BackgroundThe management of displaced supracondylar fracture of the humerus with closed reduction and percutaneous pin fixation is the most widely accepted method of treatment, but controversy continues regarding the pin fixation techniques. A prospective randomized controlled study was undertaken to compare the stability, functional outcome and iatrogenic ulnar nerve injury between lateral pin fixation and medial–lateral pin fixation.Material and methodSixty-two patients with Gartland type III supracondylar fracture of the humerus were randomized into two groups—lateral pin fixation (n = 31) and medial–lateral pin fixation (n = 31). Primary assessment was performed for major loss of reduction and iatrogenic ulnar nerve injury. Secondary assessment included clinical outcome, elbow range of motion, radiographic measurements, Flynn grade, and complications.ResultsThere were two (6.5 %) iatrogenic ulnar nerve injury cases in the medial–lateral entry group and two (6.5 %) cases with mild loss of reduction in the lateral entry group. No major loss of reduction was observed in either of the groups. There was no statistically significant difference in change of Baumann angle, metaphyseal–diaphyseal angle, Flynn grade, carrying angle, and the total elbow range of motion (P < 0.05) between the two groups.ConclusionsLateral pin fixation offers similar functional and radiological outcome and almost equal mechanical stability compared with medial–lateral pinning without the risk of iatrogenic ulnar nerve injury.Level of evidence [OCEBM 2011]Level 2.

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Objective. To review functional outcome in high energy tibial plateau fractures treated by plating. Design. Retrospective analysis. Material and Methods. Sixty-five patients with Schatzker type V and type VI tibial plateau fractures treated with open reduction and internal fixation using plates were included in the study. The functional evaluation of the patients was carried out with Oxford knee scoring. Results. Fifty-four cases (83%) had Oxford knee score between 40 and 48. Seven (10.7%) had score between 30 and 39, three (4.6%) had score between 20 and 29, and one patient (1.5%) had a score of 18. Delayed union was seen in two cases and nonunion was seen in one case. The superficial wound infection was noticed in (9.2%) patients which was resolved with regular dressings and oral antibiotics. Three (4.6%) patients had developed deep wound infection and one among them had developed osteomyelitis. Conclusion. Open reduction and internal fixation in high energy tibial plateau fractures can provide good functional results in appropriately selected cases.

We have encountered three cases of bilateral clavicle fractures with different modes of trauma in three different age groups. One of these patients had a high-velocity roadside accident while the other case suffered a crush injury between a wall and a tractor. In the third case, a motorcycle fell over the patient. All of the fractures united well after conservative treatment with the return of normal functional activity. With the increasing incidence of high-energy trauma, we may encounter more of these injuries in the future. Case 1A 6-year-old girl presented to our hospital with pain swelling and bony instability over both the midclavicular regions. She was unable to move both of her shoulder girdles due to pain. She fell off from a stationary motorcycle and then the motorcycle fell over her. The patient had a history of a short period of unconsciousness followed by one episode of vomiting. Her GCS score was to be normal when brought to the hospital after few hours of the injury. CT scan head was found normal. X-ray chest with bilateral shoulders revealed displaced mid-clavicle fractures on both the sides [ Bilateral clavicle fractures are uncommonly reported in the literature with the incidence being less than 0.5% of all the clavicle fractures. Bilateral clavicle fractures are caused either by high-energy transfer of compression forces across both shoulder girdles or by a direct trauma to one clavicle followed by that to the other clavicle. These fractures could be missed due to their association with more severe chest injuries or a more symptomatically displaced fracture on one side or due to inadequate chest radiographs. We report three cases of traumatic bilateral clavicle fractures with three modes of injuries in different age groups. All the fractures were treated conservatively with good functional outcomes without any sequelae. Bilateral clavicle fractures should be actively sought by every trauma team with proper clinical examination and chest radiographs including both shoulder joints in high-energy trauma cases or with bilateral shoulder compression injuries.her upper limbs. The trauma team managed the fractures with a figure-of-8 bandage with shoulder slings conservatively. The patient was observed for 24 hours for a minor head injury that she sustained and was discharged thereafter. She was reviewed in outdoor at 3 weeks, 6 weeks and 12 weeks respectively. Both clavicles united in acceptable positions with full, pain-free shoulder function bilaterally [Table/ Fig-2a,b]. Case 2A 25-year-old man was involved in a high-velocity road traffic accident when his bike skidded on a road divider. He complained of pain on the left upper chest wall and in the left clavicle region. On examination he was found to be hemodynamically stable. He sustained a blunt chest injury with tenderness and bruises over the left upper chest wall. He was found to have multiple rib fractures on the left side along with a left clavicle fracture [Table/ Fig-3a] on initial evaluation. The patient had no lung injuries and had a no...

PurposeSoft tissue healing is of paramount importance in distal tibial fractures for a successful outcome. There is an increasing trend of using anterolateral plate due to an adequate soft tissue cover on anterolateral distal tibia. The aim of this study was to evaluate the results and complications of minimally invasive anterolateral locking plate in distal tibial fractures.MethodsThis is a retrospective study of 42 patients with distal tibial fractures treated with minimally invasive anterolateral tibial plating. This study evaluates the bone and soft tissue healing along with emphasis on complications related to bone and soft tissue healing.ResultsFull weight bearing was allowed in mean time period of 4.95 months (3–12 months). A major local complication of a wound which required revision surgery was seen in one case. Minor complications were identified in 9 cases which comprised 4 cases of marginal necrosis of the surgical wound, 1 case of superficial infection, 1 case of sensory disturbance over the anterolateral foot, 1 case of muscle hernia and 2 cases of delayed union. Mean distance between the posterolateral and anterolateral incision was 5.7 cm (4.5–8 cm).ConclusionThe minimally invasive distal tibial fixation with anterolateral plating is a safe method of stabilization. Distance between anterolateral and posterolateral incision can be placed less than 7 cm apart depending on fracture pattern with proper surgical timing and technique.