Introduction: Fracture clavicle used to be treated conservatively. But, risk of mal-union and shoulder dysfunction has raised many concerns regarding this way of treatment. Operative treatment for clavicle fracture gained popularity recently for displaced fracture clavicle. So, in our study we compared between the two methods of treatment. Patients and methods: We conducted a prospective study for all adult patient presented to our hospital with unstable fracture clavicle from August 2016 to September 2017. Patients were divided in two groups A and B, with exclusion of poly-trauma patients. Group A treated conservatively and group B treated by open reduction and internal fixation with plate and screws on the superior surface of the clavicle. The patients were followed up and assessed by constant shoulder score. Results: The study included 20 patients in two group 10 patient for each group. The demographic data in both groups showed no significant differences. Follow up was 6.2 and 7.3 months in both groups respectively. Union occurred in 5.8 and 5.3 months in both groups respectively. The difference was insignificant for follow up and union; p value> 0.05. Functional outcome was excellent in 8 and good in 2 in group A, and excellent in 6, good in 4 in group B. This difference was found to be significant, p value ˂ 0.05. Conclusion: From our study and supported by others we recommend that conservative treatment should be the first choice for most patients and operative fixation to be reserved for selected cases.

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Background: Tibial shaft fracture is an incapacitating pediatric injury. The treatment has traditionally been age-related, influenced by the type of injury, associated injuries and the location and type of the fracture. To a great extent, treatment options vary according to the surgeon's preference. Objective: The aim of the present study was to evaluate the results of treatment of displaced diaphyseal fractures of the tibia in children aged between5 and 15 years by closed reduction and percutaneous flexible intramedullary nailing. Patients and methods: A total of 18 patients were included in the study; they were admitted to the hospital suffering from tibial shaft fractures. On admission all patients were assessed by history taking, clinical examination and radiological evaluation. Results: The mean age was 10.22 (SD 1.99) years. Only 5 (27.8%) patients were girls, while 13 (72.2%) patients were boys. The mechanism of trauma in the patients was road traffic accidents in 15 (83.3%) patients and falling from height in 3 (16.7%) patients. Radiographic angulation occurred in 1 patient had varus malalignment (more than 5 and less than 10°). Limb-length inequality is less than 1 cm in all cases. The final results obtained were excellent in 15 (83.3%) patients and satisfactory in 3 (16.7%) patients. There was no statistically significant difference found between two reduction methods (opened and closed) regarding malalignment, complications and score flynn. Conclusion: Flexible intramedullary nailing is a relatively simple and effective way to stabilize open and closed fractures of diaphyseal tibial fractures in the six to twelve years age group with few complications, allowing early mobilization and excellent functional outcome. The procedure has low morbidity and good results with short hospitalization.

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