Introduction It is critical to identify asymptomatic vertebral compression fractures (VCFs) as soon as possible in order to avoid subsequent fragility fractures. The purpose of the study was to see how many vertebral compression fractures there were in patients admitted to the COVID-19 pneumonia unit in a single tertiary care hospital who underwent chest computed tomography (CT) scans. Materials and methods Sagittal reconstruction of the thoracic spine was done in around 504 patients and classified into mild, moderate, and severe categories, and we compared it with the radiological reports of the same. Results In our study, the median age was 53 years (range: 31-91 years); 63% were men and 37% were women. Of the 504 patients, 76 (15%) had at least one vertebral compression fracture (VCF); 53 (10.2%) had one VCF, and 23 (4.8%) had multiple VCF, with 50 having mild fractures, 15 having moderate fractures, and 11 having severe fractures. Males (13.87%) and females (14.72%) had the same proportion of VCF (p = 0.83). Only 10% of the patients with VCFs we identified had a description in their report (eight patients). Conclusion The reporting of VCF is insufficient. VCF detection should be included in the search patterns of radiologists and physicians, regardless of the primary reason for performing chest CT. Although many patients are unable to come to the hospital during pandemic/epidemic, careful evaluation and inclusion of mild fractures in reports, as well as an explanation of the risk of subsequent fractures and treatment accordingly, would completely eliminate the risk of subsequent fractures.

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Background and Objectives: Acromioclavicular joint dislocation corresponds to 8.6% of all joint dislocations. Non operative treatment is considered the standard of care for type I and II Acromioclavicular joint dislocation. But the treatment of acute type III and above injuries is still controversial. The purpose of this study is to determine the functional outcome of conservative treatment of Type III severity of acromioclavicular dislocations with respect to pain, range of movements, cosmesis and radiological displacement. Materials and Methods: 25 patients with Acromioclavicular joint dislocation of type 3 were included in our study conducted between August 2018 and July 2020. Stress X-Rays were taken to diagnose type 3 acromioclavicular joint dislocation. All patients were treated conservatively with strapping for three weeks and gradual mobilization over next three weeks. Patients were evaluated at 6 weeks, 3months and 6months. At each follow up patients were assessed subjectively for pain, objectively for range of abduction and radiographs were taken to note any displacement. Results: Sixteen patients had excellent results with no pain or limitation of movements. Six patients had good results with pain only on excessive activity and terminal restriction of movements. Two patients had fair results and no poor results. Improvement in subjective and objective symptoms was highly significant (p<0.01). But at final follow up all acromioclavicular joints were subluxed or dislocated. Conclusion: Conservative treatment of acute Type 3 Acromio clavicular joint dislocation with short periods of immobilization by bandages and slings and early rehabilitation of shoulder gives good short term results clinically although not correlated radiographically.

Background and objectiveMany controversies exist in the literature regarding proximal humerus fractures treated with various surgical procedures. The chosen approach decides the level of comfort with which the surgeon can perform a particular surgery in orthopedics and the amount of reduction a surgeon can bring to a fractured bone. The purpose of this study was to compare variables such as time taken for surgery, achievement of reduction, and intraoperative blood loss between the two most frequently employed surgical approaches for proximal humerus in comminuted fractures: the deltoid-split (DS) approach and deltopectoral (DP) approach. MethodsAll patients with Neer III and IV types proximal humerus fractures treated with Proximal Humeral Interlocking System (PHILOS) plating from 2017 to 2020 were invited to participate in the study. The exclusion criteria were as follows: Neer type I and II fractures, pre-existing limb pathology, patient refusal or patient being unfit for surgery, and patient requiring a different modality of treatment like external fixator and pinning. After obtaining consent, the dark envelope method was used to randomize patients into one of the two treatment methods. The variables analyzed were time taken for the surgery, intraoperative blood loss, anatomical reduction in immediate postoperative X-ray, and complications. The results were analyzed and findings were recorded. ResultsA total of 42 patients were randomized into the two groups (22 DS, 20 DP; mean age of 44.85 years for DS and 49.61 years for DP). In terms of age, gender, and Neer fracture classification, the groups were comparable. The average blood loss estimated was less in the DS group compared to the DP group; however, the difference was not statistically significant. Intraoperative time was not significantly different between the DS and the DP groups. The surgeons were able to achieve a significantly higher anatomical reduction in the immediate postoperative X-ray with the DP approach compared to the DS approach. The complications (two in DS and two in DP) in either approach were equal in number although all of them were unique. ConclusionsThe proximal humerus fracture treatment with a PHILOS plate is considered to be a reliable option using either of the described approaches. Based on our findings, the choice of the approach has no impact on surgical time and blood loss. However, patients who were operated on with the DP approach fared better in terms of achieving reduction as assessed by immediate postoperative X-ray owing to limited exposure distally limited by the axillary nerve.