Objective: To compare outcomes of interlock intramedullary nails with Dynamic compression plates for the treatment of humerus shaft fractures in terms of hospital stay time and shoulder Impingement. Subjects and Methods: In this comparative study, a total number of 74 patients having age 20-60 years who presented with closed and open Gustilo type I or II in middle third of humerus were included. Study was conducted in Islam hospital Sialkot and and Rajib Tayyip Erdogan Hospital, Muzaffargarh from June-2019 to June-2020. Group A (n=37) patients underwent dynamic compression plating (DCP) for treatment of fractures and group B (n=37) underwent interlocking intramedullary nailing (ILN) for humerus shaft fractures. We noted post-operative hospital stay, shoulder impingement and bone union rate in all patients. Results: The mean of patients included in this study was 42.45 (SD 9.89) years. There were 57 (77.03%) males and 17 (22.97%) females. The mean duration of fracture at the time of surgery was 39.98±7.23 days. Mean hospital stay was 4.72±1.23 days in in group A and 4.89±1.40 days in group B (p-value 0.60). There were 4 (10.8%) patients in group B in whom shoulder impingement occurred but there was no patient in group A with shoulder impingement (p-value 0.04). Complete union occurred in 35 (94.6%) patients in DCP group and in 34 (91.8%) patients in ILN group (p-value 0.64). Conclusion: Both DCP and ILN are associated with high bone union rates. The complications rate of ILN is higher in comparison to DCP group. Keywords: Humerus shaft fractures, dynamic compression plates, interlocking intramedullary nailing.

Objectives: To compare the complications and outcomes of lateral entry pin fixation with medial and lateral pin fixation for Gartland type III supracondylar fractures of humerus. Methodology: This prospective comparative study involving 190 patients of Gartland type III close supracondylar fractures were included. from March-2019 to Dec-2020. In all patients, initially the elbow was mobilized using the splint placed above the elbow joint at 30 to 45 degrees’ flexion. After closed reduction, lateral pinning was applied in group I and in group II lateral and medial cross pinning was applied using the standard protocol. Patients were followed for iatrogenic ulnar nerve injury, radiologic and function outcomes in-terms of loss of reduction, elbow range of motion, loss in carrying angle and functional outcomes. Results: The two groups were comparable for loss of elbow range of motion, loss of carrying angle and loss of Bauman's angle. On clinical examination, immediate post-operative ulnar nerve injury was diagnosed in 4 (4.2%) cases in group II and in no patient in group I (p-value 0.12). Satisfactory functional outcomes were achieved in 85 (89.5%) patients in group I and in 88 (92.6%) patients in group II (p-value 0.44). Conclusion: Lateral pinning provided stable fixation clinically and radiologically as compared to lateral and medial cross pinning. Keywords: Supracondylar fracture of Humerus, Iatrogenic ulnar nerve injury, Lateral pin entry, lateral and medial cross pin entry.

Background: Supracondylar fractures of humerus are one of the largest sources of serious problems and treatment controversy in childhood fractures. The advantages and disadvantages of different methods of treating supracondylar fractures of humerus in children are still evolving and need to be investigated. Objective: To compare the effectiveness of two techniques of treating Gartland type III supracondylar fractures of humerus in children Materials and Methods: This quasi-experimental study was carried out at Orthopedic Unit, Jinnah Hospital, Lahore from 22nd August 2007 to 31st May 2008. Sixty patients selected by non-probability sampling with Gartland type III supracondylar fracture of humerus were divided in Group A and B with 30 patient in each group. After stabilizing patients, group A was managed with closed reduction and percutaneous pinning and group B with open reduction and internal fixation. Patients were discharged when stable and followed clinically and radiologically for effectiveness of reduction and union of fracture at 2, 4, 8 and 12 weeks. Results: There were 78.3% males and 21.7% were females. Majority of patients (36.7%) were between 5-7 years of age. Right humerus was fractured in 63.3% of patients. Most common mode of injury (40%) was fall during play. Eighty percent of children were presented in 1st 24 hour of injury. Sixty percent of children in group A had a hospital stay of 2 days and in group B, 60% had hospital stay of 4-5 days. In group A, 16.6% patients developed postoperation complication and in group B, 46.7% developed complications. Functional outcome was excellent in 73.7% in group A and 60% in group B. Radiologically, callus formation was relatively poor to start in group B. Conclusion: Closed reduction & pining under image intensifier is as good as open reduction and internal fixation for these fractures in children with early callus formation.

Background: Trimalleolar fracture is very hamstring if it not maintained accurately. It is one of the pitiful condition. Trimalleolar ankle injuries have become more common in the last decade, with up to 40 per 100,000 people affected each year. Study design: It is a prospective study conducted for the duration of six months from February 2022 to July 2022 at Islam teaching hospital, Sialkot. Material and Methods: The study was carried out on 52 patients who were admitted in tertiary care unit during a period of one year. All the patients were following inclusion criteria, those who were unable to fulfill were excluded from the study. There were 36 males and 16 females taken for study. 30 patients had injury in the right side and 18 reported left side injury. The hospital review board committee give the approval to the study. The data was collected and statistically analyzed by using the renowned software SPSS. The result were presented in the form of table. Results: The injury pattern that was frequently observed in patients was supination external rotation reported in 40 patients. While 8 had pronation external rotation and 4 had to face supination adduction pattern. There were 4 cases that complaint about superficial infection and deep infection was observed in case of 2 patients. Conclusion: It is concluded that for the fixation of Trimalleolar fractures, there is a need for proper planning and reduction of lateral malleolus fractures by a lateral plating method. Keywords: ankle fracture, operative planning and Posterior malleolus fracture.

Objective: To compare the clinical outcome of flexible intramedullary nailing (FIN) with external fixator in pediatric open tibial fractures. Subjects and Methods: In this randomized comparative study, 80 children having age 5 year to 14 years who presented with open tibial fractures were included. The study was conducted from June-2020 to June-2021 in Islam Hospital Sialkot and Allama Iqbal Memorial Hospital Sialkot. Patients were divided into two equal groups. Group A: underwent external fixation and group B: underwent flexible intramedullary nailing for the surgical management of tibial fractures. Frequency of infections surrounding pins, painful bursitis and re fracture rate within 3 months after surgery was recorded. Results: The mean age of children was 8.42±3.82 years in external fixator group versus 8.40±4.0 years in FIN group (p-value 0.97). Infection-surrounding pins occurred in 9 (22.5%) children were belonging to external fixator group and 01 (2.5%) children was belonging to FIN group (p-value 0.007). Refracture occurred in 6 (15.0%) patients in external fixator group and in no (0.0%) children in FIN group (p-value 0.01). Painful bursitis occurred 2 (5.0%) patient was in external fixator group and in 13 (32.5%) in FIN group (p-value 0.002). Conclusion: Clinical outcome is better in patients treated with FIN as compared to the external fixator for the treatment of pediatric open tibial shaft fractures. Keywords: Flexible intramedullary nails, External fixator, Tibial fractures.