Double Trouble of "Double Segmental" Fractures - A Report of Two Cases.

Introduction: A "double segmental" fracture is an injury pattern that has three fracture sites and four fracture segments in a single bone. It is extremely rare, with only three "Double segmental femoral fracture" and only four "double segmental tibia fracture" cases reported in the literature. These fractures are associated with difficulty in deciding the implant for fixation, segment reduction, maintenance of reduction, maintaining blood supply of segment during fixation, and the high risk of post-operative complications. Case Report: We present two unique cases, one of "double segmental femur fracture" and the other of "double segmental tibia fracture," fixed with intramedullary nailing. When Schanz screw or Steinman pins were used to reduce the intermediate fragments and hold them in place, they interfered with the reaming due to the protruding part in the narrow canal. This problem could be solved using weber clamps to hold reduction as they do not obscure the canal. All the fractures united uneventfully at 9 months follow-up. Conclusion: A "single intramedullary device" to fix "all the segments" can help provide stabilization without compromising soft-tissue attachments and viability of the intermediate fracture segments in "double segmental" fractures.

Comparative Study of the Management of Intertrochanteric Fracture Femur With Proximal Femoral Nail vs. the Dynamic Hipscrew With Derotation Screw in Elderly Population.

BACKGROUND: Intertrochanteric fractures can be treated, both by conservative and operative methods depending upon the status of the patient. The purpose of this study was to assess the functional outcome of intertrochanteric fracture of femur treated with dynamic hip screw (DHS) with de-rotation screw comparing and proximal femoral nail (PFN). METHODOLOGY: We compared 30 (male: 23, female: seven) cases of intertrochanteric fractures with a mean age of the population was 65 years and male to female ratio in was 2.75:1. Patients were recruited in this study having inclusion criteria of adults above 50 years of age, isolated intertrochanteric fractures of the AO Foundation/Orthopaedic Trauma Association (AO/OTA) type A1 and A2, fracture less than two weeks, and intertrochanteric fracture with or without distal extension. RESULTS: Post-operatively, patients treated by either of these two methods were statistically analyzed in terms of comparing advantages and disadvantages in terms of the time of fracture union and outcome of both above-mentioned procedures using Harris hip score. CONCLUSION: PFN gives better results than DHS with De-Rotation Screw-in intertrochanteric fractures in terms of the amount of blood loss during surgery, duration of surgery, early toe-touch weight-bearing, and Harris hip scores. There is no difference between the two modalities in terms of duration of hospitalization, fracture union, mortality and morbidity, and postoperative complications.

Acromioclavicular joint tuberculosis: A report of two cases.

Acromioclavicular joint tuberculosis is an extremely rare presentation with only 16 cases reported so far and has a relatively high propensity to be misdiagnosed. India being a tuberculosis endemic region accounts for almost 27% of cases worldwide (global index of 2018 was 10 million). With a higher index of suspicion an earlier diagnosis can be made. We report two patients of AC joint tuberculosis, treated with multidrug chemotherapy resulting in a good functional outcome.

Bilateral Asymmetric Hip Dislocations with Vascular Compromise: A Case Report.

Bilateral asymmetric hip dislocations are rare injuries and associated vascular compromise is even rarer. We report a unique case of bilateral asymmetric hip dislocations with vascular compromise, due to mechanical arterial compression by the anteriorly dislocated femoral head on one side. Prompt closed reduction re-established the blood flow. Operative intervention was done subsequently to remove intra-articular loose bodies in the hip on the same side. At 6-month follow-up, patient had good functional outcome and no radiographic evidence of complications.