field of Medical, Dental and other allied health and BioMedical Sciences. The Journal publishes 4-four issues in a year.</p> <h3>Connecting Researchers Globally</h3> <p style="text-align: justify;">IABCR offer Researchers, Academicians a better option when it comes to Open Access Journal publishing. Our platform vies to become the standard for all open access publications, irrespective of subjects or branches and aims to bring together researchers from all over the world and under a single global organization to form a community that actively creates new data and shares it with everyone with the utmost ease and simplicity.</p> <h3>Ethical guidelines for journal publication</h3> <p style="text-align: justify;">The Editor-in-Chief/Editor of International Archives of BioMedical and Clinical Research (IABCR) is responsible for determining which of the research papers/articles submitted to the journal should be printed. The publication decision is based on the recommendation of the journal's reviewers. The Editor-in-Chief /Editor may be maneuvered by the policies of the journal's editorial board and constrained by such legal requirements as shall then be in force regarding libel, copyright infringement and plagiarism. The Editor-in-Chief/Editor may consult with other editors or reviewers in getting to this determination.</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> Ibn Sina Academy of Medieval Medicine & Sciences, registered in 2001 under Indian Trusts Act, 1882. Publication Manager: Dr. Tayyaba Farhan en-US International Archives of BioMedical and Clinical Research 2454-9886 Study of Morphometry of Clavicle – Length and Angles <p><strong><em>Background: </em></strong><em>The clavicle is a subcutaneous bone most frequently fractured at the junction of medial 2/3rd and lateral 1/3rd of its shaft. The knowledge about the morphometry of clavicle is important for surgeons as well as orthopaedics surgeons.</em></p> <p><strong><em>Methods: </em></strong><em>This study was over a period of one year. Total 54 dry clavicles were included in this study. This study was conducted in Departments of Anatomy, NCR Institute of Medical Sciences and Asia Metropolitan University, Malaysia.</em></p> <p><strong><em>Results: </em></strong><em>The results revealed that, in males the average lateral angle of left side was more than the right side but not so in case of female where the right side was more than the left side. This difference was statistically significant in case of both males and females.</em></p> <p><strong><em>Conclusion: </em></strong><em>This study concludes that, the average length of the clavicle on the left side is more than the right side in both sexes. The morphometric values also may help the anthropologists as well as the forensic experts.</em></p> Chhitij Anand Dyutimoy Datta Copyright (c) 2021 Chhitij Anand, Dyutimoy Datta 2021-07-12 2021-07-12 7 2 HA1 HA3 To Evaluate the Effect of Deep Breathing in Non-Diabetic Offsprings of Type 2 Diabetic Patients <p><strong><em>Background: </em></strong><em>Type 2 diabetes mellitus (DM) has a strong genetic component. Individuals of a parent with type 2 DM have an increased (40%) risk of diabetes. If both parents have type 2 DM, the risk approaches to 70%. Thus, this study was designed to evaluate cardiovascular parasympathetic functions in offsprings of type 2 diabetic parents.</em></p> <p><strong><em>Methods: </em></strong><em>This study was conducted in Department of Physiology, United Institute Of Medical Sciences, Allahabad, UP. This study was conducted over a period of one year. This study we were included 50 cases, who are healthy but they were having parental history of type-2 diabetic mellitus &amp; 50 healthy controls who are healthy as well as their parent also do not have such type of any diabetic history.</em></p> <p><strong><em>Results: </em></strong><em>The result of this study revealed that Study showed decrease in all the three parasympathetic function tests (heart rate variability in response to deep breathing, heart rate variation in response to standing, and valsalva maneuver) in offsprings of type 2 diabetic parents (cases) as compared to non-diabetic parents (controls). However, the results were not statistically significant.</em></p> <p><strong><em>Conclusion: </em></strong><em>These findings can be utilized to prevent future cardiovascular risk in subjects by non-pharmacological means as exercise and yoga.