As one-third of the tibial surface is subcutaneous throughout its length, open fractures are commonly encountered in this bone. The factors which determine the outcome of these fractures are severity of the injury, indicated by the degree of initial displacement, comminution and soft tissue injury and the damage to the tibial blood supply. In open fractures not only is the endosteal circulation disrupted but also the periosteal circulation, because of periosteal stripping. The various available options of treatment such as conservative short leg or long leg casting, open reduction and internal fixation with plates and screws, intramedullary fixation (Including Ender pins, Intramedullary nails and Interlocking Intramedullary nails with reaming or without reaming) and external fixation techniques have their own advantages and disadvantages. The present study was conducted in the Department of Orthopaedics, Gandhi Hospital, during the period from October 2013 to November 2015, to evaluate the results of internal fixation with interlocking intramedullary nailing without reaming in the treatment of the open fractures of tibia. In our study, we got 91% good-to-excellent results evaluated by Johner and Wruh criteria. We opine that closed unreamed interlocking intramedullary nailing yields good-to-excellent results in compound diaphyseal fractures of the tibia, as this technique allows a good control over the rotations with axial stability of the fracture, thus maintaining the length of the limb and enabling early joint motion. The endosteal blood supply is also well preserved. These factors help in lowering the rates of infection, malunions and non-unions.

Pseudoarthrosis involving lamina of C2 vertebra requiring intervention is very rare. We report the unusual case of a 38-year-old man presenting with pseudoarthrosis of an old fracture involving left lamina of C2 vertebra. The patient presented with progressive spastic quadriparesis and history of sustaining injury to his neck 15 years ago. Imaging showed pseudoarthrosis involving the left lamina of C2 vertebra with significant cord compression. Posterior approach was used and decompressive laminectomy was done at C2 and C3 levels with removal of the affected segment with pseudoarthrosis. The postoperative period was uneventful and the neurological recovery was good.

Hypophosphatemic mesenchymal tumors of the skull bone otherwise known as oncogenic osteomalacia and aneurysmal bone cysts of the skull are rare tumors occurring in calvaria. This report consist two rare tumors recently encountered in the Department of Neurosurgery, KIMS Hospital, Secunderabad. Both the patients presented with different clinical pictures. A middle aged person with hypophosphatemic mesenchymal tumor presented with generalized weakness, tremors, pains and fracture left hip joint associated with scalp swelling with hypocalcemia and hypophosphatemia. The other patient with aneurysmal bone cyst was a child and presented with progressive painless enlargement of swelling in the parietal region. Both the tumors were locally aggressive though they were benign histopathologically. Both the patients underwent surgical excision of the tumor. Complete surgical excision reverted the biochemical and clinical picture of the hypophosphatemic mesenchymal tumor patient to normal level. Oncogenic osteomalacia and aneurysmal bone cysts are rare tumors to occur in calvaria, operation is reasonably an easy procedure and complete excision of the tumor will cure the problem. Keywords: unusual calvarial tumors; hypophosphatemic mesenchymal tumors; oncogenic osteomalacia