Nailing proved more cumbersome intraoperatively due to escalated operating time and blood loss and successive anterior knee pain necessitating implant removal but this detriment may be offset by an inclination towards earlier union. With Less Invasive Stabilization System (LISS), technical errors are more common and less forgiving and must be overcome with proper preoperative planning and intraoperative attention to detail.

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The inception of Locking Compression Plate (LCP) has revolutionized fracture management. With their dramatic success for articular fractures, there is a speculation that they might be more appropriate for diaphyseal fractures as well.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">In this randomized prospective cohort study, 56 patients with diaphyseal fractures involving both bones of forearm were segregated into two groups based on internal fixation with Limited contact dynamic compression plate (LC-DCP)(n=28) or with Locking compression plate (LCP)(n=26). Clinical and radiological parameters were studied and functional evaluation was done with Disabilities of arm, shoulder, and hand (DASH) score</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Andersons’ criteria was employed to categorize the functional results. The mean duration of surgery and time to union were discovered to be less in favor of LCP group although statistically insignificant. No significant differences in two groups with respect to the functional evaluation (range of movement, Andersons’ criteria and DASH score) and complications could be discerned. No incidence of refracture or synostosis was encountered in any of the group. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Although LCP is an effective treatment alternative and may have a subtle edge over LC-DCP in the management of these fractures, their supremacy could not be certified. We deduce that surgical planning and expertise rather than the choice of implant are more pivotal for outstanding results.</span></p>

This evidence-based analysis shows that there is good evidence for the treatment of open fractures with antibiotics and surgical debridement. Vacuum treatment can be recommended if wound closure is not possible.

Introduction: Pain management in total knee arthroplasty is aimed to minimize postoperative pain and improve functional outcomes in patients. Although there are many methods used for controlling the pain there has been no consensus on most appropriate or the best protocol. Adductor canal block (ACB) has the unique advantage of providing localized analgesia but it doesn't provide pain relief to the posterior capsule, it has been postulated that IPACK (interspace between the popliteal artery and the capsule of the knee) combined with ACB will provide better pain relief than ACB alone. Materials and Methods: 60 Patients were studied in two groups. Group A had those patients with ACB+ ipack and Group B had ACB. Group A -Patient were subjected to combined ACB block with IPACK. Group B -Patient in this group were given ACB. Patient were studied for pain score VAS on Day 0 and Day 1 morning and evening, range of movement at postoperative Day 1 and distance walked on Day 1. Results: Group B had better outcome as compared to Group A. The mean VAS score for the ACB+IPACK group was less than for ACB alone at end of Day 0 and Day 1 in morning and evening. The ROM for the ACB+IPACK group was better than ACB alone and number of steps walked by patients were more in ACB+IPACK as compared to ACB alone. The statistical difference was significant when Adductor +IPACK group was compared to Adductor group for VAS, ROM and number of steps walked. Conclusion: ACB+IPACK is better mode than ACB for control of postoperative pain in patient undergoing Total knee replacement. IPACK is relatively safe and combined with adductor canal block decreases posterior pain in TKR patients.

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