Background and Objectives: Trochanteric fracture is a leading cause of hospital admissions in elderly people. The number of such admissions is a rise because of increasing life span & sedentary habits. Conservative methods of treatment result in malunion with shortening and limitation of hip movement as well as complications of prolonged immobilization like bed sores DVT and respiratory infections. This study is done to analyze the surgical management and traumatic fractures using Dynamic Hip screw. Methods: This is a prospective study of 20 cases of fresh trochanteric fractures admitted to Tertiary care Hospital, Surat, from November 2016 to February 2018. Cases were taken according to inclusion and exclusion criteria i.e., patients with trochanteric fracture above the age of 18yrs. Medically unsuitable and old malunited trochanteric fractures were excluded from the study. Operation was done keeping the Tip Apex Distance (TAD) into consideration. Results:The study shows sex ratio of 7:3 (M:F) with maximum presentation between 66 to 80yrs with an average of 63 yrs. Mode of injury was more due to fall, 11(55%); followed by RTA, 9(45%). Left side was slightly more than right side. L: R = 11:9. 30% of patients had associated injury. Type II fractures were maximum with 11 cases followed by 9 cases Type I&II. Post-operative results were found to be excellent in 3(15%), Good in 10(50%), Fair in 6(30%) and poor in 1(5%). Conclusion and Interpretation:This study shows that trochanteric fracture is common in elderly population with male preponderance mainly occurring between 66 to 80yrs. Common mode of injury being trivial fall, Left side being slightly more involved in injury. Early operative intervention with Dynamic hip screw with 135 0 side plate with barrel gives good results, helps early mobilization of elderly patients decreasing morbidity & mortality and achieves rigid fixation even in osteoporotic bone. From our study we concluded that DHS still is implant of choice by many surgeons and have stood against test of time. Results are similar to past studies.

No abstract

Low back pain occurs in almost 80% of the adults in some point in time in their life and herniation of the lumbar intervertebral disc is one of the leading causes for it. Discectomy by fenestration method is an accepted procedure for the treatment of herniated lumbar disc. The functional and neurological recovery following this procedure was analysed in this study. Out of the 20 patients who were operated for single level lumbar disc herniation by fenestration discectomy between September 2014 and March 2017, only 19 patients were available for follow up. Patients were followed up for a period of 1 year. The postoperative outcome was analysed using the Prolo economic and functional scoring system. The outcome was analysed with age, sex, employment, duration of unemployment and neurological deficits as variables. The change of Prolo scale between pre-operative and post-operative status was also analysed. The functional outcome showed good results in 68.44% of cases proving that the surgical results were good following fenestration and discectomy. Good neurological recovery was noted, but neurological status had no influence over the functional recovery of the patients. Better outcome was noted in females and patients below the age of 30 years as well as in patients doing light work. The duration of symptoms had no influence on the outcome of the surgery. This study proves that discectomy by fenestration method is a good surgical procedure for treatment of lumbar disc heniation.

Introduction: Anterior bridge plating with minimally invasive technique for type A shaft humeral fractures is reported as an acceptable less traumatic and reproducible procedure by several authors. We have evaluated the clinical, radiological, and functional outcome of such fractures in twenty patients, all of which were managed with dynamic compression plate over an average follow-up period of 12 months. Though open reduction and plating technique of humerus shaft fracture is prevailing, this technique also gives favorable outcome. Materials and Methods: Twenty patients with type a humerus shaft fractures were managed by anterior bridge plating using MIPO technique between March 2017 to November 2019 were included in this series. All cases were treated with closed reduction and 10-12 whole 4.5mm dynamic compression plate fixation over anterior aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, and fracture union time, and complications were noted. The UCLA shoulder and Mayo elbow performance scores were used for assessing the shoulder and elbow function. Results: Of the Twenty patients in the study, ten were males and ten were females. The mean age was 34.3 years (range 18 to 85 years) twelve out of twenty patients (60%) had the dominant side fractured. Mean surgical time in minutes was 88.98 (range: 50 to 150 minutes). The mean fracture union (radiological) time was 14.3 weeks (range: 10-16 weeks) and clinical union time was 10.4 week. However Shoulder function was excellent in 20 cases (100%) on the UCLA score. Conclusion:This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique for type A fracture shaft humerus gives good functional results and should be considered as an effective, cosmetically advanced surgical option in the treatment of type A humeral shaft fractures. It is a safe and less time consuming method for type a humeral shaft fractures when the surgeon is experienced in the technique.

The distal femur is an area that is particularly vulnerable to the dangers of our modern life styles and high velocity methods of transportation. Among young patients, fractures of the distal femur usually are a component of multiple traumas sustained through highvelocity, high-impact injuries such as motor vehicle accidents or fall from a height. Objectives: To analyze the functional outcome of distal femoral fractures treated by retrograde intramedullary nailing. Materials and Methods: Between January 2016 and June 2018, 11 distal femoral fractures in 10 patients were operated using retrograde intramedullary nail at tertiary care hospital Surat. There were 7 (70%) males, & 3 (30%) were females; Age was ranging 18-74 years, with an average of 43.4 years. 7 patients were due to polytrauma. Fractures were classified according to Muller's classification, 4.76% were Type A1, 14.8% were Type A2, 42.8% were Type A3, 9.52% were Type C1, 14,28% were Type C2 and 14.28% were Type C3. All the cases were operated with retrograde intramedullary nailing using patellar splitting approach. Observations: The mean operative time was 19 minutes (16 to 240 minutes). Primary bone grafting was done in 2 cases (19%), Open reduction was done in 2 cases. Post operatively knee mobilization was done using CPM. The average follow up interval was 13 months (3 to 36) months. Results: All fractures healed by 4 months range 3 to 3.5 months. The mean knee range of movements was 98 0 (80 0 to 140 0 ). There was deep infection in one case, shortening more than 2 cm in one case, 8 0 valgus angulation in one case, anterior knee pain in 1 case and implant protruding to knee joint in 1 case. There were no late mechanical failures of the implant. Neer's knee rating system was used to evaluate the function, there were 3 (30%) excellent, 5 (50%) satisfactory results, 1 (5%) was unsatisfactory results and 1(5%) of the case failed. The results correlated with age of the patient and the presence of an intra-articular fracture. Conclusion:This study shows distal femoral fractures were common in males due to high velocity injuries. Retrograde intramedullary nailing is an excellent technique for management of distal femoral fractures since there is less soft tissue dissection. The preferred portal of entry can be reached quickly & effectively, shortens the duration of surgery, decreases the need for bone grafting, high union rate and good knee range of movements. Complications were few, which includes infection, shortening, angulation and anterior knee pain.