Neglected fracture neck of femur is a common presentation in developing countries like India. We report a case of 58years old male patient which was successfully managed at our institute. Treatment options vary from arthroplasty and osteotomy (with or without graft) to osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularized, and non-vascularised fibular graft). We performed a non vascularised fibular graft with cancellous screw fixation. Patient had a satisfactory bony union without any avascular changes. We emphasize that Non vascularised fibular graft is a treatment option for surgical management of fracture neck of femur. KEYWORDS: Fracture neck of femur, Non-vascularised fibular graft, cancellous screw. INTRODUCTION:Hip fracture is the most common serious injury in the elderly population and the most common reason for admission to an orthopaedic ward. Delay in the treatment is associated with avascular necrosis of femoral head. Various methods of treatment options are available, but none of them give uniformly good results. [1] In younger age groups less than 60 years osteosynthesis is indicated. Various types of osteosynthesis options available are valgus osteotomy, free or vascularised fibular graft, [2] quadratus femoris muscle pedicle graft, [3] combined osteotomy with fibular graft [2] and Non vascularised cortical autografts. Non vascularised cortical autografts have been used for reconstruction of skeletal defects of long bones since long. The grafts are usually removed from fibula, iliac crest or tibia. Less donor site morbidity associated with removal of fibular graft has popularized its use. Taylor, Miller and Ham, in 1975, [4] were the first to use free vascularized bone graft in tibial defect. Literature [2,5] supports osteosynthesis using non vascularised fibular strut graft in both fresh and old femoral neck fracture. We report a case of neglected fracture neck of femur in 58-year old male patient operated with non vascularised fibular graft.

Proximal humerus fractures are common and debilitating injuries and incidence of them are increasing especially in elderly. Treatment of unstable, displaced, and comminuted fractures of the proximal humerus remains challenging. Various operative procedures are carried out, recent trend in internal fixation has moved on to locking plates. The goal of the study is to test the efficacy and functional outcome of PHILOS plating in proximal humerus fractures.To evaluate the incidence of complication that may occur with PHILOS plating in proximal humerus fractures. MATERIALS AND METHODS: It is a prospective study conducted in our institute from 2013 to 2015. The study purpose to include patients with proximal humerus fractures. Clinical and radiological evaluation done. Fractures classified using Neer s classification. Patients will undergo Open reduction internal fixation with philos plating for the sustained fracture under general anesthesia .Post-operative physiotherapy followed according to protocol. Patients will be followed up at 6 weekly intervals until fracture union and, at once at 1yr after the surgery. A minimum of 20 cases studied without any sampling procedure. RESULTS: In our study most common age group was 51-60 yrs and male:female ratio 3:1 and 55% were 2 part fractures were treated by philos plating final functional outcome is assessed with NEER'S score. 5(25%) of 20 patients had excellent results, 10(50%) had satisfactory results and 5(25%) had unsatisfactory results.All cases of unsatisfactory results were had complication and elderly patients. None of patients in our study were failure. CONCLUSION: In conclusion, fracture of the proximal humerus is still a debatable and controversial subject in orthopaedics. The common mode of injury in these fractures is fall on shoulder in elderly and RTA in young population, open reduction and internal fixation with LOCKING COMPRESSION PLATES has given good results and it is the implant of choice now a days. The advantages of locking plates are: Stable internal fixation, early mobilization, Functional restoration of the tuberosity can be obtained. Secondary reduction loss uncommon. Accurate anatomical restoration of the articular surface and tuberosity appear to be more important for the better functional outcome. An adequate surgical technique will minimize complications and an aggressive rehabilitation regime (active physiotherapy) will ensure the best possible result.

BACKGROUND:This prospective consecutive case series was done to evaluate indications, technical pearls and pitfalls and functional outcomes of distal femoral supracondylar fractures treated with retrograde intramedullary nailing. METHODS: The surgical outcome of 80 patients (59 males and 21 females) who were treated with retrograde intramedullary nailing for. Patients were followed-up both clinically and radiologically every 6 weeks for a mean duration of 20 (12 -24) months. The patients were assessed based on Schatzker and Lambert criteria. RESULTS: The mechanism of injury was motor vehicle accident in 48 (60%) patients and fall in 32 (40%) patients. Sixty four (80%) fractures were closed and 16 (20%) fractures were compound. Average operation time was 2 hours and average blood loss was 300 ml. The mean union time was 5.6 months (5 -7 months). Knee flexion of more than 120 degree was achieved in 60 patients, 110 degree in 16 patients and 100 degree in 2 patients. Six patients had anterior knee pain of transient nature which subsided within one year after rehabilitation, full weight bearing and self exercises. By the end of 1 year, overall outcome was excellent in 59 patients (74%), good in 12 patients (15%) and fair in 8 (10%) patients. CONCLUSION: Retrograde intramedullary femoral nailing is an optimal tool in the treatment of AO/ASIF type A and type C distal femur (supracondylar) fractures. It provides rigid fixation in a region of femur where, wide canal, thin cortices and frequently poor bone stock make fracture fixation difficult. It also provides excellent results in selected comminuted fractures of the distal femur with a low complication rate.

