Introduction: Proximal humeral fracture pattern varies based on the mechanism of injury and the patient's age at the time of the injury. The purpose of this study was to prove short-term clinical and radiographic results of closed reduction and percutaneous pinning in displaced proximal humeral fractures in pediatric patients. Materials and Methods:We conducted this prospective study in Govt. Bone and Joint Hospital Barzulla an associated Hospital of Govt. Medical College Srinagar. A total of 18 paediatric patients with proximal humeral fractures were enrolled in this study between July 2019 and June 2022. The mean age of the study population was 10.98 (range 7-15) years. Results: Average time to union was 5 and a half week with a range from 4 and a half to 6 and a half weeks. Average time to pin removal was 5 (range 4-6) weeks. As per Constant-Murley scoring criteria 13 (72.22%) patients were excellent, 3 (16.67%) were good and 2 (11.11%) were fair. Among 18 patients, 16 (88.89%) had no pain at the end of the follow-up. 13 (72.22%) patients had active flexion above 150 0 . There were 15 patients with full muscle strength. In this study superficial wound infection was seen in 3 (16.67%) patients which subsided with oral antibiotics. In 1 (5.56%) patient of stiffness physiotherapy was done and achieved good result. 14 (77.78%) patients showed no complications. Conclusion: Closed reduction and percutaneous pinning gives more stability for the severely displaced proximal humeral fractures with rotational or angular instability in paediatric population.

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Introduction: Awake fiberoptic intubation (AFOI) under sedation and local anaesthesia is gold standard in anticipated difficult airway scenarios. Various drugs are used to achieve conscious sedation with adequate analgesia such as propofol, fentanyl, nalbuphine and midazolam. In this study, we compared the analgesic and sedative effects of fentanyl and midazolam with nalbuphine and midazolam in patients undergoing AFOI using spray as you go method. Materials and Methods: 60 patients between the age of 18 and 60yrs of either sex, scheduled for elective surgery were included after taking written informed consent. Premedication with Inj. Glycopyrrolate 0.2 mg i.m. 30 mins before and Inj. Midazolam 1 mg i.v. 15 mins before the procedure was given. Then patients were randomly divided into 2 groups. Group N (n=30) received inj. nalbuphine 0.2 mg/kg i.v. and group B (n=30) received inj. fentanyl 2 mcg/kg i.v., both 5 mins prior to the introduction of fiberscope. The nasotracheal fiberoptic intubation was carried out using spray as you go technique. Level of sedation, intubation score and VAS score were observed along with patient comfort score. Results: Group F patients had better sedation score (P=0.328), VAS score (P=0.184), significantly better intubation score (P=0.00), intubation time (0.00) and patient comfort score (P=0.05). Hemodynamics (heart rate, systolic blood pressure, diastolic blood pressure) were significantly better in group F. Conclusion: Fentanyl-midazolam combination for awake fibreoptic intubation using spray as you go technique, provided better sedation and analgesia, obtunded airway reflexes and minimized pressor response to awake fibreoptic intubation and provided better patient comfort.