Arterial injury following impalement due to a trochanteric hip fracture-fragment per se has been documented rarely. We report a case of pseudoaneurysm of profunda femoris artery at the first perforator branch in a 48-year-old male, with trochanteric hip fracture following a fall during an epileptic episode. Persistent recalcitrant pain, globular swelling in the groin, unexplained drop in the haemoglobin level, and color doppler ultrasonography findings were salient features to the diagnosis. Additionally, we collected all reported cases of pseudoaneurysm associated with hip fractures. We reviewed the literature regarding the incidence, treatment, and prognosis for the same. Acute vascular injury was probably caused by the spikes of fractured lesser trochanter which was found to be displaced superomedially. All trochanteric fractures especially those with displaced lesser trochanter fragment should be closely watched for the possibility of vascular injury. Early diagnosis and treatment in a staged manner can prevent the catastrophic vascular event and hence the limb.

BACKGROUND Operative treatment and fusion for isthmic spondylolisthesis can be achieved by various fusion techniques such as posterolateral fusion (PLF), anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) and circumferential fusion. The purpose of this study is to evaluate the clinical outcome and radiological correction achieved after TLIF and assess the correlation between them if any. METHODS This is a retrospective cohort study analysing 30 cases of adult isthmic spondylolisthesis who failed conservative treatment and were then treated with transforaminal lumbar interbody fusion between 2011 and 2013. The clinical follow-up was done with the modified Oswestry disability index (ODI) and visual pain analogue score (VPAS). For the radiological follow-up radiographs were taken and several radiographic parameters were noted and analysed. RESULTS The mean of the Oswestry disability index scores in all patients decreased from 67.73 to 13.1 at final follow up. Similarly, visual pain analogue score reduced from mean 8.43 to 1.76 at final follow up. The average anterolisthesis was significantly reduced from the preoperative 27.1 ± 14 % to 7.1 ± 5 % at final follow-up radiographs (P < 0.001). Segmental lordosis increased from a mean of 11.5 degrees to 15.7 degrees. The difference in slip angle was significant from preoperative -4.87 ± 4.8 degrees and - 7.23 ± 4.63 degrees on the initial postoperative and - 7.2 ± 4.57 degrees at final follow-up radiographs (P = 0.14 and 0.13 respectively). CONCLUSIONS Thus, adult isthmic spondylolisthesis can be safely and effectively treated by TLIF with significant clinical relief and decrease in disability. TLIF procedure in isthmic spondylolisthesis is capable of reducing the sagittal translation and restoring disc height. Also, sagittal alignment and lordosis can be restored to a large extent. KEYWORDS Spondylolisthesis, Pelvic Incidence, Sagittal Balance, TLIF

BACKGROUND Current management of Intertrochanteric (IT) fractures has evolved with the introduction of dynamic hip screw (DHS) and proximal femoral nail (PFN). The purpose of this study was to compare the functional outcomes between the DHS and PFN for IT fracture fixation. METHODS This study is a retrospective comparative analysis of 455 patients with IT fractures; DHS (292) and PFN (163), who were treated from June 2012 to June 2015. The patients were reviewed postoperatively for a minimum of 12 months to evaluate functional outcome using Salvati-Wilson score. Categorical data was present as absolute number or percentages, and parametric variables were presented as Mean ± SD, while non parametric data were presented as median. Statistical significance was defined as P < 0.05. RESULTS Intramedullary nails offer no advantage over extramedullary devices to treat IT fractures caused by low-energy trauma (AO 31 - A1). However, clinically significant outcomes were established for PFN group in terms of duration of surgery, x- ray exposure and SW Score for AO / OTA 31 - A2 and 31 - A3. Reoperations encountered for local pain due to implant prominence were significantly higher in the PFN group (4.90 % versus 1.02 %). Kaplan Meier survival probability of 69.3 % and 79.5 % predicted for DHS and PFN respectively, 3 years postoperatively. CONCLUSIONS Our conclusion reinforces indication for PFN in unstable IT fractures (31 - A2 and 31 - A3), owing to its better functional outcome and biomechanical properties. Functional outcomes for stable IT fracture (AO 31 - A1) were comparable between DHS and PFN, therefore final decision for implant choice depends on implant cost, surgeon’s preference for specific technique. However, understanding the morphology of proximal femur, peritrochanteric region is crucial to analyse the anatomical variations in Indian population which will provide the basis for intramedullary nail design modifications. KEYWORDS Intertrochanteric Fractures, DHS Fixation, PFN Fixation

This study was conducted to compare the effects of equi-sedative doses of dexmedetomidine and propofol in patients undergoing elective surgical procedures after taking place regional anesthesia. Method: A prospective double-blind study was carried out in 80 patients of either sex, aged between 20 to 60 years and American Society of Anaesthesiologist (ASA) grade I, II and III. Patients were randomly allocated into two groups of 40 patients in each group. Group I (D) received i.v. dexmedetomidine (1 μg/kg initial loading dose for 10min, maintenance 0.5-0.7μg/kg/min). GroupII (P) received i.v. propofol (75μg/kg/min for 10min; maintenance 30-60μg/kg/min), two groups were compared in terms of cardio-respiratory effects, time to achieve and terminate sedation (using BIS index and OAA/S score), post-operative analgesia, side effects and complications of these drugs. Results: Both groups were comparable with regard to demographic variables. Time to achieve sedation was early in group II (10-15 min) as compared to group I (25 min). In post-operative period, the value of OAA/S after 5 min was lower (4.22±0.42) in group I as compared to group II (4.45±0.50) and termination of sedation in group I was late as compared to group II. Intraoperatively, fall in mean blood pressure and heart rate were statistically significant in both groups but fall in MBP was more in group II and fall in HR was more in group I (p<0.05). In post-operative period, blood pressure and heart rate remained lower in group I but in group II these parameters reached near the base line value. VAS score remained lower in group I than group II which was statistically significant (p<0.05) and more analgesic doses were recquired in group II (propofol) in recovery period. No significant changes were seen with regards to SpO2, respiratory rate and postoperative nausea vomiting. Conclusion: Dexmedetomidine provided similar levels of sedation to propofol, with a slower onset and offset of sedation with an additional advantage of postoperative analgesia. Thus, Dexmedetomidine with its stable cardio-respiratory profile, better sedation, overall patient's satisfaction, and analgesia could be a valuable adjunct for intraoperative sedation during regional anesthesia especially when postoperative pain might be predicted to be worse than usual.

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