</em></p> Panna Mishra Shweta Bhagat Vikas Trivedi Mir Abdul Munif A K Lavania Copyright (c) 2021 Panna Mishra, Shweta Bhagat, Vikas Trivedi, Mir Abdul Munif, A K Lavania 2021-07-12 2021-07-12 7 2 HP1 HP3 Correlation of Anthropometric Measurements with the Serum Total Estradiol Level in Adult Males <p><strong><em>Background: </em></strong><em>In males, normal Estradiol (E2) levels are required for proper fertility, cardiovascular health and bone mass deposition etc. which changes with Age, Body weight, BMI and WHR. The present study was planned to study the serum total estradiol (E2) level according to body mass index and waist hip ratio in adult males</em></p> <p><strong><em>Methods: </em></strong><em>The present study was a cross sectional study, conducted on 89 adult males (aged 18-50 years). Anthropometric measurements of each subject were measured and BMI &amp; WHR were calculated. Morning Venous blood sample was drawn between 8-11 A.M. from each subject and serum was separated. Serum Total estradiol was measured using ELISA.</em></p> <p><strong><em>Results: </em></strong><em>In non-obese “Group A” (BMI &lt;25 kg/m<sup>2</sup>), Serum Total Estradiol was 18.9±7.71 pg/ml and in overweight and obese “Group B” (BMI ≥ 25 kg/m<sup>2</sup>) it was 52.83±29.23 pg/ml (p&lt;0.05). In subjects with WHR &lt; 0.9 “Group C” serum Total Estradiol was 17.58±7.87 pg//ml and whose WHR ≥ 0.9 “Group D” it was 48.55±28.69 pg/ml (p&lt;0.05).Thus it was concluded that Serum Total Estradiol level significantly increased in “Group B” overweight and obese (BMI ≥ 25 kg/m<sup>2</sup>) and&nbsp; in Group “D’ subjects, with Waist Hip Ratio ≥ 0.9 as compared to “Group A” non-obese (BMI &lt;25 kg/m<sup>2</sup>) and subjects in Group “C” with Waist Hip Ratio &lt; 0.9.</em></p> <p><strong><em>Conclusion: </em></strong><em>Therefore we can infer that serum total estradiol might increase significantly because of more body fat mass in overweight and obese subjects i.e. subjects who had increased body mass index and waist hip ratio.</em></p> Enam Ahmad Abid Ahsan Sonu Kumar Copyright (c) 2021 Enam Ahmad, Abid Ahsan, Sonu Kumar 2021-07-12 2021-07-12 7 2 HP4 HP6 A Study to Evaluate the Accuracy of Calculated Serum LDL Cholesterol Levels in Hypertriglyceridemic Individuals <p><strong><em>Background: </em></strong><em>Farmers are vulnerable to a range of MSDs including osteoarthritis of the hip and knee, low back pain (LBP), upper limb disorders, and hand/arm vibration syndrome, as well as to the consequences of trauma such as sprains, fractures, and dislocations. The present study was conducted to assess prevalence of musculoskeletal disorders among agricultural workers in a known area.</em></p> <p><strong><em>Methods: </em></strong><em>A community based cross sectional study was done for a period of 3 months. The study included agricultural workers aged more than 20 years and 390 agricultural workers were selected. A pretested, structured, interviewer administered questionnaire was used for data collection. Modified Nordic musculoskeletal questionnaire was used for assessing the presence of musculoskeletal problem. The recorded data was compiled, and data analysis was done using SPSS Version 22.0 (SPSS Inc., Chicago, Illinois, USA).</em></p> <p><strong><em>Results: </em></strong><em>Pearson’s test for correlation shows a positive and significant correlation with the directly measured LDLc levels with all calculated values. But on application of two tailed t test only Chen’s method satisfied the null hypothesis question that the difference between the calculated and the directly measured LDLc level was zero. (r=0.923 with a p=0.000 and t=0.343 and p value of 0.732.)</em></p> <p><em>Among the three groups defined on bases of TG:TC level only Modified Friedewald’s method showed a statistically significant r value and t value in group 1. (r=0.965 with p=0.000 and t=-1.056 with a p=0.296) No other group showed any statistically significant t value even though the r value was significant for all methods in all groups except for Hattori’s method in group 3.</em></p> <p><strong><em>Conclusion: </em></strong><em>Our study suggests that most commonly used methods of calculating LDLc fail in hypertriglyceridemics with TG levels over 400mg/dl. Our study also shows importance of t tests and Band Altman plot when comparing two diagnostic methods.