Trivial Injury Research Articles

Penetrating Orbital Injury: A Narrative Review for Emergency Clinicians.

Penetrating orbit injury is a rare but complex and life-threatening occurrence that may easily be overlooked. Management in the emergency department requires an early multidisciplinary approach but still lacks standard guidelines. This narrative review aims to provide a systematic approach to the management of penetrating orbital injuries for emergency clinicians. Mortality and morbidity are significant due to the orbit's proximity to numerous anatomical structures. Complications may be infectious, ocular, or cerebro-vascular. Their incidence depends on the mechanism of injury, entry point, and object's characteristics such as its shape, composition, and velocity. Non-occult cases are often associated with medial orbital rim or medial eyelid penetration, whereas occult cases mainly present with trivial lateral eyelid injury and could be overlooked. Radiological workup consists of computed tomography or magnetic resonance according to the object's composition. Treatment in the emergency department focuses on initial resuscitation, broad-spectrum antibiotics, and tetanus immunization. Subsequently, early removal of the foreign object in a controlled environment and other specific treatments must be discussed with a multidisciplinary team. Penetrating orbital injury is an uncommon but complex type of head trauma that may be challenging to diagnose. Systematic and multidisciplinary management in the emergency department is crucial to improve overall prognosis.

A Comprehensive Analysis of Surgical Outcomes for Spinal Fractures in Patients With Ankylosing Spondylitis: A 13-Year Prospective Study.

Ankylosing spondylitis (AS), a chronic inflammatory spondyloarthropathyaffecting the spine, progressively leads to increased spinal stiffness. This condition increases the risk of spine fractures in patients, even from trivial injuries. The process of slow bone formation within the ligaments of the spine and the fusion of the spinal diarthrosis contribute to the most prominent symptom of progressive stiffness of joints, predominantly affecting the spine and sacroiliac joints. In advanced AS, the ossification of the paraspinal tissues and inflammatory osteitis result in a spine that is brittle and fragile, making it susceptible to fractures. This study aimed to observe and analyze the postoperative surgical outcomes after spine fracture fixations in patients with AS, focusing on the intricacies that existin diagnosis and surgical treatment. A prospective interventional study was conducted in a tertiary care center during the period from 2010 to 2023. This studyevaluated 25 cases of spinal fractures diagnosed with AS. The mean patient age was 58.61 ± 18.54 years, with the majority being male (72%; n = 18) over female (28%; n = 7). The predominant cause of injury was falling from a height (56%, n = 14), and the most frequent fracture location was the C7-T1 (n = 10). Fracture distribution included cervical (32%, n = 8), lumbar (28%, n = 7), thoracic (24%, n = 6), and thoracolumbar (16%, n = 4). Sixteen percent (n = 4)of the patients had no fracture on X-rays but eventually were diagnosed with a fracture on an MRI. Following surgery, there was a notable improvement in neck disability index (NDI) and visual analog scale (VAS) scores (p < 0.05). Neurological status improvement was observed, with 24% (n = 6) of patients improving to Frankel D and 68% (n = 17) to Frankel E. The postoperative complicationnoted was wound infection in 8% (n = 2) of the cases. This study emphasizes the effectiveness of anterior surgical interventions fortreating spine fractures in AS patients, as shown by significant improvements in both quality of life and neurological status. Despite the complexities of treating spinal fractures in this population, marked by a high incidence of cervical and lumbar injuries, our results demonstrate positive outcomes. The occurrence of postoperative complications such assepsis and instrumentation failure necessitates careful surgical planning and attentive postoperative care. This study offers valuable insights for enhancing treatment strategies and patient management in cases of spine trauma involving AS.

A rare presentation of unilateral posterior reversible encephalopathy syndrome following a trivial head trauma

AbstractPosterior reversible encephalopathy syndrome is typically a reversible clinico‐radiological entity associated with some specific features on brain imaging. However, there are several atypical radiological presentations. Unilateral presentation of this condition has rarely been reported in past and may mimic other pathologies. Here, we report a very rare case of atypical, unilateral posterior reversible encephalopathy syndrome in a 25‐year‐old female following a trivial head injury. All other relevant secondary causes had been ruled out.

