Background: The carriage of loads on the back in children, >10% of one’s body weight (BW), induces postural change and morbidity related to spinal pain. We studied the weight of schoolbags and the prevalence of musculoskeletal pain related to carrying schoolbags among children in Thimphu, Bhutan. Methods: This was a cross-sectional study, with a multistage cluster sampling, conducted amongst grade 8 and 10 students. Data were collected using a standardized self-administered questionnaire and weights of students and schoolbags were measured. Descriptive statistics were used to present the findings. Means were compared using t test and risk factors were identified using logistic regression. Results: There were 131 students whose schoolbags weighed >10% body weight (BW). The mean weight of schoolbags was 4.6 ±1.5 kg for grade 8 students and 4.0 ±1.5 kg for grade 10 students. Musculoskeletal pain in at least one body region was reported by 411 students. Schoolbags weighing >10% BW and carrying the bags over only one shoulder were significant risk factors for reporting musculoskeletal pain. There were 197 students whose schoolbags did not have any safety feature; students did not use them consistently even if they were present. Conclusions: The weight of school bags that were more than the recommended ≤10% BW was a strong factor in reporting musculoskeletal pain. Parents and students may be educated on the use of schoolbags with safety features. Measures such as providing storage facilities in schools may reduce the weight of bags.

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PSO surgery for sagittal imbalance usually requires a long fusion at least two levels above and below the osteotomy site to achieve adequate stability and better global alignment. However, longer fixation may decrease the patients' quality of life and cause a proximal junctional failure. Our novel technique may shorten the fixation area after osteotomy surgery. These slides can be retrieved under Electronic Supplementary Material.

Introduction: Intraosseous lipoma is a very rare neoplasm accounting for < 0.1 % of primary bone tumors. Pain is the leading symptom in majority of the reported cases but it can be asymptomatic. There is slight male predominance in occurrence of this lesion. The plain radiological findings are not specific and requires differential diagnosis. The lesion is mostly diagnosed by histopathological examination. Case report: A 31-year-old male presented with localized pain around the medial aspect of right ankle joint for one week. Examination revealed mild tenderness over the distal part of the right tibia over the medial aspect. Plain radiograph of the right leg showed well-defined expansile osteolytic lesion with sclerotic rim and calcified matrix at metaphysis of distal tibia. MRI showed enhancing T1-weighted hypo intense and T2-weighted hyperintense lesion. For this case, radiological impression was giant cell tumor with differential diagnosis of aneurysmal bone cyst and fibrous dysplasia. However, the histopathological examination showed intraosseous lipoma, consistent with stage II of Milgram’s classification. Conclusions: Although the diagnosis of intraosseous lipoma can be very challenging due to its rarity and indistinct plain radiograph findings, combination of computed tomography or magnetic resonance imaging may be useful by being able to show the presence of fat within the lesion. However, the clinicians, surgeons and radiologist should be familiar and be aware of these findings to be able to come to a correct diagnosis since not all cases need surgery and can be managed conservatively.

The occurrence of Brown-Sequard syndrome with Horner’s syndrome in a child with spinal trauma is a very rare and unusual entity. Brown-Sequard syndrome results from hemisection injury of the spinal cord, mostly in the cervical cord region. The Horner’s syndrome presents when the injury is in the cervical region involving the sympathetic pathway. We present you with the case of a 12-year-old boy who was referred from a local hospital with weakness on the left half of his body after sustaining a penetrating injury to his neck by a khuru (Bhutanese dart). Clinical examination was consistent with the diagnosis of Brown-Sequard syndrome with ipsilateral Horner’s syndrome. Although cervical spine plain radiographs showed no fracture, computed tomography and magnetic resonance imaging showed a C2 lamina fracture at the left side of the spinous process with indentation to the cord. He was managed conservatively with a soft cervical collar, intravenous antibiotics, and physiotherapy. He had complete resolution of Brown-Sequard syndrome and Horner’s syndrome after 1 year. Patients with Brown-Sequard syndrome associated with Horner’s syndrome usually have a good prognosis and full recovery rate with regular physiotherapy and rehabilitation. Early diagnosis and treatment will have a better chance of recovery and return to pre-injury status.