Introduction: Diaphyseal fractures of humerus treated with bridge plating are showing superior results in view of post-operative pain and union time. In our study we have evaluated the clinical, radiological, and functional outcome of such fractures in 15 patients, all of them were managed with dynamic compression plate over an average follow up period of 12 months. Though open reduction and plating technique of humerus shaft fracture is gold standard, this technique also gives good outcome. Materials and Methods: Fifteen patients with humerus shaft fractures were managed by anterior bridge plating using Minimum invasive osteosynthesis technique between Jan 2017 and Jan 2018 were included in this study. All cases were managed with closed reduction and 4.5mm dynamic compression plate fixation over anterior aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, and fracture union time, and complications were noted. The UCLA shoulder and Mayo elbow scores were used for assessing the shoulder and elbow function. Results: Out of the fifteen patients in the study, eleven were males and four were females. The mean age was 40.2 years (range 25 to 60 years). Ten out of fifteen patients (66.67%) had the dominant side fractured. Mean surgical time in minutes was 90min (range: 60-120 minutes). The mean fracture union time was 10.6 weeks (range: 10-18 weeks). However Shoulder function was excellent to good in 13 cases (86.6%), fair in 1 case (6.67%) & poor 1 case (6.67%) on the UCLA score. Conclusion:In our study, small incision percutaneous anterior bridge technique for fracture shaft humerus results in good functional outcomes. It is based on relative stability which provides healing, and subsequent formation of the bone callus, and reduces the possibility of infection and non-union.it requires experience and a good assistance.

Introduction: Negative pressure wound therapy (NPWT) in its present form was first described by Fleischmann et al. 1 in 1993. In Orthopaedics it has gained popularity in past 2 decades for management of acute open fractures, pressure sores as well as chronic wounds associated with osteomyelitis2. It involves the controlled application of sub atmospheric pressure to a local wound environment, using a sealed wound dressing connected to a vacuum pump. In our institute, we provided NPWT using locally available materials to manage Orthopaedic wounds. This present study evaluates the efficacy of NPWT. Aims and Objective: To evaluate the efficacy of indigenously developed negative pressure wound therapy. Methodology: In Our study we included 15 patients in the age group of 10 to 69 years to evaluate the efficacy of indigenously developed NPWT this is 6 months prospective study. Result Wound Culture: Gradually cultures became negative to any microorganism. At 3 months the wounds of all patients were healed Granulation Tissue: About 80 percent wounds were granulated till 6 week. At 3 months 15 (100%) wounds were healed. Conclusion: Indigenously negative pressure wound therapy has a safe and effective method of wound coverage. It decreases the bacterial load and promote the neovascularization. Further long term controlled studies are needed which would help in providing affordable and effective wound management.

Background: Extra capsular Intertrochanteric hip fractures occur in older age person. These are pathological fracture mostly (osteoporosis). Currently, these hip fractures are generally fixed with intramedullary or extramedullary implants. Implants preference mainly determined by the fracture classification (stable or unstable). Most common complications in standard proximal femoral nail and extramedullary implants is neck screw cutout. Due to Research and improvement in surgical technique incidence of neck screw cutout has reduced considerably but still remains the most common fixation failure with intramedullary implants. With this question in mind we did study to find out functional outcome of proximal femoral nail antirotation with helical blade fixation in extra capsular hip fractures in Himalayan region. Methodology: This prospective study was done on 75 patients with extra capsular hip fractures, for fixation of fracture, implant of choice were used proximal femoral nail antirotation with helical blade. Study were done during the period from September 2015 to August 2016. Informed written consent were taken from all patients. The study was approved by institutional ethical committee. We included > 45 year cases. Fracture was classified according to Boyd and griffin classification. Exclusion criteria were age<45 years, open intertrochanteric hip fractures, pathological fracture other than osteoporosis and polytrauma patients. After discharged from hospital patients were called in OPD for clinical and radiological evaluation at regular intervals (6wks. 12wks, 24 wks, 36 wks. and 48 wks). Results: 75 cases of hip intertrochanteric fractures were included and operated with proximal femoral nail antirotation with helical plate. Mean age of patients was 65.67±10.60 yrs. (45-94 yrs.). Based on preoperative x-rays fracture pattern 8 cases in type1, 18 cases in type 2 and 3 in each group, 31 cases in type 4 were recorded. Assessment of osteoporosis were done according to Singh index. Type 1 (n=8), type 2 (n=18), type 3(n=18), type 4 (n=31) were had mean Singh's index 5.13, 4.59, 4.76, 4.70 respectively. Maximum number of patients (97.2%) showed sign of union between 18 to 24 weeks. The mean TAD was 24.69 mm±3.16 mm (Range 20-32mm). Union was achieved in all patients (n=66) at 48 weeks Harris Hip score was 38.47±13.14, 61.70+19.10, 83.44+12.24, 94.06+4.71, 98.18+4.27 and 98.68+1.84 respectively. At all the follow up intervals, Harris Hip score was improved (p<0.001). In our study overall outcome of patients (n=70) at 48 weeks who could complete the follow-up were good in 41 (58.5%), average in 25 (35.7%) and poor in 4 (5.7%) cases. Conclusion: Proximal femoral nail antirotation with helical blade gives better fixation even in osteoporotic intertrochanteric unstable femoral fractures. But preoperative assessment and planning, reduction and surgical technique should be followed. Intramedullary fixation has biological and biomechanical advantages over extra medullary fixation, helical blade has better bone hol...

Introduction: ACL avulsion mainly occurs from its tibial attachment. Open are arthroscopic fixation is required in comminuted avulsions. Screw fixation is stronger construct than any other modality. In this study we have included patients operated by arthroscopic fixation with suture disc and endobutton. This is cheaper modality with simple instrumentations. Purpose of study was to assess the clinicoradiological outcome of such patients. Material Methods: 15 patients were included in the study. Who were assessed by lachman test and radiographs pre operatively, post operatively and follow up. Suture disc and endobutton were used for the arthroscopic fixation. Knee bending exercises and quadriceps strengthening exercises advised post operatively. Result: Union was present in 100% patients on radiographic evaluation. 93.3% patients were returned to their pre injury status within one year. 6.6% patient developed extension lag and stiffness. Infection was not seen in any patient. Conclusion: This is newer and cheap modality of fixation with satisfactory outcome. Large sample size studies are required.