Background: Distal femur fractures account for less than 1% of all fractures and 4%-6% of all femur fractures. Soft tissue damage, comminution and articular extension makes the treatment difficult and they often result in unsatisfactory outcome and poor knee function. Open fractures further complicate the situation. In our study we compared functional outcome, time of union and complications of open complex distal femoral fractures treated with delayed plating or primary Ilizarov ring fixator. Material and Methods: we retrospectively reviewed 23 cases presented at department of Orthopedics, from January 2011 to January 2017. All skeletally mature patients with AO type C distal femur fractures and up to Gustilo Anderson grade IIIA were included. Pathological fractures, types IIIB and IIIC open fractures and patients with other fractures in the ipsilateral limb were excluded from the study. Patients in group A were treated with delayed plating and in group B with primary Ilizarov. Result: Out of the 23 cases, all cases in both groups showed radiological union between 16-22 weeks. 3 cases of group A showed shortening of >2 cm while Ilizarov group had none. In 5 cases of group A, primary bone grafting done during surgery having severe comminution (C3 type) and in one case secondary bone grafting done after 5 months for delayed union. Out of 12 cases of group A, 5 patients (42%) achieved full flexion. In group B limited knee flexion was seen in all cases with mean flexion at final follow-up of 92°. Conclusion: Delayed fixation with autologous fibular grafting and distal femoral locking plate provides adequate restoration of knee motion and early knee mobilization with high risk of infection. Whereas Ilizarov fixator shows better outcome in terms of infection control, LLD management, lesser number of surgeries, lesser hospital stay, earlier post-op rehabilitation and acceptable knee function.

This is the 3rd case of schwannomatosis involving the dorsal and lumbar spine, in which excision of the tumours led to resolution of symptoms.

BACKGROUNDDisplaced bicondylar tibial platue fractures (Schatzker V and VI) are otherwise known as high grade Schatzker type tibial platue fractures. They are always associated with soft tissue injury which possess a challenge for orthopaedic surgeons due to higher rate of post-operative infections, skin necrosis and wound dehiscence. Circular external fixator is a good option. However, delayed ORIF reduces the chance of infection & maintains articular congruity resulting in better functional outcome.

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<p class="abstract"><strong>Background:</strong> Medial tibial plateau fractures is a subtype of proximal tibial fractures that involve the articular surface and can present in several distinct patterns. Purpose of this study was to assess the clinical outcome of stabilizing these biplanar medial tibial plateau fractures using dual plating technique through a single incision.</p><p class="abstract"><strong>Methods:</strong> Between 2017 to 2019, 12 men and 8 women with closed medial tibial plateau fracture who underwent reconstruction using two plates through a posteromedial approach were included in the study group. The fractures were classified using the three column concept of Lou.<strong></strong></p><p class="abstract"><strong>Results:</strong> One patient had an articular step off that was unacceptable and two patients had an acceptable articular step off. Functional assessment was done using the objective scoring of Oxford knee score criteria and radiological assessment was done using the Rasmussen modified score.</p><p class="abstract"><strong>Conclusions:</strong> Biplanar reconstruction using dual plates is a reliable and safe technique to reconstruct complex medial tibial plateau fractures.</p>