<p class="abstract"><strong>Background:</strong> Minimally invasive percutaneous plate osteosynthesis (MIPPO) is an established technique for fixation of fractures of the distal third tibia. Aim of our study was to manage extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications &amp; efficacy of the procedure reviewed.</p><p class="abstract"><strong>Methods:</strong> From June 2018 to June 2019,25 patients of closed distal tibial fractures were operated by MIPPO technique with a distal tibial anatomical locking plate having 4.5 out of 5 proximal and 3.5 out of 4 distal screw holes. The follow up duration was for 1 year.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean fracture healing time was 17 weeks (range 16 to 32 weeks) and average The American orthopedic foot and ankle score was 88.2 out of a total possible 100 points. At last follow up, superficial infection occurred in 3 patients, deep infection in 1 patient, ankle stiffness in 1 patient, limb length discrepancy &lt;1 cm in 1 patient and malunion in 2 patients.</p><p class="abstract"><strong>Conclusions:</strong> MIPPO technique provides good bone healing and decreases incidence of non-union and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminute fractures.</p>

Introduction: Intertrochanteric hip fractures are common with increasing age.Unstable intertrochanteric fractures are now commonly fixed using PFN, however it cannot engage greater trochanter on its own. Gluteus Medius and gluteus minimus (main abductors) attach to greater trochanter, hence abductor weakness is a likely consequence especially in comminuted fractures. In this study we measured the incidence of post-operative abductor weakness and result of targeted physiotherapy on it. Materials and Methods: 135 patients with unstable intertrochanteric fractures underwent proximal femoral nailing at our hospital. The patients included in this study were more than 18 years of age with unstable fractures classified according to Modified Evans classification type 3, 4 and 5 with the duration of trauma less than 3 weeks. The functional assessment was made using Modified McKay criteria through analysis of abductor muscle strength. All patients underwent a pre-determined physiotherapy as per protocol. Result: Immediate post-operative muscle power was Grade 1-(09 pt.), Grade 2 (39 pt.), Grade 3 (43 pt.) and Grade 4 (43 pt.). Most of the patient improved their muscle power grade at 12 weeks with only 09 patients with grade 2 and 23 patients with grade 3 power. At final months follow up only 08 patients had grade 3 power and only 6 patients had grade 4 power while the rest had muscle power grade 5.In our study excellent score was seen in 87 patients (83%), good in 12 patients (12%) and poor only 7 patients (5%) at 6 months, as per Modified Mckay criteria. Conclusion: Abductor weakness and Trendelenburg gait are surprisingly common in patients treated with PFN and this complaint is often overlooked. Correct surgical method and targeted physiotherapy can help alleviate this problem.

Introduction: Shaft of femur fracture are one of the most common diaphyseal fractures in children with an incidence of about 19/1 lakh population. The aim of treatment is mainly anatomical reduction and realignment with proper functioning of hip and knee joints. TENS is now the preferred treatment of choice because it involves the insertion of two or three titanium nails. Aim of Study:The aim of this study was to assess functional and radiological outcome of paediatric shaft of femur fractures treated with TENS nail. Materials and Methods: The study has been conducted in Department of Orthopaedic, K.R. Hospital December 2017 and December 2018. Patients underwent operative treatment on table with manual traction. After proper reduction of fracture, small skin incision was given on either side of distal thigh around 2 cm proximal to distal epiphyseal plate. Titanium elastic nail of the correct size with curve ends were introduced from both medial and lateral side simultaneously till fracture site after it one nail was passed across the already reduced fracture site followed by another one. Postoperatively patients were encouraged quadriceps strengthening and knee bending exercises as soon as patients could tolerate (Usually within 24 hours of surgery) and for few days, patients were kept non-weight bearing following which partial weight bearing allowed depending on the stability of fracture and callus formation but full weight bearing was allowed only after radiological evidence of firm union. Results: Total 22 patients with shaft femur fracture were operated between December 2017 and 2018 with TENS nail in the Department of Orthopaedics K.R Hospital. There were 15 boys and 7 girls aged between 5-15 years who were taken. Most of the cases were due to RTA (54%) and self-fall accounted for 46%. Out of the fractures, proximal accounted for 9%, mid-shaft fractures 68% and remaining were distal. The most common side affected in our case series was right which was in 17 kids (77%). Out of all types of fractures, transverse accounted for 31%, spiral 22% and the remaining were oblique. Closed reduction and internal fixation was done with negligible blood loss. Our patients underwent an average stay of 5 days in the hospital with minimum of 2 days and maximum of 8 days. Union in our study was achieved at an average of 9.2 weeks and cases were followed up at 2, 6, 12, 16 weeks. Conclusion: TENS is a good method of choice for paediatric fracture shaft of femur fractures particularly in the age of group of 5-15 years of age as it acts an internal splint without disturbing periosteum, promotes faster bridging and callus formation and finally early mobilization.

Introduction: Of all the lower limb fractures ankle fractures are one of the most common accounting for almost 9% with the annual incidence being 107-187 per 1 lakh population. Treatment of this fracture is complicated and challenging as the outcome will influence the locomotive power. Improper and inadequate fixation can cause long term disability as body weight is transmitted through it. Aim of study: To assess the functional and radiological outcome of displaced bimalleolar ankle fractures and to assess the rate of complications. Materials and Methods: This prospective study was done at the Department of orthopaedics in K.R. Hospital, Mysuru after obtaining informed consent from patients. A total of 50 patients between the age of 18-50 years were treated with Open Reduction and Internal Fixation with various methods for bimalleolar fracture between August 2017-January 2018; These patients were followed for 12 months and evaluated based on union rate, complications (Infections, Nonunion) and functionally by Baird and Jackson ankle scoring system. Results: In our study of 50 patients, bimalleolar ankle fractures treated by ORIF by various methods were followed up for 12 months. In our study, majority were males (72%). Mean age group included in the study was 33 years. In majority of patients, the mode of injury was RTA (72%) and most common fracture type being AO Type 44 A (56%). As per Baird and Jackson scoring system excellent to good functional outcome was seen in 78.3% individuals with fair outcome in 17.9% and poor outcome in 5.6%. Complications were seen in 9 patients and only two underwent re surgery for non-union. Conclusion:We found that ORIF yielded good results in terms of anatomical reduction, stability and post-operative functional outcome. Hence as per our study we can safely conclude that open reduction and internal fixation should be the treatment of choice for all unstable ankle fractures.