A 62-year-old woman was admitted for elective bilateral nephrectomies for symptomatic large bilateral polycystic kidneys. In the immediate postoperative period, the patient was hypotensive requiring multiple crystalloid boluses and received stress dose steroids. On postoperative day 4, while on mechanical ventilation, the patient developed a large hydropneumothorax on the left. Sonographic evaluation of the right lung did not show signs of pneumothorax; however, the left lung ultrasound scan revealed signs consistent with pneumothorax. A 28F chest tube was inserted on the left side to drain the hydropneumothorax. On entering the left thoracic cavity with Kelly clamp, there was no air release, only clear serous pleural fl uid drained, with absence of air leak from the drainage system. The postchest tube insertion chest X-ray revealed resolution of the left pneumothorax with development of a new contralateral right pneumothorax, demonstrating a shift of the pneumothorax from the left to the right side. This study reports a case of nonsimultaneous bilateral spontaneous pneumothorax using lung ultrasound in the diagnosis with a literature review and discussion on the possible explanation of this unique phenomenon.

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BACKGROUND:The surgical treatment of fractures, according to A O principles has seen a change in the past decade, from anatomical reduction and rigid fixation to the current concept of Biological fixation, precise reduction being a goal only in intra-articular fractures. With the advent of internal fixators like PC-Fix and LISS (Less Invasive Stabilizing System) this was being achieved to some extent. There cent development of LCP has revolutionized the treatment by over-coming the few drawbacks of these internal fixators. The present study is aimed at the assessment of results of plate osteosynthesis of diaphyseal fractures of humerus using locking compression plate and to assess the functional recovery with this procedure. MATERIALS & METHODOLOGY: It is a prospective study which was carried out from October2011 to March 2013 in Sri Siddhartha Medical College & Research Centre, Tumkur. In this study period, 60 cases of fracture shaft of the humerus were treated by open reduction and internal fixation using Locking Compression Plate. RESULTS: In our series, the majority of the patients were males, middle aged, with road traffic accidents being the commonest mode of injury, involving middle third of shaft of humerus. We followed up all the patients and the duration ranged from 6 weeks to 24 weeks. All the fracture eventually united including 3 which had delayed union. Functional recovery was assessed using DASH scoring and Rommens et al grading. There was significant improvement in DASH scores (P=0.001) in all the 60 cases indicating the functional recovery. According to Rommens et al grading, 51 cases had excellent results while 9 cases had good results. CONCLUSION: This is a prospective study with age incidence varied from 21-40 years (65%) with male predominance (70%), with type A3 as the commonest fracture (50%) involving the mid shaft (70%) of humerus, underwent open reduction and internal fixation using locking compression plate. All the cases had adequate physiotherapy started on 3 rd or 4 th postoperative day and continued for 3-4 weeks, which had contributed to the excellent functional recovery. The results were assessed using the DASH score and the significant functional recovery was achieved in all the cases (P=0. 001), with Rommen's grading, excellent and good results were achieved. It is a very good procedure for fractures of shaft of humerus, however the small sample size and short duration of study were the limitations of this study.