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Objective To clarify the causes of the increased incidence of injuries inflicted by wild animals in Kashmir, and to suggest preventive measures. Methods A retrospective study reviewed records of these injuries. Data were collected from the hospital in Srinagar and from the Wildlife Protection Department of Kashmir. Results A total of 203 attacks (26 deaths and 177 near-fatal injuries) were recorded from January 2005 to October 2007, involving 145 (71.5%) male and 58 (28.5%) female victims. The attacking animal was a black bear in 104 (51.2%), a leopard in 18 (8.8%), a wolf in 7 (3.4%) and unidentified in 74 (36.4%) cases; 130 (64%) of these attacks occurred in southern Kashmir. Conclusion The steady increase in human population in areas close to jungle results in deforestation and destruction of wildlife habitat. The reduction in monkeys and deer (the staple food of leopards) causes these dangerous predators to search for food in the areas occupied by humans, who may then be attacked. Treatment of these cases requires a multidisciplinary approach, including an orthopaedic surgeon, plastic surgeon, microbiologist and psychiatrist, to achieve best cosmetic and functional results.

Increased incidence of wild-animal attacks has made these a serious threat to public health in Kashmir. To establish patterns of injury and management, 35 case histories were reviewed. After resuscitation, of paramount importance were vigorous irrigation, removal of all foreign material, administration of antibiotics, and prophylaxis against rabies and tetanus as indicated. A multidisciplinary approach and aggressive management are necessary to prevent death and provide acceptable cosmetic and functional results.

High velocity gunshot-related fracture is associated with massive soft tissue damage and severe comminution at the fracture site. This unique type of open fracture presents a serious challenge to the orthopedic traumatologist.The study was conducted prospectively involving patients who presented to the Accident and Emergency Department of the Bone and Joint Surgery Hospital Srinagar (India), from January 2005 to March 2007, with a history of high velocity gunshot wounds to the femur. Initial stabilization with external fixation was followed by delayed interlocking intramedullary nailing. The patients were followed for an average period of 26 months (range, 15-39 months).All the patients were males, with an average age of 37 years (range, 22-52 years). Twenty-four (65%) were type IIIA, 11 (30%) were type IIIB and 2 (5%) were type IIIC. All the fractures united in good alignment in an average time of 24 weeks.External fixation as a primary modality of treatment provides more than adequate stabilization to facilitate nursing, good wound care and physiotherapy. A staged protocol of primary temporary fixation by unilateral external fixation followed by delayed reamed intramedullary interlocking nail seems to be an effective method of treatment for high energy gunshot femoral fractures.

The trans-olecranon approach has been suggested to improve the visualization of complex intra-articular distal humerus fractures. Significant osteotomy complications have prompted a search for alternative approaches. The purpose of this series was to study the outcome of the olecranon osteotomy in terms of union and complications and the ultimate outcome of the fracture.Ninety-four patients with intra-articular fractures of the distal humerus (type C3) were treated by open reduction and internal fixation using the trans-olecranon approach. The patients were followed from 6 to 48 months, with an average follow-up of 24 months.All osteotomies united in an average of 11 weeks (range, 8-20 weeks). There was no non-union, although union was delayed in four osteotomies, which all healed by 20 weeks without any intervention. The most frequent complication in this study was symptomatic osteotomy fixation in 19% of patients, all of whom underwent a secondary procedure for the removal of the implant after the osteotomy had united. Seventy-one percent of the unsatisfactory results were seen in those patients who had symptomatic olecranon fixation.Despite a few manageable complications, the trans-olecranon approach is essential for the adequate visualization and fixation of the complex fracture of the distal humerus. Adequate fixation of the osteotomy is essential to prevent complications and achieve a satisfactory outcome.

In developing countries, due to limited availability of modern anesthesia and overcrowding of the hospitals with patients who need surgery, high-risk patients with “intertro-chanteric” fractures remain unsuitable for open reduction and internal fixation. The aim of this study was to analyze the results of external fixation of “intertro-chanteric” fractures in high-risk geriatric patients in a developing country. The results of 62 ambulatory high-risk geriatric patients with a mean age of 70 years (range 58-90 years) with “intertrochanteric” fractures, in whom external fixation was performed, are reported. Eight patients died during follow-up due to medical causes unrelated to the surgical procedure. So only 54 patients were available for final assessment. Procedure is simple, performed under local anesthesia, requires less time for surgery and is associated with less blood loss. Good fixation and early ambulation was achieved in most of the patients. Average time to union was 14 weeks. Thirty-one patients developed superficial pin tract infection and 28 patients had average shortening of 15 mm due to impaction and varus angulation. Functional outcome was assessed using Judet’s point system. Good to excellent results were achieved in 44 patients. This study demonstrated that external fixation of “intertrochantric” fractures performed under local anesthesia offers significant advantage in ambulatory high-risk geriatric patients especially in a developing country.

The treatment of distal femoral fractures remains a significant surgical challenge. With the rigid fixation of the distal femoral fractures, bone grafting is frequently needed. Biological osteosynthesis using dynamic condylar screw (DCS) and retrograde intramedullary supracondylar nail (RIMSN) preserve the blood supply and limit the need for bone grafting.From September 2002 to December 2004, 68 closed fractures of the distal femur were treated by bridge plate osteosynthesis using DCS in 31 and RIMSN in 37. The patients were allocated to one of the two groups randomly and followed for 24-36 months (average: 30 months).With respect to operation time, the DCS group presented significantly better results than the RIMSN group (p=0.000). However, the blood loss was significantly more in the DCS group (p=0.000). There were no significant differences in terms of cumulative rate of union (p=0.855), range of motion of the knee (p=0.727), overall results (p=0.925) and complications (p=0.927) between the two groups.No implant or surgical technique is superior to any other under all circumstances for distal femoral fracture. RIMSN is standard care, yet the biological osteosynthesis using DCS is a very good alternative for the treatment of distal femoral fractures.

Introduction More than two years delay in the union of fracture neck of femur is a very rare entity. The treatment of an established non union depends on numerous factors including age of the patient, vascularity of the femoral head and other factors. It is timing of intervention that is not clearly defined in the literature. Case presentation We report 2 cases where fracture neck of femur in 2 Asian males of 37 and 52 years of age took more than 2 years to unite after primary intervention. Conclusion We believe if the implant is holding and patient is able to bear some weight, some of these fractures may unite without any further intervention.