Introduction: Forearm fractures are one of the most common orthopaedic injuries in paediatric age group. Normal function is often achieved with closed reduction and casting. Loss of fracture reduction is the most commonly reported complication of forearm fractures. An important modifiable risk factor for fracture redisplacement is the quality of casting, which can be measured objectively by the use of casting indices. An attempt is made to validate the role of cast index in middle third fractures of both bones of forearm in children. Materials and methods: Patients in the age group of 2 to 12 years with fracture of both bones of forearm involving the middle third treated by closed manipulation and cast application were included in the study. An above elbow cast was applied in the emergency room after closed reduction in all patients. Cast Index, defined as ratio of inner diameter of the cast in lateral view to that in anteroposterior view was measured at the fracture site in all the radiographs.The mean Cast Index in nondisplaced and displaced groups were calculated and compared. Results: Thirty children with middle third fractures of radius and ulna were included in the study. At 1 and 2 week follow-up, all but 5 cases maintained acceptable reduction. The mean cast index in 25 cases which maintained reduction was 0.75 whereas that in the group with significant displacement was 0.84. Conclusion: Majority of paediatric forearm fractures are amenable to conservative treatment. Quality of casting as expressed by indices such as cast index is one of the indicators of satisfactory outcome following middle third forearm fractures when used as a measure of risk of redisplacement.

Introduction: Intertrochanteric hip fractures are common with increasing age.Unstable intertrochanteric fractures are now commonly fixed using PFN, however it cannot engage greater trochanter on its own. Gluteus Medius and gluteus minimus (main abductors) attach to greater trochanter, hence abductor weakness is a likely consequence especially in comminuted fractures. In this study we measured the incidence of post-operative abductor weakness and result of targeted physiotherapy on it. Materials and Methods: 135 patients with unstable intertrochanteric fractures underwent proximal femoral nailing at our hospital. The patients included in this study were more than 18 years of age with unstable fractures classified according to Modified Evans classification type 3, 4 and 5 with the duration of trauma less than 3 weeks. The functional assessment was made using Modified McKay criteria through analysis of abductor muscle strength. All patients underwent a pre-determined physiotherapy as per protocol. Result: Immediate post-operative muscle power was Grade 1-(09 pt.), Grade 2 (39 pt.), Grade 3 (43 pt.) and Grade 4 (43 pt.). Most of the patient improved their muscle power grade at 12 weeks with only 09 patients with grade 2 and 23 patients with grade 3 power. At final months follow up only 08 patients had grade 3 power and only 6 patients had grade 4 power while the rest had muscle power grade 5.In our study excellent score was seen in 87 patients (83%), good in 12 patients (12%) and poor only 7 patients (5%) at 6 months, as per Modified Mckay criteria. Conclusion: Abductor weakness and Trendelenburg gait are surprisingly common in patients treated with PFN and this complaint is often overlooked. Correct surgical method and targeted physiotherapy can help alleviate this problem.