BACKGROUND Tibia is the major weight bearing bone of the leg. It is the most commonly fractured long bone in the body with an annual incidence of Tibial shaft Fractures is two per 1000 individuals. Tibial fractures can cause a long morbidity and extensive disability unless treatment is appropriate. We wanted to assess extraarticular distal tibial fractures and compare the two surgical modalities of treatment i.e.; intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPPO). We also wanted to compare the clinical, radiological and functional outcome of these modalities of treatment. METHODS This is a prospective study conducted among 40 patients in the age group of 20-70 yrs., of both sexes taken up for intramedullary nailing/ MIPPO at Rajarajeswari Medical College and Hospital, Bangalore. Age group ranged from 22 to 62 years with majority of patients having RTA (77.5%). Duration of hospital stay in majority was about 10 days and IMN for 7 days. Union time in weeks for MIPPO group was about 20 weeks and in Intra Medullary Nailing group was about 18 weeks. Both intramedullary nailing and plating by MIPPO are the optimal methods of treatment in extra articular distal tibia fractures with no significant differences between union and complication rates. MIPPO is usually preferred in fractures which are within the AO muller square whereas IMN is preferred in fractures which are above it. RESULTS In MIPPO group, mode of injury was RTA in 70% and self-fall in 30% and in Intra Medullary Nailing group, mode of injury was RTA in 85% and self-fall in 15%. There was no significant difference in mode of injury between the two groups. In MIPPO group, 5% had Gustilo Anderson Grade 1 and in Intra Medullary Nailing group 10% had Gustilo Anderson Grade 1. There was no significant difference in Gustilo Anderson Grade 1 between the two groups. CONCLUSIONS Both intramedullary nailing and plating by MIPPO are the optimal methods of treatment in extraarticular distal tibia fractures with no significant difference between union and complication rates. MIPPO is usually preferred in fractures which are within the AO muller square whereas IMN is preferred in fractures which are above it.

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BACKGROUND AND OBJECTIVE: Tibial plateau fractures are one of the commonest intra-articular fractures. It results from indirect coronal or direct axial compressive forces. It comprises of 1% of all fractures. These fractures encompass many and varied fracture configurations that involve medial, lateral or both plateaus with many degrees of articular depressions and displacements. Being one of the major weight bearing joints of the body, fractures around it will be of paramount importance. METHODS: 30 cases of tibial plateau fractures treated by various modalities were studied from September 2009 to september 2011 at Kempegoda Institute of Medical Sciences and followed for minimum of 6 months. RESULTS: The selected patients evaluated thoroughly clinically and radiologically, after the relevant lab investigations, were taken for surgery. The indicated fractures treated as per the SCHATZKER'S types, accordingly with CRIF with percutaneous cannulated cancellous screws, MIPPO with LCP/ Butress plate and screw, ORIF with buttress plate/ LCP and screw. Early range of motion started soon after the surgery. No weight bearing upto 6 weeks. The full weight bearing deferred until 12 weeks or complete fracture union. Immobilization in insecurely fixed fractures continued for 3-6 weeks by POP cast. The knee range of motion was excellent to very good, gait and weight bearing after complete union was satisfactory. Infection in two cases and stiffness in 2 cases were seen and there was no non-union in our cases. CONCLUSION: Surgical management of tibial condylar fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early motion, hence to achieve optimal knee function and reducing post-traumatic osteo arthritis.

ABSTRACT:In the last two decades, there was an increased interest in the operative treatment of pediatric fractures, although debate persisted over its indications. There is a little disagreement concerning the treatment of long bone fractures in children less than 6 years (POP cast) and adolescents, older than 16 years (locked intramedullary nailing).

INTRODUCTION:The term "Spondylolisthesis" refers to a condition where one of the vertebrae (usually L5) becomes misaligned anteriorly (slips forward) in relation to the vertebra below. This forward slippage is caused by a problem or defect within the pars interarticularis. Occasionally, facet joint and/or posterior neural arch defects may also cause this syndrome as well. We encountered 3 cases of two levels spondylolisthesis, a case series rarely documented. CASE REPORTS: Patient, Kanthaiah 5yrs male, presented with low backache radiating to left lower limb associated with tingling and numbness sensations. X-rays showed spondylolisthesis L4-L5-S1. MRI showed left sided nerve root compression and myelogram showed cut off at L4-L5, L5-S1. Patient had left sided deficits and so the patient was operated and post operatively improved clinically and was followed up regularly. Another patient Muniyamma, 68 yrs female, presented to our hospital 10 yrs back with two levels spondylolisthesis. In a outside hospital, posterior spinal decompression and interbody fusion was done without stabilization at only one level (L4-L5). On subsequent follow up the other level (L5-S1) worsened. Right now patient is not willing for any surgical intervention so we are managing with conservative treatment. Our third patient, Geetha 42yrs female, presented to our hospital with two levels spondylolisthesis, grade 2 at L3-L4 and L4-L5 levels. Patient was operated and has improved clinically. CONCLUSION: Incidence of spondylolisthesis is 3% to 6%. Multilevel spondylolisthesis is rarely documented in literature. This case series is being reported because of the rare documentation.