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Background: The incidence of road traffic accidents (RTA) is increasing every day, especially in developing nations. Amongst various attributable factors, the menace of the stray animals remains one of the most underrecognized factors leading to animal-vehicle collision (AVC). Objectives: Our prospective cross-sectional study aims to survey the incidence of RTA attributable to stray animals and record the pattern of injuries along with other epidemiological parameters. Methods: The present study was conducted at a tertiary care trauma centre located in a major city of eastern India, between June 2019 and March 2020. Variables like demographic details, type of vehicle and injury with severity score, use of safety gear including types of stray animals were collected and analysed. Results: A total of 185 patients had suffered RTA due to AVC during the study period. The median age of occurrence was 29.0 years. The evening was the most frequent time of accidents (4 PM to 8 PM) with two-wheelers affected in 92% of cases. Stray dogs account for 69% of cases followed by cattle 21% cases. 41% of all RTA victims had polytrauma. Patients with RTA due to impact with ox were found to have higher injury severity score (ISS). The ISS comparison between two-wheeler drivers with and without helmet and influence of alcohol were statistically significant (P

Proximal fibular tumors are treated by en bloc excision and lateral collateral ligament (LCL) repair. Intraoperative injury to the popliteal artery or its trifurcation, common peroneal nerve, and LCL can occur. Three cases of giant cell tumor and one case of exostosis of proximal fibula were analyzed. Apart from routine tests, preoperative computed tomography angiography (CTA) was done in two cases. Vascular injury was seen in two cases where CTA was not done, while in others, it was safe. Foot drop was seen in one case due to peroneal nerve resection. None of the patients developed varus instability even without LCL repair. Authors suggest preoperative CTA in all tumors of proximal fibula for preoperative planning, counseling of patients, vascular consultation, and to prevent complications.

Context: Road traffic accidents (RTA) are a foremost rising cause of morbidity and mortality in developing countries like India. The Government of India enacted a new motor vehicle amendment act (MVA) on September 1st 2019 that permits heavy penalties for traffic rule offenders. Aims: To find out the early impact of “THE MOTOR VEHICLES (AMENDMENT) ACT, 2019”. Settings and Design: A retrospective observational study was performed during the time period July to October 2019 on RTA patients admitted to the Trauma and Emergency department. Methods and Materials: Patients studied in two groups – One Pre MVA group (n = 371) and one Post MVA group (n = 415). The data were extracted from medical case records of the department and filled up in a structured format. Detailed demographic profile, including the use of safety measure and clinical variables such as the pattern of injury and injury severity scores, were recorded. Statistical Analysis Used: Statistical analysis was done by R version 3.6.1. Results: There is a 41% drop in RTA victims post MVA implementation. Polytrauma reduced (25% vs 45.5%) significantly (P = 0.002) and so was Injury severity score (6.00 vs 13.00). More RTA victims were wearing helmets as compared to previous (42% vs 18%), and there was a steep decline in the alcohol driving (25% vs 10%) between the pre and post MVA group. A significant reduction noted in the under 18 yrs. Two-wheeler riders in the post MVA group compared to earlier (P = 0.016). Conclusions: The study reveals that there is a commendable reduction in the injury severity, violation of safety gears, alcohol use and rash driving following the implementation of MVA September 2019. Primary care and family physician can play a crucial role in creating public awareness about the personal safety measures, which will help in strengthening of this law to reduce the incidence of RTA and the associated mortality and morbidity

Context: Trauma is an immediate cause of patients flowing to the emergency department of any hospital. Besides epidemiology, clinical profile and treatment strategy forms an important aspect to reflect the gap in the existing public sector health-care system and the requirement. Aims: To evaluate the clinicoepidemiological profile of trauma patients admitting to an apex trauma hospital in east India. Settings and Design: A prospective observational study was performed during the time period of December 2018 to July 2019 on trauma patients admitted to the Trauma and Emergency department. Methods and Material: Patient's demographic profile, injury type, mechanism, the vehicle involved in the accident, and transportation were recorded. Various trauma scores (clinical) and outcome measures were recorded. Statistical Analysis Used: Statistical analysis was done by R version 3.6.1. Results: Male: female ratio was 407:93 with the 21–30 age group predominantly. 2–6 PM was the most common time of injury and ambulance was the predominant mode of transport (58%). Road traffic injury (RTI) accounted for 75% victims; two-wheelers (68%) dominated over others. Thirty percent (drivers 18%, pillion riders 12%) were wearing helmet; 41% were wearing seat belts (drivers 34%, passenger 12%). Twenty-five percent of drivers consumed alcohol. The median ± Interquartile range of injury severity score (ISS), revised trauma and trauma score and injury severity score were 17 (11–26), 7.8 (4.1–7.8), and 98.41 (95.95–99.30), respectively. Extremity injury (54% fractures) and head injury (50%) were the frontrunners in the pattern of injury, with half of the victims were polytrauma (ISS > 15). Conclusions: The injury was prominently RTI and the trauma victims/patients were young male drivers on two wheelers. The focus should be directed to make use of safety measures among the youth.

Ipsilateral hip and knee dislocation (double blow) occurring simultaneously during trauma are rare occurrences that are associated with secondary complications. These are high energy injuries that warrant acute emergency management more so if associated with vascular compromise. We encountered a poly trauma patient having a combined right anterior hip and ipsilateral knee dislocation with vascular occlusion at popliteus level apart from associated segmental radius fracture of the left upper limb. This young patient presented after 22 h being referred form elsewhere making the situation critical to the surgical team. An attempted thrombolysis was done but as gangrenous changes started, we ended up in a below knee amputation. This case highlights a typical scenario in a developing country where facilities involving super specialty services are scarce and even patients are complacent about need for emergent referral. All this adds to surgical dilemma as guidelines are unclear for the best treatment.

Introduction: Venous air embolism is a catastrophic complication that can result in sudden cardiac arrest and death. Massive air embolism has been reported with central venous catheter through the internal jugular and subclavian veins. Though external jugular vein is a potential site of an air embolism to cardiac chambers and subsequently to vital organs such as brain, heart and lungs but has not been reported yet in literature. Case presentation: We are reporting a case of sudden pulmonary air embolism in a patient through the open hub of an intravenous cannula, vigilant monitoring and timely action saved the patient from a catastrophic outcome. Conclusion: We recommend vigilant monitoring and adequate precaution in patients with external jugular venous cannulation in the operation theater, intensive care unit or wards to prevent iatrogenic complications. Keywords: Air embolism, External jugular vein, Intravenous cannula, Vigilance

Bifid rib presents usually as an isolated and asymptomatic finding on x-rays and cadaveric dissections. This may be due to atypical process of segmentation of developing somites. Sometimes it may occur with other malformations. Aim of the case report presented here was to give a description of the characteristics of bifid rib and to look for any associated abnormalities. During routine dissection, bifid rib was found in thoraco-abdominal region of a male cadaver. The dimensions of the bifid rib were measured with digital vernier calliper of resolution 0.01mm and photographed using a digital camera. Survey of other regions of the cadaver was done by dissection. Bifurcation of anterior part of right third rib enclosing an additional intercostal space was found. Follow-up dissection in other regions of the cadaver revealed characteristics of Crohn-s disease of jejunum, ileum, and transverse colon and signs of dysmorphism of both the kidneys. The knowledge of such variations will be of use to the clinicians, radiologist and anatomist to investigate any incidental bifid rib finding.