BACKGROUNDFracture of the humerus shaft accounts to 3% to 5% of all fractures. Majority of the fractures are unstable due to distraction force of the gravity in the upper limb and strong muscle contraction leading to displacement. Internal fixation and early mobilisation is more stressed on than splinting and prolonged immobilisation to allow earlier mobilisation and rapid return to work.The aim of the study was to study the union rates and the functional outcome and complications associated with shaft humerus fractures in KIMS Hospital. In this study period, 25 cases of fracture shaft of the humerus were treated by open reduction and internal fixation using DCP. Skeletally mature patients with fresh humerus diaphysis fractures were included in the study. Pathological fractures and Tscherne grade 2 and above, Gustilo Anderson type2 and above were excluded from the study. RESULTSIn our series of 25 cases, there were 21 men and 4 women with average age of 42.5 years. Sixteen (64%) cases were due to RTA and with predominance of right side. Transverse fractures were most common that is 15 (60%) patients. Eleven (31%) cases were having associated injuries. 92% of the fractures united with good to excellent outcome. There were 2 (8%) cases of non-union due to infection and comminution. CONCLUSIONOpen reduction and internal fixation with dynamic compression plate is still the standard treatment of choice for fracture shaft of humerus achieving excellent to good functional outcome.

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Fragility fractures, a form of stress fracture brought on by physiological stress on weak bones, are not common. It might be challenging to diagnose a fragility fracture since a standard radiograph shows signs of fracture repair rather than the actual fracture. We present a case of a 32-year-old woman who has been complaining of both leg pain for the last 4 months and has been unable to stand for the last 1 week. Further analysis revealed that her vitamin D levels were insufficient.

<p class="abstract"><strong>Background:</strong> The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.</p><p class="abstract"><strong>Methods:</strong> This is a prospective observational study of 30 cases of complex subtrochanteric femoral fractures admitted to our hospital from January 2018 to June 2019. Cases were taken according to the inclusion and exclusion criteria i.e. type IV, type V Seinsheimer’s classification, above 18 years and those who are willing to participate in the study has been included and pathological fractures, open fractures were excluded. All the patients are followed up on 2 post-operative day, after 4 weeks, 8 weeks, 12 weeks and 6months. X-ray hip with thigh anteroposterior (AP) and lateral view taken during each follow up. Out comes was assessed using modified Harris hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study of 30 cases there are 22 males and 8 females and the mean age of 43.7 years. 73.3% patients are due to Road traffic accidents predominance of right side. In our study 66% had type 4 Seinsheimers and 34% cases had type 5 Seinsheimers fracture. The mean duration of hospital stay was 17 days. Mean time for full weight bearing is 12 weeks. Good to excellent results are seen in 80% of type 4 subtrochanteric fractures and 75% of cases of type 5 subtrochanteric fractures. 4 cases had surgical site infection, 3 cases had varus, 1 case had developed implant failure, and 1 case had reverse Z effect.</p><p class="abstract"><strong>Conclusions:</strong> From this study, we conclude that proximal femoral nail is an excellent implant in the treatment of complex subtrochanteric femoral fractures the terms of successful outcome include a good understanding of fracture biomechanics, good preoperative planning and accurate instrumentation.</p>

The reconstructive surgeon faces a problem when dealing with larger soft tissue lesions over the knee and the proximal two thirds of the tibia, two crucial sites of the lower limb. Large free flaps or pedicled local flaps are two solutions of the problem. The soleus or gastrocnemius flaps by itself are insufficient. Without using free flaps, combined gastrocnemius-soleus flaps can be employed effectively. Indicators for this kind of flap are still quite uncommon in children. In two clinical cases, authors will share their expertise and talk about the use of this kind of flap in the treatment of soft tissue abnormalities in children. Two cases were outlined: the use and outcome of the combination pedicled gastrocnemius-hemisoleus double muscle flap to repair significant defects around the knee and leg in children.