Background & objectives: Surgical intervention is increasingly used for treatment of humeral mid-shaft fractures nowadays. The aim of study was to identify the outcomes of titanium elastic nailing and exploring the relevance of carrying weight to these outcomes in adults. Methods: This study was a prospective follow up study conducted in Erbil teaching hospital in Erbil city from 1st of January, 2010 to 30th of November, 2013 on sample of 40 eligible injured patients who were non-randomly selected. The fractured patients were operated surgically using titanium elastic nails in both retrograde and ante grade ways. Postoperatively, carrying weight was used with follow up x-rays to check the union of bone. Results: Mean time to return to previous activity after elastic nail surgery was 15.7weeks and mean union duration of fractures after surgery was 12.2 weeks. The main adverse outcomes after surgery were shoulder pain (30%), shoulder stiffness (17.5%), supraspinatus pain (30%), superficial infection (27.5%), mal-union (7.5%), non-union (5%), delayed union (2.5%) and conversion to internal fixation (5%). Mal-union, non-union, delayed union and conversion to internal fixation were significantly prevalent among patients not carrying weight after surgery. Conclusions: titanium elastic nails represented the good treatment option for adulthood mid-shaft humeral fractures with promising outcomes of carrying weight postoperatively.

Background: Proximal humerus fractures represent 4-5% of over-all fractures. In patients above 40 years of age, it accounts for 75% of all humerus fractures. Fractures of the proximal end of the humerus oftentimes represent a management dilemma with the multiple surgical options available to deal with them. Objective: To evaluate the functional and radiographic outcomes of the percutaneous pinning techniques in the management of two-part and three-part proximal humerus fracture. Patients and Methods: A case series of 25 patients, functional outcome was determined by ASES and Constant scores and multiple radiographic views were taken to assess the fracture union, mal-union, and the presence of avascular necrosis. Results: ASES score of the whole group was 87.27 while the mean Constant score was 79.04. Only 16% of the entire group developed varus malunion (defined by Neck-Shaft-Angle <=120degrees). Moreover, 16% of the whole group developed OA of the glenohumeral joint. Conclusion: This study supports that the percutaneous close reduction and pinning technique is an effective and reliable surgical technique in the management of closed two-part and three-part proximal humerus fractures in adults. Appropriate preoperative planning is important to achieve a successful surgical result, and regular postoperative follow-up and rehabilitation are essential to get an optimum functional outcome. Keywords: Proximal humerus fracture, percutaneous pinning, upper extremity surgery, trauma surgery, Clinical outcomes, Percutaneous fracture fixation

Background and objectives: Management of calcaneal fractures is controversy. Many options of treatment have been described, but there is no agreement about absolute indications. A study of the functional outcome is carried out in surgically treated intra articular calcaneal fracture in this prospective study. We studied the functional outcomes and postoperative complications including; infection, impingement, varus, Synovitis and flap necrosis in operative management of intra articular calcaneal fracture. Methods: A total of 24 Patients with 26 calcaneal fractures operated over a period of 24 months (first January 2016 to first December 2017), in the study. Pre-operative computed tomography scans done in all patients. Maryland foot score was used to assess the functional outcome. Results: Twenty-four pa -tients (22 unilateral and 2 bilateral), the mean age is 35.41 years (range 18-60), consisting of 3(12.5%) female and 21(87.5%) male were included in this study. Most common mode of injury was fall from height in 23(95.8%) patients, while road traffic accident was in 1 (4.16%) patients. Results according to Maryland foot score were excellent in 25%, good in 62.5%, and 12.5% have fair outcome and none of them had poor results. Conclusion: Open reduction and internal fixation with restoring the articular congruity with low profile locking plate is the ideal treatment for Sanders Type II, III and IV. Even Sanders Type IV had a good result in short-term follow-up. Use of proper surgical timing, technique and asepsis can lead to excellent or good results in about (87.5%) of patients.

Background and objectives:Anterior ankle impingement (as a common cause of anterior ankle pain) is becoming re- cently a common diagnosis in peoples who do excessive dorsiflexion of ankle joint in their daily activities. Arthroscopic debridement is nowadays a gold standard procedure for anterior ankle impingement treatment in both osseous and soft tissue type impingements. The objectives of this study are to provide a comprehensive overview of the clinical outcomes of arthroscopic procedures used as a treatment strategy for anterior ankle impingement. Methods:We per- formed a prospective study on 20 patients diagnosed as cases of anterior ankle impingement on the basis of clinical and radiological examination, the patients complained from either soft tissue or bony impingement. All patients were treated by arthroscopic debridement or burring. Clinical outcome was evaluated according to American orthopedic foot and ankle society score questionnaires, visual analogue scale, and ankle dorsiflexion range achieved. Results: The mean age of the patients was 37.4 year, mean AOFAS ankle hind-foot scale improved from 52.65 preoperatively to 86.95 postoperatively (statistically significant). The mean pain visual analogue scale decreased from 7.9 to 3.1. The mean dorsiflexion angle increased from 7 degrees to 14.5 degrees. Conclusion: Arthroscopic debridement and excision of impinging soft tissues and burring of impinging bones is the treatment of choice for patients with anterior ankle impingement syndrome of both osseous and soft tissue nature after failure of conservative measures to relieve the symptoms and improve the range of motion.