Release of retromalleolar flexor retinaculum and combined flexor digitorum longus and flexor hallucis longus Z-plasty in checkrein deformity: a case report

BackgroundCheckrein deformity is a rare abnormality comprising flexor hallucis longus (FHL) tendon entrapment in the posterior foot due to post-traumatic or ischemic retraction of the FHLtendon following soft tissue trauma. The diagnosis is essentially clinical, but complemented by imaging to rule out unrecognized causes and evaluate the fracture healing process. This case report is the first Indonesian study to describe release of the flexor retinaculum and Z-plasty (lengthening) of flexor digitorum longus (FDL) and FHL tendons through a medial retromalleolar approach to repair the deformity. Case DescriptionWe present the case of a 51-year-old male who complained of clawing of his right first and second toes. The interest of this study lies in the fact that this patient had never experienced ankle or distal tibial fractures, only a trivial injury two years back when the patient kicked a stone at work and had a bruise on his right second toe with no fracture. Exploration of FHL tendons was performed at the level of the midfoot. The patient was planned for surgery with a medial retromalleolar ankle approach, which facilitates the release of the flexor retinaculum, in conjunction with a Z-tenotomy on the FHL and FDL tendons. ConclusionA correction was achieved, and two months post-surgery there were no recurrences of the deformity. However, this surgical procedure requires more cases to support an evaluation of its effectiveness. We suggest that exploration at the ankle and midfoot should be the primary surgical intervention in similar cases of checkrein deformity.

PATHOLOGICAL HUMERAL FRACTURE FROM BONE METASTASIS OF A GASTROINTESTINAL STROMAL TUMOR: FIRST REPORTED CASE

Background: Gastrointestinal stromal tumor (GIST) is the most prevalent mesenchymal tumor of the GI tract. Metastases commonly occur in the liver and peritoneum, with very rare reported cases of bone metastases, hence, no therapeutic standard has been established for the management of bone metastases. Modern targeted therapy has improved patient survival, and although there are only a small number of reported GIST bone metastases, the incidence will likely continue to increase. Further understanding of GIST bone metastases is required for the implementation of an accurate and effective treatment plan. Case presentation: We report a 56-year-old patient who has a history of bleeding duodenal GIST resected with a Whipple operation. Post-operatively, Imatinib was started, but she developed liver metastasis 6 years later, requiring segmentectomy. She reported pain over the left humerus 2.5 years later and sustained a trivial injury to the left arm, resulting in a distal humerus shaft spiral fracture associated with a radial nerve palsy (Holstein-Lewis injury). Images showed a lytic lesion with cortical erosion and soft tissue extension at the fracture site. Biopsy confirmed GIST bone metastases. She underwent an open reduction and internal fixation with plating and curettage of the lytic lesion and made a good functional recovery afterward. Conclusion: This is the first reported case of a GIST bone metastases pathological Holstein–Lewis fracture. It highlights the potential for bone metastasis to present a long time after the diagnosis of a GIST. Although bone metastases are rare, they are now increasing due to the prolonged survival of patients and the introduction of targeted therapy. It is important to conduct long-term surveillance in specific patient demographics and future studies should be carried out to facilitate the development of a surveillance protocol in patients with GIST.

From garden to lab: C-3 chemical modifications of tomatidine unveil broad-spectrum ATP synthase inhibitors to combat bacterial resistance

Antibiotic resistance is escalating alarmingly worldwide. Bacterial resistance mechanisms are surfacing and proliferating across the globe, jeopardizing our capacity to manage prevalent infectious illnesses. Without drastic measures, we risk entering a post-antibiotic era, where even trivial infections and injuries can cause death again. In this context, we have developed a new class of antibiotics based on tomatidine (TO), a natural product derived from tomato plants, with a novel mode of action by targeting bacterial ATP synthases. The first generation of compounds proved highly specific for small-colony variants (SCVs) of Staphylococcus aureus. However, optimization of this scaffold through extensive structure-activity relationship studies has enabled us to broaden its effectiveness to include both Gram-positive and Gram-negative bacteria. Notably, the results showed that specific C3-modification of TO could improve ATP synthase inhibition and also bypass the outer membrane barrier of Gram-negative bacteria to gain substantial growth inhibition including against multi-resistant strains.

Fragility fracture in a 28 yr old male

A fragility fracture may be defined as a pathological fracture that results from trivial trauma. These "fragility fractures" are linked to significant pain and suffering. A 28-year-old male with a right side subtrochanteric fracture following a trivial injury, the possibility of a pathological fracture should always be raised. The subtrochanteric region commonly causes issues for the orthopaedic surgeon as the best method of restoration may not always be clear. 28-year-old male presented to emergency department with a/h/o deformity in right thigh and weakness in the bilateral lower limb. On examination tenderness, bony crepitus, bony irregularity was present and loss of transmission of movements. Patient was managed with closed reduction and internal fixation with long proximal femoral nail (PFN).A long proximal femoral nail (PFN) is an excellent option for stabilising a Fragility fracture of subtrochanteric region and in-bed mobilisation helped in preventing the development of any more bed sores. The postoperative period was uneventful. The patient visited for routine follow-ups; the incision site was healthy.

