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.

<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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<p class="abstract"><strong>Background:</strong> Sciatic neuralgia is a result of nerve root oedema because of the inflammatory, immunological and mechanical factors. Steroid injections play an important role in the management of sciatic radiculopathy. Steroids act by reducing the oedema around the nerve roots and decreasing pain. Locally administered steroids have the advantage of reduced dosage and targeted delivery around the nerve roots. This forms the basis of epidural steroid injections. This can be given around the nerve root in the transforaminal space or in the interlaminar space. There is a paucity of literature comparing the two techniques of epidural steroid injections. We have done a randomized comparative trial, to compare the effectiveness of the two modalities of injection in the management of a single level unilateral foraminal disc herniation.</p><p class="abstract"><strong>Methods:</strong> Patients were randomized in two groups Group A: Transforaminal epidural (SNRB) and Group B: interlaminar epidural. Same dose of steroid was used in each group.<strong></strong></p><p class="abstract"><strong>Results:</strong> Immediate post injection, 2 week and 1 month transforaminal epidural (SNRB) was better compare to interlaminar epidural however at the end of 3 months the difference was not significant (p=0.08).</p><p><strong>Conclusions:</strong> Both transforaminal and interlaminar epidural injection are effective form of treatment in mild to moderate grade of disc disease. Both the technique provide short lasting relief in the symptoms associated with disc pathology, however pain management is better in transforaminal group compared to interlaminar group. Thus these techniques can be considered for delaying surgery and providing intermitant relief. </p>

Lumbar rdiculopathy is a very common problem encountered in day to day practice of every orthopaedic surgeon. Management of this problem varies from only conservative management to complete surgical decompression. Spinal steroid injections also play a role in the management of low to moderate grade of disc disease. Selective nerve root block (SNRB) is a form of directed steroid injection around a particular nerve root. In this study we have evaluated the efficacy of SNRB in a single level disc disease. We found that SNRB is an effective intermediate form of treatment between conservative management and Surgery. Though it produces a significant improvement in pain and disability scores initially, after three months there are chances of recurrence for which surgical management would be required.

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Tibia is the most common fracture in the lower limb (1). Tibia is the subcutenously placed bone and has a precarious blood supply. Hence special care and expertise is necessary while treating this fracture. Biological principles should be followed during fixation of tibial shaft fractures. Intramedullary interlocking nail is a excellent device which provide good fracture stabilization. Objectives: In this study we evaluated the fracture union time and functional outcome following intra medullary nailing in tibial shaft fracture. Materials and Method: 30 patient meeting the inclusion criteria were included in the study. Surgical management was done by the same surgeon. Post operatively patient were followed at intervals of 15 days for the first month followed by monthly visit for next 6 months. Results: the most common age group was between 25-35, and the most common location was at middle third, 70% of the fracture were united wetween 12 to 16 weeks, Conclusion: Closed internal fixation with intramedullary interlocking tibial nail is a standard surgical procedure for management of tibial diaphyseal fractures. The advantage of rapid rehabilitation and relatively few complications serve to recommend it for wider use.