BACKGROUND:Fractures of the radius and ulna occupy a large field of the modern traumatology. Therefore, these fractures are a major subject in modern orthopaedics and traumatology. The study of the mechanisms of the trauma, and the pathophysiological changes that occur are of great importance for the development of ever more efficient and varied ways of the treatment and prophylactics of this type of fracture.AIM:The aim of this paper was to study the pattern of the diaphyseal fractures of the forearm in adults, to decide the modalities of surgical management, to observe the period of fracture healing clinically and radiologically, as well to study the rehabilitation of the patients.MATERIAL AND METHODS:The present study included 45 cases of diaphyseal fractures of both bones forearm in adults presenting to the orthopaedic outpatient department. For all the patients a detailed history was taken. A thorough clinical examination was carried out, required X-rays were taken, and initial treatment was given and admitted as in all patients. After careful pre-operative planning and evaluation for anaesthetic fitness, patients were operated for the fractures of both bone forearms. Twenty-three cases with 46 fractures were treated by open reduction and rigid fixation with DCP & Semi-tubular plates and 22 cases with 44 fractures were treated by closed reduction and fixation with “Talwarkar” intramedullary square nails.RESULTS:United results were found in 100% of plating group vs. 86% in the nailing group. Delayed and non-union results were found in 9% of the nailing group only. Average time to union in weeks was 9.4 weeks in the plating group vs. 10.2 weeks in the nailing group.CONCLUSION:Open reduction and internal fixation with compression plates with strict adherence to surgical technique is the gold standard method of treatment in both bones forearm fractures with excellent results than closed reduction, internal fixation with “Talwarkar” square nails which is also again a simple method with better results than conservative methods.

BACKGROUND:Fractures of the clavicle are one of the most common fractures in modern orthopaedics and traumatology practice. Knowing the mechanism of trauma, and it’s pathophysiological elements, it’s clear distinction and it’s individual features are essential to the development of more new and effective methods for their treatment, and the minimising of postoperative complications.AIM:The aim of this paper was to present the results of our patients treated with minimally invasive plate osteosynthesis (MIPO).MATERIAL AND METHODS:Between January 2011 and March 2013, 12 patients were treated with MIPO technique. The mean age was 47.5 years (range, 16-79 years). Outcomes and complications of clinical treatment were reviewed.RESULTS:All fractures healed within a mean period of 4.9 months (range, 2-10 months). Regarding complications, there was no occurrence of implant failure or deep infection. There were no nonunions, but one 79-year-old man had a delayed union. Almost of all the cases didn’t need bending of the plate. Seven plates were removed by their hopes. And there weren’t any cases that required new incisions.CONCLUSIONS:A pre-contoured plate anatomically configured to fit the clavicle was easier to apply. MIPO technique for midshaft clavicle fractures may be a good option.

AIM:The aim of this retrospective study was to report the scapular fractures in patients with blunt chest trauma and to present the type and the frequency of associated thoracic injuries.MATERIAL AND METHODS:Nine patients with fractures of the scapula were included in the study. The mechanisms of the injury, the type of scapular fractures and associated thoracic injuries were analysed.RESULTS:Scapular fractures were caused by high-energy blunt chest trauma. The body of the scapula was fractured in all scapular fractures. In all cases, scapular fractures were associated with other thoracic injuries (average 3.25/per case). Rib fractures were present in eight patients, fractured clavicula - in four cases, the affection of pleural cavity - in eight of the patients and pulmonary contusion in all nine cases. Eight patients were discharged from the hospital up to the 15th day. One patient had died on the 3rd day because of postconcussional lung oedema.CONCLUSIONS:The study confirms the role of scapular fractures as a marker for the severity of the chest trauma (based on the number of associated thoracic injuries), but doesn’t present scapular fractures as an indicator for high mortality in blunt chest trauma patients.

