No abstract

Tibial condylar fractures are specially challenging to the Orthopaedic surgeons because of their variation, complexity, and injuries associated with it. Proximal tibia gives attachment to the various elements of knee stabilizers and is an integral part of the knee mechanism. So, alteration of its anatomy caused by injury result in functional impairment of knee. A study has been carried out to know the mode of injury, fracture pattern, outcome of various modalities of treatment, complications encountered and associated with management of tibial condylar fractures in adults. Study consists of 35 patients with tibial condylar fractures. Out of 35 patients, 12 patients were managed by conservative methods and remaining 23 Patients were managed by surgical methods. Conservative treatment included closed reduction and above knee cast application and surgical management included CRIF with CCS or ORIF with BP with or without bone grafts. Functional evaluation of the knee was done, based on the modified HohI and Luck evaluation methods. Incidence of osteoarthritis was assessed based on the most recent radiograph of tile patient's weight bearing. The management of tibial plateau fracture has always been a subject of debate because of their variety and complexity. It is concluded that surgery is the treatment of choice for displaced fractures belonging to Schatzker type I and II. Schatzker's type III fractures can be managed conservatively if the depression is less than 2 mm. Schatzker's type IV and V can be managed by open reduction and internal fixation with Buttress plate and bone grafting especially in young individuals who require perfect anatomical reconstruction of the articular surface, stable fixation and early mobilization. Conservative method is a valid and useful alternative for undisplaced Schatzker type I fractures.

Background: Fractures of the clavicle are one of the injuries which are often inadequately treated. Nonunion, malunion and shortening arising out of nonoperatively treated clavicular fractures cause significant disability due to pain, impaired function of the shoulder joint and limitations of activities. To evaluate the functional outcome following precontoured locking compression plate fixation in displaced midshaft clavicle fractures in adults using Constant and Murley scoring and to assess interrelationship among different covariates. Materials and Methods: Study was conducted at Karpaga Vinayaga Institute of Medical Sciences, Madhuranthagam, Tamil Nadu. Forty patients with displaced midshaft clavicular fractures operated using precontoured locking compression plates were recruited for the study. They are followed up for a period of six months and the outcome was noted. The primary outcome was assessed by Constant-Murley Scoring system and the results were analysed with statistical tools. Results: In our study the mean Constant and Murley scoring was 89.60 at the end of six months. Average time taken for radiological union was 13.45 weeks. We found a statistically significant difference (p value <0.001) in Constant and Murley scores between the first month, third month and sixth months indicating improvement in functional status of the patient over a period of six months after surgery. There were no cases of implant removal due to hardware prominence despite having had this complication in four of our cases (20%). Conclusion:Based on our study, we recommend the use of precontoured locking compression plates for displaced midshaft clavicular fractures. These plates also avoid the need for intra operative contouring and potentially eliminate the necessity of a second surgery for implant removal. Sterile precautions, early surgery, perfect anatomical reduction and early postoperative rehabilitation are needed to achieve favourable results.