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Proximal humerus fractures account for 4-5% of all fractures. Traditionally, the surgical treatment options for fractures of proximal humerus includes transosseous suture fixation, intramedullary nailing, plate-and-screw constructs and percutaneous pinning. The ideal treatment of displaced proximal humeral fracture is still the centre of scientific debate. The use of external fixators in the management of proximal humeral fractures has begun to gain acceptance over the last 10 years. The idea of biological fixation now leads to the fact that the blood supply to the head of the humerus is preserved. The smaller K-wires used in JESS have lesser risk of soft tissue, neural, and vascular injury. Multiple K-wires used add to the rotational stability to a reduced fracture. We hereby present our clinical experience in treating 18 such patients over a period of4 Years and 9 months by JESS. We used a novel frame structure as compared to those described elsewhere. The mean Constant -Murley score was 81 in our series. Overall, the results could be regarded as good. In our view, JESS should be considered as an alternative option in treating Neer's 2 part, 3 part and 4 part valgus impacted fractures with minimal complications and good results.

BACKGROUND: Intraarticular displaced distal humerus fractures in adults always require open reduction and internal fixation with some plate and screw osteosynthesis after accurate reduction and alignment of fracture fragments. But high velocity trauma or gunshot injuries often lead to a compound fracture with contamination and devitalization of soft tissue cover which requires some kind of external fixation. We thereby report the outcome of a series of ten patients who were treated definitively by extensive debridement and JESS type external fixation. This external fixator construct gave excellent fracture fragment stability and early mobilization of elbow joint. It provided patient friendly definitive fixation assembly resulting in early fracture consolidation with reasonably good range of elbow movement for such difficult fractures. MATERIAL AND METHODS: Ten cases of compound intercondylar distal humerus fracture between January 2007 to December 2011were treated by early debridement & uniplanar bilateral JESS fixator application at the same sitting. This study includes cases of age group 18-65 yrs. of which 3 were females & 7 were males. Mean age was 31.5yr. Only one case had injury to elbow with Gunshot injury & rest were of high energy road traffic accidents. All patients reported within 40 hrs. average time to emergency department except 2 cases. A case of Gunshot injury reported after 5 days & one case reported after 7day with pus discharge wound. According to A.O. Classification, 4 cases with C 3 type& 6 were C 2 type. All cases were operated within a mean of 8.7hrs of presenting to the emergency department. The average interval between injury & operation was 48.7 hrs. RESULTS: Complete painless supination pronation movement was achieved in six weeks At the end of six months of aggressive physiotherapy, the average extension was 9 degrees (range = 5-15 degrees) and average flexion was 106 degrees (range = 70-120 degrees). Clinical evaluation of elbow functions was done at sixth month using Mayo elbow score where 20% excellent, 60% good, 10%fair and10% poor results were obtained. CONCLUSION: This is a relatively new technique of fixing compound intra-articular distal humerus fractures with JESS external fixator without spanning and immobilizing elbow joint has given good results, good patient compliance, least complications in our series of ten cases.

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Any overview of the treatment of venous disease should begin with a brief examination of its history. From the first rudimentary attempt at venous thrombectomy in the early 1920s to the evolution of percutaneous and mechanical thrombectomy and endovascular stents in the 21st century. It is the aim of this review to provide a comprehensive summary of the state of the art of venous disease treatment at the turn of the new century.