The floating elbow is an uncommon grievance. It consists of a fracture of the humerus and one or both bones of the homolateral proximal forearm [1] . We present a composite pattern of floating injury, which included distal humerus fracture with intraarticular extension of the humerus and associated ipsilateral proximal fracture of radius and ulna. Pleasing outcomes were finally gained after operative management and early physiotherapy. This clinical case exemplifies the importance of judiciously assessing floating elbow injuries when they occur to improve the surgical strategies and the adequate timing of the treatment to obtain optimal results.

Introduction: Role of epidural analgesia is well established in the literature and practice. Epidural anaesthesia is a very common procedure of anaesthesia for induction of lower limb orthopaedic cases. Considering the intra-articular fractures of the knee, they are one of the most common fractures associated with knee stiffness. Even after an adequate and rigid fracture fixation early rehabilitation is necessary to drastically improve the outcome and reduce stiffness. Hence, epidural analgesia through a lumbar epidural catheter is the most commonly used protocol in top up after surgery for post-operative analgesia. The aim of this study is to evaluate whether this method of post-operative analgesia can be helpful in improving rehabilitation after peri-articular knee injuries. Methodology: This is a prospective study. A total of 40 patients with peri-articular of distal femur and proximal tibia were included in the study. Patients were randomised into 2 groups. Group A was given spinal anaesthesia for surgery and Group B was given combined spinal plus epidural anaesthesia with a lumbar epidural catheter. Site chosen was L1-L2 /L2-L3 for epidural analgesia and site for spinal analgesia was L3-L4 was used (in case of combined spinal epidural).Post operatively knee ROM was initiated on day 1 in both the groups. Total knee ROM was recorded on Day 2, Day 10, Day 42 (6 weeks) and Day 90 (3 months). Assessment of knee ROM was done by a single observer who was blinded for the groups. Results: A total of 40 patients were included in this study, out of which 9 were female and 31 were males. Mean knee range of motion for group A was 20 degrees on day 2, 45 degrees at Day 10, 90 degrees at 6 weeks and 120 degrees at 3 months whereas the mean knee range of motion for group B was 40 degrees on day 2, 70 degrees at Day 10, 110 degrees at 6 weeks and 130 degrees at 3 months. Conclusion: Peri-articular knee fractures are a common cause of limitation in knee function despite proper surgery which can be due to inadequate rehabilitation. To address this problem, it is important to give a pain-free post-operative period to the patient to develop and initiate proper post-operative rehabilitation. This can be achieved by performing peri-articular fracture fixations using Epidural anaesthesia through which post-operative analgesia can be continued in a more effective manner which also increases overall outcome of the patient.

Fracture of the femoral head is a severe, relatively uncommon injury; typically, it may have associated with traumatic posterior dislocation of the hip joint with or without acetabulum fracture. The Pipkin classification is the most commonly used classification system. Controversies include the preferred surgical approach (anterior versus posterior) versus ganz safe surgical dislocation approach and whether to perform femoral head fragment excision or internal fixation. Presenting a case report of 28 years old young male with a motor vehicle road traffic accident and suffered a head of femur fracture on right hip joint with posterior wall of right acetabulum fracture with Judet-Letournel type posterior wall and type 4 Pipkin’s classification of femoral head fracture. This patient was undergone for emergency surgical intervention of open reduction, internal fixation through Ganz approach and insertion of Herbert screws for femoral head and interfragmentary screw for trochanteric osteotomy. The patient was followed up for 1 year and have a complete range of motion at hip joint with painless daily lifestyle. Type 4 Pipkin classification of femoral head fracture managed timely and with surgical intervention by ganz safe surgical dislocation approach provides visualization to femoral head and whole acetabulum with internal fixation of femur head by herbert screw which preserves normal anatomic contour of femoral head shows appropriate reduction of fracture fragments and it may also avoid hemiarthroplasty surgeries. Fracture of the femoral head has been associated with a relatively poor functional outcome and requires timely management and surgical intervention. Specially type 4 Pipkin classification of femoral head fracture treated by ganz safe surgical dislocation approach with internal fixation of femur head by herbert screw shows better outcome and avoid risk of AVN of femoral head. Complications associated with fracture of the femoral head and subsequent treatment include osteonecrosis, post-traumatic osteoarthritis, heterotopic ossification and implant failure.