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Introduction: Ankylosing spinal disorders present significant challenges in cases of trauma, and the treatment of ankylosed spine infections may also be challenging. However, to the best of our knowledge, only one study to date has addressed this topic, reporting a mortality rate of 62%., Case Report: Our patients were four men and one woman with a mean age of 72 years. Treatments consisted of intravenous antibiotics, a hard brace, and surgical interventions including percutaneous pedicle screw fixation in two patients, laminectomy and evacuation of the epidural abscess in one, and percutaneous lavage of the affected disc in two. The time from referral to intervention averaged 16 days. The mortality rate was 0% with healing of the infection with segmental bony fusion in four patients., Conclusion: This is the second reported case series of ankylosed spine infections. Early surgical intervention aimed at drainage or stabilization of the infectious lesions is crucial to disease control., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Automatic nail gun injuries to the hand commonly occur with the use of these machines in construction. However, such injuries to the cardiothoracic area are atypical. Herein, we report a case of emergency surgery to remove a nail, which was accidentally shot through the sternum and reached the heart. A 24-year-old man was working in a narrow space at a construction site, where he tripped over the air hose of an automatic pneumatic nail gun. The trigger was accidentally pulled, while the machine was facing his direction, and a nail entered his sternum. The patient felt chest pain, walked to a nearby orthopedic clinic, and then was transferred to our hospital for treatment. On examination, the nail was completely embedded in the midline of the precordial chest. Chest X-ray and computed tomography (CT) images showed a rod-shaped nail penetrating the sternum from the precordial region and reaching the anterior medi-astinum. The nail tip was located between the pulmonary artery and the aorta; it was touching the main trunk of the pulmonary artery. Emergency surgery was performed to remove the 45-mm-long nail (2 mm in diameter) on the same day, considering the possibility of massive bleeding and infection. An auxiliary circulatory system was not used, and intraoperative blood transfusion was not required. The patient was extubated on the same day. On post-operative day 7, CT confirmed that there were no issues of concern and no signs of infection. The patient was discharged on post-operative day 8 and returned home on foot. The patient was followed up for 6 months in the outpatient clinic, and there were no signs of infection or abnormal hemodynamics. This case demonstrates the need for careful assessment of nail gun injuries, which may initially appear insignificant.

Introduction: Vertebral fractures associated with ankylosing spinal disorders pose significant diagnostic and therapeutic challenges. Notably, the ankylosed spine remains in ankylosis after fracture treatment, and the underlying susceptibility to further fractures still remains. Nevertheless, information is scarce in the literature concerning patients with ankylosing spinal disorders who have multiple episodes of vertebral fractures., Case Report: Case 1 involves an 83-year-old male patient with diffuse idiopathic skeletal hyperostosis (ankylosis from C2 to L4) who had three episodes of vertebral fractures. The first episode involved a C5-C6 extension-type fracture, which was treated with posterior segmental screw instrumentation. Five years later, the patient sustained a three-column fracture at the L1 vertebra following another fall. The fracture was managed with percutaneous segmental screw instrumentation. One year and two months postoperatively, the patient fell again and had a refracture of the healed L1 fracture. The patient was treated with a hard brace, and the fracture healed. Case 2 involves a 76-year-old female patient with ankylosing spondylitis (ankylosis from C7 to L2) who had two episodes. At the first episode, she suffered paraplegia due to a T8 vertebra fracture. The patient was treated with laminectomy and posterior segmental screw instrumentation. The patient recovered well and had all the hardware removed at 10 months postoperatively. Five years later, she had another fall and suffered a three-column fracture at L1. The patient underwent percutaneous segmental screw instrumentation. The patient required revision surgery with L1 laminectomy and L1 right pediclectomy for persistent right inguinal pain. At one-year follow-up, the patient recovered well, and the fracture healed., Conclusions: The abovementioned cases show that an age older than 75 years and a long spinal ankylosis from the cervical spine to the lumbar spine may serve as risk factors for the repetition of vertebral fractures associated with ankylosed spinal disorders., Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.