Background: Fracture of the clavicle accounts for 5 to 10% of all fractures and almost half of the shoulder girdle injuries and70-80% of clavicular fractures are mid clavicular fractures. Most clavicular fractures are benign. Non operative treatment has been a mainstay of a modality of treatment, and irrespective of the type of fracture and amount of comminution, all these fractures were treated nonoperatively. Different surgical methods for clavicle midshaft fractures have been described and these are locking compression plate fixation, intramedullary K-wires, Steinmann pin fixation, and intramedullary nailing with TENS. Therefore in this study we have compared the functional outcome of displaced clavicle fractures treated by non-surgical management with that of surgical management by TENS and by open reduction and internal fixation with clavicular locking compression plate. Methodology: 30 Patients of age above 18 years having closed clavicular fracture who are admitted in DR. B.R. Ambedkar Medical College and Hospital, meeting the inclusion criteria are taken for study after obtaining their written informed consent. Patients were followed up for a period of 6 months at 1,6 and 24 weeks after surgery. In total 15 patients were operated and 15 patients were treated conservatively. Outcome was analysed in terms of radiological union and functional outcome of the patient. Results: Among 30 patients with clavicle fractures, majority of the injury occurred in male patients-21 cases (70%), whereas a total of 9 cases (30%) were seen in females. The functional outcome at the end of 6 months in 15 conservatively managed cases showed, 2 cases (13.3%) with excellent outcome, 3 cases (20%) had good outcome, 8 cases (53.3%) had fair and 2 cases (13.3%) had poor outcome. While in surgically managed 15 cases, the functional outcome at the end of 6months showed a total of 11(73.3%) cases with excellent outcome, 2 cases (13.3%) had good outcome, 1 cases (6.6%) had a fair, and 1case (6.67%) had poor outcome. At the end of 6 months, functional outcome of both the groups were compared and in our study operative group had fewer complications, early bony union and better functional outcome as compared to the conservative group. Conclusion:This study concludes that irrespective of surgical modalities of management used, surgically treated cases have better functional outcome, fewer complications, early bony union and better overall patient satisfaction.

Background: Femoral shaft fractures account for 1.6% of all pediatric bony injuries. Angulation, malrotation and shortening are not always corrected effectively by conservative methods. These also depend on fracture anatomy; stable (transverse and oblique) and unstable (spiral and communited). Fixation of femur fractures in children & adolescents by flexible intra-medullary nailing is becoming widely accepted because of the lower chance of iatrogenic infection and prohibitive cost of in-hospital traction and Spica cast care. The objective of our prospective study was to compare stable and unstable diaphyseal fractures of femur in children aged between 5-15 years by using Titanium Elastic Nailing System. Subjective and objective study of clinical parameters like pain, comfort to the patients, early mobilization, operative technique, radiological evaluation for union, stages of weight bearing till complete recovery and any associated complications by using the above mentioned methods. Methodology: Children and adolescents between the age group of 5-15 years with femoral shaft fractures who were admitted in Dr. B.R Ambedkar Medical College & Hospital meeting the inclusion criteria were selected. All patients underwent titanium elastic nailing for the femur fracture. Patients were followed up for a period of 6 months at 6, 12 and 24 weeks after surgery. 15 stable and 15 unstable fractures cases were studied. Results: The outcome in stable fracture was good where as in unstable fractures there were 3 angular deformities and 1 case of limb length discrepancy. Conclusion: Titanium elastic nails leads to rapid fracture union by preservation of fracture hematoma and limited soft tissue exposure. It also helps in preventing damage to the physis. A stable pediatric femoral diaphyseal fracture has very good results with minimal complications. Unstable pediatric femoral diaphyseal fractures though had good results in most cases but had angular deformities in 3 cases and 1 case developed limb shortening. According to our study it is better to use other operative techniques for severely unstable paediatric femoral diaphyseal fractures.

Background and Objectives: Intertrochanteric fractures is one of the most frequently operated injuries in the elderly. The incidence of these fractures increases with increasing age. Many studies show certain parameters have an adverse effect on functional outcome and quality of life in patients with intertrochanteric fractures treated surgically. However, very few studies have evaluated the outcome of patients treated surgically having comorbidities such as hypertension, diabetes mellitus, anaemia and asthma. Methods: We conducted a prospective observational study of 30 patients aged 65 years or above, with at least one comorbidity (hypertension, diabetes mellitus, anaemia, asthma and cardiac dysfunction) who underwent PFN for closed intertrochanteric fractures at our hospital. Radiographs were reviewed at 1, 3, and 6 months or till fracture union, whichever came first. Result: In our study, 33% of patients (10) belonged to ASA grade 2, 47% of patients ( 14) belonged to grade 3, and 20% of patients (6) belonged to grade 4. In our study, 14 patients (46.6%) had one comorbidity, while 16 patients (53.4%) had two or more comorbidities. Harris Hip Score at the end of 3 months was 73.8 and at the end of 6 months was 84.3. Five patients had excellent, 17 patients had good, 7 patients had fair, and 1 patient had a poor functional outcome. Using Cox Regression analysis for hazard ratio of poor post-surgical Hip scores, we found a significant correlation between functional outcome and age of surgery, number of comorbidities, anaemia and length of hospital stay. Conclusion: Proximal femoral nail is a good choice for internal fixation of intertrochanteric fractures. The comorbidities and their correction should be taken into consideration before and after the operative procedure.

Introduction: Proximal humeral fractures (PHFs) are the seventh most frequent fractures in adults [1]. Proximal Humerus Fractures constitute about 4% of all fractures and 26% of all humerus fractures [2] . Management of three-part and four-part fractures is still a challenge owing to associated complications including osteoporosis, angulation, unstable reduction, varus collapse, screw back out etc. Aim of our study was to assess the functional outcome proximal humerus fractures (Neers classification 2 part, 3 part and 4 part) treated with PHILOS (Proximal humeral internal locking system). Methods: Our study was a prospective study conducted at our institution from October 2018 to December 2019. The study group consisted of 30 patients including 6 female patients and 24 male patients. The Proximal humerus fractures were classified using Neer's classification system. Open reduction and internal fixation with a PHILOS plate was carried out on all the patients under general anesthesia. All patients underwent a similar post-operative physiotherapy. Functional parameters were assessed using Constant-Murley scoring system. Results: In our study, 14 (46.7%) cases showed Excellent outcomes, 9 (30%) showed good outcomes, 4 (13.3%) showed fair outcomes and 3 (10%) showed poor outcomes. The mean constant score was 78 in our study. Our study group had 7 (23.3%) cases of complications. The most common complication was varus malunion which was seen in 3 (10%) cases. Conclusion: PHILOS plate provides a high degree of angular and axial stability eliminating screw loosening and backout. The divergent and convergent orientation of the screws engaging in the humeral head prevent pull out and failure of fixation.