<p class="abstract"><strong>Background:</strong> Forearm fractures are one of the commonest injuries accounting for 40% of paediatric fractures with a refracture rate of nearly 5%. Forearm refractures are increasing probably due to poor bone mineralization as a result of decreased physical activity, Vitamin D deficiency. These are treated by conservative measures with closed reduction and casting or by surgical fixation with flexible nails or plates. There are no definitive guidelines for management of forearm refracture and implant removal.</p><p class="abstract"><strong>Methods:</strong> The study is aimed at the epidemiology, methods and difficulties of management and functional outcome of forearm refracture treatment. A prospective study of all the cases of forearm refracture who presented to our institution from 2010 to 2016 with refractures treated either by conservative methods or by IMN. All cases were followed up for 2 years and functional outcome was assessed serially according to price et-al criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> Our study contained 17 males and 8 females between 6 years and 14 years. 76% refractures occurred before 16 weeks and majority had only tricortical union at this time. 42% patients underwent surgical fixation following refracture. Price et al criteria showed excellent results in 72% of patients.</p><p class="abstract"><strong>Conclusions:</strong> Forearm refractures in children can be treated both conservatively and surgically like a primary fracture depending on the indications but needs 2 to 3 more weeks of immobilization. A good functional outcome was obtained in majority of the cases. We suggest using splints till quadricortical union is achieved to prevent chances of refracture.</p>

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Background: Total joint replacement is a frequently done procedure in modern day practice of any orthopedics unit. Limiting blood loss both postoperatively and intraoperatively presents a challenge to the surgeon. Use of tranexamic acid (TA) reduces perioperative blood loss and need for allogenic blood transfusion in patients undergoing total knee replacement. Methods: This is a randomized controlled study that involved 105 patients who underwent primary total knee arthroplasty at our institute. A total of 105 consecutive patients underwent total knee replacement (TKR) between 2009 and 2014 at our institute. No patients who had primary TKR were excluded from the study. The information was collected prospectively but reviewed retrospectively. Patients were allocated to either the TA group (TA, n = 55) or the control group (n = 50). Results: The results were analyzed and no significant differences between the groups were found in the demographic data. Our results demonstrate significant reduction in blood loss with the use of TA. Conclusions: We can conclude that TA use might be a good solution to the problem of massive allogenic transfusion requirements especially in developing countries. A meta-analysis which looked at double-blinded randomized controlled trial also found that TA was useful in reducing blood loss in major orthopedic procedures.

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Background: Osteosynthesis and partial patellectomy with patellar tendon repair are accepted procedures for inferior pole fracture of patella. Fractures of lower end of patella are usually avulsion injuries due to forceful flexion of knee against contracted quadriceps muscle. Multiple small fragments attached to patellar tendon make the management difficult. We conducted a prospective study of clinical and radiological outcome of inferior pole of patellar fractures treated with patellar tendon repair with non absorbable Ethibond and circumferential wiring. We compared the results with those of mid patellar fractures treated with modified tension band wiring technique. Materials: We included all patients with lower pole patella fractures, presented to our department from 2012 to 2015. We included patients with fracture 34 A1 (b) (extra articular lower pole) and 34C1.3 (complete articular distal 3 rd fracture). These fractures were fixed with Ethibond 5 by making transosseous longitudinal drill holes and supplemented with circumferential stainless steel wires. Bostman scoring system was used to analyze and assess clinical results. We compared the results with midpatellar fractures treated by tension band wiring at the end of follow up period. Results: We recruited 21 patients with inferior pole patella fractures. Independent T Test was used to compare the means of Bostman scoring, flexion and loss of extension of knee joint between two groups of patients. Anterior knee pain and implant loosening was found more prevalent in midpatellar fracture treated by tension band wiring technique and required implant removal. There was no significant difference between two groups of patients. Conclusion: Lower pole patella fracture can be successfully treated by this novel technique of fixation with less number of complications. Comminuted lower pole fractures which otherwise needed excision may be preserved with this technique.

<p class="abstract"><strong>Background:</strong> Medial epicondyle fracture is a common elbow injury in children. It is associated with elbow dislocation in many cases. Treatment of displaced medial epicondyle fracture with and without elbow dislocation is a debated topic. Surgical and non surgical methods are practiced with variable results.</p><p class="abstract"><strong>Methods:</strong> Our study was a prospective study of medial epicondyle fractures treated by surgical fixation with k wires. We studied total of 24 cases out of which 15 had elbow dislocation. The study period was from 2012 to 2015 and indications for surgery were displacement more than 5 mm, elbow instability, incarceration of fragment, ulnar nerve irritation. Open reduction and internal fixation with K wire done. We used joystick method while reducing the fragment with k wire which was a great help. We assessed the cases using mayo elbow performance score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Our study yielded excellent results in 92% of patients (mayo elbow performance score &gt;90). There was no major difference in clinical outcome between two groups of patients. Complications like instability and non-union not seen following surgical fixation with K wires. The mean loss of flexion, extension, supination, and pronation was 4, 5, 3 and 2 degrees respectively with elbow dislocation group and 2, 3, 1, 1 in without dislocation group. Pre op instability seen in 54% patients was absent in follow up period. Stiffness was more in elbow dislocation group but overall performance was almost equal.</p><p class="abstract"><strong>Conclusions:</strong> Surgical fixation of medial epicondyle fractures yields excellent results and may be advisable when indicated.</p>