As one-third of the tibial surface is subcutaneous throughout its length, open fractures are commonly encountered in this bone. The factors which determine the outcome of these fractures are severity of the injury, indicated by the degree of initial displacement, comminution and soft tissue injury and the damage to the tibial blood supply. In open fractures not only is the endosteal circulation disrupted but also the periosteal circulation, because of periosteal stripping. The various available options of treatment such as conservative short leg or long leg casting, open reduction and internal fixation with plates and screws, intramedullary fixation (Including Ender pins, Intramedullary nails and Interlocking Intramedullary nails with reaming or without reaming) and external fixation techniques have their own advantages and disadvantages. The present study was conducted in the Department of Orthopaedics, Gandhi Hospital, during the period from October 2013 to November 2015, to evaluate the results of internal fixation with interlocking intramedullary nailing without reaming in the treatment of the open fractures of tibia. In our study, we got 91% good-to-excellent results evaluated by Johner and Wruh criteria. We opine that closed unreamed interlocking intramedullary nailing yields good-to-excellent results in compound diaphyseal fractures of the tibia, as this technique allows a good control over the rotations with axial stability of the fracture, thus maintaining the length of the limb and enabling early joint motion. The endosteal blood supply is also well preserved. These factors help in lowering the rates of infection, malunions and non-unions.

With the increased incidence of road traffic accidents and industrial trauma, there has been a significant increase in the number of thoraco-lumbar spinal injuries. Decompression and early fusion with instrumentation is a generally accepted treatment method for patients with unstable injuries and with a neurological deficit; it helps in early mobilization, and avoids the complications of prolonged recumbency. The pedicle screw-rod system is versatile in that it stabilizes the three columns of the spine. The pedicle is the strongest part of the vertebra and is the force nucleus of the vertebral body. Through the pedicle all forces are transmitted from posterior elements to the vertebral body. Therefore, by fixation of the vertebral body through the pedicle, significant strength of the entire vertebral complex is possible. In our study we operated on 28 patients of unstable thoraco-lumbar injuries, where we performed Moss-Miami instrumentation (pedicular screw rod fixation). All the cases were followed up for a minimum of one year. In all these cases we had favorable results. There was a reduction of an average pre-op kyphotic angle of 15.8º to an average post-op kyphotic angle of 6.6º. We also noted significant neurological improvement as assessed by Frankel grading. In this study, we found that the transpedicular fixation with screws and rods system is effective in the treatment of unstable thoracolumbar spinal injuries. Although the prognosis of the neurological injury seems to be largely determined at the time of trauma, surgical decompression will definitely improve the neurologic deficit in incomplete cord injuries. Cases where there is complete neurologic deficit with no hope for recovery, will also be benefited from surgical fixation in terms of early mobilization and rehabilitation.

BACKGROUND Supracondylar humerus fracture is the most serious paediatric skeletal injury of elbow in children. Supracondylar fracture of humerus leads to many complications due to the intrinsic fracture instability, close proximity of the brachial artery, three main upper extremity nerves, poor radiographs, contradictory perception of reduction and reduction management modalities and, lastly, patient compliance with care. The aim of this research is to determine the short-term outcomes of closed and open reduction and Kirschner wire fixation in childhood Gartland type III supracondylar humerus fracture. METHODS It is a comparative case series of 2 years duration conducted among 30 patients with supracondylar humerus fracture who were admitted and treated at the Department of Orthopaedics. Closed reduction was handled in 15 out of 30 patients, with the remaining 15 patients being treated by open reduction. The outcomes are calculated on the basis of the Flynn scale, which is based on change in the carrying angle and loss of motion after treatment. RESULTS Males (56.66 %) were more affected than females; left side (66.67 %) was more affected than the right side; fractures of type III were more common. 26 patients stayed in a sufficient range of motion, 4 patients had insufficient motion with a loss of more than 100, of which 3 were treated with a closed reduction and 1 with an open reduction. Twenty-six (86.66 %) of the 30 patients showed good to excellent results and four (13.33 %) showed mediocre to poor results. Of the four cases, one was handled with a closed reduction and three were handled with an open reduction. CONCLUSIONS We conclude that open reduction and K-wire fastening without triceps is a treatment option for displaced supracondylar humerus fractures. KEYWORDS Supracondylar Fracture, Humerus Fracture