Results: Assessed as per Demerit point system of Gartland and Werley (modified by Sarmiento 1975) for functional results and criteria for anatomical results by Sarmiento (1975)

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Background: Clavicle fractures are common, with an overall incidence of 36.5 -64 per 100,000 people every year. Traditionally, midshaft clavicle fractures have been treated nonoperatively. Recently, there has been increasing interest in the operative treatment and plate fixation or intramedullary nailing is often the treatment modality of choice. Numerous clinical studies have been published to compare surgical and conservative treatments. The best treatment for displaced midshaft clavicle fractures remains a topic of debate. So We sought to compare patient-oriented outcome and complication rates following nonoperative treatment and those after operative treatment of displaced midshaft clavicular fractures. Objectives: To compare functional outcome and complication rates following nonoperative treatment and those after operative treatment of displaced midshaft clavicular fractures. Materials and Methods: 60 patients with a displaced midshaft fracture of the clavicle who were presented to RL Jalappa Hospital from June 2015 to October 2016 and either treated by conservative or operative methods of treatment and who were in regular follow up are selected. Functional assessment was done at 6 weeks, 3 months and 6 months with use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant scores Complications, if any will be recorded. Results: DASH Scores and Constant scores were significantly better in the operative group compared to the conservative group at all time points. Conclusion: Operative treatment resulted in early return to function compared to conservative treatment but at the cost if complications like infection and other hardware related problems.

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 IntroductionRadiocarpal dislocation is an uncommon entity in traumatology. Proper management depends on the type of dislocation and the presence of concomitant injury (1) . Associated injuries are common with radial styloid, ulnar styloid and marginal avulsion fractures predominating. Open injuries with significant soft-tissue disruption can occur, leading to persistent instability (1) . The paucity of reported cases and incomplete understanding of the spectrum of associated injuries has not permitted a consensus on treatment recommendations.  Case ReportA 55 year old male sustained a fall from a height of around 5 feet on an out stretched hand at home in April 2015, with impact on the ulnar aspect of the right wrist joint. Following the fall he developed a wound which was around 4 cm x 3 cm. The wound was associated with pain, swelling and deformity around the wrist joint. There was loss of extension of the medial two fingers at the metacarpophalangeal joints. The ulnar artery pulsations were not palpable; however the capillary refill time was normal. The sensations were intact over the cutaneous distribution of the ulnar nerve.Pre-operative radiographs of the wrist joint including the forearm were obtained in the antero-posterior and lateral views. The x ray showed a fracture of the radial styloid process and radio-carpal dissociation with a dorsal and lateral displacement. Initial treatment was in the form of wound irrigation, sterile dressing and immobilization with an above elbow POP slab.After an informed consent, surgery was conducted 6 hours from the time of injury. Following through wash and debridement, the fracture and radio-carpal dissociation were reduced and stabilized with ligamentotaxis with Kirschner wire augmentation. Wound closure was done. Ulnar artery was found transected and the cut ends ligated, which was done as part of primary care outside our centre. There was no attempt at arterial re anastomosis as the capillary refill time was found to be normal. Tendon repair was also not carried out in the same sitting.Post-operative period was uneventful and the patient was followed up regularly. At 3 weeks following surgery the stitches and Kirschner wires were removed and the wound was dry and had no discharge. The external fixator assembly was removed 6 weeks following surgery. Following removal physiotherapy in the form of active and passive wrist mobilization was initiated.Twelve months following surgery, the patient was found to have good range of motion at the wrist. Flexion was up to 80 0 , extension was up to 50 0 . Supination was restricted by 30 0 with no restriction of pronation. However there was complete ulnar nerve injury distal to the wrist which was evident clinically by the presence of ulnar claw hand and wasting of the hypothenar eminence. This was further confirmed by nerve conduction velocity testing of ulnar nerve. The patient was given the option of tendon transfer but the patient party declined this plan of action.