<p class="abstract"><strong>Background:</strong> Tibial plateau fractures pose a challenge to the treating surgeon especially in cases with compromised soft tissue envelope. External fixation achieves good results with minimal complications. The objective of our study was to evaluate the functional outcome of tibial plateau fractures treated by Ilizarov and hybrid external fixation.</p><p class="abstract"><strong>Methods:</strong> 46 patients with tibial plateau fractures were analysed. 6 were lost to follow-up. 20 patients were treated by Ilizarov method and 20 by hybrid external fixation.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean time for union was 24.5 weeks in Ilizarov fixator group and 28 weeks in hybrid fixator group. Mean Lysholm’s score was 86.1 in Ilizarov cases and 83.4 in hybrid fixator cases. The mean knee society score in Ilizarov fixation cases was 78.5 and 77.3 in hybrid fixator cases. At one year by Lysholm score 6 patients had fair, 10 had good and 4 had excellent result in Ilizarov group and 1 had poor, 8 had fair, 8 had good and 3 had excellent results in hybrid group. 15 patients in Ilizarov method had good and excellent knee society scores and 12 patients had good and excellent results and 1 patient had poor score in Hybrid fixator group.</p><p class="abstract"><strong>Conclusions:</strong> External fixation in complicated tibial plateau fractures gives acceptable outcomes. Ilizarov external fixator has an advantage of earlier mobilization and earlier union but requires longer operation time and a bulky apparatus. Hybrid fixator on the other hand has lesser operating time and simpler construct but has less stability and longer union time.</p>

<p>Tension band wiring (TBW) is the conventional procedure for transverse patellar fractures. Comminuted fractures of patella are difficult to treat by TBW. Routine osteosynthesis procedures are prone for infection, implant failure and symptomatic hardware in such cases. We are reporting a case of comminuted patellar fracture in a 62 years old lady treated by Ilizarov external fixator. Patient presented with h/o fall and injury to right knee. There was swelling of the right knee. She was unable to bear weight and move her knee. Radiograph revealed a comminuted patellar fracture. Pre-operative evaluation was done. Ilizarov external fixation was done under spinal anaesthesia with one half ring and 5 trans osseous Ilizarov wires. The patient was allowed full weight bearing. Knee ROM was allowed. The fixator was removed after 4 months and physiotherapy continued. The patient was followed up for 3 years. She has full range of knee movements and is able to squat and sit cross-legged and the radiographs show good union. The Ilizarov external fixator in this case helped us to treat a comminuted fracture without opening of the fracture site and has prevented complications.</p>

<p class="abstract">Infected non-union of fractures of the shaft of proximal femur in paediatric age group is rare. They pose a formidable challenge to the treating orthopaedic surgeon. Concomitant infections elsewhere in the body are a risk factor for infection of fractures treated by open reduction. In our patient the infected non-union was secondary to urinary tract infection. A 12 year old boy sustained an open pelvic injury with bladder rupture and left closed sub-trochanteric fracture. Open reduction and internal fixation (ORIF) was done initially which got infected due to concomitant urinary tract infection due to bladder injury. He was treated by Ilizarov external fixation and later by AO external fixator and the functional outcome is evaluated. This patient had to undergo multiple surgeries with external fixations to control infection &amp; achieve union which took a long period of 8 months. Primary external fixators in complicated cases and in cases prone for infection reduce the need for multiple surgeries.</p>