The management of unstable intertrochanteric fractures in elderly is challenging because of difficult anatomical reduction, poor bone quality, and sometimes a need to protect the fracture from stresses of weight bearing and the need for early mobilization. Internal fixation in these cases usually involves prolonged bed rest or limited ambulation, to prevent implant failure. This might result in higher chances of complications like pulmonary embolism, deep vein thrombosis, pneumonia, and decubitus ulcer. The purpose of this study to compare the results of trochanteric fixation nailing (TFN) and hip hemiarthroplasty in unstable intertrochanteric femur fractures in elderly patients. Out of 50 patients with unstable intertrochanteric fractures 25 patients were treated with primary cemented bipolar hemiarthroplasty and 25 were treated with trochanteric femoral nail. Follow up was done post operatively at 1 months, 3 months, 6 months. At each follow up visit patients were evaluated radiologically and clinically. Functional outcome was evaluated by Harris hip score. Out of 25 patients operated by hemiarthroplsty, 3 patients had excellent results and 12 patients had good results whereas 9 patients had fair and one patient had poor results. Out of 25 patients operated with TFN, one had excellent results and 8 patients had good results whereas 10 patients had fair and 6 had poor results. Two hemiarthroplasty patients and one TFN patient developed superficial infection whereas one dislocation was also observed in hemiarthroplasty patient. Screw cut out from head was seen in one TFN patient and one TFN patient also developed pulmonary embolism. The cornerstone of management of such fractures is early surgery, followed by mobilization. Hence Cemented bipolar hemiarthroplasty offers a modality of treatment that provides adequate fixation and early mobilization in these patients thus preventing postoperative complications such as pressure sores, chest infection and DVT, as compared to TFN where there was more chance of complication due to prolonged immobilization.

Introduction: Inferior dislocation of the hip, also called luxatio erecta femoris, is the rarest type of hip dislocation with a poorly understood mechanism of injury. We came across three such cases resulting from high-energy trauma with various other associated injuries. Case Report: The first patient, a 25-year-old man, presented with the right hip pain, hip and knee joint in flexion without rotational component, after motor vehicle collision. The second patient, a 42-year-old man, presented with the left hip pain, hip and knee joint in flexion with rotational component, following fall from 20 ft height. The third patient, a 29-year-old lady, presented with the left hip pain, hip and knee joint in flexion with rotational component, after motor vehicle collision. All three patients were diagnosed by radiograph and were managed by closed reduction under short general anesthesia, within 3 h, 9 h, and 6 h, respectively. Thomas splint was used to immobilize the limb in all for 1 month and weight-bearing was started after 2 months from injury. Two of them were followed up to 6 months and one was lost to follow up. No evidence of avascular necrosis of femoral head or other complication related to hip dislocation was noted. Conclusion: Luxatio erecta femoris is a rare type of hip dislocation and with limited publication. The position of limb on presentation should raise the suspicion of same and diagnosis confirmed through radiological investigations. Usually, this type of dislocation can be managed with closed reduction. If closed reduction is unsuccessful, then a fracture femur or bone chip in the joint could be the cause of the difficulty. Keywords: Hip, dislocation, inferior, luxatio erecta femoris.

Introduction Giant cell tumor of bone is a benign but locally aggressive tumor accounting for approximately 20% of benign osseous neoplasms. Female gender predominance, common in second to third decade of life. Commonly seen around knee, with the distal femur being more frequently involved. Method Presenting a 25year old lady with history of progressive pain and swelling around right knee for 2 years and inability to walk for 6 months. Radiography and biopsy revealed giant cell tumor of the right proximal tibia involving the medial condyle. Two staged procedure planned. Stage 1 extended curettage, cementation of cavity with PMMA and a knee spanning fixator was done. In stage 2 at 12 weeks cement was removed and knee arthrodesis using allograft performed retaining the fixator in place. Results Patient was able to partially bear weight 6 weeks post 2nd stage of surgery and was able to bear full weight after 12 weeks. A solid arthrodesis was achieved at 5 months post 2nd stage, when the fixator was removed. There is no recurrence at end of one year Conclusions This is a novel method of low-cost treatment using bone cement and external fixator for stability. Cement gives immediate structural support and fixator allows ambulation and early weight-bearing. The importance of thorough curettage cannot be overemphasized in preventing recurrence. This can be a viable alternative treatment option for patients presenting with large giant cell tumors around the knee joint who cannot afford options like wide local excision and joint replacement using mega-prosthesis.

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