BACKGROUND: Spondylolisthesis is a heterogenous disorder characterised by subluxation of a vertebral body in sagittal plane occuring frequently at l4-5 and l5-S1commonest being isthmic and degenerative variety. While majority are asymptomatic, a subset do produce pain with neurology. Complete decompression of roots is essential, as is the need for solid stabilization. Several fusion techniques were reported in literature like PLF, TLIF, PLF, ALIF On theoretical grounds, TLIF has been suggested to be safe and result in an improved outcome compared to other techniques. Data to support this view, are lacking. METHODS: A total of 21 patients (age range, 27-62 years) with adult isthmic and degenerative spondylolisthesis were operated. There were 8 males and 13 females with mean age of 46.8 pre-op and 2-year followup, pain (VAS) and functional disability were quantified by Oswestry Disability Index (ODI).Radiological union assessed with xrays by Brantigen and Steffee criteria. The global outcome was excellent in 90%.and 92% fusion. 2 patients presented motor deficit which did not recover. RESULTS: The follow-up was for 2 years. The mean VAS score for low back pain improved from 7.0 preoperatively to 2.1, as did the mean VAS score for leg pain from 6.7 to 1.4 and the mean ODI from 59.5% to 11.3%. CONCLUSION: TLIF does affect the 2-year outcome of surgical treatment of spondylolisthesis with decreased back pain and ODI's, with advantages of minimal thecal retraction, restored segmental lordosis and preserved posterior tension band.

BACKGROUND: Clavicle fractures are usually known for its conservative treatment, but for displaced middle third comminuted fractures (Robinson type 2B) plate osteosynthesis is a promising option. AIM: To evaluate the functional outcome of middle third clavicular fracture (2B1, and B2 Robinson classification) in 30 patients managed with Open reduction and internal fixation with plate and screw. METHODS AND MATERIAL: We performed a prospective study between Jan 2009 to May 2012 of 30 acute displaced comminuted middle third clavicle fractures in adults which were treated with plate osteosynthesis. There were 22 males, 8 females, the mean age of the patient was 35.6 years and 10 patients had associated injuries and average follow up was 18 month, minimum of 6 months. RESULTS: Union was achieved in 12-16 weeks. Post operatively 2 patients had superficial infection, 3 patients had scar hypertrophy, 3 Patients had hard ware prominence, no patients had hardware failure and none of the patients had deep infection. The average constant score was 96 and patients were relatively satisfied with the treatment. CONCLUSION: Plate Osteosynthesis for displaced middle third shaft fracture in adults gives excellent results.

BACKGROUND Ender's nail fixation involves insertion of several nails of smaller diameter into a non-reamed medullary canal of a long bone. Fracture fixation is based on the principle of three-point fixation. It is a reliable technique of fixation in paediatric and geriatric age groups and also for pathological fractures. The present study was undertaken to study and evaluate clinically as well as radiologically. The role of Ender's nailing in various long bone fractures with regards to functional status of the patients, union of the fracture and postoperative complications. MATERIALS AND METHODS 18 patients of paediatric age group with various long bone fractures underwent operative management with flexible multiple Ender's nails. RESULTS All children achieved union in a mean time of 12 weeks. Limb length discrepancy was seen in one child. Migration of nails was seen in one child. Slight to considerable limitation of joint movements were seen in 4 patients. One patient required reoperation.

BACKGROUNDFracture of the distal radius ('broken wrist') is a common clinical problem. It can be treated conservatively usually involving wrist immobilisation in a plaster cast or surgically. A key method of surgical fixation is external fixation. MATERIALS AND METHODSA prospective study was carried out on 66 patients admitted between June 2014 to May 2016 for evaluation of conservative and surgical management of distal radius fractures. RESULTSExcellent, fair or good result was noticed in around 85% of cases managed conservatively and in above 90% of cases managed by external fixator. CONCLUSIONThere is some evidence to support the use of external fixation for dorsally displaced fractures of the distal radius in adults. Though, there is insufficient evidence to confirm a better functional outcome, external fixation reduces redisplacement gives improved anatomical results and most of the excess surgically-related complications are minor.