Giant cell tumors (GCTs) are primary bone tumors that occur most commonly in long bones, with half such tumors occurring in the distal femur, proximal tibia, and fibula. Around 12% of patients present with a pathological fracture indicating more aggressive disease. Arthrodesis after tumor resection is a popular choice due to its affordability and early postoperative mobilization, as well as low risks of implant loosening, infections, malignant lesions, or mortality. A free fibular graft is a popular option in limb-sparing surgery for long bone tumors. A bone graft and nail can be used to reconstruct long bones and bridge defects up to 25 cm. In developing countries, the cost of the imported mega prosthesis, around 8,500 US$, means many patients cannot afford the treatment. We describe a case of a GCT of the distal femur treated by excision of the tumor and reconstruction using a fibular bone graft, with knee arthrodesis using a custom-made long intramedullary interlocking nail fixation across the femur to the knee and the tibia. The length was achieved with 1 cm shortening post-surgery. The result was satisfactory, and partial weight-bearing was allowed three months after the surgery. At the one-year follow-up, there was no recurrence, and the patient had the full weight-bearing ability.

SARS-CoV 2 pandemic has been spread around the world, the developing countries like India with enormous population, the health care system has been exhausted with patients. Social distancing, using three layered face mask, frequent use of sanitization is helpful preventing measure to spread of these deadly virus. There are no clear cut guidelines available in management of Orthopaedic patients till now. The disease and mortality burden will increase eventually without the effective vaccine and medications. With this ongoing pandemic managing elective orthopaedic surgeries and delayed trauma is a challenge. There should be effective protocol to manage emergency cases with optimum care and formulate standard postoperative rehabilitation strategy to deal with the situation. Orthopaedics training is also affected by this pandemic and that should be taken care of with appropriate measures. These article will help the surgeons and hospitals to formulate proper strategies in managing the patients and to face challenges presented in current pandemic situation. It will guide them to re-establish the orthopaedic care and to face future challenges.

Introduction:More than 13 million people in the US are morbidly obese. It is associated with various medical and anesthetic complications. Higher rate of dislocation in total hip replacement (THR) associated with morbid obesity due to thigh girth, low muscle mass and high-fat content. Morbid obesity is associated with a 38% increase in the 10-year mortality rate compare to non-obese after undergoing primary total hip arthroplasty (THA). Hip dislocation after THR is one of the earliest complications, and for every ten-point increase in BMI, the risk of dislocation increases by 113.9%. Case Report: We present a case report of a 69-year-old super-obese woman with a BMI of 62.2, who presented with repeated dislocation post THR. The patient was managed successfully with implant removal and implantation of dual mobile THR prosthesis. Conclusion: Morbid obesity with a need for arthroplasty is challenging. It needs proper planning, thorough preoperative preparation, proper intraoperative care and identification with adequate post-operative complications management. Preoperative bariatric surgery, dual mobile liner and constrained implants have shown good result in decreasing dislocation rate. The liner of dual mobile THR is efficient to prevent post-operative dislocation in morbidly obese and super-obese patients. Keywords: Dual mobile total hip replacement, super obesity, morbid obesity, bariatric surgery, hip arthroplasty, neck of femur fracture, revision hip arthroplasty.

Introduction: Cancer metastasis to the scapula and tibia is an infrequent clinical presentation. Lung cancer is one of the leading causes of death in the world. Around 80–85% of lung cancer are non-small cell lung cancer and around 30–35% of them are adenocarcinoma which metastasize to bone. Scapular metastasis is a rare event and presents with bone pain. Case Report: In this case report of 56-year-old male, presented with swelling to the scapula as a first symptom followed by swelling in the tibia. On further investigation, it was found to be multiple metastasis primaries as an adenocarcinoma of the lung. He was managed with palliative chemotherapy, which enhanced the patient’s quality of life, slowing down the disease process and clinical improvement. Conclusion: Lung cancer is the most common cancer which is progressing rapidly and spreading commonly to bones. When patients present with a mass or any suspicion of tumor, careful clinical examination and diagnostic tools often catch malignancy. Key words: Scapular metastasis, adenocarcinoma lung, bone metastasis, palliative chemotherapy, non-small cell lung carcinoma.