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doing symptomatically better. Based on current literature guidelines and evidence-based medicine, management for borderline cases is proposed to aid clinical decision-making in these situations.

With great effort and good team work (like vascular and orthopedic surgeons), badly comminuted compound injuries (Type III C injury) can be managed well with Ilizarov fixation. Even though the decision of amputation versus salvage was based on more scientific/scoring system, patient’s option should be taken, especially in borderline cases considering the present medicolegal scenario.

With great effort and good team work (like vascular and orthopedic surgeons), badly comminuted compound injuries (Type III C injury) can be managed well with Ilizarov fixation. Even though the decision of amputation versus salvage was based on more scientific/scoring system, patient’s option should be taken, especially in borderline cases considering the present medicolegal scenario.

Hoffa fractures are the fractures of the femoral condyles in the coronal planes. These are uncommon in adults and notably rarer in pediatric population. In this fracture, either one or both the femoral condyles may get involved following the injury. Such rare clinical entity warrants a high index of suspicion with apt radiological corroboration for meticulously diagnosing and planning out the treatment.

We report a rare case of Hoffa fracture involving the medial femoral condyle of right knee and undisplaced right patella fracture in a 6-year-old girl. The radiological investigations (radiographs and computed tomography [CT] scan) were done and her leg was immobilized by above knee posterior slab. Our treatment plan included surgical intervention to do open reduction and internal fixation using k-wires and two 4.5 mm partially threaded cannulated cancellous screws and was done with due care to prevent any damage to epiphysis. No signs of osteonecrosis, heterotopic ossification or physeal growth arrest in radiograph taken at 10th month were noted. The child is still under follow-up.

Hoffa fracture is a rare variety and the diagnosis of the same warrant a higher index of suspicion with more watchful eye. CT-scan firmly establishes the missed diagnosis and notably provides with the detailed configuration of the fracture to guide the treatment plan. Surgical intervention (open reduction and fixation or arthroscopy based procedures) is essential over the non-operative treatment to alleviate complications.

Hoffa fracture is a rare variety and the diagnosis of the same warrant a higher index of suspicion with more watchful eye. CT-scan firmly establishes the missed diagnosis and notably provides with the detailed configuration of the fracture to guide the treatment plan. BMS-232632 research buy Surgical intervention (open reduction and fixation or arthroscopy based procedures) is essential over the non-operative treatment to alleviate complications.

Atypical femoral fractures account for only 0.5% of femoral shaft fractures, but delayed union or non-union occurs in 50% of atypical femoral fractures accompanied by femoral lateral bowing. Such fractures are difficult to treat.

The case was an 84-year-old woman. She was diagnosed post-operative non-union of atypical femoral fracture. We planned a revision surgery for post-operative non-union of the atypical proximal femoral fracture. A two-dimensional template was used to simulate the intramedullary nail (IMN). Due to the advanced femoral lateral bowing deformity, a mismatch with the nail was noted when the unaffected femur was used to construct the template. When the opposite side nail was used as a template, the nail was aligned with the medullary canal, and the tip of the nail coincided with the center of the medullary canal; hence, the opposite side nail was chosen. Radiographical assessments of healing of the fracture confirmed callus formation and complete bone union 3 months and 1 year after the operation, respectively.

We found that exchange nailing as revision surgery for post-operative non-union of atypical femoral fractures combined with an IMN on the opposite side was useful.

We found that exchange nailing as revision surgery for post-operative non-union of atypical femoral fractures combined with an IMN on the opposite side was useful.

Primary total hip replacement (THR) surgery for the neck of femur (NOF) fracture in a case of below-knee amputation with distal femur shaft non-union is rare.

This case describes the traumatic right NOF fracture in a 49-year-old male patient with distal femur shaft non-union. The patient has a history of ipsilateral below the knee amputation along with right distal femur shaft fracture managed with retrograde femur nailing 10 months back following a road traffic accident. The NOF fracture was managed by primary THR as the definitive procedure after distal femur nail removal and distal femur plating with allograft for non-union.

Primary THR with distal femur plating and allogenic bone grafting in such cases provides satisfactory outcomes. It allows for early ambulation and rehabilitation of the patient.

Primary THR with distal femur plating and allogenic bone grafting in such cases provides satisfactory outcomes. It allows for early ambulation and rehabilitation of the patient.

Delayed slip of the capital femoral epiphysis is a rare entity in the setting of a septic hip.

A 13-year-old male presented with an inability to walk and pain around right hip and knee region with fever. On imaging evaluation, a diagnosis of septic hip and knee arthritis was made and both the joints were drained under general anesthesia by anterior approach and an empirical antibiotic therapy was started. On the initial radiograph, there was no sign of slippage of the capital femoral epiphysis. Although the limb was kept in an immobilized position in the 1st week of the surgical debridement, yet it did not prevent the subsequent development of slipped capital femoral epiphysis (SCFE). Open reduction and screw fixation was done to stabilize the slippage. Healing took place with reduction of joint space with some restriction of the hip motion.

SCFE is a disastrous complication in association with septic arthritis of a hip. Routine traction and immobilization may not prevent slippage. Disproportionate amount of pain on weight bearing in a post septic hip should raise the suspicion of SCFE.