Background: About 70 million trauma injuries that occur annually, around the world. More than 4.5 million open fractures occur per year in India. Long bone fractures nonunion (NU) rate varies from 2% to 7%. The management of open fracture is challenging for the orthopedic surgeon. The conventional protocol of management of compound fracture are debridement, temporary stabilization by external fixators, wound and definitive management. Very few prospective studies have been done comparing Illizarov and RF in infected nonunion. Thus we performed a retrospective study to compare the acceptance, complications, and functional outcome of Ilizarov ring fixator (IRF) and rail fixator (RF) in the treatment of infected NU. Materials and Methods: A retrospective cohort study of fifty infected long bone NU patients, who consulted Orthopedics Department of a tertiary care hospital of North-India from 2010 to 2014 was undertaken. Patients were divided into two Groups (Gp) of 25 each: one group was treated with IRF, another with RF and both followed for one year. Results were analyzed as per the ASAMI criteria (Association for the Study and Application of Methods of Illizarov) and complications as per Paley's classification. Patient's satisfaction was assessed by Visual Analog Scale (VAS) ranging from 0 to 100 mm. Results: Majority of the patients were in age group of 31- 45 years males with right sided involvement with previously treated infected NU of tibia involving distal one-third. According to VAS score, patients had mild to moderate pain in 13 cases in Gp-IRF and in 16 cases in Gp-RF, whereas severe pain was present in 12 cases of Gp-IRF and 9 cases of Gp-RF. Pin tract infection and pain were the commonest complication. Mean bone gap was 7.76 cm and 5.78 cm; average total treatment time was 17.64 and 13.40 months in Gp-IRF and Gp-RF, respectively. Duration of IRF application was more than RF ( P < 0.01). Both the limbs were equated in 20 cases (80%) in Gp-IRF and 18 cases (72%) in Gp-RF. Results were found to be excellent in 7 (28%) and 8 (32%), good in 8 (32%) and 13 (52%), and fair in 10 (40%) and 4 (16%) cases in Gp-IRF and Gp-RF, respectively. Bony union achieved in 100% cases. Treatment index was 68.45 days/cm and 64.29 days/cm in Gp-IRF and Gp-RF, respectively. Conclusion: In view of the patient acceptance, functional outcome and complications, rail fixator shows a better result than Ilizarov.

Background: Unstable inter-trochanteric fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. This study was done to compare the proximal femoral nail and proximal femoral locking plate for the management of unstable inter-trochanteric fractures and their postoperative complications. Material and methods: This was a prospective study of 40 patients with unstable inter-trochanteric fractures of femur who were treated with PFN (20 cases) and PFLP (20 cases). The fractures were classified according to Boyds and Griffin classification. All patients were assessed functionally by Harris Hip Score. Results: Average duration of union was 14.75±3.52 weeks (range 14 to 16 weeks) in PFN cases and 17.70±2.00weeks (range 14 to 21 weeks) in PFLP cases, union was achieved in 100% cases except one case of PFN which goes to non union due to Z effect. Various complications were seen in both cases. As per Harris Hip score, excellent results were noted in 75%PFN and 40%PFLP cases, good in 15%PFN and 25%PFLP cases and fair in 5% PFN and 35% PFLP cases and poor in 5%PFN and 0%PFLP cases. Conclusion:Harris hip score comparison of study suggests that functional results were better in PFN than PFLP. Less Blood loss, less operative time, early weight bearing were other favouring factors in PFN. Though blood loss and operative time was more, rigidity of fixation was better in unstable fractures in PFLP group. We conclude that PFN is the better implant for unstable intertrochanteric fractures with lesser operative time and lesser blood loss. While PFLP can be a good alternative for unstable intertrochanteric fractures with better results with slightly longer operative time and more blood loss when compared with PFN.

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