Introduction:The best treatment for trochanteric fracture remains controversial Many methods have been recommended. Stable fixation that allows early mobilization is the treatment of choice. In this study, we aimed to compare the results of osteosynthesis using the PFNA and DHS system, in the treatment of stable intertrochanteric fractures including operative and postoperative complications, general complications and final outcome measurements. Method: We randomised 60 patients with low-energy extracapsular pertrochanteric stable femoral fractures (AO category 31-A1.1-31A.2.1)7 to be treated with the dynamic hip screw or the proximal femoral nail A2. All fractures were categorised according to the AO/ASIF classification. Follow-up reviews were undertaken at four weeks, three and six months post-operatively using Harris hip score. Results: From the first to the 6 th month, there was a significant improvement in Harris hip score (p<0.05), when each time point was compared with the previous one in both groups. On 3 -month followup, PFNA2 group had significantly better daily functioning than DHS group, as defined by Harris hip score. At 6 months, the PFNA2 group approached but did not normalise to its pre-operative Harris hip screw values (p =0.043). In contrast, DHS group values at 6 months lagged significantly to pre-operative values (p<0.001) PFNA group has fewer complications compared to DHS group. Conclusion: PFNA can benefit peritrochaneric fractures with less blood loss, earlier mobilization, better functional outcome and fewer complication compared to DHS.

Introduction: The concept of treating displaced, middle third fractures of clavicle by open reduction and stable fixation thereby restoring the clavicular length is gaining more and more acceptance amongst trauma surgeons. The aim of our study was to analyze the clinical outcome of internal fixation of middle third clavicle fracture by anatomical pre-contoured plate. Method: 125 patients with isolated displaced middle third clavicle fractures were treated by open reduction and anatomical pre-contoured locking compression plate and followed prospectively till six months after union. All patients were assessed radiologically, clinically and according to disability of arm, shoulder and hand scoring system (DASH). Results: Average time of union was 8 weeks. Union rate in our study was 97.6%. Most of the patients returned to pre-injury working status by the end of 10 weeks. Average DASH score at the end of 6 months was 12. Conclusion: Superiorly placed anatomical pre-contoured locking plate for operative treatment of displaced middle third fractures is a safe and effective option with early return to pre injury working level and at the same time avoiding potential complications of delayed union, non-union and mal-union.Keywords: clavicle fracture, non-union, mal-union, anatomical clavicle plate Introduction Clavicle fractures are common due to indirect mechanism being fall on an out-stretched hand, accounting for upto 2.6% to 10% of all fractures and upto 44.1% of the fractures involving upper girdle [1] . Fractures of middle third account for approximately 80% of all clavicular injuries. Traditionally, these fractures have been managed non-operatively, even when substantially displaced [2] , with good to excellent results [3, 4] . The limitations of conservatively treated fractures are increased risk of non-union and mal-union resulting in altered biomechanics of upper girdle, cosmetic dissatisfaction and upper extremity weakness [5][6][7][8] . These factors have caused a gradual shift towards surgical treatment of this fracture [7, 9] . Many devices have been described for treatment by internal fixation that included circlage wires, Steinmann pins, Kirschner wires, Knowel's pins, Rush rods, Recon plates etc [10][11][12] . The proponents who favor ORIF in these fractures emphasize on early and accurate reduction achieving clavicular length resulting in quicker pain relief and early functional recovery. As the consensus for operative treatment picks-up, recent studies show lower incidence of nonunion and mal-union rates and early return to work compared to conservative treatment

Introduction: Intra-articular fractures of calcaneum pose a challenge for all orthopaedic surgeons due to different treatment options and their varied eventual functional outcome. The aim of this study is to evaluate the medium term outcome of open reduction and internal fixation by extensile lateral approach using low profile anatomical locking calcaneal plate. Method: 44 cases of intra-articular fracture calcaneum in 40 patients were included in this study. These were classified based on Sanders classification system. Open reduction and internal fixation was done using extensile lateral approach and anatomical locking calcaneal plate. Functional outcome was assessed using the Creighton-Nebraska scoring system at the end of six months. Results: Excellent result was seen in 69% cases, Good result in 13% cases, Fair and Poor results were seen in 9% cases each. Bilateral fractures showed poorer results compared to unilateral fractures. Associated injuries had a direct bearing on the eventual functional rehabilitation. Average union time was 12 weeks. Most of the patients could return to pre-injury work status by the end of six months. Conclusion: Immediate, appropriate post-traumatic soft tissue care can probably decrease the incidence of potential wound problems. Extensile lateral approach provides excellent visualization and reduction of displaced intra-articular fragments. Anatomical calcaneal plate provides stable fixation. Role of bone grafting needs further evaluation in a larger population study.

Introduction: Encouraged by the distinct advantages of minimally invasive plate osteosynthesis technique for treatment of peri-articular fractures of long bones, we have extended the concept for treatment of distal radius fractures. The aim of our study was to evaluate the clinical and functional outcome of MIPO technique for distal radius fractures. Method: Thirty patients with isolated Frkyman's type I to IV fractures of distal radius were treated using minimally invasive approach of proximal vertical and distal transverse incision and fixed with volar locking plate and followed till six months post operatively. Final assessment was done using Mayo wrist scoring system at the end of six months. Results: Based on Mayo wrist scoring system 73% had excellent results and 27% had good results. All patients could return to pre-injury work status by 8 weeks. There were no cases of neuro-vascular injury or joint stiffness and cosmetic acceptance of barely visible scar was very satisfactory. Conclusion: Fixation of extra-articular distal radius fractures and minimally displaced, stable intraarticular fractures by using minimally invasive approach appears to be encouraging, reliable and easily reproducible by all.

Introduction: Tibia shaft fractures can be treated with various modes, each having its merits and demerits. The aim of our study was to analyze clinical outcome of Ilizarov technique in patients with tibia shaft fracture. Method: 50 patients with isolated tibia shaft fracture treated with Ilizarov external fixator were followed prospectively for one year. Depending upon the level of fracture 4 or 5 rings were used. Weight bearing as per patient pain tolerance was allowed within 24 to 48 hours. The decision of frame removal was taken based on Ramos criteria. The function was evaluated based on Johner and Wruh's criteria. Results: According to Johner and Wruh's criteria, 34 patients had excellent, 12 patients had good and 4 patients had fair results. No poor results were noted. There was no case of re-operation and re-fracture. Pin-site infections were seen in 14% cases but there were no deep infections. Conclusion: Ilizarov technique can be used as an early definitive management in tibia shaft fractures with excellent clinical outcome.