Clinical Profile of Necrotising Soft Tissue Infection Patients in a North Indian Hospital

Background: Necrotizing soft tissue infections (NSTIs) or necrotizing fasciitis are infections of the subcutaneous tissue and fascia with variable involvement of the overlying skin and underlying muscle. They can be initiated by trivial injuries and can be idiopathic. Material &amp; Methods: It is an retrospective observational study conducted in our surgical unit of a tertiary care centre, from January 2017 to December 2022, were observed for age, gender, occupation, socioeconomic status, body mass index (BMI) clinical features, radiological findings (size, site, status, involvement of tissue compartments and bone). A total of 118 patient records were analyzed. Results: 60% patients were over 50 years of age and 64.2% were males. 69.85 cases had body mass index more than 30 kg/m2. 50.9% patients had history of alcohol abuse and 32.1% cases gave history of intravenous drug abuse. 73.6% cases had foul smelling discharge on presentation while fever and sepsis was seen in 64.2% and 52.8% cases, respectively. Lower limb and perineal involvement was seen in more than two third of the cases. 69.4% cases were anaemic while 44.1% had hypoalbuminemia. More than 85% cases had leucocytosis. 40.7% cases required ionotropes and 22.03% cases needed ventilatory support on admission. Diabetes mellitus was the most common associated co morbidity, seen in 53.4% cases. Conclusion: The necrotizing soft tissue infections are a significant health problem and carry high mortality and morbidity rates. The condition carries high association with modifiable risk factors like anaemia, hypoalbuminemia, diabetes mellitus and obesity.

Comparison of pathological findings in head computed to-mography with clinical presentation of pediatric patients in the Emergency Department

Pediatric trauma is a cause for over 750.000 visits to emergency departments each year. Of all types of traumas, head injuries represent the group at most risk. Computed tomography (CT) is still the most frequently used advanced imaging method to distinguish cases of severe injuries out of thousands of mild or apparently trivial injuries. The aim of this study was to review the results of CT in terms of clinical prediagnosis and radiological findings in children categorized into four age groups, who underwent a CT scan in the Pediatric Emergency Department (ED). Among all CT studies, no findings were found in 552 (80.23%) patients, whereas CT findings were detected in 98 (14.2%) boys and 38 (5.5%) girls from all participants. The incidence of lesions in the male group is 2 times higher than in the female group. The most common abnormality was hematoma representing 26.47% of all confirmed lesions and 5.23% among all head CTs performed from the ED. Head CT is an incredibly useful tool in the evaluation of some head emergencies. However, in the majority of cases, the clinical presentation with which children present to the ED does not correlate with the severity of neuroimaging results.

Hindfoot fusion with various auxiliary techniques in Charcot’s management

Abstract Introduction: Management of Charcot’s arthropathy of the hindfoot (Sanders/Frykberg Type IV) is a challenging situation to address. Complex deformities linked with ankle/hindfoot Charcot’s disease are frequently multiplanar. Due to the collapse of the distal tibia and the two bones of the hindfoot, the talus, and calcaneus, the limb frequently shortens when the skeletal architecture is damaged. A varus ankle or heel results in increased lateral column plantar pressure of the foot due to changed foot pressure loading, predisposing the patient to develop lateral foot ulceration. Collapse and secondary avascular necrosis of the talus; additional stress on the injured bone exacerbates these deformities and contributes to ulcers in the foot, instability during walking, and limb-length discrepancy. Management: The primary indication for surgical ankle stabilization is a foot that cannot be braced and is unstable during walking. Other surgical indications include imminent ulceration, nonhealing ulcers, recurring ulcers, osteomyelitis, and/or severe pain. Achieving ankle and/or hindfoot arthrodesis and correcting these complex multiplanar deformities in this location stabilizes the hindfoot. Various auxiliary techniques that can be combined with Tibio-talo-calcaneal (TTC) are tricortical iliac crest graft and femoral head allograft to build hindfoot, plate augmentation, distally mobilized fibula as biological augmentation and multiple 6.5-mm screws. The choice between internal or exterior fixation is mostly determined by the presence or absence of an active infection and the quality of the bone. Conclusion: Surgical stabilization with TTC nail for Charcot’s arthropathy of the ankle and hindfoot is associated with good clinical outcomes. Despite the high likelihood of complications, limb salvage rates are between 80% and 90%. A meticulous selection of cases, a diligent multimodal strategy, and an experienced team are required to attain this result. Assessment of vascular status, glycemic control, optimum foot care, use of protective footwear during the acute inflammatory phase to prevent inadvertent trivial foot injuries, correction of calcium and vitamin D deficiencies, and cessation of tobacco and alcohol use are preoperative factors that can improve outcomes. Various auxiliary techniques can be combined with TTC nailing for optimum results.

