A high index of suspicion is needed to identify this benign spinal anomaly that may be confused with many pathologic conditions. Knowledge of this condition helps in making rational use of extensive noninvasive and invasive diagnostic procedures.

Background: Acetaminophen (paracetamol) is one of the most commonly used over-the-counter for pain relief. Management of acute pain with plant-based nutrients has remained suboptimal due to an absence of data supporting acute relief of pain. In the present study, it was hypothesized that high-dissolution liquid treatment of black sesame extract oil, Curcuma longa and Boswellia serrata may provide pain relief in people with acute musculoskeletal pain as quickly as acetaminophen. Methods: In this randomized active controlled open label study, 88 healthy subjects with acute musculoskeletal pain were randomized to receive treatment capsule (Rhuleave-K; 1,000 mg/d) or 1,000 mg/d acetaminophen for 7 days. Change in pain intensity and pain relief at first 6 hours, 3 days, and 7 days were measured. The onset of analgesia was measured by perceptible pain relief and meaningful pain relief. Other measures were McGill Pain Questionnaire and Patient Global Impression Change. Results: The treatment formulation resulted in average magnitude of pain relief comparable to the acetaminophen. Sixty-six percent of subjects in the treatment group reported positive response in pain relief (≥50% max TOTPAR; total pain relief) after 6 hours, compared to 73% of control. Seventy-three percent of subjects on treatment were considered positive responders, compared to 80% in the control group. The average time of onset of analgesia was 1 hour for the treatment group, versus 0.83 hour for control. At the end of day 3 and 7, there was significant improvement ( P < .001 for day 3 and day 7) in the pain condition of treatment group and was comparable to control ( P = .436 for day 3 and P = .529 for day 7). The total McGill Pain score showed significant reduction in pain with the treatment irrespective of the pain intensity statistically equal ( P = .468) to control. Both the groups were equal in providing sensory pain relief ( P = .942), but the treatment was 8.57 times significantly better ( P = .027) than acetaminophen in reducing the unpleasantness and emotional aspects (affective domain) involved with acute pain. Conclusion: The results showed that the treatment used in the study may act as a natural, fast acting, and safe alternative for acute pain relief comparable to acetaminophen.

Complications can be minimized by impacting the unreamed nail till the subchondral bone while maintaining the fracture well reduced and by using multiple distal locking screws in different planes.

Skeletal xanthomas are extremely rare benign disorders with features mimicking bone tumours and their definitive diagnosis is very difficult. Patients diagnosed with primary xanthoma should be followed up regularly as they may develop dyslipidemia later. Xanthomatous degeneration occurring in other bony lesions should be differentiated with xanthomas by studying the whole specimen microscopically. A 45 year old lady presented to us with xanthoma of ulna who was a known diabetic and hypothyroid on treatment. Ours is the second case of ulnar xanthoma reported so far in the literature.

BACKGROUND:The choice of implant between the extramedullary Dynamic Hip Screw (DHS) and intramedullary Proximal Femoral Nail (PFN) in the surgical management of pertrochanteric fractures is still an enigma. Various meta-analysis conducted so far have yield conflicting results. METHODS: Prospective randomized controlled study including 30 patients with 30 pertrochanteric fractures out of which 15 were treated with DHS and 15 with PFN. RESULTS: The overall functional outcome of patients treated with the PFN was significantly better than those treated with DHS (p<0.037), especially in patients with unstable fractures. Other advantages of PFN included smaller incisions, shorter operative times, relatively less blood loss and less postoperative pain and early ambulation. CONCLUSION: We conclude that in stable intertrochanteric fractures, both the PFN and DHS have similar outcomes. However, in unstable intertrochanteric fractures the PFN has significantly better outcomes in terms of earlier restoration of walking ability and less limb length shortening.