Background: The management of unstable osteoporotic intertrochantric fractures in elderly is challenging because of difficult anatomical reduction, poor bone quality, and sometimes a need to protect the fracture from stresses of weight bearing. Internal fixation in these cases usually involves prolonged bed rest or limited ambulation, to prevent implant failure secondary to osteoporosis. The purpose of this study is to assess the mortality and morbidity and post-operative complication in high risk intertrochanteric fractures treated by cemented bipolar. Material and Methods: We retrospectively studied, 28 elderly patients with preoperative ASA grade-III with unstable intertrochanteric fractures (AO/OTA type 31-A2.2 and 31-A2.3 and Evans type III or IV) by primary hemiarthroplasty using a cemented bipolar prosthesis. All patients were operated by the same surgical team. Bipolar implants were cemented (tapered design, 2nd generation cemented technique, standard length) and trochanteric comminution was circlage to restore abductor mechanism. The assessment was done with emphasis on perioperative mortality, morbidity and complications related to prolonged bed rest. Results: Mean patient age was 75.6 (64-91) years and mean follow-up was 22.3 (5-48) months. 10 patients were able to walk with a walker in the first post-operative week. Rehabilitation was easier and faster and post op morbidity like pressure sore pulmonary complication was significantly low (P<0.05). The mortality (2/28) was significantly low. We obtained 15 excellent and 8 good results after 12 months according to the Harris hip-scoring system. The series thoroughly compared with standard international series like, Stern et al, Chris Grismud et al, Harwin et al, Haentgens et al, Chan et al, Green et al. Conclusion:Primary Bipolar Hemiarthroplasty may be a better alternative treatment for unstable comminuted osteoporotic Intertrochanteric fractures in elderly moribund patients.

BACKGROUND: Proximal tibial fractures with high energy trauma are extremely complex injuries with significant associated soft-tissue damage. This Retrospective study was used to evaluate advantage of two stage reconstructions as a protocol in management of highenergy proximal tibia fractures regards of soft-tissue management, development of complications, and functional outcomes. MATERIALS AND METHODS: This retrospective study includes 40 patients who had sustained high energy Proximal tibial fractures were managed at our institute. In all patients, we placed immediate temporary distraction external fixation with management of soft-tissue injuries with delayed definitive fixation. The mean clinical and radiographic follow-up was 1year (range 12-18 months), and functional outcome was assessed by knee society score. RESULTS: The mean follow-up is minimum 1 year (range 12-18 months) with KSS was good in 26 cases (65%), fair in 10 cases (25.0%) and poor in 4(10.0%) at latest follow-up. The complications includes 6 patients (15%) suffered superficial infection, deep infection was observed in 4 patients (10%), 2 patients had developed compartment syndrome. 2 patients had deep venous thrombosis. Malalignment included 4 (10%) cases of residual varus and 3 (7.5%) cases of residual valgus deformity. CONCLUSION: The use of this protocol, with the initial application of a temporary distraction external fixator followed by delayed internal fixation, is suggested for treatment of high energy tibial plateau fractures. The benefit of this protocol includes access to soft tissues, and prevention of further articular damage and relatively low rates of complications in patients who sustain high-energy proximal tibia fractures. In addition, this protocol allows use of MIPO technique which is based on combination of the principles of stability, restoration of anatomy and early motion, while eliminating the need for excessive soft tissue dissection.

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Background: Femoral fractures are common in children between 2 and 12 years of age and 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as conservative treatment. We compared primary hip spica with closed reduction and fixation with crossed Rush pins for diaphyseal femur fracture in children. The hypothesis was that Rush pin might provide better treatment with good clinical results in comparison with primary hip spica. Materials and Methods: Fifty children with femoral fractures were evaluated; 25 of them underwent conservative treatment using immediate hip spica (group A) and 25 were treated with crossed retrograde Rush pins (group B). The patients ages ranged from 3 to 15 years (mean of 9 years). Results: Mean duration of fracture union was 16 weeks in group A and 12 weeks in group B. Mean duration of weight bearing15 weeks in group A and 8 weeks in group B. Mean hospital stay was 5 days in group A and 9 days in group B. Mean follow up period in group A was 16 months and group B was 17 months. Complications such as angulation, shortening, infection were compared. Conclusions: Closed reduction and internal fixation with crossed Rush pins was superior in terms of early weight bearing and restoration of normal anatomy.

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