</em></p> Tariq Mahmood Sanjay Bhatt Rajeev Goyal Manoj Gupta Saba Khan Copyright (c) 2021 Tariq Mahmood , Sanjay Bhatt, Rajeev Goyal, Manoj Gupta, Saba Khan 2021-07-12 2021-07-12 7 2 BC1 BC5 Haematological and Immunophenotypical Study on Acute Leukemias <p><strong><em>Background: </em></strong><em>Acute leukemia comprises a heterogeneous group of diseases characterized by rapid and uncontrolled clonal expansion of progenitor cells of the hematopoietic system. Immunophenotyping of acute leukemia is one of the most important clinical applications of flowcytometry.</em></p> <p><strong><em>Methods: </em></strong><em>This study was conducted in Department of Pathology in , Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh. This study was conducted over a period of one year. Total 104 cases were included in this study.</em></p> <p><strong><em>Results: </em></strong><em>In our study, 104 cases of di</em><em>ff</em><em>erent patterns of acute leukemia were reported. There were total 62 cases of AML, 30 cases of B-cell ALL, 6 cases of T-cell ALL, 4 cases of bi-lineage and 2 case of bi-phenotypic leukemia. </em></p> <p><strong><em>Conclusion: </em></strong><em>It can conclude that immunophenotyping is an important diagnostic tool to di</em><em>ff</em><em>erentiate between AML and ALL in morphologically challenging cases.</em></p> Pooja Shrivastava Copyright (c) 2021 Pooja Shrivastava 2021-07-12 2021-07-12 7 2 PA1 PA4 Bacteriological profile and antibiotic susceptibility pattern of Intensive care unit patients in a tertiary care institute: An observational study <p><strong>Background:</strong> Intensive care units (ICU) are considered as high-risk areas in a healthcare setting. Patients admitted in ICU are at a higher risk of developing nosocomial infections and thus at equally greater risk of developing infections caused by drug resistant pathogens. Frequent invasive interventions and empirical antibiotic therapy adds to the risk. The present study was, therefore, designed to describe the sensitivity pattern of microbial isolates from patients in ICUs of a tertiary care rural based teaching institute.</p> <p><strong>Material &amp; Methods: </strong>An observational prospective study was conducted over a period of one year in a tertiary care teaching institute. Different types of clinical samples were collected from patients admitted in ICUs. All the samples were processed according to standard microbiological guidelines for isolation of microorganisms and their sensitivity pattern.</p> <p><strong>Results:</strong> A total of 1165 clinical samples were received in the Microbiology laboratory out of which 468 (40%) samples showed significant microbial growth. The maximum rate of isolation of pathogen was from pus sample (26%) followed by blood (24%) and respiratory specimens (24%). The most predominant isolates were gram negative organisms (75.6%), <em>Escherichia coli </em>(36 %) followed by <em>Klebsiella</em> (27%) and <em>Acinetobacter</em> (15%). Among gram-positive isolates CoNS (45%) was most predominant. Of all the gram-negative isolates 75(21%) were multidrug resistant organisms. Among the multidrug resistant organisms ESBL (77.3%) production was most common.</p> <p><strong>&nbsp;Conclusions:</strong> Regular and appropriate microbiological surveillance for identifying the prevalent pathogens and their antibiotic sensitivity pattern is important to guide in effective management of patients.</p> <p><strong>Key words: Intensive care units, Bacteriological profile, Antibiotic Sensitivity pattern </strong></p> Meenakshi Sharma Sanjeev Sahai Richa Sharma Copyright (c) 2021 Meenakshi Sharma, Sanjeev Sahai 2021-07-12 2021-07-12 7 2 MB1 MB3 Prevalence of Musculoskeletal Disorders Among Agricultural Workers in a Known Area <p><strong><em>Background: </em></strong><em>Farmers are vulnerable to a range of MSDs including osteoarthritis of the hip and knee, low back pain (LBP), upper limb disorders, and hand/arm vibration syndrome, as well as to the consequences of trauma such as sprains, fractures, and dislocations. The present study was conducted to assess prevalence of musculoskeletal disorders among agricultural workers in a known area.</em></p> <p><strong><em>Methods: </em></strong><em>A community based cross sectional study was done for a period of 3 months. The study included agricultural workers aged more than 20 years and 390 agricultural workers were selected. A pretested, structured, interviewer administered questionnaire was used for data collection. Modified Nordic musculoskeletal questionnaire was used for assessing the presence of musculoskeletal problem. The recorded data was compiled, and data analysis was done using SPSS Version 22.0 (SPSS Inc., Chicago, Illinois, USA).