BACKGROUNDMetacarpal fractures are common in adolescents and young active individuals. Mostly these are treated by conservative methods. In unstable fractures where closed reduction and final outcome are unsatisfactory, there are multiple surgical options for treating metacarpal fractures like K-wire fixation, interosseous wiring, plate osteosynthesis, etc. In this study, we assess functional outcome of closed metacarpal fractures treated with plates and screws. MATERIALS AND METHODSBetween 2014 and 2016, 20 cases of closed metacarpal fractures were studied. Fracture was approached by dorsal incision. Plate configurations were chosen according to the fracture pattern (straight plate for shaft fractures, T or L configured plates were used for periarticular fractures) and fixed with screws. Post-operative physiotherapy and followup carried out. RESULTSIn our study, all the cases showed bone union (100%). The functional result assessed by American Society for Surgery of the Hand (ASSH) Total Active Flexion score showed excellent result in 80% of the patients (16 of 20 cases), good in 10% of cases (2 of 20 cases). Stable and rigid fixation allowed early mobilisation of fingers thereby preventing stiffness and achieved overall good functional results. Although there were 10% (2 cases) of superficial infections, all settled with regular dressing and antibiotics without affecting final functional outcome. The overall results are satisfactory. CONCLUSIONPlate and screw fixation is a good option for treating closed unstable metacarpal fractures, where other modalities of fixation are less effective. The rigid stable fixation provided by plating which withstands load without failure allowed early mobilisation and achieved good functional results.

BACKGROUND Distal humerus fracture is one of the commonest fractures of young adult and elderly individuals. The treatment of these fractures continues to present challenges despite advances in internal fixation. MATERIALS AND METHODS A total of 25 fresh patients of comminuted fracture of humerus from Jan 2012 to Jan 2017 were included in the study and were treated with orthogonal plating. These patients were followed at 3, 6, 12, 24 weeks and at 1 year of follow-up and assessed in terms of time for union, range of motion, MAYO score, DASH score and complication rate. RESULTS At final follow-up, Mayo score was 96.12± 04.96 from 4.80± 01.06 and DASH SCORE was 30.42± 2.04 which dropped from 150±05.24. Range of motion improved from 23.38 to 114.1 with 100% union rate and complications less than 17%. CONCLUSION 90-90 plating for distal humerus fractures is excellent method of fixation and results are similar to those treated with parallel plating.

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BACKGROUND Treatment of old, neglected, unreduced dislocation of hip is usually associated with lot of difficulties and requires complex reconstructive procedures. [1,2] Various options available are open reduction, [3] trochanteric osteotomies, [4] arthrodesis [5,6] and arthroplasty. [1,7] CASE REPORT Here we have a case of 45-year-old male with a 14-year-old unreduced neglected posterior dislocation of Lt. hip with 7 cm shortening and muscle wasting with Trendelenburg test, telescopy test positive, weakness in active abduction and flexion deformity. For which patient is initially treated with skeletal traction to stretch the muscles and soft tissues. Then staged procedure of release of contracted muscles and soft tissues in first sitting followed by skeletal traction for 3 weeks. Then total hip arthroplasty of Lt. Hip was done. DISCUSSION Post-operatively, patient was followed up and he obtained pain free, functional and stable range of movements to do all his activities of daily living without any hindrance. Total hip arthroplasty has the upper hand in treating very old, unreduced and neglected posterior dislocation hip (like in this case-14 years old dislocation!); because as per literature open reduction is not possible for dislocations > 3 months, as it finally leads to AVN and a painful and stiff joint. Also other procedures like subtrochanteric osteotomies lead to limping and limitation of range of the hip for most of the authors and arthrodesis leads to stable but fixed and immobile hip. CONCLUSION Total Hip Arthroplasty is a safe and acceptable procedure for very old, unreduced and neglected dislocation of hip providing a stable, pain free and mobile hip.