<p class="abstract"><strong>Background:</strong> Subtrochanteric fractures in children are treated by different conservative and operative methods. Patient’s age may be the single most important factor deciding treatment. Several studies have documented superior results with internal fixation compared to non-operative treatment. The aim of the study is to evaluate the outcome of proximal humerus locking plate fixation of subtrochanteric femoral fractures in children.</p><p class="abstract"><strong>Methods:</strong> Between October 2015 and December 2017, 13 children with closed subtrochanteric femoral fractures including 3 pathological fractures were treated in our tertiary care teaching institute and the results were retrospectively analysed. Children of both sexes within 5–12½ years of age with isolated subtrochanteric fractures were included. There was no open fracture and fracture associated with neuromuscular disease or any systemic injury. In all cases, ORIF with proximal humerus locking plate was done using lateral approach.<strong></strong></p><p class="abstract"><strong>Results:</strong> Average age at the time of injury was 9.35 years (range 5–12 ½ years). There were four (30.77%) short oblique, four (30.77%) long oblique, three (23.08%) transverse fractures and two (15.38%) comminuted fractures. Average operative time was 88.76 minutes and average intra operative blood loss was 86.23 ml. Average follow-up was 13 months. All fractures showed radiological union at an average of 8 weeks. One case had superficial infection which was controlled by antibiotics. Two patients had limb lengthening (average 0.75 cm) but required no intervention.</p><p class="abstract"><strong>Conclusions:</strong> Internal fixation with adult proximal humerus locking plate appears as a good treatment option for paediatric subtrochanteric femoral fractures.</p>

Background: Distal femur fractures account for less than 1% of all fractures and 4%-6% of all femur fractures. Soft tissue damage, comminution and articular extension makes the treatment difficult and they often result in unsatisfactory outcome and poor knee function. Open fractures further complicate the situation. In our study we compared functional outcome, time of union and complications of open complex distal femoral fractures treated with delayed plating or primary Ilizarov ring fixator. Material and Methods: we retrospectively reviewed 23 cases presented at department of Orthopedics, from January 2011 to January 2017. All skeletally mature patients with AO type C distal femur fractures and up to Gustilo Anderson grade IIIA were included. Pathological fractures, types IIIB and IIIC open fractures and patients with other fractures in the ipsilateral limb were excluded from the study. Patients in group A were treated with delayed plating and in group B with primary Ilizarov. Result: Out of the 23 cases, all cases in both groups showed radiological union between 16-22 weeks. 3 cases of group A showed shortening of >2 cm while Ilizarov group had none. In 5 cases of group A, primary bone grafting done during surgery having severe comminution (C3 type) and in one case secondary bone grafting done after 5 months for delayed union. Out of 12 cases of group A, 5 patients (42%) achieved full flexion. In group B limited knee flexion was seen in all cases with mean flexion at final follow-up of 92°. Conclusion: Delayed fixation with autologous fibular grafting and distal femoral locking plate provides adequate restoration of knee motion and early knee mobilization with high risk of infection. Whereas Ilizarov fixator shows better outcome in terms of infection control, LLD management, lesser number of surgeries, lesser hospital stay, earlier post-op rehabilitation and acceptable knee function.

Pycnodysostosis is a rare autosomal recessive sclerosing bone disorder characterized by generalized diffuse osteosclerosis. Patients usually have a large head with separated sutures, open fontanels, aplasia of frontal sinuses, obtuse mandibular gonial angle and acroosteolysis of distal phalanges and multiple long bone fractures. We report this case of a 30-year-old female with repeated multiple long bone fractures and other clinico-radiological pathognomonic features of pycnodysostosis.