Objectives: The purpose of the study is to evaluate the effectiveness of a new diagnostic protocol in identifying femoral neck fractures associated with ipsilateral shaft fractures and to study the clinical and functional outcome of these patients treated by cephalomedullary nailing.

Materials and Methods: 268 consecutive patients with presenting with 273 femoral shaft fractures were subjected to AP radiographs of the ipsilateral hip along with clinical examination for neck tenderness and aspiration of the ipsilateral hip to rule out an associated neck fracture. Computerized tomography scans through the femoral neck was taken only in case of discrepancy in the initial work up. All patients diagnosed to have an associated neck fracture underwent surgical stabilization using long cephalomedullary nails.

Results: All 28 neck fractures occurring in association with 273 consecutive femoral fractures were diagnosed without delay. Computerized tomography scans were required in 8 patients. All fractures united at follow up and good functional results were obtained in 19 of the 25 patients included in the final analysis.

Conclusion: Neck fractures associated with ipsilateral femoral shaft fractures can be diagnosed without the need for higher imaging modalities on a routine basis. Fixation of both fractures with a long cephalomedullary nail gives good results with minimal complications.

Background and Purpose: Tuberculosis is a common cause of mortality and morbidity in our country. Late neurological deficits following conservative management can occur though not very common. Deformity correction and decompression at a single sitting in a healed tuberculous spine is a massive undertaking and it requires experience and appropriate technique to achieve a good correction.

Materials and Methods: We operated upon 22 patients with a deformed spine and a progressive neurological deficit following healed tuberculosis. All patients complained of pain and found the cosmetic appearance unacceptable. The average age was 29 years {19 – 35 years}. All patients had completed a course of four drugs anti tuberculous chemotherapy for a minimum period of 12 months. All patients were screened for disease activity before surgery. The average Konstam angle before surgery was 86 degrees {80–105 degrees}. All patients underwent single stage surgical correction by a posterior based pedicle subtraction osteotomy with excision of the internal gibbus and further decompression and posterior stabilization using a screw rod construct. The local bone chips removed during the surgical procedure was used to promote fusion.

Results: We achieved an average kyphosis correction of 60 degrees {52–75 degrees}. At an average follow up of 18 months the average loss of correction was 3 degrees. The mean operating time was 165 minutes {120 – 210 minutes}. The mean blood loss was 800 ml {700–1100 ml}. All patients had significant improvement in their post operative pain scores and disability outcome measures. All patients were greatly satisfied with the cosmetic result obtained. There were no major intra operative or post operative complications.

Conclusion: Transpedicular three-column osteotomy uses a posterior approach and generally leaves no gap anteriorly. The anterior column is not opened as in a Smith-Petersen osteotomy. Posterior approach offers access to all three columns of the spine and avoids the morbidity associated with the anterior approach. The internal gibbus can be addressed and the normal posterior bony elements in tuberculosis can be used for achieving fusion.