No abstract

<p class="abstract"><strong>Background:</strong> The objective of this prospective study is to investigate the relationship between the functional outcome and the radiographic results of two-, three- and four part proximal humeral fractures treated with open reduction and fixation with PHILOS locking plate.</p><p class="abstract"><strong>Methods:</strong> 35 patients (30 males and 5 females) with displaced proximal humerus fracture were treated with PHILOS plating and studied prospectively. According to Neer’s classification there were 16 two part fracture (45%), 15 three part fracture (42%) and 4 four part fracture (13%). The healing of fracture, head shaft angle (HSA) and complications were evaluated radiologically with plain radiographs whereas the functional outcome was assessed by the Shoulder Pain and Disability Index (SPADI) at 6 weeks, 3 months, 6 months and 1 year after surgery.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study, patients treated with locking plates had mean forward flexion of 123°, abduction of 124°, mean external rotation of 30° and internal rotation 53° at 1 year follow-up. Maximum improvement in range of movement occurred between interval of 12 weeks to 24 weeks due to complete fracture union occurred approximately up to 12 weeks. The mean SPADI score at end of 1 year were 10.22, 10.38 and 10.20 for two, three and four part fractures respectively. Average postoperative and follow-up HSA's were 134.1±4.4 and 132.5±1.2 degrees, respectively. Varus progression was more prominent in patients with postoperative HSA &lt;130 (p&lt;0.001). Complications included impingement in 1 case, joint penetration by screw in 1 case, failure of fixation in 1 case and infection in 1 case.</p><p class="abstract"><strong>Conclusions:</strong> Fixed angle locked plate is an extremely useful implant for reconstruction and salvage of proximal humeral fractures. Precise surgical technique, stable fracture fixation and restoration of anatomical reduction are absolutely necessary for improved outcome.</p>

<p class="abstract"><strong>Background:</strong> Fractures of talus are one of the most difficult ones to treat owing to the problems of complicated fracture patterns, wound problems, risk of osteonecrosis etc. This study aims to evaluate the relation of the fracture type and wound with the functional outcome after open reduction and fixation.</p><p class="abstract"><strong>Methods:</strong> The study was conducted in Sir J. J. Group of Hospitals from June 2014 to March 2018. A consecutive series of 28 patients with displaced fractures of talus were selected after approval from ethical committee. All patients were operated and evaluated at average of 6 months after surgery.<strong></strong></p><p class="abstract"><strong>Results:</strong> The Hawkins score was used to evaluate the functional outcome. 60% of patients of type II gained good to very good score as compared to 40% of patients of type III and 30% of type IV. With increase in severity of the fracture, percentage of score decreased.</p><p><strong>Conclusions:</strong> Most precise method of restoring and maintaining the anatomy of talus fracture is open reduction and internal fixation to allow early motion. Surgery for displaced fractures consists of anatomically correct reconstruction to avoid articular surface incongruence and angular deformity as well as preservation and rapid restoration of talar blood supply. This will ensure early mobilization and satisfactory outcome. Open fractures have worse functional outcome than closed fractures owing to lower union rates, higher osteonecrosis rates and higher re-operation and infection rates. </p>