Introduction: In spite of vast advances in implants and operative techniques in the management of femoral diaphyseal fracture, treating a case of aseptic nonunion still poses a great challenge to treating surgeon. In India, the illiteracy of the patient and the false security of stable fixation with intramedullary rods often leads to premature weight bearing causing implant failure and nonunion. Material and methods: 13 patients aged 19 yrs -52 yrs with aseptic femoral diaphyseal nonunion with implant failure were treated during Sept 2015 -Dec 2017. Twelve of them required opening nonunion site for implant removal, hence were treated by exchange nailing and auto genous bone grafts. One case treated by closed exchange nailing only. Results: 11 cases achieved solid osseous union with single procedure in an average of 5.3 months. One patient required dynamization in 4 th post-operative month. A case of closed exchange nailing without bone grafting healed in 6 months. Conclusion: Exchange nailing with bone grafting is an excellent method for treating aseptic femoral diaphyseal nonunion with implant failure.

<p class="abstract"><strong>Background:</strong> Study was conducted to find the results of dynamic hip screw in the management of trochanteric fracture by analyzing the factors which influence post-operative mobility.</p><p class="abstract"><strong>Methods:</strong> Study was conducted in the department of orthopedics, GSL Medical College. Individuals &gt;18 years, both genders who were diagnosed having trochanteric type I and II Boyd and Griffin stable fractures were included in the study. All surgeries were performed under spinal anesthesia, internal fixation with dynamic hip screw and 135o angled blade plate. Injectable third generation cephalosporins were used 24 hours preoperatively, intra- operatively and 5 days post-operatively, and oral antibiotics till suture removal. Patients allowed to sit on bed on 2nd and 3rd day and static quadriceps exercises were started from 2nd day onwards, hip and knee flexion exercises from 6 or 7th day and weight bearing walking form 10th day.<strong></strong></p><p class="abstract"><strong>Results:</strong> The average age was of the participants was 61.53 years, ranged between 41 to 80 years; 65% were female participants and 35% were male patients. In the study, 20 (50%) patients had right side fracture and left sided affection of trochanteric fracture to the remaining 50%. Most of the patients (67.5%) in this study were classified as type II Boyd and Griffin criteria, and 32.5% were type I. The clinical and functional outcome was calculated using the Kyle's criteria; 25% (10) showed excellent response, followed by good (50%), fair (15%) and poor (10%) results.</p><p class="abstract"><strong>Conclusions:</strong> Dynamic hip screw is the operative treatment of choice for stable trochanteric fractures. However, studies on large sample for long time are recommended.</p>

Background: Intertrochanteric fracture make up 45% of all hip fractures. Trochanteric fractures almost invariably occur as a result of fall, involving both direct and indirect forces. Dimon Hughson Osteotomy procedure have a role in the management of unstable intertrochanteric fractures. Method: In the present study of 40 patients of unstable intertrochanteric fractures, 20 were operated in standard technique and 20 in modified technique. The data was assessed, analyzed, evaluated and following conclusions were made. Results: Intertrochanteric fractures common between 50-78 years. In young patients it was due to high velocity trauma. Fall from height being the common mechanism of injury. Slip and fall was common mechanism in elderly. It was more common in females due to post-menopausal osteoporosis. Associated injuries were more common in high velocity trauma. Early reduction and internal fixation increases patients comfort, facilitates nursing care, helps in early mobilization of patients and decreases hospital stay. Early mobilization can be begun in all the cases of Dimon Hughston osteotomy based on the pain bearing capacity with the help of a walker. In both the techniques complications can be avoided with proper patient selection and good preoperative planning, appropriate implant selection, good surgical technique, pre and post-operative physiotherapy and regular follow up. Conclusion: Dimon Hughston osteotomy is a viable option in unstable fractures with technical expertise. Can be performed on ordinary operation theatre table with comparative results.

Introduction:In past all fracture shaft humerus due to low velocity trauma was managed conservatively. However, in recent years the increasing high-speed motor vehicular accidents has posed a greater challenge on treating surgeon for managing varied patterns of those fractures. The advances in implants, operative techniques and expectations of the patients has led to change in the perspective of management towards more of surgical treatment. Material and methods: For closed fracture shaft humerus two main modalities of fixation are available. 1. ORIF using DC plate, 2. CRIF using intramedullary interlocking nails. This study intends to study and compare the advantages and disadvantages of both modalities. Two groups of 15 patients each having fracture shaft of humerus were managed by above two methods from July 2015 -Dec 2017. The results were assessed on following points: primary union rate, time needed for union, incidence of complications and functional scoring was done using Stewart and Hundley criteria. Results: There were 9 (60%) excellent results in the DCP group and 4 (27%) in interlocking group. 5(33%) good results in the DCP group and 4(27%) in interlocking group. 5 (33%) fair results in interlocking group and none in DCP group. 2(13%) under interlocking group and 1(7%) under plating group got poor. The complications were more in the interlocking group with most of them pertaining to poor shoulder function with pain. Though both modalities of treatment offer good union, the rate of secondary complication were more with interlocking nail, which makes dynamic compression plating a more favorable option. Conclusion:Open reduction and internal fixation with a DCP remains a better treatment option as against intramedullary interlocking nails for fractures of the shaft humerus.

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