Fractures of the body of the scapula are usually caused by direct high-energy trauma 1,2. Occasionally, however, they result from indirect injury. CASE HISTORY A 51-year-old engineer sustained a mains electric shock (240 V, 50 cycles per second) while testing a washing machine. He felt the current travel up his left arm, across the shoulders and down the right arm. After 15±20 seconds he managed to pull his left arm free. He did not fall down and did not lose consciousness. On arrival at hospital, he was complaining of severe pain in both shoulders. Examination of the nervous system and cardiovascular system revealed nothing abnormal but he was very tender over the scapulae with restriction of shoulder movements bilaterally. X-rays revealed bilateral extra-articular fractures of the scapulae. An electrocardiogram was normal but his serum creatine kinase (CK) was raised at 313 iu/L. He was admitted for cardiac monitoring and pain relief. A computed tomographic scan of his shoulders was obtained to assess the extent of his fractures and to rule out any intraarticular extensions of the fractures (Figures 1 and 2). Although his CK rose to 1049, he never had cardiac symptoms and the electrocardiogram remained normal. His fractures were treated non-operatively in slings, with progressive physiotherapy and analgesia. He was discharged on day 10 and three months after the injury he was painfree and had regained a full range of movements in both shoulders.

We report retrospective analysis of results of conservative and operative methods of distal radial fractures, which was carried out to control our treatment methods. Three hundred and ninety-three patients were treated from 1. 7. 1991 to 1. 7. 1992, 361 (91.9%) were followed up to 14 months with average age of 60.1 years (16 to 92 years). Three hundred and twenty-seven patients (90.6%) were treated by conservative methods, 9 (2.5%) by percutaneous pinning, 21 (5.8%) by transfixation through bases of metacarpal bones and 4 (1.1%) by ventral supporting plates. Clinical examination showed 69.6% good, 24.9% fair and 5.5% poor results. Radiological results according to AO-scheme were compared with clinical results, and 70% clinical results correlated with radiological results. Our results show that comminuted and displaced intraarticular fractures AO-classification C 2, C 3 are indications of transfixation and A 3 and some exceptional cases of C 1 are indications of percutaneous pinning.

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Objective: To evaluate the efficacy of dynamic compression plating against interlocking nail technique for the treatment of humeral shaft fractures. Study Design: Randomized controlled trial Place & Duration: Department of Orthopedic, Mardan Medical Complex, Mardan for the period of two years from April 2020 to October 2021. Methods: Fifty six patients (18-65 years old) of both sexes were included in the study because they had a humeral shaft fracture. The patients were randomly split into two groups. Both the dynamic compression plating group (n = 28) and the interlocking nail group (n = 28) received treatment. Radiographic examination both before and after surgery were performed. At the 12-day post-operative, complications following the operation were observed. The NEERs criteria were used to analyse the results of the functional assessments. Follow-up was taken at 6 months postoperatively. Results: Mean age of patients was 41.46±10.74 years. 42 (75%) patients were males while 25% were females. Road traffic accident was the most common cause found in 37 (66.07%) patients. Mean union time in DCP and INL group was 11.62±3.05 and 13.54±4.73 weeks. Shoulder stiffness was the commonest complication in both groups. At final follow up, in DCP group 24 (85.71%), 2 (7.14%) and 2 (7.14%) patients had excellent, good and fair outcomes, while in group B (INL) 19 (67.86%), 5 (17.86%) and 4 (14.29%) patients had excellent, good and fair outcomes. No significant difference was found in both groups regarding functional outcomes. Patients satisfaction was high in DCP group as compared to INL. Conclusion: Dynamic compression plating shows better outcomes in term of union time, complications and functional outcomes as compared to interlocking nail Technique. Keywords: Dynamic Compression Plating, Interlocking Nailing, Fracture Shaft of Humerus

Objectives: To assess closed reduction by Baumann angle in supracondylar fractures humerus treated by closed reduction andpercutaneous pinning. Material and Methods: This prospective study of 50 patients who presented with displaced supracondylar fracture ofhumerus in children between ages 1-12 years were admitted to Orthopedic and Trauma unit of Hayatabad Medical Complex Peshawar overperiod from January 2008 to July 2009. Closed reduction and percutaneous pinning were performed under general anesthesia and postoperativereduction was assessed by Baumann angle. All patients were followed for one year. Results: Mean age of the patients was 7.02 years± 2.25 SD. Loss of Baumann angle in injured side was range from 2O to 8O. Loss of carrying angle in injured side was range from 3O to 9O. WhenBaumann angle and carrying angle of both sides were compared the mean Baumann angle loss and carrying angle loss were 5.360 ± 2.22 SDand 4.320 ± 1.52 SD respectively. Using Flynn’s criteria 36 (72%) patients out of 50 patients with carrying-angle loss considered to be excellentresults and 14(28%) good results. Neither of the patient developed cubitus varus deformit y after one year of follow-up. Conclusions: Baumannangle of the humerus is a simple and reliable measurement of closed reduction that can be used to predict final carrying angle in supracondylarhumeral fractures in children.