Background: Due to the large number of accidents, femur and tibia for Ipsilateral injuries eventually occur; floating injuries are likely to take place. The study was conducted to evaluate the results of surgery for adults with ipsilateral femoral and tibial fractures. Methodology: The study included 15 patients aged 20 to 60. According to Fraser et al, fractures are classified as Type I (5), IIa (3), IIb (4) and IIc (3). Femur fractures were treated using locked intramedullary nails plate-screws, or dynamic condylar screws.Tibia fractures were treated with an external fixator (in open fractures), or plate-screws, and locked intramedullary nailing. The average follow-up period is 2.1 years. Investigations for chest, pelvis, affected lower limbs, including joints and other bone injury were investigated by x-ray. Result: The mean age of the study group was 39.46 years. The time taken from admission to surgery is 2 days (1 to 11 days). The average followup time was 23.5 months (from 20 to 25 months). Most of the cases showed better results (66.7%) in extent of bonyunions, followed by good (20%), acceptable (6.7%) and poor (6.7%), according to the criteria of Karlstrom. Conclusion: Injury and fractures (openness, straightening, congestion) are predictive factors in the floating knee. The complete adequacy of critical injury-related conflicts includes fractures and post-surgical rehabilitation.

Introduction:The clavicle is most frequently and easily fractured bone, due to direct blow or fall on the outstretched hand. With changing trends in treatment of midshaft clavicle fractures, plating was one of the standard procedure remains for fixation. Recent attracting alternative new technique of fixation is the titanium elastic nailing system (TENS). Due to lacking of prospective studies, the present study was undertaken to assess effectiveness of minimally invasive method TENS for the treatment of midshaft clavicle fracture. Materials and Methods:The study population included 30 patients exclusively with fracture of midshaft clavicle on plain radiographs from January 2014 to June 2015 at a tertiary care centre. Most of cases were operated within 24-48 hours after trauma. Intra operatively, image intensifier was used for monitoring the manipulations and maneuvering of the nails for closed reductions of the fractures. Patients were followed for 6 months postoperatively and then titanium nails were removed. Result: Average age of the study population was 35.8 ± 10 yrs. Most cases were operated within 24-48 hours after trauma. In 24 cases, closed reductions and nailing were done, while in 6 cases, open reductions and nailing were done. Constant score was used to assess the clinical outcome of our patients after union of the fracture. Clinical union was achieved in 3-5 weeks, while radiographic union was achieved in 6-8 weeks. There was no post-operative infection in this study. Conclusion:Operative interventions with TENS showed better results in regards to early functional recovery. The specific advantages of TENS over plating are that it is minimally invasive, needs lesser operative time, and early mobilization.

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Pseudoarthrosis is a condition where union at fracture site is very difficult to obtain. But sticking to the very basic principles of management of non-union-that is freshening at fracture site, removal of sclerotic bone, reaming of medullary canal, rigid fixation and abundant bone grafting-helps in achieving the goal. In the below case, all the steps were carried out and the fracture has healed two months postoperatively.

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