Background: Accurate reconstruction of articular surface of distal femur by closed manipulation is not possible. The recent trend for displaced intra-articular fractures of the distal femur is open reduction and stable osteosynthesis with early rehabilitation. The best exposure is achieved through Swashbuckler approach with good results. Purpose of the study was to review the surgical management with LCP and lag screws of complex and most challenging intra-articular fracture of distal femur.Methods: 30 cases of intra-articular fractures of distal femur were treated with LCP and Lag screws in adults. Regular follow-up with all records was carried out for a period of 36 months. Most of patients were treated with Swashbuckler approach. Final outcome was carried based on Neer’s criteria.Results: Union was achieved in all the cases and mean time was 15 weeks. Patients have more range of motion in C1 and C2 types of fracture as compare to C3 Types. Mean range of motion was 1140. Early physiotherapy has big role to achieve good range of motion.Conclusions: LCP is better implant in comminuted I/A fractures of distal end of femur and in elderly patients with osteoporotic bone. In spite of the worst fracture anatomy of the comminuted fracture of distal femur and the poor quality of bone in elderly patients, this can provide better post-operative range of knee motion with overall better Knee score, achieving bony union in all the cases with early physiotherapy.

Background: The purpose of this prospective randomized study was to evaluate the results of dynamic condylar screw (DCS) system and 95º angle blade plate fixation in the management of sub-trochanteric femoral fractures, regarding stability, union time, complication rate and functional out come.Methods: Total 30 consecutive patients with sub-trochanteric fracture were studied. The inclusion criteria were closed sub-trochanteric fractures in adults of both gender aged 18 years or above. Pathological fractures and open fractures were excluded from the study. After fixation of fractures with dynamic condylar screw system and 950 angle blade plate patients were followed up in OPD at an interval of 2 weeks till full weight bearing was started and then after at an interval of 4 weeks. Results of treatment were assessed by the Harris hip score for clinical and radiological assessment at the end of 6 months.Results: Among 30 studied cases, males were 22 (73.30%) and female 8 (26.70%). Most common mode of injury was road traffic accidents that occurred in 17 patients (56.70%) and the rest 13 patients had a history of fall. Patients were divided into two random groups (A &B) of 15 cases each. Group A was treated with DCS and Group B was treated with Angle Blade Plate 95º implants. Radiological union in most of the patients (13 out of 15 cases) treated with 95°angle blade plate occurred between 14-18 weeks, while in cases treated with dynamic condylar screw radiological union in most of the patients (14 out of 15) occurred between 12-16 weeks. According to Harris hip score, good to excellent results were achieved in 10 cases (66.66%) of 95°angle blade plate group and 14 cases (93.33%) of dynamic condylar screw group.Conclusions: Patients with sub-trochanteric fractures treated with dynamic condylar screw had earlier radiological union, better functional outcome, less complications and earlier weight bearing.

Background: Fracture of proximal humerus is the second most common fracture of the upper extremity, following distal forearm fractures. Aim of the present study was to evaluate the efficacy of proximal humerus internal locking system (PHILOS) plate fixation for proximal humerus fractures.Methods: Functional outcomes of 12 men and 18 women aged 22 to 78 (mean, 58) years who underwent PHILOS plate fixation for proximal humeral fractures were reviewed. Indications for surgery were 2 part (n=9), 3 part (n=14) or 4-part (n=7) closed proximal humeral fractures with angulation of more than 45 degrees or displacement of more than 1 cm. Functional outcomes and shoulder range of movement were assessed based on the Constant scoring system.Results: All patients will be followed up at monthly intervals for 6 months. During this period patient, will be motivated for physiotherapy and gradual normal use of the affected limb. Fracture union will be assessed clinically and radiologically. In our study of fracture proximal humerus union in most of the cases (24) occurring between 10-14 weeks. Range of union time was 8 to 18 weeks. one case of avascular necrosis of head occur in our case. In out of 30 cases excellent result in 7 cases, Good in16 cases Satisfactory in 5 cases and Poor in 2 cases were obtained.Conclusions: The PHILOS plate fixation is effective treatment for proximal humeral fractures particularly in osteoporotic bones.

