Bilateral simultaneous quadriceps rupture is a rare entity. Its occurrence without associated aetiology is even rarer. It has a bimodal age distribution, with majority of cases occurring in population older than 50 years. Its occurrence in younger population is unusual. Aetiology is trauma, long term steroid usage, fluoroquinolone injections at local site or associated co-morbidities such as chronic renal failure, diabetes, obesity, hyperparathyroidism, endocrine disorders and gout, which via different mechanism lead to weakening of tendon thereby predisposing it to rupture. Surgical repair is the treatment of choice; it ranges from direct repair using Bunnel or Krackow sutures in acute cases to repair via lengthening procedures in chronic cases as described by Scuderi and Codivilla. Distal fixation to patella is a matter of debate in today's time as suture anchors have emerged as an alternative to trans-osseous repair. Although various studies have demonstrated good outcomes with suture anchors, biomechanical studies comparing the two techniques have shown conflicting results. We present a case of spontaneous bilateral quadriceps rupture in a young female without associated identifiable pathology. Also, we attempt to describe the Codivilla repair technique and discuss recent trends in quadriceps repair.

Radiofrequency ablation probes have gained popularity in arthroscopic surgeries. We report an unusual complication associated with prolonged radiofrequency use in a shoulder arthroscopy case. A 55 year old male patient suffered a second degree burn around shoulder during rotator cuff repair. Long duration of radiofrequency probe use compounded by absence of suction outlet led to high temperature fluid coming in direct contact with the surrounding skin resulting in second degree burns around the shoulder region. Burns were managed conservatively, and went on to heal with hypopigmented scar at six month follow-up. Although a safe device, caution should be maintained while using radiofrequency probe and outflow should not be allowed to come in direct contact with the surrounding skin.

Baker's cyst is usually degenerative in origin, infective etiology is rare, and tubercular origin is exceptional; only 5 such cases have been reported in English literature till date. We present a case of a young female who presented with clinico-radiological features suggestive of Baker's cyst with associated posterior horn medial meniscal tear. Arthroscopic evaluation revealed suspicious synovial hypertrophy along with meniscal tear and Baker's cyst. Arthroscopic management of Baker's cyst and meniscal pathology was done along with radical synovectomy. Histopathological examination revealed epitheloid granulomas and Langhans giant cells pointing toward a tubercular etiology. Standard ATT protocol with rehabilitation was followed. The patient was asymptomatic at 1 year with complete resolution of symptoms and full range of motion. This case highlights the need to maintain high index of suspicion in cases hailing from endemic region with unusual intra-operative findings; also, it underlines the importance of routine histo-pathological examination.

Recurrent anterior shoulder instability following shoulder dislocation has an incidence as high as 68% among the younger population, however its association with coracoid fracture is extremely rare. Majority of coracoid fractures reported earlier have been shown to be associated with seizure disorder. We report a case of displaced coracoid fracture associated with recurrent anterior instability in a patient with no history of seizure disorder and its implications in causation as well as management are discussed. A 28 year old male, paramedic by profession, presented with complaints of multiple episodes of shoulder dislocation of right dominant extremity for last ten months. Pre-operative CT scan showed Hill-Sach's lesion associated with coracoid process fracture. In view of significant engaging Hill-Sach's lesion, bony reconstruction of glenoid to increase the articular arc was planned. However in view of the small coracoid fragment occurred due to fracture, Latarjet's procedure could not be planned and iliac crest bone graft (ICBG) was planned instead. Till date only 10 cases of coracoid fracture with anterior shoulder instability have been reported in English literature. Of the ten cases, six cases had history of seizure disorder while four cases had only traumatic association. In our case as coracoid fragment was small, it could not be used for Latarjet's procedure and instead was fixed to its proximal stump with suture anchors. This case highlight's rare injury pattern and emphasises on good clinico-radiological examination supplemented by high index of suspicion needed to diagnose this unusual presentation.

We read the article ‘Evaluation of proximal femoral locking plate in unstable extracapsular proximal femoral fractures: Surgical technique & mid term follow up results’ by Nishikant Kumar et al. with interest and we compliment the authors for the study. The PF-LCP implant has been recently introduced for the treatment of pertrochanteric fractures. Short-term follow-up results are available in the literature with most authors reporting a failure rate of around 40% with this implant1Johnson B. Stevenson J. Chamma R. et al.Short-term follow-up of pertrochanteric fractures treated using the proximal femoral locking plate.J Orthop Trauma. 2014; 28: 283-287Crossref PubMed Scopus (22) Google Scholar, 2Wirtz C. Abbassi F. Evangelopoulos D.S. Kohl S. Siebenrock K.A. Krüger A. High failure rate of trochanteric fracture osteosynthesis with proximal femoral locking compression plate.Injury. 2013; 44: 751-756Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar unlike the present series, which has shown very good union rates in short time. We would like to seek some clarification from the authors on some issues pertaining to the article.1.It is believed that in cases of comminution at the fracture site, increasing the working length of the locking plate at the level of fracture enables a larger area of stress distribution on the plate and reduces the strain at the fracture site. The length of plate used should be more than 2–3 times the comminuted fracture length.3Niemeyer P. Südkamp N.P. Principles and clinical application of the locking compression plate (LCP).Acta Chir Orthop Traumatol Cech. 2006; 73: 221-228PubMed Google Scholar (Ref – Case 21). A longer plate, perhaps, is more desirable in such situations. Also, filling all screw holes may lead to stress concentration and high strain, which can lead to early implant failure after cyclic loading.2.The calcar (‘kickstand’) screw has greater axial stiffness and less torsional stiffness,4Crist B.D. Khalafi A. Hazelwood S.J. Lee M.A. A biomechanical comparison of locked plate fixation with percutaneous insertion capability versus the angled blade plate in a subtrochanteric fracture gap model.J Orthop Trauma. 2009; 23: 622-627Crossref PubMed Scopus (42) Google Scholar but its use to reduce the risk of mechanical failure cannot be conclusively established.5Streubel P.N. Moustoukas M.J. Obremskey W.T. Mechanical failure after locking plate fixation of unstable intertrochanteric femur fractures.J Orthop Trauma. 2013; 27: 22-28Crossref PubMed Scopus (57) Google Scholar Was this kickstand screw inserted in all the cases? Also, the diameter of the kickstand screw appears to be different in different figures (Fig. 7 vs. Fig. 17). Were the screw dimensions changed due to certain reasons?3.Regarding a large posteromedial void and/or comminution at the fracture site. Did the authors attempt primary bone grafting?4.Fig. 14 showing united fracture at 3-month follow-up (case no. 3) is exactly the same as Fig. 12 showing immediate post op X-ray. It is evident by the presence of the suction drain in Fig. 14 (3-month follow-up). It appears to be an oversight. The authors have none to declare.