No abstract

Clavicle fractures were traditionally treated nonoperatively, but due to higher rates of delayed union, non-union, symptomatic, malunion cosmetic deformity and other complications there is an increasing trend for operative management. Plating and intramedullary nailing are the most popular surgical options Functional results after both the techniques proved to be superior compared with conservative treatment of DMCF in some recently reported prospective randomized studies. The aim of this study was to compare the clinical result ,functional outcome along with complications rate in minimally invasive antegrade TEN for the treatment of DMCF with that of 1/3rd tubular plating anteriorly. Prospective study was conducted between 2009 and 2016 in which 66 patients (49males and 17 females) with ota type b DMCFs underwent surgical fixation with antegrade TENs and 1/3rd tubular plate. They were randomized in two groups-one with TENS & other with plate fixation with 1/3rd tubular plate. Evaluation done by constant-murley shoulder outcome and dash scores at 6, 12 weeks, 3, 6, and 12 months to determine outcomes. During analysis we have 34 pts in TENS group & 32 pts in plate group. There was no significant difference in union time, CONSTANT & DASH score. Lesser operating time, less blood loss, easier implant removal & minimal complication with no any case of deep infection seen in TENS group but shortening[>0.5 cm ]was noted in few cases. In plate group there were no major complications, only minor complications of superficial infection, deep infection, hypertrophied scarring without pain, limited shoulder motion with no case of shortening.There is no significant difference regarding union [clinical and radiological] and stability .However TENS is preferable for treating simple displaced fracture of DMCFs in view of lesser morbidity, better cosmetic result, easier implant removal. Fixation with plate seems to be little more stable & its the implant of choice in comminuted fracture

Clavicle fractures were traditionally treated nonoperatively, but due to higher rates of delayed union, non-union, symptomatic, malunion cosmetic deformity and other complications there is an increasing trend for operative management. Plating and intramedullary nailing are the most popular surgical options. The aim of the study was to evaluate the clinical outcome of displaced midclavicular fractures (DMCFs) in adults treated with 1/3 rd tubular plate Prospective study was conducted between 2012 and 2016 in which 32 patients (23 males and 9 females) with mean age of 34.56 years with DMCFs underwent surgical fixation with 1/3 rd tubular plate.Evaluation done by constant-murley shoulder outcome and dash scores at 6, 12 weeks, 3, 6, and 12 months to determine outcomes. All the patients achieved clinical and radiological union at 9.66±1.75weeks. The final Constant and DASH scores were 91.09±4.18 and 6.09±1.17. There were no major complications, only minor complications of superficial infection (n=2, 6.25%), deep infection (n=1, 3.13%), hypertrophied scarring without pain (n=2, 6.2%), limited shoulder motion (n=2, 6.25%), screw loosening causing neither pain nor functional disablility (n=1, 3.13% ), breakage of plate (n=1, 3.13%). Clavicle fractures are usually treated conservatively but there are specific indications for which operative treatment is needed .In this study 1/3 rd tubular plates were used as it can be contoured to the shape of the clavicle and we can conclude that fixation of DMCFs with 1/3 rd tubular plate is a effective procedure, which provides good functional outcome, high union rate, return to work, and results with minimal complications in indicated cases.

Pott's spine may be associated with neurological deficit due to presence of inflammatory oedema, extradural abscess or sequestra. However, there may be unusual rare presentation of Pott's spine as extradural granuloma without involvement of bone which may present as spinal tumour syndrome. MATERIALS AND METHODSWe present a case of paraparesis of two weeks' duration in a 13-year-old female. MRI showed extensive extradural SOL from C7 to D5 with mass effect over the cord with no abnormality of vertebrae. Excisional biopsy was done after D2 to D4 laminectomy, thereby relieving cord compression. Challenges in the case being skeletal immaturity, lesion being extensive, extent of laminectomy and the role of posterior fusion. RESULTHistopathology report diagnosed it to be tuberculous granuloma. ATT under DOTs, category 1, was started. Excellent functional recovery was noted. CONCLUSIONIn endemic country, granuloma must be kept as a possibility in case of spinal tumour syndrome. Though granuloma improves with ATT, decompression should be considered in case of neurological involvement.

BACKGROUND Clavicle fractures were traditionally treated nonoperatively, but due to higher rates of delayed union, non-union, symptomatic, malunion cosmetic deformity and other complications. There is an increasing trend for operative management. Plating and intramedullary nailing are the most popular surgical options. The use of intramedullary titanium nails requires smaller incisions, avoidance of significant soft tissue stripping, minimal complications, and early return to work. The aim of the study was to evaluate the clinical outcome of displaced midclavicular fractures (DMCFs) in adults treated with titanium elastic nails (TENs). MATERIAL AND METHODS Prospective study was conducted between 2009 and 2013 in which 34 patients (26 males and 8 females) with mean age of 39.1 years with OTA type B DMCFs underwent surgical fixation with TENs. Evaluation done by Constant and DASH scores at 6, 12 weeks, 3, 6, and 12 months to determine outcomes. RESULTS Closed reduction was possible in 20 patients (58.82%). All the patients achieved clinical and radiological union at 9.38±1.44 weeks. The final Constant and DASH scores were 93.37±3.06 and 5.63±2.66. There were no major complications, only minor complications of shortening >0.5 cm (n=3, 8.82%), superficial infection (n=3, 8.82%) and medial TEN protrusion (n=7, 20.58%). CONCLUSION The intramedullary fixation of DMCFs with TENs is a minimally invasive, safe, and effective procedure, which provides good functional outcome, high union rate, early pain relief, return to work, and better cosmetic results with minimal complications in indicated cases. LEVEL OF EVIDENCE Level III.