Unusual Mechanism of Injury during a Wedding Tradition Leading to a Metacarpal Shaft Fracture - A Case Report.

Introduction: "Joota Chori" is a traditional Indian wedding ritual which involves playful competition between the bride's and the groom's friends, with the aim of hiding and retrieving the groom's shoes. Case Report: We describe a rare case scenario wherein an orthopedic surgeon sustained a metacarpal shaft fracture while gripping the shoe and engaging in a tussle with the groom's friends. Despite feeling a sudden snap and experiencing pain, the surgeon held onto the shoe. The subsequent diagnosis revealed a 4th metacarpal long oblique shaft fracture. Conclusion: This case highlights the uncommon mechanism of injury involving forceful hyperextension of the MCP joint and the potential risks associated with physically intense wedding rituals. It also emphasizes the importance of adequate first aid resources and medical attention at wedding venues to promptly address musculoskeletal injuries.

"Screw First" Technique to Get Past Nail-Jig Mismatch in Proximal Femoral Nailing.

Proximal femoral nailing is the gold standard of surgical treatment for unstable intertrochanteric hip fractures. One of the intraoperative complications encountered in this procedure is the nail-jig mismatch due to causes such as manufacturing errors and fatigue deformation of sleeves or jig. Nail-jig mismatch leads to eccentric placement of guidewire within the screw slots of PFN and subsequent difficulty in reaming and screw insertion. The potential complications of this include guide wire deformation, breakage, nail damage and screw malposition. We propose a simple and effective technique to tackle this complication, called as "Screw first" technique. The principle of this technique is to utilize screws as guide wire sleeves to effectively centralize the guidewire position within nail slots. On identifying a mismatch by the eccentric position of guidewire, a long screw is first inserted partially till its shaft engages into the screw slot allowing subsequent insertion of a guidewire which assumes a centralized position, thus bypassing the mismatch of jig. Following this, the usual steps of reaming and final screw insertion are undertaken. This method is effective, simple, quick and requires no special instrumentation.