Outcomes of Geriatric Hip Fractures in a Tertiary Referral Center in Malaysia During the COVID-19 Pandemic.

Introduction With the advancing age of the population, there are an increasing number of patients with geriatric hip fractures. Despite the advancement of surgical knowledge and improvement of implant designs to treat geriatric hip fractures, mortality and morbidity remainhigh among these frail patients. In conjunction with the COVID-19 pandemic, the collateral damage dealt to these patients remains unknown as scarce resources are funneled to deal with the pandemic. This study is geared to investigate the surgical outcomes of patients with geriatric hip fractures who were admitted during the initial phase of the COVID-19 pandemic. Methods This retrospective study was carried out at Hospital Kuala Lumpur, the largest public hospital in the capital of Malaysia, from March 1, 2020, to March 1, 2021. All patients of age 60 years and above were screened for suitability. Only patients who had undergone surgical intervention during the study period were included in this study. Patients' demographic data, mechanism of injury, waiting time for surgery, type of surgery, complications and ambulatory status were obtained from the medical records. Univariate analysis was performed to determine the factors associated with complications as well as the post-operative ambulatory status of the patients. Results A total of 52 patients were included in this study, with a median age of 72 years. The majority of the patients were Chinese (n=21, 40.4%). This was followed by Malay and Indian (n=14, 26.9% each) and other ethnicity (n=3, 5.8%). More than three-quarters of the patients had a trivial injury such as a fall due to a miss-step (n=16, 30.8%) and slip (n=16, 30.8%) and a fall due to dizziness (n=8, 15.4%). Only 12 patients (23.1%) sustained hip fractures due to trauma. The median time to surgery for these patients was 5 days (interquartile range: 4 days). Most of these patients underwent total hip replacement (n=30, 57.7%). This was followed by unipolar hemiarthroplasty (n=11, 21.2%), bipolar hemiarthroplasty (n=10, 19.2%) and internal fixation (n=1, 1.9%). Among these patients, six of them had documented complications. There were periprosthetic joint infection (n=2, 3.8%), dislocation (n=2, 3.8%), hematoma formation (n=1, 1.9%) and seroma (n=1, 1.9%). Six months after the surgery, most of the patients were able to ambulate, albeit some patients required walking aid such as walking stick and walking frame. Univariate analysis showed that all the factors were not associated with the complications and the post-operative ambulatory status of the patients. Conclusion The incidence of geriatric hip fractures remains high during the COVID-19 pandemic despite the movement control order (MCO) being enforced in Malaysia. With prompt surgical intervention, most of the patients can regain ambulatory status, albeit with a walking aid.

Pseudoaneurysm of the Persistent Median Artery: A Rare Vascular Injury

Median artery is usually a transient vessel during the embryonic period and may persist in adult life as the persistent median artery (PMA) in the upper limbs. It remains asymptomatic in most people; however, thrombosis leading to features of carpal tunnel syndrome is one of the known complications. We report a case of pseudoaneurysm of PMA following a trivial injury. This case report highlights the importance of being aware of this anatomical variation, to avoid complications during hand surgeries.