</em></p> <p><strong><em>Results: </em></strong><em>Among the 390 agricultural workers participated in this study out of the which about 87.17% people (340) had musculoskeletal disorder. Based on the NORDIC questionnaire, of all the farm workers who suffered from musculoskeletal disorders, 25% people had low backache which was most common MSD reported followed by shoulder pain in 15.29% and elbow was the least affected site (5%).</em></p> <p><strong><em>Conclusion: </em></strong><em>The present study concluded that prevalence of MSD among agricultural workers was about 87.17%. Low backache was most common MSD reported.</em></p> Kapil Pandya Dhara V. Joshi Nikunj H. Patel Mihirkumar M. Patel Copyright (c) 2021 Kapil Pandya, Dhara V. Joshi, Nikunj H. Patel, Mihirkumar M. Patel 2021-07-12 2021-07-12 7 2 GM1 GM3 Should Patients of Hyperthyroidism be made to wait in the Department Post Low-Dose I-131 Therapy? <p><strong><em>Background: </em></strong><em>Patients of hyperthyroidism are usually sent home immediately after oral administration of Low Dose Iodine Therapy (LDIT) without taking into account socio-economic conditions, psychological aspects of patients and mode of travel undertaken by patient when going home. These patients may then become a source of unnecessary exposure to family members and general public which comes in the close proximity of the patients. Our study evaluated the minimum time hyperthyroidism patients should be made to wait in the isolation room of the department after LDIT in order to reduce the radiation exposure to family members and general public.</em></p> <p><strong><em>Methods: </em></strong><em>A total of 51 patients of hyperthyroidism treated with LDIT during the period of Feb 2019–Aug 2020 were included and&nbsp; divided into two different groups with Group 1 comprising of patients administered 5-15mCi of I-131 and Group 2 comprising of patients administered 16-29mCi of I-131. Radiation exposure rate was measured at 1-meter distance with ionization based survey meter at 5min, 1hour and 2hour post I-131 administration.</em></p> <p><strong><em>Results: </em></strong><em>Mean radiation exposure rate at 1metre distance for Group 1 at 5min, at 1hour and 2hours was 1.63mR/hr, 1.5mR/hr &amp; 1.35mR/hr respectively whereas for Group 2 it was 3.80mR/hr, 3.60mR/hr &amp; 3.45mR/hr respectively. Significant difference was observed in exposure level taken at 5min, at 1hour and 2hours time interval (p value &lt;0.01).&nbsp; </em></p> <p><strong><em>Conclusion: </em></strong><em>Hence, we recommend patient should wait minimum of 2 hours in isolation room of the department post LDIT in order to further reduce radiation exposure to their family members and general public.&nbsp; </em></p> Bhavay Sonik Vijay Pratap Singh Neeraj Sharma Sanjiv Gupta Yasmeen Atwal Amandeep Kaur Copyright (c) 2021 Bhavay Sonik, Vijay Pratap Singh, Neeraj Sharma, Sanjiv Gupta, Yasmeen Atwal, Amandeep Kaur 2021-07-12 2021-07-12 7 2 GM4 GM7 Effectiveness of PTMC in Mitral Stenosis after Resolution of Left Atrial Appendage Thrombosis by Oral Anticoagulant. <p><strong>Abstract</strong></p> <p><strong>Background and Aims:</strong> Open Surgical Commissurotomy is considered as the only treatment option in presence of a thrombus that contraindicates PTMC. However, this study was designed to see the effectiveness of PTMC after resolution of Left Atrial (LA) Appendage thrombus by anticoagulant (Warfarin and Rivaroxaban ) for 3-6 months .</p> <p><strong>Methods: </strong>It is a prospective observational study of total 12 patients with Rheumatic Mitral Stenosis with LA Appendage thrombus. Out of them, 8 patients underwent PTMC after resolution of thrombus at Cath lab under Department of Cardiology of Chitwan Medical College from July 2019 to March 2020. PA pressure, LA pressure and Aortic pressure were assessed by right heart catheterization by using multipurpose /pigtail catheter whereas mitral valve area and mean mitral valve gradient were assessed by TTE.