a b s t r a c tPurpose: High rate of malunion and non union in displaced fracture clavicle treated conservatively lead to use of different types of internal fixation methods which also were found to be associated with various complications. Moreover their superiority over conservative treatment has not been established. This study was designed to compare clinical outcome of conservative treatment with external fixator in cases with displaced midshaft clavicle fractures.Methods: Fifty adult consenting cases of acute midshaft fracture clavicle, displaced >15 mm were included. Twenty five cases were allotted to conservative (group A) and external fixator (group B) each. In group A treatment was given in form of clavicle brace. In group B schanz pins were inserted obliquely between supero-inferior and anterior-posterior direction and connected with rod. The outcome was measured by Constant score, union time and complications.Results: Mean radiographic union time in group A was 23.45 ± 1.40 weeks (with 8% non union and 80% malunion) and in group B it was 9.36 ± 1.49 weeks. Mean Constant score at 6 months in group A was 78.28 ± 6.45 and in group B 92.72 ± 1.48. Mean shortening at 6 months in group A was 19.36 mm. In group B shortening at 6 months was noticed in three cases (6, 5, 6 mm).Conclusion: Close reduction of acute fracture mid clavicle and application of external fixator is a simple procedure providing the benefits of rigid fixation and undisturbed fracture environment. Pain relief is faster, union time is shorter and there are no hardware related problems.

Early arthroscopic decompression and debridement of septic arthritis with continuous suction irrigation can eradicate the infection. The duration of intravenous antibiotics and the hospital stay required is shorter. The functional outcome of joints is satisfactory.

INTRODUCTIONBreast cancer is the leading malignancies in the world and accounts for 15.4% of all malignancies and appears to be increasing with time. Breast lump is the most common reason for presenting to surgery department.Various types of lesion from inflammation to carcinoma can affect breast. Some lesions are common in young females while others in elderly age group. Early presentation and prompt diagnosis is essential to relieve anxiety of non-neoplastic conditions, and in case of carcinoma, it can save the patient from metastases. ABSTRACTBackground: A lump in the breast is a common complaint presenting in the surgical outpatient department of all major hospitals, with anxiety regarding a possible malignancy being extremely common. Early presentation and prompt diagnosis is essential to relieve anxiety of non-neoplastic conditions, and in case of carcinoma, it can save the patient from metastases. This retrospective study aims to audit the clinic pathologic features of patients with breast lump at teaching hospital in northern India. Methods: A total of 138 patients were included for the present study. The data on all patients who presented with history of breast lump to the surgical outpatient department at a teaching hospital, Maharaja Agrasen Medical College, Agroha from 1st January 2013 to 31st December 2015 were retrospectively analyzed. Information on age at presentation, parity, duration of symptom before presentation, previous breast disease, side and quadrant of breast affected, maximum diameter of breast lump, clinical diagnosis made by the senior registrar or unit consultant, type of biopsy done and histology diagnosis for patients who returned with histology report were extracted from the case files. All the results were analyzed by Statistical Package for Social Sciences (SPSS) software. Chi-square test was used to measure the level of significance. Results: in our present study, out of all the patients, 7 were males and rests were females. Out of 131 females, 3 (2.1%) were premenstrual and 35 (25.4%) were postmenopausal. 39 (28.3%) female patients were nulliparous. Lump was painless in 75 (54.3%) patients. Duration from discovery of lump to presentation was < 1 months in 24 (17.4%), 1-3 months 10 (7.2%), 3-6 months 18 (13.0%), 6-12 months 20 (14.5%), > 12 months in 56 (40.6%) and ranges from 2 days to 19 years. The duration was not documented in 10 (7.2%) patients. Left breast was more affected i.e. 65 (47.1%) cases than right sided. Bilateral involvement in around 12 cases (8.7%). Breast lump was presenting complaint in 138 patients in 3 years. The mean age of patients presenting with breast lump was 36.8 years (Range 15-70 years). Conclusions: Breast lump was the most common presenting complaint with most patients not presenting within one month.

A 33 years old female patient presented with posttraumatic pain in the right foot for which radiographs of the right foot was advised. No fracture was detected on radiographs and patient was managed conservatively on medications and posterior splint immobilization. We found coincidentally a short fourth metatarsal and an accessory navicular bone in the right foot radiographs. After 3 weeks of immobilization, she underwent mobilization of the right foot, weight bearing and intensive physiotherapy for 6 weeks. After two months of injury she was still complaining of pain on the plantar aspect of right foot which was diagnosed as metatarsalgia and operated on by excision of the neuroma present in the 3rd web space of the right foot. After surgery she was completely relieved of pain and could do activities well related to the right foot.

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