Pathological fractures in teen and middle age women with primary hyperparathyroidism

Primary hyperparathyroidism (PHPT) is a disease commonly seen in postmenopausal women. We report two cases of pathological fractures following trivial injuries in two different age groups; the middle and teen age group presented as PHPT due to parathyroid adenoma. PHPT usually presents with symptomatic hypercalcemia and target organ damage. Biochemical manifestations in both cases are similar i.e. hypercalcemia, elevated serum intact parathyroid hormone (iPTH), and mass in the parathyroid gland. Histopathological examination is consistent with parathyroid adenoma. We highlighted these two cases due to long delay before the PHPT diagnosisisconfirmedbecause of various investigations commenced in these patients to rule out other diagnoses. Bangladesh Journal of Medical Science Vol. 22 No. 01 January’23 Page : 234-238

Clinicoepidemiological profile of necrotizing fasciitis in a tertiary care center of western Odisha

Background: Necrotizing fasciitis (NF) is a state of infection promptly intensifying the destruction of skin with underlying tissue leading to permanent infirmity and high mortality irrespective of good parenteral drug coverage and contentious surgical handling. NF normally begins as a confined infective focus that initially presents as cellulitis later rapidly progresses to large areas of infection which disproportionate to pain. Aims and Objectives: The primary aim of this study is to determine the incidence and management methods of NF in tertiary health-care center of western Odisha. Materials and Methods: A retrospective review of medical records of patients diagnosed with NF presenting to department of general surgery, Veer Surendra Sai Institute of Medical Sciences and Research Burla, from March, 2020 to February, 2022 was performed. Various information such as patient’s demographics, type of presentation at the time of admission, age group affected, body parts affected, mode of injury, and microbiological status were collected in a predesigned format for analysis. Data were presented in number and percentage. Results: A cumulative of 96 cases with clinical features of NF was reviewed. The median age group range was 31–40 years. Nearly 94.7% cases had significant underlying comorbidities. Extremities were most commonly affected part. About 82.2% cases had undergone surgical debridement, 13.5% cases fasciotomy, and 4.2% cases skin grafting. Most common mode of injury is trivial injury. Group A Streptococcus is most common cause of organism. Almost 78.3% cases were healed. Conclusions: NF can induce upscaled morbidity and mortality if left undetected and untreated in primordial stages. The medics, paramedics, and specialists including surgeons need to have a high degree of intuition to diagnose NF at its beginning stages and thus precisely put resuscitative efforts, plan for debridement, and need for any urgent referral.

Lumbar Plexus Palsy Caused by Massive Psoas Hematoma Related to Vertebral Compression Fracture in a Patient with Liver Cirrhosis.

Osteoporotic vertebral compression fractures (VCFs) are common injuries in elderly patients and are usually stable because only the anterior column is involved. However, neurological deterioration may complicate osteoporotic VCFs, and most of them are related to canal invasion. Liver cirrhosis (LC) and its related complications have been identified as risk factors for an increased bleeding tendency, which, in turn, is associated with increased morbidity and mortality risks. We herein present a rare case of an osteoporotic VCF and a massive psoas hematoma that resulted in lumbar plexus palsy in a patient with LC after a stable-type spinal injury. To our knowledge, this is the first reported case of lumbar plexus palsy attributed to a liver-cirrhosis-related massive psoas hematoma and a stable VCF after minor trauma. This case highlights the potential risk of severe neurological deficits related to this type of common and seemingly trivial injury. The possible pathophysiological mechanisms are discussed and the relevant literature is reviewed.

A noisy-channel approach to depth-charge illusions

The “depth-charge” sentence, No head injury is too trivial to be ignored, is often interpreted as “no matter how trivial head injuries are, we should not ignore them” while the literal meaning is the opposite – “we should ignore them”. Four decades of research have failed to resolve the source of this entrenched semantic illusion. Here we adopt the noisy-channel framework for language comprehension to provide a potential explanation. We hypothesize that depth-charge sentences result from inferences whereby comprehenders derive the interpretation by weighing the plausibility of possible readings of the depth-charge sentences against the likelihood of plausible sentences being produced with errors. In four experiments, we find that (1) the more plausible the intended meaning of the depth-charge sentence is, the more likely the sentence is to be misinterpreted; and (2) the higher the likelihood of our hypothesized noise operations, the more likely depth-charge sentences are to be misinterpreted. These results suggest that misinterpretation is affected by both world knowledge and the distance between the depth-charge sentence and a plausible alternative, which is consistent with the noisy-channel framework.

Is Adult Tetanus an Endemic in India?

Background: Tetanus is a life-threatening disease in developing country like India, with high morbidity and mortality rate. Though maternal and neonatal tetanus is eliminated, adult tetanus still remains in boom and is overlooked. Methods: An observational descriptive study using retrospective secondary data was undertaken among the patients admitted to a regional referral hospital to study the epidemiological factors influencing tetanus, clinical features and the outcome of tetanus. Results: Analysis of 41 clinically diagnosed cases of tetanus showed that, majority were in 50-69 years of age group who resided in rural area and agriculture was their main occupation. Case fatality rate was 53.6% which revealed that mortality was the major outcome. And 95% of those infected were not aware of their immunization status. Conclusion: An early diagnosis, a proper wound management immediately after the injury, health education programs to create awareness among the public not to neglect even trivial injuries would definitely lead India to the path of elimination of adult tetanus. Strong emphasis is to be laid on adult immunization beyond the age of 10 years.

