No abstract

Midshaft clavicular fractures have traditionally been treated nonoperatively. Prevalence of non-union or mal-union in displaced midshaft clavicular fractures after conservative treatment is higher as compared to those treated with open reduction and internal fixation. Surgery is believed to be the primary treatment for displaced midshaft clavicular fractures. Operative fixation of the clavicle fractures result in improved function, shorter time for union and early return to activity as compared to those treated conservatively. Objectives: The objective of the study was to compare the functional & radiological outcome of open reduction and internal fixation of clavicle with conservative management. Materials and methods: A prospective study was conducted at Department of Orthopaedics, Govt. TD Medical College Hospital for 2 years. In this study period 100 cases of midshaft clavicle fractures, treated by operative and non-operative methods (50 patients each treated by operative and non-operative methods). All the patients in this study were asked to follow up at 6, 12 and 24 weeks. The patients were evaluated both clinically and radiologically. Clinical evaluation was done based on Constant-Murley and DASH score. Results: Males outnumbered females by 66% (i.e. 83% against 17%). Among 100 patients, 54 patients (54%) had RTA while the remaining 46 patients (46%) had a history of fall. The youngest patient was 19yrs and the oldest was 72yrs old. Mean age was 36.93 years. Complications included plate breakage in 1 patient, nonunion in 13 patients and restriction of range of motion in 18 patients were seen. Constant and Murley scoring system showed, out of 50 patients conservatively treated, 23 patients (46%) fell under Good category, 18 patients (36%) had Fair functional outcome while 9 patient (18%) had Poor outcome. In the Operative group, out of 50 patients, 41 patients (82%) fell under Good category, 8 patients (16%) had Fair functional outcome while 1 patient (2%) had Poor outcome. Conclusion:We conclude that midshaft clavicular fractures treated operatively had a better functional outcome as compared to those treated conservatively.

Background: Subtrochanteric fractures are often difficult to treat and may well be associated with a mortality of more than 20%. The subtrochanteric region is the site of very high mechanical stresses, the medial and posteromedial cortices were subject to high compressive forces whereas the lateral cortex experiences high tensile forces. Operative management is the treatment of choice to achieve the goals of early rehabilitation and optimal functional recovery. The purpose of the present study is to evaluate functional outcome of the subtrochanteric fractures -both high energy and low energy -treated by PFN. Functional as well as anatomical results were evaluated with regard to pain, limping, activities, deformity and range of movements. The present study was done with the hope to find out a solution for the treatment of unstable comminuted subtrochanteric fractures. Materials and Methods: A total of 24 patients with subtrochanteric fractures presenting in the Department of Orthopaedics from August 2015 to August 2016 were treated by closed intramedullary nailing using PFN and the peroperative and postoperative complications and the functional outcome were studied. All the data was arranged in a tabulate form and analyzed using SPSS software. Chi square test was applied as a test of significance. Probability value of less than 0.05 was considered significant. Result: Out of the 24 patients 16 (66.66%) were males and 8 (33.34%) were females. Most of the cases came under. Type IB (62.50%) and Type IA (20.84%). There were 8.3% cases each of Type II A and Type II B. In this study, 14 cases (58.34%) were locked proximally and distally with 2 screws each. In 4 cases (16.66%), 2 proximal screws and 1 distal screw, in 2 cases of intertrochanteric fracture, only 2 proximal screws were used. Average duration taken for union in this study was 4.5 months (Ranges from 3 months to 7.5 months). 22 (90%) united by 6 months. There were no cases of infection. No shortening in 10 cases. Less than 1 cm shortening in 9 cases and 3.2 cm shortening in one case was found. Proximal screw penetration was noted in one case (RT type II A) at the time of 3 months follow up. Conclusion: PFN is a safe, effective and patient friendly device useful for the treatment of all subtrochanteric fractures irrespective of their comminution. Early mobilization and rehabilitation is possible since it is a closed intramedullary procedure.