</p> <p><strong>Result</strong>: Among 12 patients with LA appendage thrombus, 8 patients (66.67%) underwent successful PTMC after complete resolution of thrombus. After the procedure, the mean mitral valve area and mean aortic pressure increased from 0.83±0.2 cm<sup>2</sup> to 1.63±0.18 cm<sup>2</sup> and from 99.50 ±7.93 mmHg&nbsp; to&nbsp; 106.13±12.25 mmHg respectively. Whereas, mean pressure gradient decreased from 15.88± 4.42 mmHg to 7.13±2.10 mmHg, mean pulmonary artery pressure decreased from 44.13 ±20.85 mmHg to 33.25±19.40 mmHg and mean left atrial pressure decreased from 26.13±6.31 mmHg to 17.38±6.12 mmHg.</p> <p><strong>Conclusion:</strong> This study showed that PTMC in mitral stenosis was successful in those patients whose LA appendage thrombus was resolved by giving oral anticoagulant for 3-6 months without significant MR and tachycardia.</p> ananda GC Copyright (c) 2021 ananda GC 2021-07-12 2021-07-12 7 2 GM8 GM10 Evaluate an Association Between Diet and Acne Vulgaris: A Cross Sectional Study <p><strong><em>Background:</em></strong> <em>Acne vulgaris is a common chronic skin disease involving blockage and/or inflammation of pilosebaceous units. The possible causes of acne can be hormonal overstimulation of the pilosebaceous units of genetically susceptible individuals. Endogenous reproductive and growth hormones, exogenous reproductive hormones, insulin and endogenous insulin-like growth hormone-1, sourced from and stimulated by dairy and high glycemic load foods, all appear to contribute to this overstimulation.</em></p> <p><em>Aim:</em></p> <p><em>This study was designed to identify the possible associations of diet with acne vulgaris.</em></p> <p><strong><em>Methods: </em></strong><em>A cross sectional study was conducted among 50 acne vulgaris patients and 50 controls aged 18 to 30 years from March 2020 to March 2021. To determine acne severity comprehensive acne severity scale (CASS) was used. A questionnaire comprising questions about patient’s family history and dietary patterns was distributed. Subjects were asked to record their food intake on two weekdays and one day on a weekend in a three day food diary. Anthropometric measurements including body weight, height and body fat percentage were taken. Acne severity was graded as mild moderate and severe.</em></p> <p><strong><em>Results: </em></strong><em>It was seen acne patients had significantly higher dietary glycemic load (180 ±40) compared to control group (120 ± 25) (p &lt; 0.001). The frequency of milk, and ice-cream consumptions was significantly higher in cases compared to controls. Females in the case group had a higher daily energy intake compared to their counterparts in the control group. No significant difference was found in other nutrient intakes, body Mass Index, and body fat percentage.</em></p> <p><strong><em>Conclusion: </em></strong><em>Glycemic load diet and frequencies of milk and ice cream intake were positively associated with acne vulgaris.</em></p> <p><em>&nbsp;</em></p> Shafia Nisar Kakroo Md Ashraf Jamal Mirza Aumir Beg Basit Kakroo Copyright (c) 2021 Shafia Nisar Kakroo, Md Ashraf Jamal, Mirza Aumir Beg, Basit Kakroo 2021-07-12 2021-07-12 7 2 SD1 SD4 Posterior Tibial Artery Decompression for Neuropathic Plantar Ulcerations in Diabetic Foot <p><strong><em>Background: </em></strong><em>Posterior tibial artery (rather than nerve) decompression has shown good results in patients with neuropathic ulcers in leprosy. We carried this procedure in diabetics with sensory–neuropathic ulcers of foot.</em></p> <p><strong><em>Methods: </em></strong><em>Twenty–eight diabetic patients who had neuropathic plantar ulcerations underwent posterior tibial artery decompression under local anaesthesia.</em></p> <p><strong><em>Results: </em></strong><em>Complete healing of ulcers occurred in all except one by end of 3–6 weeks. No patient had worsening of ulcer, wound infection or local complications. Patients were happier with such day case surgery, which kept them ambulatory. Even though two patients had recurrence of ulcers they healed with further conservative treatment.</em></p> <p><strong><em>Conclusion: </em></strong><em>Posterior tibial artery decompression is a safe, simple procedure which can be done by any general surgeon at any set–up is highly recommended for sensory neuropathic ulcers.</em></p> Jayant D Mohite Yatindra Kashid Copyright (c) 2021 Jayant D Mohite, Yatindra Kashid 2021-07-12 2021-07-12 7 2 GS1 GS2 Assessment of Low Back Pain in Reproductive Female Presenting in OBG OPD in a Tertiary Care Hospital <p><strong><em>Background: </em></strong><em>Low back pain related disability and work absence accounts for high economical costs in modern society. A prevalence of 28-80% has been found with increase of prevalence with age and female preponderance.