Background: Supracondylar fractures of femur constitute 6-7% of all femoral fractures. In elderly patients, they are invariably low-energy fractures predisposed by osteoporosis. Aim of this article is to assess the complications of retrograde intramedullary femoral interlocking nail (RIFIN). Materials and methods: The study was conducted at a tertiary health care centre, cases were selected from November 2017 to December 2018. This prospective study was performed on 37 patients with supracondylar femoral fractures (AO type A and C). Results: Complications in our study included knee stiffness in 8 patients, anterior knee pain in 6 patients, shortening (1-2cm) in 3 patients, 3 patients had implant failure due to early weight bearing ambulation (one patient had distal screw back-out, one patient distal screw breakage and one patient had nail breakage), 2 patients had non-union (in which one patient had infected non-union), one patient had periimplant fracture and one patient had protruding nail. Conclusion: RIFIN is mostly limited for use in extra-articular distal femoral fractures. Although it has a high incidence of complications, it requires a greater amount of attention to the operative technique and patient selection in order to prevent these complications.

Introduction: Chronic osteomyelitis is the bane of orthopedics. Along with being difficult to treat for surgeons, it also impacts the patient’s life immensely, severely restricting their life in all the aspects. Treatment with antibiotic coated cement spacers, which are removed after a duration of 6–8 weeks for the definitive surgery, is a frequently done procedure in conjunction with an adequate debridement of the necrotic tissues and prolonged IV antibiotics. We report a case of acute osteomyelitis superimposed on the chronic osteomyelitis of the left proximal humerus. Case Presentation: An immunocompetent and otherwise healthy 14-year old Indian male who was operated 1 year ago for chronic osteomyelitis presented to us with an acute tense swelling, unbearable pain, and toxemia, with a cement spacer and multiple cement beads in situ. With regards to his initial injury, he had history of fall from height with a puncture wound, possible humerus fracture, treatment by local healers as well as surgical procedures in an outside facility with debridement and placement of cements spacer and beads. On presentation to our facility, removal of retained cement plus debridement was carried out, and after serial surgeries, the defect was successfully treated with the use of antibiotic loaded absorbable calcium sulfate. Conclusion: A basic knowledge about the ideal practices for taking treatment is still inadequate in many population groups within India . It is important to spread awareness of proper healthcare seeking practices among people so that the disability associated time and loss of activity related to injury is significantly reduced. Furthermore, calcium sulfate can be an effective option for treatment of bone defects associated with chronic osteomyelitis.

Background: Intracapsular fractures of the neck of femur are a major cause of morbidity and mortality in elderly population in India. The primary goal of treatment in these patients is to get the patients to the preinjury level of functionality as early as possible and with minimal complications. Multiple modes of operative treatment in the form of fixation devices (screws, plates, nails) and replacement (hemi or total replacement) are available for this fracture. However, a high rate of complications and revision surgeries has been found after internal fixation in this population group owing to the unique challenges to fixation in the form of co morbidities and osteoporosis among others. Instead of internal fixation, replacement is thus a viable option. Materials and Methods: 100 patients (age >65 years) with a femoral neck fracture were treated over a two-year period (May 2018 to April 2020) with some form of hip replacement after appropriate anesthetic fitness. Results: We had good results in majority of the patients in terms of return to pre-fracture level of functionality, independent ambulation and satisfaction with the results. A majority of patients treated with hemiarthroplasty recovered without incidence while all patients of total hip replacement progressed without incidence. There were 10 cases of suture line infection which recovered satisfactorily with a change of antibiotics, 4 cases of deep infection for which debridement and implant removal was required, 3 cases of deep vein thrombosis and 7 cases of dislocation. Conclusion: Hip replacement is a viable option for treatment of femoral neck fractures in patients more than 65 years of age. Return to preinjury level of functionality is pretty satisfying and early if the patient is actively mobilized as early as possible postoperatively. There are no risks of nonunion, malunion and implant related complications as compared to internal fixation devices.

<p class="abstract"><strong>Background:</strong> Hemi-arthroplasty of hip for intracapsular fractures of femoral neck is one of the most commonly done surgical procedures in the low mobility older Indian population. Although there are numerous complications associated with the procedure, we want to study the types and management of peri-prosthetic fractures in patients treated with hip hemi-arthroplasty.</p><p class="abstract"><strong>Methods:</strong> A total of 26 patients were included in the study. A retrospective analysis of the radiological cum clinical diagnosis and management of peri-prosthetic fractures was performed. All patients were followed up till 1.5 years post-operatively.<strong></strong></p><p class="abstract"><strong>Results:</strong> According to Vancouver classification of peri-prosthetic fractures, 10 fractures were classified as type A, 7 as type B1, 3 as type B2, 4 as type B3 and 2 as type C. Fractures were managed either by Open Reduction with Internal Fixation (ORIF) or Revision hemi-arthroplasty. Fractures type AG, B1 and C were managed with ORIF and type B2 and B3 fractures were managed with revision hemi-arthroplasty using longer stem.</p><p class="abstract"><strong>Conclusions:</strong> As evident in our study, majority of fractures occurred intra-operatively, a thorough evaluation of pre-operative x-rays of both hips should be done along with special focus on anatomical variations. Correct diagnosis based on radiological and intraoperative findings followed by appropriate treatment are of paramount importance in the management of peri-prosthetic fractures.</p>

Introduction:A benign cystic lesion, the simple bone cyst (unicameral/essential bone cyst), it may be found in any long bone (most commonly found in femur and proximal humerus), usually in immature skeletal persons. Metacarpal simple bone cyst is an exceedingly rare occurrence and few treatment options have been described for the same. Case Report: A 42-year-old manual laborer male (right hand dominant) came with history of trivial trauma to right hand thumb with hammer. He complained of mild swelling and pain since trauma. On imaging the right hand, an expansive lytic lesion was seen in the metaphyseo-diahyseal region of the first metacarpal. There was thinning of the cortex with break in cortex visible at mid diaphyseal region. There was absence of any soft-tissue involvement or periosteal reaction. Magnetic resonance imaging reported a T2 hyperintense and T1 isointense benign osteolytic lesion with pathological fracture. On aspiration, a reddish tinged fluid was found. A closed fixation was performed with the help of an intramedullary k-wire. Conclusion:Simple bone cyst, although rare in metacarpal bone, is an important differential diagnosis in cases with cystic lesion. Simple bone cyst, although a benign lesion, can cause extensive involvement of the metacarpal bones and destroy the entire diaphysis. It requires adequate treatment which is simple and effective. Keywords:Simple bone cyst, K-wire, metacarpal.