No abstract

Background: Treatment of fractures of proximal humerus has been a subject of much controversy and confusion with diversity of opinion regarding the management of fractures of proximal end of humerus. The aim of this study was to know the best modality of management of proximal humerus fracture in a defined patient group by reviewing the outcome, results and complications of the various operative procedures for fixation of proximal humerus fracture and their comparison in a series of thirty patients. METHODS: Over a two-year period, we treated thirty patients of two-part fractures and three-part fractures, with percutaneous pinning with K-wires, cancellous screws, buttress plate (T/Clover leaf), and LCP. All patients underwent rigorous postoperative rehabilitation under the supervision of physiotherapist and functional outcome was assessed with the use of Neer's shoulder score. RESULTS: All fractures united within the first year and 1 patient had pin infection, 1 had loss of reduction, 3 cases malunion, 2 impingement and 1 case of AVN. The functional outcome of the assessment performed with Neer's score 57% of the cases had excellent results, 20% satisfactory results, 16% of them had unsatisfactory results and failure was seen in 7% of the cases. CONCLUSION: ORIF in adult patients with proximal humeral fractures reduces hospital-stay thereby preventing loss of earning and in elderly patients prevents reflex sympathetic dystrophy, stiffness and shoulder hand syndrome by early mobilization without any undue risk of loss of fixation and reduction.

Distal femoral fractures have been one of the greatest treatment challenge since ages. Before 1970, conservative treatment is associated with risk related with prolonged bed rest, and immobilization, persistent angulatory deformity, knee joint incongruity and loss of knee motion with poor final outcome. Due to continued research by AO, better implants are now available promising better results. DF-LCP is one of those recently developed implants. Present study is designed to confirm the utility of DF-LCP as a better substitute for the treatment of supracondylar fracture femur. A prospective study was conducted from June 2016 to July 2018 in the Department of Orthopaedics on 30 patients (21-71 yrs old, 19 males, 11 females) with distal femoral fractures. They were treated using DF-LCP and followed up for 6 -18 months. Results were evaluated using Neer's rating System. Average union-time was 15.1 week. There were 2 delayed union and no nonunion. Average time taken for full weight bearing was 13.43 weeks. Overall average knee flexion in 30 patients in this study was 114.47°. Neer's score was assigned for each patient after 24 to 36 weeks. Using this scale 16 cases (53.3%) showed excellent, 11 cases (36.7%) good and 3 cases (10%) poor result. Conclusion: DF-LCP is a better implant for OTA type A and type C supracondylar femur fractures in both young and elderly patients with osteoporosis.

Introduction: Distal radial fracture is one of the most common injuries to the musculoskeletal system, which are managed both conservatively & surgically. There are pitfalls, advantages & disadvantages in each method. This study was conducted in orthopaedic department of our medical college from September 2016-November 2018 to compare the results of conservative versus operative treatment of intraarticular distal end radius fractures. Material and methods: Total of 80 patients, (53 males & 27 female) of 20-80 yrs of age were treated conservatively or surgically depending upon the displacement and comminution. Those with minimum comminution and displacements (40 patients) were managed conservatively and others with more displacements and comminution (40 number) were treated surgically using either pinning, plating or external fixation. Results: Most commonly the mode of injury, wrist involvement & fracture type were RTA (45%), Right side (51.25%) & Frykman's III (41.7%) respectively. Excellent results were seen in 47.5% in surgical group & 30% in conservative group. Conclusion:We conclude that surgical management is better than conservative in the treatment of comminuted & displaced intra articular fractures of distal end of radius. However, we cannot generalize one treatment method for all fracture patterns & it should be individualized to a particular fracture.

Introduction: In spite of vast advances in implants and operative techniques in the management of femoral diaphyseal fracture, treating a case of aseptic nonunion still poses a great challenge to treating surgeon. In India, the illiteracy of the patient and the false security of stable fixation with intramedullary rods often leads to premature weight bearing causing implant failure and nonunion. Material and methods: 13 patients aged 19 yrs -52 yrs with aseptic femoral diaphyseal nonunion with implant failure were treated during Sept 2015 -Dec 2017. Twelve of them required opening nonunion site for implant removal, hence were treated by exchange nailing and auto genous bone grafts. One case treated by closed exchange nailing only. Results: 11 cases achieved solid osseous union with single procedure in an average of 5.3 months. One patient required dynamization in 4 th post-operative month. A case of closed exchange nailing without bone grafting healed in 6 months. Conclusion: Exchange nailing with bone grafting is an excellent method for treating aseptic femoral diaphyseal nonunion with implant failure.