BACKGROUND: Distal femur fractures are commonest fractures in high velocity trauma, the records of a consecutive series, from 1969 to 1976, of 135 adult patients with 137 fractures of which Eight-three fractures were caused by moderate and 52 by severe trauma. 1 Isolated fractures can lead to complications such as ARDS and pulmonary embolism. This leading to the need for early stabilization of fractures, with internal fixation being the choice of treatment for distal femur fracture by LCP. Plating has given the best results in terms of recovery, fracture union, return to work and in turn the functional outcome. OBJECTIVES: To study the functional outcome of the distal femur fracture fixation using LCP with MIPPO technique. METHODS: The surgical outcome of 30 patients (24 males and 6 females) who were treated by closed reduction with locking compression plate using MIPPO technique, were followed for an average of 12 months, then by radiological and clinical evaluation assessment was done using the NEER'S score. RESULTS: In the study of 30 patients with acute trauma, median age being 45 years ranging from 22-68 years. 22 fractures were caused due to RTA, 6 of them with self-fall and 2 presenting with assault. 23 amongst them were fractures of the right femur and the rest being the left. Using the NEER'S scoring system 50% excellent results were obtained, with 30% good, 20% fair results. Range of motion of hip and knee was well preserved with excellent to good results. Gait and weight bearing after complete union was satisfactory. CONCLUSION: Closed reduction and internal fixation of the distal femur fractures by LCP using MIPPO technique is one of the best modalities of treatment, with the extension of fractures into the articular congruencies, maintaining of the same is very vital. Fixation with locking condylar plates proved to be very effective especially in severe osteoporosis, decrease in the duration of hospital stay was also seen along with faster recovery, earlier union rates and good functional outcome compared to alternative procedures known. KEYWORDS: Supracondylar femur fracture, locking condylar plate, MIPPO technique, intra-articular fractures, NEER's scoring system, closed reduction and internal fixation. INTRODUCTION:With the increase of RTA and industrialization many young lives have crippled and need for decreasing their morbidity is gaining demand.Fractures of the distal end of the femur are often difficult to treat due to their complexity and intra articular involvement at times and their associated complications.In the early 1960's, there was a great reluctance towards the operative intervention of these fractures as they were associated with higher rates of malunion, non-union, sepsis, inadequate fixation, lack of proper tools and so on. Then the traditional management of supra condylar femur displaced fracture swept, mainly consisting of skeletal traction, manipulation of fracture and external immobilization in the form of casts and cast bracings. These were associated with problem...

BACKGROUND:This prospective consecutive case series was done to evaluate indications, technical pearls and pitfalls and functional outcomes of elastic stable intramedullary nailing of displaced mid clavicular fractures and the effectiveness of the titanium elastic stable intramedullary nails in the surgical treatment of the mid clavicular fractures in adults. MATERIALS & METHODS: A total of 80 patients (60 men, 20 female) were included in this study. Constant score and radiographs were evaluated after 1 and 6 weeks, 3 months and 6 months in 80 patients. Mean age was 28 years. RESULTS: Length of incision, operation time, blood loss and duration of hospital stay were significantly less. The average follow-up was 17 months. Mean operation time was 62 minutes. Open reduction through an additional small incision was necessary for some fractures. Mean hospital stay was 1.2 days. The Constant score averaged 81 after 1 week, 96 after 6 weeks and 98 after 6 months. Compared to the contralateral side, average shortening of the clavicle was 1.7 mm. CONCLUSION: Elastic Intramedullary Nailing provided a good restoration of the length of the clavicle allowing immediate active mobilization and early return to normal activity with excellent functional results. KEYWORDS: Clavicle fractures; Intra medullary nailing; elastic stable intramedullary nails. INTRODUCTION:Fracture of the clavicle is a frequently seen injury which represents about 10-15% of all fractures in adults. (1) In most cases a fall with a direct trauma causes the clavicle to fracture. About 80% of all clavicular fractures involve the middle third of the bone. (2) Standard treatment for this fracture pattern is non-operative, using an arm sling or figure-ofeight bandage for external fixation. For open fractures, imminent skin perforation, neurovascular involvement, floating shoulder or in combination with multiple ipsilateral rib fractures, open reduction and plating is generally accepted. (3) While fracture healing and functional outcome is generally good for non-operatively treated mid clavicular fractures, a poor cosmetic result due to shortening and angulation is not uncommon. (2) Non-unions occur in an average of 5%. (3) Furthermore decreased shoulder function due to clavicular shortening of more than 1-2 cm after non-operative fracture management has been reported. (5,12) Whereas a mild decrease in shoulder function is easily tolerated by most patients, restoration of the clavicle length and early return to full activity with unimpaired function is of great importance for every individual irrespective of the profession or socio-economic group they belong to.As non-operative treatment is successful in most cases for this fracture, relevant clinical benefit may be limited to a selected group of patients with a high demand on shoulder function.