Background: Fractures of radius and ulna are amongst the leading injuries in upper extremity in geriatric age group. Associated rotational instability of forearm bones in such fractures renders them suitable for operative fixation. Non-the less conservative management has also been employed in such injuries. We conducted this study to analyze and compare the outcomes of using Locking plate and Non-locking plates for internal fixation in geriatric population for distal 1/3 rd shaft radius and ulna fractures in terms of fracture union, range of motion and functional outcome. Methods: Aprospective study of 20 patients with distal third radius and ulna fracture was conducted with 10 patients managed with locking 3.5 mm Dynamic Compression Plate and 10 with non-locking 3.5 mm Dynamic Compression Plate. All patients with extra-articular fractures were selected for this study and were randomly chosen for each procedure. They were followed up regularly at 3 weeks, 6 weeks and 12 weeks for time of union, wrist flexion, elbow flexion, supination, pronation and functional outcome. Results: There were a total of 13 males and 7 females. Mean time for radiological union was 5.8 weeks for Locking plate, 8 weeks for non-locking plate. Mean Flexion/Extension at elbow was 134 o /140 o for locking plate, 132 o /139 o for non-locking plate. Average supination/pronation was 61 o /66.4 o for locking plate, 57 o /61.8 o for non-locking plate. Mean duration for surgery was 75.25 minutes for locking plate, 75.70 minutes for non-locking plate. Conclusion: Open reduction and internal fixation with locking plating can be considered as the treatment of choice when considering fixation of distal third Radius and Ulna fractures in geriatric age group.

The floating elbow is an uncommon grievance. It consists of a fracture of the humerus and one or both bones of the homolateral proximal forearm [1] . We present a composite pattern of floating injury, which included distal humerus fracture with intraarticular extension of the humerus and associated ipsilateral proximal fracture of radius and ulna. Pleasing outcomes were finally gained after operative management and early physiotherapy. This clinical case exemplifies the importance of judiciously assessing floating elbow injuries when they occur to improve the surgical strategies and the adequate timing of the treatment to obtain optimal results.

Introduction: Role of epidural analgesia is well established in the literature and practice. Epidural anaesthesia is a very common procedure of anaesthesia for induction of lower limb orthopaedic cases. Considering the intra-articular fractures of the knee, they are one of the most common fractures associated with knee stiffness. Even after an adequate and rigid fracture fixation early rehabilitation is necessary to drastically improve the outcome and reduce stiffness. Hence, epidural analgesia through a lumbar epidural catheter is the most commonly used protocol in top up after surgery for post-operative analgesia. The aim of this study is to evaluate whether this method of post-operative analgesia can be helpful in improving rehabilitation after peri-articular knee injuries. Methodology: This is a prospective study. A total of 40 patients with peri-articular of distal femur and proximal tibia were included in the study. Patients were randomised into 2 groups. Group A was given spinal anaesthesia for surgery and Group B was given combined spinal plus epidural anaesthesia with a lumbar epidural catheter. Site chosen was L1-L2 /L2-L3 for epidural analgesia and site for spinal analgesia was L3-L4 was used (in case of combined spinal epidural).Post operatively knee ROM was initiated on day 1 in both the groups. Total knee ROM was recorded on Day 2, Day 10, Day 42 (6 weeks) and Day 90 (3 months). Assessment of knee ROM was done by a single observer who was blinded for the groups. Results: A total of 40 patients were included in this study, out of which 9 were female and 31 were males. Mean knee range of motion for group A was 20 degrees on day 2, 45 degrees at Day 10, 90 degrees at 6 weeks and 120 degrees at 3 months whereas the mean knee range of motion for group B was 40 degrees on day 2, 70 degrees at Day 10, 110 degrees at 6 weeks and 130 degrees at 3 months. Conclusion: Peri-articular knee fractures are a common cause of limitation in knee function despite proper surgery which can be due to inadequate rehabilitation. To address this problem, it is important to give a pain-free post-operative period to the patient to develop and initiate proper post-operative rehabilitation. This can be achieved by performing peri-articular fracture fixations using Epidural anaesthesia through which post-operative analgesia can be continued in a more effective manner which also increases overall outcome of the patient.