Background This prospective comparative study was done to evaluate the effectiveness of implants of different design (titanium elastic intramedullary nail versus anatomical precontoured dynamic compression plate) in treatment of displaced midshaft clavicular fractures.Materials and methods Sixty-six patients between 18 and 65 years of age were included in this study. They were randomized in two groups to be treated with either elastic intramedullary nail (EIN) or plate. Clinical and radiological assessments were performed at regular intervals. Outcomes and complications of both groups over 2 years of follow-up time were compared.ResultsLength of incision, operation time, blood loss and duration of hospital stay were significantly less for the EIN group. American Shoulder and Elbow Surgeons (ASES) and Constant Shoulder scores were significantly higher (p < 0.05) in the plating group than the EIN group for the first 2 months but there was no significant difference found between the two groups regarding functional and radiological outcome at the 2-year follow-up. Significantly higher rates of refracture after implant removal (p = 0.045) in the plating group was observed. Infection and revision surgery rates were also higher in the plate group, but this difference was insignificant (p > 0.05).ConclusionsEIN is a safe, minimally invasive surgical technique with a lower complication rate, faster return to daily activities, excellent cosmetic and comparable functional results, and can be used as an equally effective alternative to plate fixation in displaced midshaft clavicle fractures.Level of evidenceLevel 2.

BackgroundThe aim of this retrospective study was to compare outcomes and complications of displaced fractures of the shaft of the humerus treated with limited-contact dynamic compression plates (LCDCPs) and locking compression plates (LCPs).Materials and methodsTwo hundred and twelve patients with displaced fractures of the shaft of the humerus, treated with plate osteosynthesis from January 2005 to December 2009 were reviewed. One hundred and two patients (group A) were treated with LCDCP osteosynthesis and 110 patients (group B) were treated with LCP osteosynthesis. Clinical and radiological assessments were made at monthly intervals for the first 6 months and then at 2-month intervals for the next 6 months. Primary outcome measures like operative time, duration of hospital stay, time to fracture union, union rate and secondary outcome measures (functional outcome and complications such as infection, malunion, delayed union, nonunion, implant failure and iatrogenic radial nerve palsy) were compared between both groups. The ULCA scoring system and Mayo elbow performance index (MEPI) were used to assess shoulder and elbow functions, respectively. Rodriguez-Merchan criteria were used to assess the functional outcomes of the fracture fixation.ResultsThere was no significant difference found between the two groups in terms of primary outcome measures. According to Rodriguez-Merchan criteria, comparison of functional outcomes of both groups showed insignificant difference (p = 0.48). There was no significant difference found between the two groups regarding mean ULCA score (p = 0.34) and mean MEPI sore (p = 0.54). In terms of complications, no significant difference was found between the two groups.ConclusionThis study concludes that the principle of fracture fixation was more important than plate selection in fractures of the shaft of the humerus.Level of evidenceLevel 3.

INTRODUCTION: Perforation of tympanic membrane constitutes a major portion of patients attending ENT OPD for which they are advised surgical procedures. Most of the cases with small perforations can be managed by doing OPD procedure of cautery patching and hence surgical procedure can be avoided. METHODS: The study was conducted in the tertiary hospital from August 2018 to July 2019. The patients were selected on the basis of the inclusion criteria after doing clinical examination, and audiometry. All the patients underwent cautery patching with tincture ferri perchloride and patch placed. The patients were followed up weekly till the perforation was completely closed or uptill 3 months. RESULTS: Total of 65 patients was included in the study. Most common etiology of perforation was inflammatory involving anteroinferior quadrant as most common etiology with success achieved in 56 patients. CONCLUSION: patients with small central dry perforation of tympanic membrane, cautery patching using tincture ferri per chloride and paper patching gives good results comparing to the surgical procedure, while ablating the morbidity and psychological trauma of the surgery.