Introduction: Successful outcome in the treatment of intertrochanteric fracture in elderly lies in early mobilization of the patient so as to avoid the morbidity, complications and poor recovery. With the associated medical comorbidities and osteoporosis, presents a great challenge in selecting the surgical procedures in these patients. Even though the primary choice of surgery revolves around Osteosynthesis in these type of fractures, there is a conspiracy in the choice of implants for the fractures. Many surgeons have resorted to primary hemiarthroplasty in these fractures to avoid uncertainties and implant failures and able to allow full weight bearing walking after surgery. Off late PFNA2 nail have been preferably used to stabilize these fractures with relatively lesser complications and early mobilization of these patients. The purpose of this study is to compare the outcome of PFNA2 and hemiarthroplasty and to study advantages, disadvantages, complications of both the groups. Materials and Methods: 20 patients each were included in PFNA2 group and hemiarthroplasty group from May 2017 to August 2018 who satisfied the inclusion and exclusion criteria. Patient followed up upto 1 year. Patients were evaluated with multiple variables, complications and Harris hip score. Results: PFNA groups had significantly less blood loss, less surgery time, less hospital stay as compared to hemiarthroplasty group. Both groups had similar medical and Orthopaedic complications. PFNA patients can be mobilised early as with hemiarthroplasty group. Hemiarthroplasty groups have better Harris hip score in initial 3 months but similar score at the end of 1 year. Conclusion: PFNA2 provide less morbidity to patients with early mobilisation and good functional outcome. It can definitely be a better option than replacement in elderly intertrochanteric fracture.

Unstable intertrochanteric fractures in elderly patients pose a challenge for treatment in view of coexistent medical problems and osteoporosis. Osteosynthesis in these group of patients often leads to implant failure and also does not allow early weight bearing. The objective of the present study is evaluate Arthroplasty as primary treatment of choice in these unstable intertrochanteric fractures in elderly. Methods: Between January 2013 to Feb 2016, 25 elderly patients with unstable intertrochanteric fractures who had undergone arthroplasties (Hemi/THR) were followed up. Their fractures were classified according to the AO/OTA classification and their osteoporosis was evaluated by Singh's index and graded accordingly. After optimization of medical problems and pre-anesthetic workup, Arthroplasty was performed in all patients and the outcomes analyzed using the Harris hip score system. Results: In these 25 patients, 17 were women, 8 were men and the mean age was 76 years (range, 68-88 years). At a mean follow-up of 1 year (range, 1-3 years), there were 18 excellent, 5 good, and 2 fair results according to the Harris hip score system. Conclusion:In select elderly patients with unstable intertrochanteric fractures arthroplasty has a role instead of Osteosynthesis which allows early pain free mobilization of patients, thereby avoiding revision surgeries, prolonged morbidity and uncertainty associated with Osteosynthesis.

Background: FDA Panel definition of nonunion ----"Established when a minimum of 9 months has elapsed since injury and fracture shows no visible progressive signs of healing for 3 months". Tibial nonunion is most frequently met while considering the other long bone nonunion. This is mostly due to increase in the number of tibial fractures both close and open and in high-speed Road Traffic Accident (RTA) injuries. Failure of union may be due to an inappropriate mechanical environment or infection and in some cases, there is no apparent reason. The Ilizarov method relies on distraction osteogenesis and is used not only for segmental defects, but also to complex malalignment with minimal surgery. Ilizarov technique has the additional advantage of efficient fixation, early ambulation, elimination of bone grafting with minimal complications. Ilizarov provides stability and at the same time allow micro movements with axial loading with neo vascularization due to distraction, giving an excellent biological environment for fracture healing. Methods: Sample size of twenty (20) patients fulfilling the inclusion criteria admitted to Department of Orthopaedics, Chettinad Hospital and Research Centre, Kelambakkam. Study period from to November 2020.

To study and evaluate the clinical and radiological outcome of open reduction and volar locking plate fixation in AO Type 23B3 fracture of the distal end of radius. Method: 20 patients operated for AO Type 23B3 fracture of the distal end of radius were prospectively studied and the functional outcome were assessed using the Gartland-Werley functional scoring system. Result: The overall anatomical result using the criteria of sarmiento's modification of lidstrom's classification was fourteen patients (70%) with excellent results, four patients (20%) with good result and two patients with fair results (10%). Based on the functional criteria as described by Gartland and Werley the overall functional results were excellent in twelve patients (60%), good in 6 patient (30%) and fair in two patients (10%). In the present series grip strength was good in eighteen patients (90%) fair in two patients (10%). There were two patients (10%) with complications and eighteen patients (90%) who had no complications. Conclusion: AO Type 23B3 fracture of the distal end of radius has excellent outcome with volar locking plate fixation, which allows for a anatomical reduction and early mobilization. This improves the wrist function and final outcome significantly.

No abstract