Old pelvi-acetabular fracture are very difficult to operate in terms of achievement of anatomical reduction. Although two staged procedures are still treatment of choice(first stage acetabular osteosynthesis then THR if complication occurs) but neglected cases(more than 3 weeks old untreated fractures)can also treated by total hip replacement. Our case is A 35 years old patient sustained railway traffic accident. He had crush injury left lower limb severe abdominal and chest trauma, bilateral sacroiliac join disruption, iliac wing fracture left side and pelvi-acetabular fracture right side.at that time patient was treated at other hospital where above knee amputation of left lower limb done, abdominal and chest injury managed but pelvi-acetabular fracture was treated conservatively. After 1 year patient presented to us with pain and restriction of movement of right hip and inability to sit also. we performed primary complex total hip replacement using multi-hole acetabular cup and un-cemented femoral stem with metal on ultra high molecular polyethylene bearing and bone graft. results are satisfactory with fair range of motion at hip and modfied harris hip score. So primary complex total hip replacement is viable option for old pelvi-acetabular fracture cases where anatomical and biological reduction of fracture is not possible.

Background: The complex anatomy of distal humerus with proximity of radial nerve make the exposure and fixation of these fractures difficult. The standard technique of plate osteosynthesis consider at least eight cortices hold in both distal and proximal ends. Obeying these principles becomes difficult in distal humerus fractures. These difficulties have been overcome with the use of anatomical extra-articular distal humerus plate which has more hole density in the distal part with 3.5 mm screws for greater hold in distal part.Methods: A prospective study was carried out at Institute of Medical Sciences BHU Trauma Centre for 19 cases of distal third fracture excluding open fractures of patients between 18-68 years who attended our OPD or Emergency from June 2017 to July 2019. All patients were operated with the triceps-reflecting modified posterior approach. Regular follow-up was done to evaluate elbow functionality, fracture union, secondary displacement, non-union, implant failure and any complications; Mayo Elbow Performance score (MEPS) was used for the final functional assessment.Results: Fourteen 73.6% male and 5 (26.3%) female patients with mean age 41 years constituted the study group, who had an average follow-up of 17.1 months. Preoperatively one patient had radial nerve palsy (neuropraxia) who recovered completely 3 months after surgery. Overall, 18 (94.7%) patients were adjudged to have complete radiological union within 14 weeks; Mean flexion achieved was 134±11.5 (range 90–140). Average MEPS at the latest follow-up was 94.7±7.5.Conclusions: Extra-articular fractures of distal humerus can be satisfactorily treated with the use of single anatomically pre-contoured locking compression plate with excellent elbow functional range of motion and union rates.