Background: Fractures of distal radius are very common injuries, accounting for about 15% workload of an Orthopedic trauma unit. While cast treatment is universal for stable fractures, unstable fractures with comminution and intrarticular involvement are a different injury and are treated mainly by ligamentotaxis with proper restoration of anatomy. In this study, we evaluated the effectiveness of external fixator with or without augmentation for management of unstable distal radius fractures. Methods:The study was performed on 49 patients with unstable distal radius fractures admitted in the emergency department. Patients who met inclusion criteria, were operated with bridging external fixation using 2 pins in radius and 2 pins in second metacarpal augmented with percutaneous K wires in some patients. Functional evaluation at 12 months was done using Solgaard Scoring. Results: The study comprised of 49 patients in age group of 20-60 years, including 28 males and 21 females with a mean age of 42 years. Laterality included right side (n=23) and left (n=26). Mechanism of injury was road traffic accident (n=19), fall from height (n=17) and fall from standing height (n=13). The mean admission to surgery interval was 1.2 days, the mean operative time was 35 minutes and the mean time to union was 7.2 weeks. Complications included pin tract infections (n=7), transient neuropathies (n=5), early sympathetic dystrophy (n=2), malunion (n=2) and loss of motion more than 20 0 (n=9). Final evaluation done using Solgaard scoring system revealed excellent results in 22 patients, Good in 18 patients, Fair in 8 patients and Poor in one patient. Conclusion: For unstable distal radius fractures excluding shear injuries, external fixation with or without augmentation is the preferred method of treatment as it is simple, less expensive, with acceptable complications and yields excellent results in a majority of patients.

A rare case of symmetrical open bimalleolar fractures with bilateral dislocation of ankles is described. A 30-year-old man sustained indirect trauma working in squatting position with a heavy log of wood falling on his knees with ankles in inversion, and sustained symmetrical open III B bimalleolar fractures with dislocation of bilateral ankles with the distal fibula coming out of the skin. The patient underwent operative management on bilateral ankles and the post-operative course was uneventful. The patient had no complaints at 4 years' follow-up and had a full, pain-free function. The probable mechanism of the fracture is discussed.

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Background: A prospective study was conducted at Government Hospital for Bone and Joint Surgery, Barzulla, Jammu and Kashmir from 2015 to 2017. The study was a hospital based descriptive review of data of patients obtained from the tertiary care Orthopaedic hospital of Kashmir valley. Material and Methods: We performed a hospital based prospective review of data of patients obtained from a tertiary care orthopedic hospital for Kashmir valley, namely Government hospital for Bone and Joint surgery hospital, Barzulla. Data from patients admitted for acetabular fractures from June 2015 to December 2017 was collected prospectively. Data on patients' ages, sex, side affected by the fracture, mechanism of injury, patterns of fracture, complications of the operation and associated fractures was collected. Results: In this study sixty patients were evaluated from 2015 to 2017. 55% (33) of these patients presented a fracture in the left-side acetabulum, while 45% (27) presented a fracture in the right-side acetabulum. Car accidents accounted for 45% (27) of cases, followed by motorcycle accidents (30%; 18) and falls (10%; 6). The most common fracture pattern according to Letournel classification was anterior column with posterior hemi transverse (31.67%; 19) followed by posterior wall fractures (20%;12) and transverse type (18.33%;11). The most common associated injury was fracture of distal end of radius (8.33%; 5) followed by pelvic injuries (5%; 3). Conclusion: It was observed in this population that 1. The left side was more affected. 2. The mechanism of injury that most often caused this type of fracture was automobile accidents. 3. Most common pattern of injury was anterior column with posterior hemi transverse. 4. Injuries to the sciatic nerve were the commonest surgical complications. 5. The most common associated injury was fracture of distal end of radius.

Background. The Kocher-Langenbeck approach is recommended in the majority of common posterior acetabular injuries. Trochanteric osteotomy can be used to extend the exposure of the Kocher-Langenbeck approach superiorly and anteriorly. We evaluated the functional outcome of common acetabular fractures operated on through the Kocher-Langenbeck approach with or without trochanteric flip osteotomy. Material and methods. This prospective study enrolled 42 patients with posterior wall, posterior column, transverse, posterior wall with posterior column, transverse with posterior wall and both column acetabular fractures. The Kocher-Langenbeck approach was used in 35 patients and trochanteric flip osteotomy was done in 7 patients. The radiological outcome was evaluated by Matta’s criteria and the functional outcome was evaluated using modified Merle d'Aubigné and Postel criteria. Results. D’Aubigne Postel scores at the final follow-up were excellent in 12 patients, good in 18, fair in 8 and poor in 4. Thirty-seven patients had congruent reduction (anatomical in 29, imperfect in 8) and 5 patients had non-congruent reduction on radiographs as per Matta’s criteria. Radiographic congruity (88.09%, 37 out of 42 cases) correlated fairly well with the functional outcome (excellent or good functional outcome in 71.4%, 30 out of 42 cases). The complications included traumatic nerve palsy (3 cases), iatrogenic nerve palsy (2 cases), deep venous thrombosis (2 cases), wound infection (3 cases), non-congruent reduction (5 cases), 8 cases of osteoarthritis of hip, 2 cases of avascular necrosis of femoral head and 3 cases of heterotrophic ossification. Conclusions. 1. Surgical treatment of common acetabular fractures with major posterior involvement can be attempted via a single posterior approach (Kocher-Langen­beck with or without trochanteric flip osteo­tomy) and leads to good-to-excellent results in a majority of the cases. 2. It is superior to conservative management, which has been found to be accompanied by a much higher rate of complications. 3. A thorough study of the pre-opera­tive radiographs, Judet’s views and 3D-reconstructed CT images helps in classifying the fracture and thereby assigning or not assigning it for the posterior approach.