The management of unstable intertrochanteric fractures in elderly is challenging because of difficult anatomical reduction, poor bone quality, and sometimes a need to protect the fracture from stresses of weight bearing and the need for early mobilization. Internal fixation in these cases usually involves prolonged bed rest or limited ambulation, to prevent implant failure. This might result in higher chances of complications like pulmonary embolism, deep vein thrombosis, pneumonia, and decubitus ulcer. The purpose of this study to compare the results of trochanteric fixation nailing (TFN) and hip hemiarthroplasty in unstable intertrochanteric femur fractures in elderly patients. Out of 50 patients with unstable intertrochanteric fractures 25 patients were treated with primary cemented bipolar hemiarthroplasty and 25 were treated with trochanteric femoral nail. Follow up was done post operatively at 1 months, 3 months, 6 months. At each follow up visit patients were evaluated radiologically and clinically. Functional outcome was evaluated by Harris hip score. Out of 25 patients operated by hemiarthroplsty, 3 patients had excellent results and 12 patients had good results whereas 9 patients had fair and one patient had poor results. Out of 25 patients operated with TFN, one had excellent results and 8 patients had good results whereas 10 patients had fair and 6 had poor results. Two hemiarthroplasty patients and one TFN patient developed superficial infection whereas one dislocation was also observed in hemiarthroplasty patient. Screw cut out from head was seen in one TFN patient and one TFN patient also developed pulmonary embolism. The cornerstone of management of such fractures is early surgery, followed by mobilization. Hence Cemented bipolar hemiarthroplasty offers a modality of treatment that provides adequate fixation and early mobilization in these patients thus preventing postoperative complications such as pressure sores, chest infection and DVT, as compared to TFN where there was more chance of complication due to prolonged immobilization.

Fractures involving the ankle are one of the most common injuries treated by orthopedic surgeons. The anatomy of the joint makes it very unstable in cases of fractures or ligamentous injuries of the ankle. As fractures of the ankle have been treated with various modes of internal fixation devices, the best possible implant is determined according to the anatomy of the fracture. Various internal fixation devices like interfragmentary screw, reconstruction plate, tubular plate have been used for lateral malleolus fracture. We studied the use of fibula hook plate for lateral malleolus fracture. Total 40 patients were studied and were followed up post-operatively after 3 months, 6 months and 12 months. The fractures were classified according to the Lauge-Hansen classification system. Ankle score for symptom evaluation of ankle fracture by C. Olerud and H. Molander was calculated. Radiological evaluation was done by Kristenson's criteria. Out of 40 patients, 10 patients had excellent outcome and 19 patients had good outcome. Eight patients showed fair results whereas three patients had poor results. No intra-operative complication was observed. Post-operatively six patients developed skin infection. Anatomical reduction of ankle fractures is very important for normal weight bearing stress. The length of fibula must be maintained for this purpose. Hook plate helps to achieve this by holding the reduction of lateral malleolar fragment.

The management of comminuted intertrochanteric fractures in elderly is challenging because of difficult anatomical reduction, poor bone quality, and sometimes a need to protect the fracture from stresses of weight bearing and the need for early mobilization. Internal fixation in these cases usually involves prolonged bed rest or limited ambulation, to prevent implant failure. This might result in higher chances of complications like pulmonary embolism, deep vein thrombosis, pneumonia, and decubitus ulcer. The purpose of this study is to analyze the role of primary cemented bipolar hemiarthroplasty in cases of comminuted intertrochanteric femur fractures. Fifty patients with comminuted intertrochanteric fractures were treated with primary cemented bipolar hemiarthroplasty. There were 31 females and 19 males with a mean age of 73.98 years (range, 65-89 years). The average surgery time was 101.86 mins (rang, 80-120 min). The patients walked on an average 4 days after surgery (range, 1-21 days). One patient had superficial skin infection and one had bed sore with no other significant postoperative complications. One case had DVT which was managed by close monitoring and conservative management in ICU setup. One patient had pulmonary embolism as result of cementing which was managed by intensive care in ICU setup. Eventually all patients recovered well and progressed to full weight bearing. A total of 48 out of 50 patients (96%) had excellent to fair functional results and 2 had poor result with respect to the Harris hip score (67-93) at the end of 6 months. Cemented bipolar hemiarthroplasty for comminuted intertrochanteric fractures in elderly patients results in early ambulation and good functional results.