1. Trans-osseous limited lateral approach is an effective method for management of intra articular calcaneal fractures. 2. Anatomical reduction for intra articular calcaneal fractures is essential. 3. Functional outcome of intra articular calcaneal fractures depends upon the initial damage of the articular cartilage. 4. There is a need for multi-center prospective randomized study for accurate assessment of the results of operative management of intra articular calcaneal fractures involving pre and post-operative CT for assessment of reduction and using a rational scoring system and a long period of follow up.

Background. This study investigated the clinical outcomes of fixation of displaced middle-third clavicular fractures using percutaneous elastic stable intramedullary nails. Material and methods. This study included sixty patients with a mean age of 26.40 ± 8.91 years (16-53 years) presented with a displaced middle third fracture of the clavicle. According to the Robinson classification, 48 cases (80%) were type 2B1, 9 cases (15%) type 2B2 and 3 case (5%) 2A1. All cases were treated by elastic intramedullary nails and followed up for at least 12 months. Results. At the end of the twelve months’ follow-up period, the mean Constant Shoulder score was 95.70 ± 13.55, ranging from 48 to 100. 54 patients (90%) had excellent results, 3 patients (5%) had an adequate result and 3 patients (5%) had a poor result. There was a statistically significant relationship between the final score and age and associated medical conditions. Conclusions. 1. Elastic Stable Intramedullary Nailing is an image-dependent procedure indicated best for young medically free athletes with simple 2-part middle third clavicle fracture. 2. Hammering is not recommended to avoid dorsolateral cortex perforation. 3. The most common complication is medial skin irritation because of the subcutaneous position of the clavicle as well as the sharp end of the cut nail.

Background: Bicondylar tibial plateau fractures present a therapeutic challenge to the orthopaedic trauma surgeon, both in terms of the osseous injury as well as the concomitant soft-tissue insult. Double Plating with single incision or dual incisions provide more insult to the compromised soft tissue. However, single locking plate combines the technical advantages of an angular stable plate with those of the modern biological plating technique. Methods: The Study was held at Razi Orthopedic hospital in Kuwait. Between May 2012 and November 2013, 20 patients with a mean age of 37.65 years (Range from 24-57 years) with bicondylar tibial plateau fractures with or without metaphyseal extension. Patients were diagnosed clinically, checked with standard X-rays, CT was done for all cases. Patients were treated by single lateral anatomically contoured locked plate through LISS or Polyaxial locking plate systems with or without additional screws from medial side. Radiological evaluation and functional assessment was done according to the Rasmussen Knee score. Patients were followed-up for an average of 12 months. Results: Union was achieved in all patients with a mean knee range of motion of 1.5°-130° (range: 0°-10° for extension lag, range: 100°-135° for flexion). The mean Functional Rasmussen Knee score at 6 month follow up (25.32±1.53 SD) ranged from (23.0-28.0). The mean Functional Rasmussen Knee score at last follow-up was (28.33±1.57 SD) ranged between (25.0-30.0) with significant P value (P value<0.001). The mean Anatomical Rasmussen Knee score at 6 month follow up (16.11±1.56 SD) ranged from (14.0-18.0). The mean Anatomical Rasmussen Knee score at last follow-up was (16.67±1.37 SD) ranged from (14.0-18.0) with insignificant P value (P value 0.096 ). Of the 20 patients, one patient had wound related problems, one patient had preoperative compartment syndrome, one patient suffered from hardware irritation and one patient had fixation failure upon which revision with double plating done for him. Conclusions: Surgical treatment of bicondylar tibial plateau fractures with the single lateral locked plate that was evaluated in our study can lead to a good functional and anatomical outcome and considered an effective system for providing fracture stabilization provided that the correct surgical technique is used. Awareness of potential hardware complications is essential. Level of Evidence: Level IV, Prospective Therapeutic Study