Background:Extraarticular distal tibial fractures are among the most challenging fractures encountered by an orthopedician for treatment because of its subcutaneous location, poor blood supply and decreased muscular cover anteriorly, complications such as delayed union, nonunion, wound infection, and wound dehiscence are often seen as a great challenge to the surgeon. Minimally invasive plate osteosynthesis (MIPO) and intramedullary interlocking nail (IMLN) are two well-accepted and effective methods, but each has been historically related to complications. This study compares clinical and radiological outcome in extraarticular distal tibia fractures treated by intramedullary interlocking nail (IMLN) and minimally invasive plate osteosynthesis (MIPO).Materials and Methods:42 patients included in this study, 21 underwent IMLN and 21 were treated with MIPO who met the inclusion criteria and operated between June 2014 and May 2015. Patients were followed up for clinical and radiological evaluation.Results:In IMLN group, average union time was 18.26 weeks compared to 21.70 weeks in plating group which was significant (P < 0.0001). Average time required for partial and full weight bearing in the nailing group was 4.95 weeks and 10.09 weeks respectively which was significantly less (P < 0.0001) as compared to 6.90 weeks and 13.38 weeks in the plating group. Lesser complications in terms of implant irritation, ankle stiffness, and infection, were seen in interlocking group as compared to plating group. Average functional outcome according to American Orthopedic Foot and Ankle Society score was measured which came out to be 96.67.Conclusion:IMLN group was associated with lesser duration of surgery, earlier weight bearing and union rate, lesser incidence of infection and implant irritation which makes it a preferable choice for fixation of extra-articular distal tibial fractures. However, larger randomized controlled trials are required for confirming the results.

Aim and Objective: Lower lumbar burst fractures are rare entity with most of the literature restricted to small case series. There is no clear cut consensus on the guidelines for management. Here we present functional results of different modalities of treatment of this rare type of spine injury. Material and Methods: The study was conducted at two tertiary care centres over a period of 9 years. Patients with lower lumbar burst fractures were evaluated for associated injuries, modality of treatment, Pain score (VAS) and neurological status (Frankel Grade) at the time of injury and at final follow up were recorded. The final functional outcome was evaluated using Smiley-Webster functional score. Results: A total of 34 patients with an average age of 37.3 years (24 males; 10 females) and a mean final follow up of 27.9 months were enrolled. 21 patients had L3, 8 had L4 and 5 had L5 burst fractures. 10 patients were managed conservatively by brace and 24 underwent surgical intervention. The pain score (VAS) improved from a mean of 8.5 at the time of injury to a mean of 1.6 at final follow up. Patients with neurological injury had on average improvement of one Frankel grade. 88% patients had excellent to good final functional outcome. Conclusion: Lower lumbar burst fractures are high velocity injuries with other non-spinal injuries being associated. Most of the patients have good functional outcome with both conservative as well as surgical intervention. Patients with complete cauda equina have poor outcome with respect to neurological recovery.

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Right bundle branch block (RBBB) and left bundle branch block (LBBB) are commonly seen in geriatric cases posted for surgeries. LBBB usually results from conduction system degeneration or myocardial pathology. LBBB is often associated with hypertension, myocarditis, coronary heart disease, aortic valve disease, cardiomyopathy etc. We report a case of diagnosed LBBB preoperatively posted for emergency spinal decompression. After induction of anaesthesia, the heart rate settled below 77 beats per minute (bpm) and led to reversion of LBBB to normal sinus rhythm. LBBB is a red flag diagnosis to the anaesthesiologist. But the knowledge of critical heart rate is important; below which the rhythm may revert back to normal sinus rhythm. The knowledge to differentiate between myocardial ischaemia and LBBB is the need of the hour.