Intracapsular fracture neck of the femur (NOF) has been termed as “unsolved” fracture. Despite the ever-increasing literature on hip fractures, current treatment guidelines are conflicting and provide no authoritative, evidence-based recommendations on the ideal timing and modality of surgical management. Studies are going on with regard to solving the mystery behind the fracture NOF, still many of the controversial issues are remaining as a big challenge to orthopedic surgeons across the world. We are trying to enlighten a few of the controversial issues here with regard to:

• Classification of fracture NOF
• Treatment for undisplaced fracture
• Timing of surgery for a young patient with a displaced fracture NOF
• Reduction techniques of the fracture
• Internal fixation (IF) or replacement for displaced fracture NOF
• Positioning of the implant for IF
• Aspiration of the hip
• Surgical approaches
• Cemented versus uncemented prosthesis
• Hemiarthroplasty versus total hip arthroplasty
• Postoperative weight-bearing and moblilization.

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Rotator cuff tears commonly occur at their attachment on greater tuberosity. Musculotendinous junction (MTJ) tears in itself are relatively uncommon and a partial musculotendinous junction tear is even more uncommon. These tears are difficult to treat. All MTJ tears may not require surgery. There are reports stating the role of conservative management. However, a high-demanding individual may not be beneficial with conservative management. A case of a 35-year-old male came with the complaint of sudden onset of pain in the shoulder while doing gym 3 days ago. In magnetic resonance imaging, we identified a partial tear in MTJ of supraspinatus (SSP). Given his high-demanding lifestyle, we opted for a surgical repair and describe the surgical procedure in this case report. The aim of this case report is to emphasize on the existence of partial tear in MTJ of SSP and the need for surgical repair in high-demanding individuals. A partial tear of SSP MTJ may need surgical repair in high-demanding individuals, for them to return to their previous level of activity.

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A 15-year-old female presented with left-sided neck and shoulder pain for the past 1 year. Computed tomography scan and contrast magnetic resonance imaging revealed a mass lesion at the C7 level suggestive of osteoblastoma. Tumor resection was performed along with posterior stabilization. At 1-year follow-up, the patient had no restrictions on daily activities, and to date, there has been no evidence of recurrence. In case of neck pain, which is persistent and accompanied by stiffness, deformity, or neurological deficit, especially in young adults, osteoblastoma of the cervical spine may be considered one of the differential diagnoses.

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Background: Vitamin D deficiency is a growing health concern and pregnant population is considered to be high risk group. The proposed regimen for the Vitamin D supplementation during pregnancy is 400 IU,1000 IU daily for routine and high risk group (dark skin, obese, inadequate sunlight exposure) respectively. 20,000 units weekly for 6-8 weeks followed by maintenance dose in population with Vitamin D deficiency. The effects of Vitamin D deficiency include pre-eclampsia, increased LSCS incidence, impaired glucose tolerance for mother and low birth weight, hypocalcaemia, poor skeletal growth and immunity for the foetus. Although food may provide small amounts of both vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol), exposure to sunlight is by far the major source of vitamin D to the body, the vitamin being synthesized from cholesterol derivatives. Materials and Method: A cross sectional study over 50 subjects was done after ethical clearance in the department of orthopedics of our medical college. The blood samples along with demographic and clinical data in a questionnaire collected. Results: The results revealed 92% of the study subjects to have either deficiency or insufficiency of vitamin D. The various other parameters contributing directly or indirectly were evaluated. Conclusion and Recommendation: There is need for taking a multidisciplinary approach to patient care and referral to Orthopedics department at the earliest red flags signs of vitamin D deficiency. Creating awareness in the target population can be achieved with counselling and using print media with the pregnancy kits.

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Background: The fractures of both bones' forearms are the most common fractures seen. It can be managed by various methods. Open reduction and internal fixation is the procedure of choice for displaced forearm fractures involving the radius and ulna in adults using a locking compression plate (LCP). The study is undertaken to verify the claims made by the authors of the plate (LCP) and to learn the techniques, functional outcomes, and complications of this method of internal fixation. Objectives: To study the functional outcome of treating diaphyseal fractures in both bones' forearm with LCPs. To study the duration of union with LCP. To study the complications of LCPs. Materials and Methods: It is a prospective study which was carried out from August 2015 to January 2017 at MVJ Medical College and Research Hospital, Bengaluru. In this study period, 30 cases of fractures in both bones of the forearm were treated by open reduction and internal fixation using LCP. Results: In our study, the majority of the patients were male, middle aged, with road traffic accidents being the most common mode of injury, involving the middle third. Transverse or short oblique fractures were the most common. The fractures united in all 30 patients. Excellent or full range of mobility of elbow and wrist joints was present in 25 patients (83%), with 5 (17%) patients having good range of movements. Interpretation and Conclusion: The LCP of forearm fractures produces excellent results, the advantage being early mobilization, and early union but the complication, duration of surgery, and surgical techniques remain unchanged.

