Background: Clavicle fracture is one of the common fractures accounting for 2.6-12% of all fractures and 44-66% of shoulder fractures. Mid-clavicle fractures account for almost 80% of clavicle fractures. Most of the these fractures were treated conservatively in past but recently there has been an increasing tendency for operative management. Though many studies have been conducted to assess the benefit of primary surgical management against conservative management, no consistent results have been obtained to show which one is better. So, this study was carried out to compare the radiological and functional outcome following conservative management to that of operative management with open reduction and internal fixation (ORIF) with plating for displaced midshaft clavicle fractures. Methods: In a single centre, prospective clinical trial, 60 patients with displaced midshaft fracture of the clavicle were systematically randomized (alternate patient) into either operative treatment with plate fixation or non-operative treatment with clavicle brace and arm sling. Outcome was analysed in terms of functional outcome and radiological union by standard follow-up, Constant and Murley shoulder score and plain radiographs. All sixty patients completed six month follow up and there was no difference between two groups with respect to patient demographics, mechanism of injury and fracture pattern. Result: There was no significant difference in Constant shoulder score between the two groups. The mean time of union was 14.57 weeks in operative group compared to 16.04 weeks in nonoperative group (p value=0.191). There were two non-union in nonoperative group compared to none in operative group. The complications in operative group were mainly hardware related (four had loosening of screw, two had implant failure and one had infection). At six months after surgery patient were more likely to be satisfied with the results in operative group compared to nonoperative group (p=0.02). Conclusion: Six months after a displaced midshaft clavicular fracture, nonoperative treatment resulted in higher malunion and non-union rate but similar functional outcome and union time compared to operative management. However, patients were more likely to be satisfied in operative group compared to nonoperative group.

Introduction: There have been many advances in internal fixation techniques to deal with poor quality of bone and severely comminuted intertrochanteric fractures so as to allow early ambulation. Failure rates with an internal fixation range between 3% and 12%. There have been a number of technical issues to convert these fractures into hip arthroplasty such as extraction of implants, bone deformity, bone loss, poor bone quality and associated trochanteric nonunion. Intertrochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Rate of failure with internal fixation, with dynamic hip screws and with nail has been found to be high, especially in osteoporotic bones. Weak purchase of the internal fixation device because of osteoporosis and comminution of the fracture increases the incidence of failure of internal fixation such as cutting out the screws and displacement of the bone fragments. Case summary: 75 years male previously operated with proximal femoral nail later had fall due to which implant failed, which were manged with implant removal with bipolar hemiarthroplasty. Conclusion:Management of intertrochanteric fractures depends on age, stability of fracture, bone density. Young patient with good bone density should managed with proximal femoral nail, but in older individuals with osteoporotic bone stock hemiarthroplasty is good option. As we cannot rely on internal fixation devices to allow early full weight bearing of patients in the presence of severe osteoporosis and marked comminution at the fracture site, partial weight bearing is very difficult to be followed by these patients; thus, they shift to full weight bearing on the operated limb, causing mechanical failure. Hemiarthroplasty using bipolar prostheses for the unstable intertrochanteric fractures of the femur in elderly yields good clinical results in terms of early postoperative ambulation. This will have a direct effect on the general condition and postoperative rehabilitation.