Introduction: Complex tibial plateau fractures usually have complicated intra-articular fracture pattern, often associated with severe soft tissue injury and high risk of wound complications. Single or dual column plating fixation principle based upon conventional x-ray for such fractures may not address multiplanar comminution that  often has posterior shearing or  coronal fractures. Computed tomography based evaluation of such fractures  and column specific  approach allow direct fracture visualization and anatomic reduction  that results in satisfactory outcome. Objectives: To assess the clinical and functional outcome and complications of complex tibial plateau fractures fixed with column specific fixation principle. Methodology: This prospective study was carried out from September 2019 to August 2021 in Orthopaedic department of Nobel Medical College, Biratnagar. Consecutive sampling was used among patient with complex tibial plateau fractures meeting the inclusion criteria. Among 30 patients, with  closed and Gustilo grade I or II Schatzker type V-VI fractures or AO type-C injuries to the proximal tibia were operated on column specific approach and followed up for clinico-radiological evaluation. Results: In this study, most of the patients belonged to 31-40 years of age group with mean age of 40.47 years. Majority of patients were male( 76.7%). Fracture was highly associated with road traffic accident which accounted for 83%. Fourteen patients underwent anteromedial and anterolateral plating(46.67%), 10 patients underwent anterolateral and posteromedial plating(33.33%) and remaining 6 patients underwent triple column plating(20%). The Rasmussen’s functional score at final follow up was  27.17±2.793(range 21-30). 86.7% patients had acceptable clinical outcome. The mean Rasmussen’s radiological score at final follow up was 8.97±1.217(range 6-10). Thus 93.4% patients had acceptable radiological outcome. Conclusion: Column specific approach addresses all the fracture fragments of complex tibial plateau fractures to achieve acceptable clinical and radiological outcome.

Introduction: The ideal implant for treating unstable intertrochanteric fracture has been controversial. Studies have shown good results with various intra-medullary nails. Likewise, Proximal Femoral Anti-rotation-II (PFNA-II) has been designed for the Asian population. But the knowledge about the outcomes of PFNA II in our particular region has been lacking. Objectives :  To evaluate the radiological and functional outcome of unstable intertrochanteric fractures in elderly patients managed with PFNA-II. Methodology: This is a prospective clinical study conducted at Nobel Medical College between February 2019 and March 2021. Patients above 65 years of age with unilateral unstable intertrochanteric fracture were managed with PFNA-II. Radiological union and complications were recorded. Functional outcome was assessed on the basis of modified Harris Hip Score. Results: Twenty-nine patients were included in the final evaluation and had at least one year follow-up. Two patients (6.8%) had superficial infection. The average Tip Apex Distance (TAD) was 22.28 mm (range, 18- 28 mm). Mean modified Harris Hip Score at one year was 82.59 with good outcome in 23(79.3%) patients. Conclusion: This study showed that good clinical outcome can be obtained when radiological parameters are restored. Good intra-operative fracture reduction, and optimal positioning and length of helical blade are crucial. We believe that PFNA-II is an excellent implant to treat unstable intertrochanteric fractures in elderly patients.

Background:  Open tibia fractures are high energy injuries often associated with large soft defects, extensive soft tissue stripping and contamination requiring multiple debridement procedures. Collective ortho-plastic approach helps us achieve proper debridement, adequate fixation and early soft tissue coverage. Due to fairly high incidence of failure, steep learning curve, time consuming procedure and the cost of treatment for those tedious free flaps, non-microvascular flaps are being preferred to cover the soft tissue defects or exposed hardware in open tibia fractures. Materials and Methods: A prospective study was carried out in 19 patients to assess the outcome of soft tissue coverage in open tibia fractures with non-microvascular flap. Out of these patients, 6 patients were treated with medial gastrocnemius flap, 5 patients with medial hemi-soleus, 5 patients with reverse sural fasciocutaneous flap, and 3 patients with local rotational random flaps. Outcome measures included bony union, deep surgical infection and flap failure. Results: 84% patients were male whereas 16% patients were female. Road traffic accident was the major cause of the defect among the patients (74%). Complications in the form of deep infection (10%), non-union (21%), delayed union (10%) and marginal flap necrosis (21%) were observed. Conclusion: In our study, early soft tissue coverage with appropriate non-microvascular flaps in management of severe open fractures of tibia was associated with more favourable outcomes.