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Vascular injuries following an arthroplasty are a nightmare for both patient and surgeon. When the presentation is delayed and atypical, it is of major concern. We present a case of late presentation of pseudoaneurysm of common femoral artery left hip following total hip replacement. A 54-year-old male presented with complaints of weakness and numbness left knee, following total hip arthroplasty, which was performed 4 months earlier at an outside institution for secondary osteoarthritis of the left hip. on evaluation was found to have pseudoaneurysm of Femoral artery. Due to the co morbid condition of the patient (CKD, DM, Obsity) elevated creatinine values non surgical method of embolization of the pseudoaneurysm via one coil and Gelfoam was deferred and was decided to manage the psuedoaneurysm surgically with repair and PTFE graft. High suspicion in the setting of unresolving postoperative pain, paralysis, or need for blood transfusions may allow for earlier diagnosis and avoidance of serious limb-threatening complications. Care during the procedure for accurate retractor placement and careful manipulation may help avoid serious complications.

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“Four pillar concept” of hip function, consists of providing good femoral head cartilage, stable head in the acetabulum, Impingement free hip motion and optimum abductor function for any hip pathologies. In management of peadiatric and adult hip pathologies, hip optimization is achieved with the Four pillar concept.

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Management of fracture neck of the femur in young adults with above-knee amputation is a challenging scenario for even the most experienced orthopedic surgeon owing to the short lever arm possessed by the residual limb to perform a closed reduction. We report a unique case of fracture neck of the right femur successfully managed by closed reduction and percutaneous screw fixation in a 43-year-old male who had undergone an ipsilateral transfemoral amputation 15 years back.

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Osteochondroma is commonly found in the appendicular skeleton, though, relatively rarely, they occur in the spine, especially in the thoracic pedicle. A thorough radiographic workup is mandatory for a diagnosis. This is a case of a 13-year-old boy who developed gradual weakness over the lower limbs for the past 6 months, which worsened rapidly to 2/5 motor power over the last 3 weeks. A multidetector computed tomography suggested the diagnosis of a solitary osteochondroma of the D6 pedicle. Laminectomy and costotransversectomy with partial facetectomy and complete excision of the tumor with posterior instrumentation were done. Histopathological biopsy confirmed the tumor to be an osteochondroma. The power of the lower limbs improved postoperatively with physiotherapy to 3/5 at 6 weeks, 4/5 at 3-month follow-up, and 5/5 at 6-month follow-up. At 6-year follow-up, the patient is doing absolutely fine without any residual weakness or neurological deficit. Osteochondroma of the spine is rare. However, if they do occur, they usually need to be thoroughly investigated for accurate diagnosis and precise surgical treatment. These tumors could be presented with just a back pain or with progressing neurological deficits. A high index of suspicion and wide options of evaluation and management could change the course of the disease and the functional outcome of the patient.

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Goldenhar syndrome is a condition comprising various congenital anomalies of structures developing from the first and second branchial arches. Classically, it includes impaired development of structures such as eyes, ears, lips, tongue, palate, mandible, maxilla, and vertebral anomalies. The etiology for this syndrome is not clear; however, genetic and many other causes have been described for the development of the abovementioned anomalies. A 13-year-old boy presented with deformity of the back since birth, which is gradually progressing, now causing difficulty in breathing on exertion. Parents give a history of anomalies of the eyes, ear, face, and deformities of the neck and chest since birth. X-ray, computed tomography, and magnetic resonance imaging of the spine showed severe congenital scoliosis with multiple vertebral and rib anomalies with no intraspinal anomalies or spinal cord malformations. Posterior scoliosis correction and fusion with convex side costoplasty were performed after a detailed preoperative workup in view of syndromic etiology. Postoperatively, the boy was stable and the check X-ray showed satisfactory deformity correction. Severe scoliosis with Goldenhar syndrome always throws a challenge to treating spine surgeons as they are associated with multiple other regional and systemic abnormalities. A detailed examination, preoperative clinical and radiological workup, and proper planning are very much essential in treating these deformities.

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Paget's disease (PD) is a metabolic bone disease characterized by abnormal bone remodeling. The bone passes through different phases depending up on the osteoblast and osteoclast activity. The prevalence of the disease is rare in the Asian population. The vertebrae are the second-most commonly affected site. It may mimic metastatic spine lesions clinically and radiologically. X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI), and bone/positron emission tomography scan are used in aid of diagnosing the disease. The confirmation is by biopsy. Complications of the disease range from back pain to neurological deficits and malignant transformation. Here, we present a case of PD of thoracic vertebrae which is a rare entity in the Indian subcontinent. The patient presented with back pain and neurogenic claudication. MRI with CT correlation showed suspicion of vertebral malignancy and a biopsy was done which showed PD. He was treated with posterior stabilization using pedicle screws and rods. The importance of this case report is to present a case which is rare in the Indian population and to make awareness regarding PD as one of the differentials in vertebral lesions.

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