A case of bilateral pedicle fracture in the lumbar spine of a sedentary office worker is being presented. No such case has been reported in the literature previously. Bilateral pedicle fracture is a rare entity. Few cases have been reported in literature. All the reported cases had some underlying causative factors like degenerative spine disease, previous spinal surgery or stress-related activities, e.g. athletes. Our case is a 36-year-old sedentary office worker with none of the factors mentioned. We present a case of a 36-year-old sedentary worker with long-standing low backache. There were no root tension signs. Plain radiographs were inconclusive. The patient had a CT scan. The CT scan revealed long-standing defects in the pedicles of L2 vertebra with pseudoarthrosis. Infiltration with anaesthetic relieved the symptoms. Our patient was managed conservatively with spine rehabilitation physiotherapy program. Pedicle fracture can develop due to abnormal stresses in the pedicle either because of previous spinal surgery or spondylitic changes in the spine. Bilateral pedicle fracture in the absence of these conditions is extremely rare.

Supracondylar fracture of the humerus is a common upper limb fracture in children for which treatment is controversial and often technically difficult, and complications are common. Cubitus varus is the most prevalent complication encountered in such fractures, with a mean incidence rate of 30%. A variety of methods for treating displaced fractures have been recommended. We reviewed 20 cases of severely displaced grade III supracondylar fractures of the humerus in children. There was marked swelling and distorted local anatomy in all these fractures, which were managed conservatively with straight-arm lateral traction. The patients were treated in skin traction for 2 weeks, following which they commenced physiotherapy. The traction was applied with the arm at 90 degrees of abduction and the forearm in supination. None of the patients developed any complication, and all had the full range of movements. None had cubitus varus deformity, and none of these patients required further surgical treatment. There was a complete patient and parent satisfaction. Open or closed reduction with internal fixation is the most common method of treating these injuries, however in some cases this can be very difficult and dangerous. If the local anatomy and swelling do not allow this treatment then non-operative measures have to be adopted. We conclude that straight-arm lateral traction is a safe and effective method of treating these fractures, especially when the local anatomy is disturbed and the swelling makes operative intervention relatively more risky and difficult. Moreover, this method is also appropriate in areas where access to specialised centres in treating these injuries is either difficult or delayed.

BACKGROUNDSimultaneous bilateral femoral neck fractures are relatively rare injuries. They are usually associated with underlying metabolic bone disorders or systemic diseases. Long-term use of narcotics and bisphosphonates can also result in similar fracture patterns; however, association of this fracture type with long-term use of antiepileptic drugs is not very common. Only one such case has been reported in the literature. This article describes the second.CASE REPORTWe report a case of simultaneous displaced bilateral femoral neck fractures in a 50-year-old epileptic patient, who had taken phenytoin for the past 3 years. The fractures were a result of low-velocity injury following a fall from the bed. The fractures were managed with a bilateral hemi-replacement arthroplasty. Oral bisphosphonates were given to improve the bone quality in the post-operative period. The patient had a good post-operative outcome, that was sustained throughout the entire follow-up period of 1 year.CONCLUSIONAntiepileptic drugs should be supplemented with bisphosphonates and vitamin D to improve bone quality and prevent fractures in epileptic patients.

Pseudogout or calcium pyrophosphate dihydrate deposition disease (CPPD) primarily affects the joints and the periarticular tissues. Tophaceous or tumoral pseudogout is a rare form of this disease which is seen around the joints of extremities. It can be misdiagnosed as a neoplastic condition because of its clinicoradiological similarities, and thus, a proper histopathological examination is indispensable. We report one such case of extra-articular deposition of the CPPD crystals in a 65-year-old man who presented with an asymptomatic swelling around the left ankle. Radiographs showed a dense homogenous calcification, and FNAC revealed dense calcium deposits with numerous rhomboid-shaped crystals. It was managed by en bloc excision, and postoperative biopsy reports confirmed the diagnosis. Possibility of pseudogout should be kept as a differential diagnosis in patients presenting with calcified soft tissue swellings and should be subjected to a detailed histopathological examination for confirmation.

<p class="abstract"><strong>Background:</strong> Fractures of the neck of fifth metacarpal are commonly encountered in orthopaedic practice. Management of these fractures is a debatable topic with treatment varying from conservative management to surgical fixation. In our study we used a pre-bent k wire in antegrade fashion to achieve fracture fixation. We found that pre-bent K wire provides an excellent reduction with good correction of neck shaft angle and good restoration of movements at the metcarpo-phalyngeal and inter-phalyngeal joints. Pre-bent K wire provides an efficient and economical modality of fixation in fracture neck of fifth metacarpal fractures.</p><p class="abstract"><strong>Methods:</strong> All patients presenting with fracture neck of fifth metacarpal were managed by pre-bent K wire in antegrade fashion by a single surgeon using a single prebent K wire.<strong></strong></p><p class="abstract"><strong>Results:</strong> All the fractures involved the dominant hand (16 right and 6 left). The mean duration of surgery was 24 mins. Intra operatively the mean no of X ray shoots were 12. At the end of the follow-up there was no significant difference in the TAM in the affected and the unaffected hand. The p=0.17. The mean DASH at the end of the follow up was 2.42. The mean fracture healing time was 45 days.</p><p class="abstract"><strong>Conclusions:</strong> Boxers fracture is very common fracture type in young active adults. Conservative management is usually associated with shorting and angular deformities. Percutenous fixation of the fracture with bent K wire placed in antegrade fashion provides good stability at the fracture site.</p><p class="abstract"> </p>

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A complex fracture involving the distal humerus is a difficult fracture to treat and more so when it is involved with the ipsilateral shaft of the humerus. Open reduction and internal fixation of the humeral shaft with articular reconstruction have been described for a successful outcome of these complex fractures. However, it has drawbacks, especially in terms of soft tissue dissection and subsequent scarring and non-union.A 42-year-old female presented to the emergency department with a fracture of the intercondylar humerus with an ipsilateral shaft of the left humerus. Combined olecranon osteotomy with posterior minimal plate osteosynthesis was used to treat this fracture. At the one-year follow-up at the postoperative fracture clinic, there was no pain, the range of motion (ROM) of the elbow was 10 degrees to 140 degrees and the radiograph showed a healed fracture with the implant in situ.We present and review a novel technique to treat complex humerus fractures. Articular fragments can be directly visualized and fixed simultaneously. This approach allows for the biological fixation of the fracture and forms a reliable option for treating such complex fractures.