trauma, open anterior, dislocation, hip, femoral head, osteonecrosis.

SUMMARYOsteochondromas, or exostoses, are overwhelmingly found as isolated lesions although they can be present within the context of multiple hereditary exostosis. Increased exostotic load associated with multiple hereditary exostosis can lead to limb-length discrepancy, increased femoral anteversion, valgus angulation, and acetabular dysplasia. Solitary osteochondromas have been linked with bursal inflammation and pain, compression on neurovascular structures, and malignant degeneration, groin and lower extremity pain. Isolated exostosis involving the femoral neck is a rare entity which is often diagnosed late when the patient is being investigated for other problems. We present a young female with a history of hip pain for 3 years with restriction of movements around the hip joint and radicular pain which turned out to be a solitary osteochondroma of the femoral neck. Surgical excision relieved the symptoms.

Radial head and neck fractures are common in young to middle age adults and are seen in nearly 20 % of acute elbow injuries in this age group. These are usually associated with high energy traumas like falls from height, road traffic accidents and sports injuries. Unilateral radial head fractures are relatively common and may be associated with other concomitant injuries. Bilateral radial head fractures are rare and are mostly seen in situations when the patient has a fall on outstretched, supinated hands or a direct fall on the elbow. These injuries can be easily missed by the attending physician if the symptoms are more severe on one side, thus neglecting the other. The treatment of these fractures may be conservative or operative, depending upon the degree of head comminution, the percentage of articular surface involved, presence of loose intra-articular fragments and angulation between the radial neck and proximal shaft. We present a case series of three patients with bilateral type 1 radial head fractures (one case having type 3 on one side) managed with brief immobilization followed by active physiotherapy and full, uneventful recovery. The emphasis in these cases is the need for a high index of suspicion in the diagnosis of multiple injuries, no matter how `trivial` the mechanism of injury and, unless the history of the mode of trauma is highly suggestive, such injuries can be missed easily and cause long term problems for the patient.

Background: The incidence of femoral neck fractures, one of the most common traumatic injuries in the elderly increases continuously due to the ageing of population on the planet and urbanization. Aims and Objective of the Study: To study the incidence of intracapsular femoral neck fractures in the elderly population with respect to age, sex, occupation, fracture type and laterality of injury. Materials and Methods: The prospective study included 30 patients with intracapsular femoral neck fractures referred to the Department of Orthopaedics, Ashwini Hospital, Gulbarga were selected for this study. Patients with intracapsular femoral neck fractures and aged above 55 years were considered. Patients were briefed about the nature of the study, the interventions used and written, informed consent was obtained. Further, descriptive data of the participants like name, age, sex, detailed history, were obtained by interviewing the participants and clinical examination and necessary investigations were recorded on predesigned and pretested proforma. Results: Majority of the patients (seven patients, 23.33%) were in the age group between 71 to 75 years and five patients, (16.67%) each were in the age groups of 55 to 60 years, 76 to 80 years and above 80 years. In the present study, out of the 30 patients there 18 were female accounting to 60% and 12 male patients making up the remaining 40%. The average interval between admission to the hospital and surgery was 3.6 days with a range of 01 to 17days. The average duration of hospital stay was 13.3 days with a range of 7 to 26 days. The duration of hospital stay is less in our series as the patients were mobilized early. Out of 18 female patients 14 females were house wives. Three were retired from job, and one was self-employed. Among the males, seven were retired from their jobs, four males were businessman and one male patient was self-employed. Majority of the fractures occurred due to fall in bathroom (56.67%) and fall in living room (30%). Right side involvement was more commonly seen than the Left in this study group. Right side was involved in twenty patients making up for 66.67% of the fractures and the left was involved in ten patients accounting for 33.33% of the fractures. Out of the 30 fractures, majority were type IV fractures (23 patients) accounting for 76.7%. Remaining 23.3% (07 patients) were type III fractures. Conclusion: In conclusion, hip fractures are a serious injury in the elderly population. There is a very mortality rate and morbidity rate following hip fractures in the elderly. Once diagnosis has been made, appropriate stabilization of the patient from a medical standpoint and rapid operative fixation of the fracture or prosthetic replacement helps patients obtain a better functional result. Adequate rehabilitation in an inpatient setting, as well as at the patient's home with home health is an important adjunct to an overall successful outcome.

OBJECTIVE:The purpose of this study is to evaluate the usefulness of external fixation of intertrochanteric fractures in high risk geriatric patients. DESIGN: Prospective clinical study. SETTINGS: Level-1 trauma Centre. PATIENTS: Fifty high risk geriatric patients with intertrochanteric fractures. INTERVENTION: Close reduction and external fixation using AO external fixator. OUTCOME MEASURED: fracture union, time to union, pin tract infection rate, shortening, varus collapse and range of motion at knee. RESULTS: Fifty patients with average age of 68.5 years all high anaesthetic/surgical risk were managed by closed reduction and external fixation. Forty were operated under regional and ten under local anaesthesia. Eight patients died before fracture union and four were lost in follow up after removal of fixator. Remaining thirty eight were in regular follow up for at least six months. Pin tract inflammation was the most common complication while shortening and varus collapse occurred in ten cases. CONCLUSION: external fixation of intertrochanteric fractures is useful in high risk geriatric patients. KEYWORDS: intertrochanteric fractures, external fixation. INTRODUCTION:Hip fractures are a leading cause of death and disability among the elderly. 1 These fractures include femoral neck and intertrochanteric fractures. Intertrochanteric fractures generally occur as a result of low energy trauma in advanced age, whereas they are caused by high energy trauma in young age. 2 The incidence of intertrochanteric fractures is increasing day by day as is the life expectancy. Life time risk in industrialized countries of intertrochanteric fractures is 6% for men and 18% for women. 3 Thus we have old patients, many of them with co morbidities, having intertrochanteric fractures. Treatment goals in this population include early rehabilitation, restoration of the anatomic alignment of the proximal part of the femur and maintenance of the fracture reduction. 4 Various treatment methods used for intertrochanteric fractures include operative and nonoperative. 5 Historically, non-operative management took one of the two different protocols. In first approach, directed at early mobilization within the limits of the patient discomfort, the patient is allowed out of bed and in chair within a few days of injury. Ambulation was delayed, but the early bed to chair mobilization helped prevent many complications of prolonged recumbence. This approach did not attempt to treat the fracture specifically and accepted the deformity that invariably ensues. The second approach, in contrast, attempted to establish and maintain a reasonable reduction via skeletal traction (Hamilton Russel traction) until fracture union occurred. This technique was prolonged with difficulty in maintaining the reduction; further all the complications of prolonged recumbence like pressure sores, urinary tract infection, deep vein thrombosis, pulmonary embolism, chest infection are there. Operative methods include open reduction and internal fixation by sli...