</em></p> <p><strong><em>Method: </em></strong><em>The present study was conducted on 250 non pregnant women complaining of low back pain attending Department of Obstetrics and Gynaecology. A brief questionnaire was used to screen, among the respondents, the occurrence of low back pain in the past year.</em></p> <p><strong><em>Results: </em></strong><em>Low back pain was associated with high BMI, high waist circumference, more number of children, irregular and prolonged duration of menstruation, young maternal age at first birth and with history of abortion.</em></p> <p><strong><em>Conclusions</em></strong><em>: Hormonal and reproductive factors are associated with low back pain.</em></p> Ekta Ramesh Dhawale Copyright (c) 2021 Ekta Ramesh Dhawale 2021-07-12 2021-07-12 7 2 OG1 OG2 Immediate Breast Reconstruction in Carcinoma Breast – Morbidity, Technical and Psychological Issues <p><strong>Background:</strong> Immediate breast reconstruction (IBR) in breast cancer patients is although a well accepted option but not commonly offered (in our setup). The purpose of present study was to evaluate the technique, morbidity and outcome of IBR in our institute.</p> <p><strong>Materials and methods</strong>: A prospective study with 40 patients of operable cases of carcinoma breast was done where patients undergoing modified radical mastectomy (MRM) were compared with patients undergoing MRM followed by IBR using autologous tissue. Both the groups were evaluated in terms of technical issues, morbidity and clinical outcome. The results were expressed as mean of continuous data. The psychological satisfaction in either groups was noted on body image scale</p> <p><strong>Results</strong>: In the post operative period, complication rate of 35% was noted in study group as compared to 10% in control group. Among these, the rate of seroma formation was 10%, superficial skin necrosis- 15%, total flap loss- 5%, and fat necrosis was 10%. One patient in the study had total flap loss. In study group, 95% of the patients were satisfied with the body image while 80 % of the patients undergoing MRM alone were not satisfied at all.</p> <p><strong>Conclusion: </strong>IBR is a valid option to preserve the feminity and gives a higher level of patient satisfaction than external prosthesis. It can be learnt easily and requires a change in the mindset of the surgeon to incorporate it into practice.</p> Mini Bedi Parvinder Singh Copyright (c) 2021 Mini Bedi, Parvinder Singh 2021-07-12 2021-07-12 7 2 OG3 OG6 Analysis of Functional Outcome of Staged Treatment of Gustilo Anderson 3B Tibia Fractures: Experience from Tertiary Care Hospital of North India <p><strong>Introduction:</strong> Open fractures of the tibia are the most common open long bone fractures, with an annual incidence of 3.4 per 100 000. The management of open tibia fractures with loss of skin and soft tissue coverage is complex and requires combined orthopaedic and plastic surgery expertise. Our objective was to analyse the functional outcome of staged treatment of Gustilo 3B tibia fractures.</p> <p><strong>Methodology</strong>: 30 cases of Gustilo Anderson 3b tibia fractures aged 18-70 years were recruited as study participants. Treatment was given in three stages. First stage included debridement and irrigation using normal saline followed by stabilization of fracture with external fixator application. Second stage involved skin flap or soft tissue repositioning with skin graft. Third stage was external fixator removal with internal fixation of bone with or without bone graft.</p> <p><strong>Results:</strong> All the patients were managed for injury and fracture with staged treatment protocol. All the skin flaps/grafts survived. During the internal fixation, 4 (13.3%) patients underwent bone grafting. Bone union occurred at predicted time in 28 cases. Treatment outcome was excellent in 63.3%, good in 23.3% and fair in 13.3% patients.</p> <p><strong>Conclusion</strong>: Management of such fractures is appropriately done using staged treatment approach. The treatment planning and execution should incorporate principles of infection control.</p> Sagar Arora Kapil Bansal Deepak John Bhatti Radhe Shyam Garg Durgesh Singh Nikhil Gupta Copyright (c) 2021 Sagar Arora, Kapil Bansal , Deepak John Bhatti , Radhe Shyam Garg , Durgesh Singh , Nikhil Gupta 2021-07-12 2021-07-12 7 2 OT1 OT5