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<p class="abstract"><strong>Background:</strong> Ideal management of intertrochanteric fractures in elderly individuals has been debated for several years. Due to difficulty in obtaining anatomical reduction, management of the complex intertrochanteric fractures in elderly patients is challenging and controversial<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> In the present study prospective comparative evaluation has been done between dynamic hip screws<strong> (</strong>DHS), proximal femoral nail (PFN) and bipolar hemiarthroplasty for overall clinical outcome of patients with unstable intertrochanteric fractures. The total numbers of patients were 90 with each group consisted of 30 patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> Complication rate and requirement of revision surgery was more in DHS group but this was not found to be statistically significant. Harris Hip Score &amp; hence the functional outcome was found to be more in PFN group as compared to DHS which was statistically significant. Bipolar hemiarthroplasty provides early full wieght bearing leading to better HHS at 6 weeks evaluation but almost similar score to PFN in long term<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> PFN is better choice of fixation if good bone quality present while extremely osteoporotic patients or extreme comminution at fracture site favours bipolar hemiarthroplasty in elderly patients<span lang="EN-IN">.</span></p>

Morphological variants of plasma cells have been described in cases of Plasma cell neoplasm. Presence of these atypical forms poses difficulty in morphological diagnosis and demands the use of ancillary techniques to ascertain the nature of these atypical cells. We hereby report a series of 6 such cases where the bone marrow examination showed plasma cells with atypical morphology, leading to varied differential diagnosis; however immunophenotyping by flow cytometry in adjunct to serum electrophoresis, immunofixation and free light chain assays confirmed the diagnosis.

<p class="abstract"><strong>Background:</strong> Pedicle screw instrumentation in case of fracture spine provides stable fixation. However in absence of experience and proper technique of pedicle screw insertion, it is associated with many complications. We aim to study the results of patients with thoracolumbar fracture stabilized with short segment pedicle screw instrumentation.</p><p class="abstract"><strong>Methods:</strong> 33 cases of thoracolumbar wedge compression fracture spine presenting to Nair Hospital were included in the study. All patients were operated by the senior author via a posterior approach and short segment pedicle screw fixation. Patients were followed up for one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> 33 patients with a mean age were 37.6 years of which 3 were females and 30 were males in our study. Fall from height (93.93%) was the most common mode of injury followed by road traffic accident (6.07%). D12 and L1 were the most common vertebrae involved. Statistically significant (p=0.01) correction in the vertebral body height occurred in the immediate postop period and there was 4.1% loss of correction at final follow-up. There was statistically significant improvements in the Regional angle (p=0.03) and anterior wedge angle (p=0.03). Residual regional angle at final follow-up was found to be &gt;5° in 3 patients. Neurological improvement was seen in 23 (74.19%) patients (p=0.01). No improvements were seen in 8 (25.81%) patients. None of our patients had postoperative worsening of the neurological status. None of the patients had pedicle wall breach on final follow up CT scan.</p><p class="abstract"><strong>Conclusions:</strong> Short segment fixation in case of wedge fracture can restore the vertebral body height, mean regional angle and mean anterior wedge angle and provide good outcome. There are poor chances of recovery of patient with Frankel grade A. Meticulous dissection and careful technique of pedicle screw insertion, adequate decompression, good contouring of the rod with correction of kyphosis can provide excellent results.</p>

The Thompson’s approach is used as the standard posterior approach by many surgeons. Although posterior interosseous nerve palsy following the Thompson’s approach has been reported by several authors, isolated paralysis of the extensor digitorum communis (EDC) is a rare occurrence. We report to you a case of isolated paralysis of EDC following the Thompson’s approach in a 14-year-old boy who recovered completely on the 5th postoperative day. Each of the approaches to the proximal radius poses a risk of damage to the posterior interosseous nerve and its branches because of traction. Damage may occur during exposure or implant insertion. Any surgery around the supinator and the radial tunnel region is dangerous because of complex anatomy, lack of intermuscular planes and varying distribution of the radial nerve. Avoiding excessive posterior or ulnar retraction of the EDC and improper dissection can avoid the “sign of horns” deformity following the Thompson’s approach.