Background:Displaced supracondylar fractures are notorious for difficulty in reduction, maintenance of reduction and frequent involvement of neurovascular structures. No general agreement on the treatment is evident with controversy prevailing regarding the ideal timing of surgery, method of maintenance of reduction and configuration of the pin fixation. A crossed pin configuration, though believed by some to be mechanically more stable than the lateral pins alone, has the risk of ulnar nerve injury due to the medial pin. Lateral pins alone impart less rotational stability to the fracture although it has been attributed mainly to technical errors of pin placement. The aim of this study was to assess the efficacy of treatment of this fracture using one lateral and one trans-olecranon K-wires or lateral entry K-wires alone.Materials and Methods:Ninety cases of displaced supracondylar humerus fractures were included in the study. The mean age of the patients was 6.7 years (range 3–12 years). The male/female ratio was 5:1 and left side was involved in 70% whereas 30% had right sided injuries. The most common mode of trauma was fall from height with elbow in extension. All the 90 consecutively admitted patients had extension type injury with 73.3% fractures being Gartland type III and 26.7% were type II. Posteromedial displacement was noted in 70% whereas 30% fractures were posterolaterally displaced. In 60 cases, lateral entry wires alone were used whereas, in 30 cases, one lateral and another transolecranon transarticular K-wire was used. K-wires were removed at 3 weeks postoperatively and followup was done at 6 weeks and 12 weeks when they were evaluated according to the criteria described by Flynn. Chi-square test was used as a statistical test of significance to compare results among different variables.Results:Results were graded according to Flynn's criteria. Excellent results were achieved in 12 (13.3%), good in 54 (60%), fair in 15 (16.7%) while in nine patients (10%) poor results were obtained.Conclusions:Both lateral entry K-wires and lateral-trans-olecranon wire techniques provide stable fixation when observing the guidelines for wire placement and consistently satisfactory results can be obtained, both cosmetically and functionally with both the techniques.

Introduction: Metacarpal fractures account for upto 10% of all body fractures and 36% of all hand fractures in adolescents, young adults, and active adults. Fractures of the metacarpal shaft and neck are common in all metacarpal fractures after direct trauma, roadside accidents, or sports injuries. The ratio of the shaft to the neck is 1:2. Closed reduction and plaster of paris cast can be used to treat the majority of these fractures conservatively. Unstable and comminuted fractures necessitate surgery. Aim: To compare the clinical, functional and radiological outcomes in antegrade intramedullary fixation and transverse pinning of metacarpal fractures in patients of unstable and displaced metacarpal shaft and neck fractures. Materials and Methods: A single-institutional prospective interventional study identified 60 cases of metacarpal fractures between November 2019 to August 2021. Each of the cases met the inclusion criteria for closed extra-articular fractures, displaced and unstable fractures of the metacarpal bone. The patients were divided into two groups having 30 subjects each, randomly allotted to two groups (Antegrade intramedullary K-wiring and Transverse Pinning). Outcomes were compared for range of movement by the American Society of Hand Surgeons Total Active Motion score (ASSH TAM), Visual Analog Scale (VAS), and radiological parameters (Angulation). Patients were followed-up for 12 weeks. Complications were listed in terms of pin site infection. Results: Most of the patients were found to be in the third decade of life. The fracture union was achieved at 8±2 weeks. Clinical evaluation done by VAS score which was found to be statistically insignificant between two groups (p-value=0.243). Radiological assessment evaluated by measuring postoperative angulation between two groups was found to be statistically insignificant (p-value=0.248). Difference in functional evaluation between the two groups done by ASSH TAM was found to statistically significant between the groups (p-value=0.036). Conclusion: Both antegrade intramedullary K-wiring and transverse pinning demonstrate good and comparable results for extra-articular neck and shaft metacarpal fractures. However, the former is superior in terms of final range of motion as per ASSH TAM score.

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Background:The main surgical principle in the management of diaphyseal bone infection is thorough debridement of all nonviable tissue. None of the previously mentioned techniques afford surgeon the ability to correct deformities, eliminate antibiotic therapy, regenerate new bone without grafts and allow weight bearing during treatment. Objectives: The present study was conducted to evaluate the clinical follow-up results with Ilizarov technique using three parameters: union, infection and function and to know the complications if any faced by the patients. Material and Methods: This was a prospective study planned to evaluate the results of Ilizarov ring fixator on follow-up of 18 cases of either sex with infected non-union tibia. Average age of presentation was 34.5 years. Follow-up roentgenographs were used to assess alignment, bone contact and later callus formation. Healing status of the fracture was monitored using biplane roentgenographs, unchanged fracture alignment with loosening of the frame, absence of pain during ambulation with the frame destabilized. The data thus collected were analysed by using percentage and valid conclusions were drawn. Result: Pain and swelling were the most common complication after application of ilizarov ring fixator. In this study of 18 cases, 11 (61.11%) patients had excellent, 2 (11.11%) good, 5 (27.77%) fair and none had poor results as per criterion laid down by Catteneo et al. Conclusion:Ilizarov technique was found to be useful to progressively lengthen the extremity, achieve union without bone grafting and to correct deformities in infected non-union with or without bone gap.