INTRODUCTIONIn the modern world with the increase in the number of fast moving vehicles there is a great increase in number and severity of musculoskeletal trauma. The goal of fracture treatment is to obtain union of the fracture in the most compatible anatomical position which allows maximal and full restoration of the extremity. 1Fractures of the distal tibia accounts for less than 10% of all fractures of lower extremities and occur more frequently in men than women aged between 35-40 years.2 The management of distal tibial fractures remained challenging in orthopaedic traumatology. By its location and subcutaneous position in the leg, tibia is exposed to risk of injury and open fractures. High energy trauma and poor blood supply at lower one third shaft of tibia pose difficulties in bringing out optimal results. The management of the tibial fracture remains controversial despite advances in both non-operative and operative care. Orthopedic opinion is often cyclic, and in no area of orthopedic endeavor is this better seen than in the management of the fractured tibia. Böhler had ABSTRACT Background: The management of the tibial fracture remains controversial despite advances in both non-operative and operative care. Plates and intramedullary nails are two well-accepted and effective methods, but each has been historically related to complications. The present study was conducted to compare the results of displaced extraarticular distal tibia meta-diaphyseal fractures OTA/AO Type 42A-C (distal) and 43-A treated with intramedullary nailing versus plating with respect to union of fracture, early Restoration of function, the axial alignment and Complications, if any. Methods: In this study 30 patients of extra-articular distal tibia fracture AO type 42 A-C (distal) and 43 A were randomly selected and 15 were operated with intramedullary nailing and remaining 15 with plating. The patients were regularly followed up for a period of 9 months with radiological and clinical examination. Final assessment was done by Tenny and Wiss clinical assessment criteria. Results: In Interlocking group, average time for union was 20.33 weeks in Interlocking nail group compared to 23.21 weeks in plating group which was significant (p value 0.011). Also, the average time required for partial and full weight bearing in the nailing group was 7.2 weeks and 13.2 weeks respectively which was significantly less as compared to 9.33 weeks and 16.64 weeks in the plating group. Lesser complications in terms of implant irritation, ankle stiffness and infection (superficial and deep) were seen in Interlocking group as compared to plating group. Conclusions: In present study ILN showed better outcome as it offers advantage in terms of mean operating time, less invasive surgery, hospital stay, partial and full weight bearing time and union time.

Even with symptoms of spinal cord compression, some patients with TB infection of the posterior elements of vertebrae can be managed medically without surgery.

Advantages of intramedullary nailing over plating• IM nail can tolerate bending and torsional loads better than plates Conclusions: Closed intramedullary interlocking nailing is the treatment of choice of comminuted fractures of long bones in lower limbs which cause minimum damage to the blood supply of the fracture fragments which promotes the chances of bone union.

Background: Accurate reconstruction of articular surface of distal humerus by closed manipulation is not possible. The recent trend for displaced intra-articular fractures of the distal humerus is open reduction and stable osteosynthesis with early rehabilitation. The best exposure of both columns of the distal part of the humerus and articular surface is achieved through trans-olecranon approach. Objective of the study was to evaluate the management and outcome of two column fixation of intra-articular fracture of distal humerus in adults by posterior approach via olecanon osteotomy and to restore early elbow joint function. Methods: Twenty-five cases of intra-articular fractures of distal humerus were treated by open reduction and internal fixation. All the patients were of adult age group. Chevron type olecranon osteotomy was performed and fixed with tension band wiring in all cases and follow-up period was upto 36 months. Regular clinical examination and periodical radiological evaluation were done. Results: All fractures united within average duration of 3 months. Results were evaluated as per Mayo Elbow Performance Score. According to this criteria, excellent result was achieved in 8 patients (32%), good in 13 (52%), fair in 3 (12%) and poor in 1 (4%) patients. Thus satisfactory result was obtained in 96% cases. Conclusions:The critical factors for a successful outcome of intra-articular fractures of the distal humerus depend upon severity of fracture, meticulous surgical technique, stable internal fixation, surgical experimentation and early controlled postoperative mobilization.

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