Background: Proximal Femoral Nail (PFN) provides tangible evidence for its usage in unstable pertrochanteric fractures. There are a veritable number of references which show that PFN by virtue of its intramedullary fixation reduces the tensile strain thereby mitigating implant failure. Ours is a prospective study done on 50 subjects to assess the outcome of PFN usage in unstable pertrochanteric fractures. Methodology: 50 patients with Jensen Michaelsen type III, IV, V intertrochanteric and reverse oblique fractures were included in the study. The reduction obtained intra operatively was assessed using the modified criteria of Baumgaertner. Follow up evaluations were done at 6, 12, 24 and 52 weeks thereafter. Clinical evaluation was done using the Mobility score of Parker and Palmer. Radiographic parameters like fracture union, screw slide and degree of varus collapse were also assessed. Statistical analysis was provided by Friedman test. Results: Jensen Michaelsen type IV was the most common pattern observed (44%). The mean pre-injury parker score was 8.4. Patients with reverse oblique fracture morphology, type V fractures and patients with osteoporosis were treated with Long PFN (19 cases). The mean operating time was 92 minutes (range 60 -180), and the mean blood loss during the surgery was 145 ml (range 100ml -320 ml). The reduction was good in 40 patients (80%) and acceptable in the rest. The average time taken for fracture union was 15 weeks. It was observed that patients reached their preoperative mobility score of Parker and Palmer by 6 months post-surgery which was statistically significant (χ2 = 217.642, p < .001). Discussion: Proximal Femoral Nailing is done through a minimally invasive approach not disturbing the fracture hematoma which is a vital in fracture consolidation. The biomechanics of intramedullary fixation in cases of destabilised medial cortex is optimised by medialization of the fulcrum point and resultant reduction of the bending moment with respect to proximal fixation. Fracture reduction was good in 80% cases and in 10 cases the reduction was acceptable with a mean varus malalignment of 13.2 degrees.The mean intraoperative blood loss of 145 ml in our series compares favourably with previously reported values in the literature. Most of the fractures in our series (66%) united by 12-14 weeks. The mean preoperative mobility score of Parker was 8.4, which was reached by patients on their 6 th postoperative month (p & lt; 0.001). Each period showed statistically significant improvement over the previous period as evident from the rank total of the scores and the critical ratio.

Middle third clavicle fractures are one of the most common types of fractures especially in young adults. But management part is still under debate. In olden days most of the fractures managed by conservative methods by arm sling and figure of eight bandage. But increasing demands, early mobilization of patients and anatomical fixation nowadays these fractures are managed by Open Reduction and Internal Fixation with plates and screws and Closed Reduction and Internal Fixation with Titanium Elastic Nailing System (TENS).In our study 15 patients treated with ORIF with plating, another 15 patients treated with CRIF/ORIF with elastic nailing. Though each procedure having advantages and disadvantages the functional outcome of surgical methods found to be better when compared to conservative methods. Elastic nailing not indicated for comminuted fractures and fracture nonunion. The advantage of intra medullary fixation and not disturbing the fracture hematoma are additive features of closed nailing. Keywords: Plate, intramedullary fixation, midshaft clavicle fractures IntroductionThe clavicle or collar bone is an S-shaped long bone which by its horizontal orientation forms a strut between the sternum and the scapula. A fracture of clavicle is one of the most common bony injuries rarely requires open reduction. In 94% of 122 patients with clavicular fractures, Stanley et al. found the mechanism of injury to be consistent with a direct blow rather than a fall on the outstretched hand, which is widely believed to be the most common mechanism of injury. In Neer's series of 45 fractures treated by open reduction, nonunion occurred in two (4%). Rowe reported nonunion in 0.8% of fractures treated by closed methods and in 3.7% treated by open reduction. Although displaced fractures of the clavicle often cannot be reduced and maintained in perfect position, cosmesis is acceptable and functional results are uniformly excellent. Even if the ends of the fragments heal in an overlapped or bayonet position with a substantial bony prominence, this is largely resorbed with time, and the mass decreases. Even the most fastidious patient usually is satisfied with the results.

Introduction: Till the end of nineteenth century, the clavicle fractures were managed conservatively. Recent studies have showed that there is a higher rate of nonunion and alteration of shoulder biomechanics in subgroups of patients with these injuries. The flexible titanium elastic nail has more advantage to accommodate for the "S" bend of clavicle is a new concept. In this study we analyse the functional outcome of management of midshaft clavicular fractures treated by elastic nailing and compared it with the outcome of conservative management. Materials and Methods: A cohort of 30 cases were studied for a period of 1 year postoperatively for the functional outcome of elastic nail for midshaft fracture of clavicle. Result: This study comprised of 30 patients and followed for minimum of 12 months. Success rate is 100% union at anatomical position without any complication were reported in patients treated with elastic nail. Conclusion: We recommend Titanium elastic nail of 2-3mm diameter for displaced midshaft clavicle fractures. Surgical management has excellent functional outcome in patients having severe displacement and shortening of more than 1.5 to 2cms.

An open fracture presents with disruption of skin and underlying soft tissues results in a communication between the fracture and outside environment. In the treatment of open fractures, the objectives are to prevent infection, promote fracture healing and prevent complications with restoration of normal function. In our study we have reported an outcome analysis of open fractures of the ankle joint in 23 patients.