Spontaneous rupture of the extensor pollicis longus (EPL) tendon is rare, and spontaneous non-traumatic rupture of both extensor pollicis longus (EPL) and extensor carpi radialis brevis (ECRB) tendons is not reported in literature. Rupture of EPL is usually associated with rheumatoid arthritis, systemic or local steroid injections, fractures of the wrist and repetitive and excessive abnormal motion of the wrist joint. We describe a case of spontaneous rupture of the EPL and ECRB tendons in a female patient, washerwoman by occupation, with no predisposing factor. Exploration of the tendons along with end to end tendon repair was done with excellent results. We describe the possible mechanism of the injury and result after one year follow up.

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<p class="abstract"><strong>Background:</strong> Usually delayed union of fracture long bones are managed by putting a bone graft at fracture site , but bone grafting have donor site complication like scar, infection ,hernia ,gait disturbance , cosmetic problem, as well as recipient site complication like soft tissue trauma , de-vascularisation of fracture fragment. Bone marrow infiltration is a minimally invasive method done percutaneously. It is easy, safe procedure with no associated complications that may occur in bone grafting.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted in the Department of orthopedics, Government Medical College, Kota from June 2011 to November 2013 to evaluate the efficacy of percutaneous bone marrow infiltration in cases of delayed union of long bones. 27 patients included in study with 28 bones, as one patient has given bone marrow injection in two bones (tibia &amp; femur), so the cases included in study counted as 28 cases. The mean age of this study was 38.28 years, ranging from 18 years to 75 years.  All cases were follow up after 4 to 6 weeks and thereafter one month interval. Final follow up was taken when fracture site shows clinical and radiological sign of union.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 23 united cases 19 had excellent results and 04 cases had good results. The five cases which fail to unite were taken as poor results.</p><p class="abstract"><strong>Conclusions:</strong> Bone marrow infiltration is a minimally invasive, safe bone graft substitute for delayed union of long bones and have less complications.</p>

Introduction:Renal injuries account for up to 1-5% of all trauma related injuries. Over the years there has been a shift towards non-operative treatment for blunt renal trauma. The aim of our study was to assess outcomes of patients managed conservatively (non-operatively) for high grade blunt renal injury at our centre. Material and methods:The study was conducted in a retrospective manner using hospital records of last 5 years. All patients with blunt renal injuries were included. These patients were categorized based on AAST(1989) injury grading and further subdivided into operative and non-operative management groups. These management strategies were analyzed in terms of 'failure of non-operative management', complications and need for adjunctive procedures. Descriptive analysis was done using Microsoft Excel(2010, ver14) software.Results: Forty three patients were included in the study with a mean age of 44.6 years. Out of the total, 28 had grade I -III injuries, 11 had grade IV and 4 had grade V injuries. All the grade I-III patients were managed conservatively and required no adjunctive procedures. One (9%) of grade IV and 2(50%) of grade V injuries underwent immediate exploration. Out of 10 cases of grade IV injuries which underwent nonoperative management, 3(30%) required delayed exploration and none of the grade V injuries required delayed exploration. Complications included urinary tract infection (UTI) (6 cases), persistent hematuria (3 cases), hypertension(2 cases), urinoma (2 cases) and ileus(2 cases) .All complications were Clavien grade 1-2 with no mortalities overall. Conclusion:If the patient is hemodynamically stable, even grade IV and V blunt renal injuries can be managed conservatively, as is seen in our study where failure of nonoperative management occured in only 30% of grade IV and none of the Grade V injuries.