PURPOSEE: We report a rare case of hematoma in the Baker's cyst with subfascial extension into the calf. The hematoma was demonstrated by magnetic resonance imaging and removed by mass excision. METHODS: A 55-year-old man with a major complaint of painful mass at the lower calf was referred to our hospital. RESULTS: Histopathological examination showed that the hematoma was surrounded by synovial membrane and was composed of thick fibrous tissue; it also contained macrophages that had phagocytosed red blood cells and hemosiderin. The pathologic diagnosis was hematoma in the Baker's cyst. CONCLUSION: In this report, we presented a rare case of Baker's cyst that was accompanied by hematoma causing abrupt pain and swelling in the lower extremity.

BACKGROUND:Open supracondylar fractures of the humerus are rare in children, and the treatment strategy for these fractures is yet to be standardised.AIM:We present the case of a 7-year-old boy with open supracondylar humerus fracture that was managed with an external wrist fixator.CASE PRESENTATION:A 7-year-boy was brought to our department with pain in the right arm after a fall from a height about 3 hours before admission. On examination, the elbow was found to be markedly swollen with restriction of movement of the right arm. A 4-cm-wide wound was also observed on the flexural aspect of the elbow, indicating severe contamination of the fractured site. Neurological examination revealed restriction of hand movement and decreased sensations, which suggested the possibility of nerve injuries.CONCLUSION:A good clinical outcome was achieved in this case, without the development of any complications over a 6-month follow-up period.

PURPOSE: The aim of this study is to investigate the influence of Intermittent Pneumatic Compression (IPC) on the time from diagnosis to surgery in adult patients with internally fixated ankle fracture. METHODS: The 1 st of February 2014 IPC was introduced in our department and implemented as a standard of care. IPC was prescribed 30 minutes 3 times daily until surgery. All patients with an unstable ankle fracture or lateral malleolar displacement more than 4 mm underwent standard surgical care.Intermittent pneumatic compression (IPC) is a system which enhances venous circulation and reduces edema. It consists of an air pump and a boot for the lower leg. In theory IPC compresses the edema and thereby preventing a surgical delay. RESULTS:Patients managed with IPC had a statistically significant 50% reduction in time from presentation to surgery compared to those managed without, and had a reduced hospital stay. This resulted in a net saving for both patients and the hospital. CONCLUSION: We conclude that foot pumps reduce the time to surgery and total hospital stay of patients requiring ankle Open Reduction and Internal Fixation (ORIF), and are cost effective.

In this study, we reported a rare paediatric closed medial malleolus fracture non-union (the fracture did not involve the growth plate). Methods: The fracture was initially treated with Plaster-of-Paris cast for 6 weeks followed by physiotherapy. The fracture position and union were assessed regularly with X-rays. Open reduction and internal fixation with cannulated screw was performed. Intraoperatively, there were only minimal soft tissues in the fracture gap and they were cleared prior to fixation. Further regular Xrays suggested fracture position was maintained but lack of callus formation. The patients remained symptomatic. A few months following the operation, the non-invasive ultrasound bone stimulator treatment was arranged for six months in view of the non-union. On completion of the treatment, she remained painful on weight-bearing. Subsequently radiological investigations confirmed fracture nonunion. Further open reduction internal fixation with autologous bone-grafting was performed. Results: The fracture was finally united a few months following the autologous bone-grafting procedure and the patient's symptoms resolved. The fracture was also confirmed to be united radiologically. Conclusion: In this study, we reported one of these rare closed symptomatic medial malleolus nonunion without growth plate involved. While following multiple treatment modalities (both conservative & invasive), fracture union was finally achieved. The union occurred over more than a year period.

Radial neck fractures are not common (5-10%) but are very difficult to treat and have many possible complications. [1,2] In the conservative treatment it's impossible to reduce severe displaced fractures, resulting in malfunction. Open reduction frequently leads to intra articular calcification, avascular necrosis, and joint stiffness. [3] In most cases, intramedullary nailing allows complete reduction without capsulotomy and very low complication rate of infection.[4] The pin is left in the bone, stabilizes the epiphysis, and prevents secondary displacement. [8,9]