Subgaleal Hematoma with Bilateral Proptosis as a Manifestation of Fibrinogen and Factor X Deficiency - A Case Report

Subgaleal hematomas are usually seen after high-velocity head trauma; however, their presence following trivial injury should raise suspicion regarding an associated clotting disorder. Here we describe an interesting patient who presented to us with bilateral proptosis associated with a subgaleal hematoma due to fibrinogen and factor X deficiency. This condition can result in serious bleeding diathesis often necessitating multiple surgeries to control haemorrhage.&#x0D; Our patient, an 11-year-old male child presented to us 4 weeks after a minor head injury. He had a gradually progressive soft swelling on his forehead with proptosis of both eyes. Aspiration of the swelling at a nearby private hospital had revealed blood. The swelling recurred over a span of 2 weeks.&#x0D; On neurological examination, there were no positive findings. On local examination, he had a large, non-tender subgaleal hematoma over the bilateral fronto-temporo-parieto-occipital region of his head extending to both eyes. There was associated bilateral subconjunctival haemorrhage, periorbital ecchymosis and gross proptosis. The vision was affected on the right side, finger counting at 1 foot. Left side vision was intact. Extraocular movements were restricted in both eyes in all planes. CT scan of the brain showed subgaleal hematoma over the bilateral fronto-temporo-parieto-occipital region with an extension over the supraorbital ridge into the bilateral orbit beneath the orbital roof, there were bilateral relatively symmetrical areas of subperiosteal haemorrhages involving superior aspect of orbit causing proptosis and inferior displacement of the globes. On haematological examination, his haemoglobin was 5 gm/dl. Platelet count was 240,000/cumm. On coagulation profile, prothrombin time was 45 seconds (normal range 11.1–14.5 seconds) with an activated partial thromboplastin time of 39.5 seconds (normal range 28.1–39.7 seconds), and thrombin time was 58 seconds. The plasma fibrinogen levels were &lt; 100 mg/dl (normal range- 200-400 mg/dl). D-dimer was strongly positive. The patient also had factor X deficiency. The peripheral blood smear had a normocytic normochromic picture.

Outcome of Cemented Hemiarthroplasty of Hip in Elderly Patients Operated for Neck of Femur Fracture

Introduction: Femoral neck fractures are a common entity in elderly patients. This commonly occurs following trivial injury and the insult is compounded by osteoporosis in this age group. Cemented hemiarthroplasty is recommended by several studies and by several registries, due to low comorbidities compared to uncemented hemiarthroplasty. Significantly improved mobility scores, low pain scores make this a treatment of choice. Materials and Methods: This study included 108 patients who presented with fracture neck of the femur with an average age of 68.30 years and were operated with hemiarthroplasty by two consultant orthopedic surgeons in a standard operative setting over 5 years with modular bipolar prosthesis using lateral approach (Hardinge approach). Patients on follow-up were evaluated using Oxford Hip Score and Forgotten Joint Score. Results: The mean Oxford Hip Score was 39.46 suggestive of satisfactory joint function which may not require any further treatment. The mean Forgotten Joint Score was 83.46 suggestive of high degree of forgetting artificial joint. Conclusion: A very high Oxford Hip Scores and very high Forgotten Joint Scores after surgery suggests that the patients have retained or regained their independence and are doing good. This goes on to suggest that in spite of advancements in surgical techniques and implants for osteosynthesis, hemiarthroplasty done in indicated cases gives a good functional outcome and a lasting solution for these fractures.

Missed Intra-Orbital Wooden Foreign Body

Intra-orbital wooden foreign bodies (IOFB) are always a diagnostic challenge. Those are entered by unmarked trivial injuries, as in our case, may become even more difficult, and maybe notorious and remain quiescent for a long time, before presenting with a variety of complications. It may lead to a more diagnostic dilemma, which can especially occur with wooden foreign bodies (FB) due to the variable nature of radio-imaging. The lack of clinical suspicion may lead to a series of errors both in diagnosis and management, subjecting the patient to unnecessary intervention. In this case report, we will describe a missed wooden foreign body that, after a long quiescent period, presented as an intra-orbital mass.