Introduction: Winging of scapula is defined as a failure of dynamic stabilizing structures that anchor the scapula to the chest wall, leading to prominence of the medial border of scapula. It could be primary, secondary, or voluntary. Primary winging could be true winging due to neuromuscular causes or pseudo-winging due to osseous or soft-tissue masses. A scapular osteochondroma is a very rare presentation site and causes pseudo-winging leading to pushing away of the scapula away from the chest wall presenting as medial border prominence. Here, we are reporting a rare case of a scapular osteochondroma causing a pseudo-winging of the scapula. Case Report: A 2-year-old male child presented with painless, immobile, and non-fluctuant swelling over the left scapular region, insidious in onset and progressive in nature. On examination, a non-tender, immobile swelling was palpable with a painless and unrestricted range of motion at the shoulder joint. After evaluating radiographs and CT scan, the patient was diagnosed to have a ventral scapular osteochondroma leading to pseudo-winging of the scapula. Conclusion: Despite the rarity, a differential diagnosis of a scapular osteochondroma should be kept in mind while examining a young child presenting with a winged scapula. Keywords: Scapula, osteochondroma, pseudo-winging.

Introduction: There is no set protocol for treatment of supracondylar humerus presenting more than 6 days after injury. Older studies indicate treatment with traction or leaving them alone to malunite and treat with an osteotomy later in view of significant complications or attempting delayed treatment. The aim of the current study was to look at the outcome of supracondylar humerus fractures presenting after a delay of minimum 6 days. Patient and Methods: A retrospective study of 14 pediatric patients with supracondylar humerus fractures was undertaken with review of patient's records and radiographs for pre-operative, intraoperative and post-operative follow up data. Delay between injury and presentation, need for open reduction, operative time and length of stay, post-operative complications, malunion, heterotopic ossification and neuro-vascular injury were evaluated. Patients were called for follow up to evaluate outcomes using the Pediatric Outcome Data Collection Instrument (PODCI) score. Results: The average age of the patient was 8 years. The average time from injury to surgery was 7.2 days and the patients were in the hospital for 3.2 days (Range: 2 to 8 days). The average operative time was 67.5 minutes. Only two out of 14 patient's required open reduction while the others could be reduced closed. None of the patients developed heterotopic ossification, residual coronal plane deformities, iatrogenic nerve injuries or vascular compromise at the latest follow up. The overall outcome as assessed with PODCI scoring in 10 out of 14 patients was excellent. (91.5 out of 100) Conclusion: Majority of supracondylar humerus fractures presenting late can be closed reduced and percutaneously fixed giving excellent clinical outcomes with no residual deformity and complications.

Introduction: Primary total hip replacement (THR) surgery for the neck of femur (NOF) fracture in a case of below-knee amputation with distal femur shaft non-union is rare. Case Report: This case describes the traumatic right NOF fracture in a 49-year-old male patient with distal femur shaft non-union. The patient has a history of ipsilateral below the knee amputation along with right distal femur shaft fracture managed with retrograde femur nailing 10 months back following a road traffic accident. The NOF fracture was managed by primary THR as the definitive procedure after distal femur nail removal and distal femur plating with allograft for non-union. Conclusion: Primary THR with distal femur plating and allogenic bone grafting in such cases provides satisfactory outcomes. It allows for early ambulation and rehabilitation of the patient. Key words: Primary total hip replacement, Below-knee amputation, Distal femur non-union.

Introduction: Total hip arthroplasty after McMurray’s osteotomy increases the operative difficulties and decreases the chances of better outcome. With the advent of modular femoral stems, minute changes can be done to individual joints, which allow intraoperative flexibility and better post-operative outcome. Thus, it should be considered as an option for complicated cases. Case Report: We report a case of a 35-year-old female with chief complain of pain in the left hip while walking for the past 2 years. The patient also had difficulty in squatting and sitting cross legged. History of fracture in the left hip at 4 years of age for which McMurray’s osteotomy was done. The patient was operated with total hip arthroplasty using modular Sivash range of motion (S-ROM) stem. Conclusion: Modular S-ROM total hip arthroplasty is a good option for treatment in cases with previous osteotomy in femur. Keywords: McMurray’s osteotomy, total hip arthroplasty, Sivash range of motion.