BACKGROUND Diaphyseal fractures of the forearm are one of the common fractures in the paediatric population. Closed reduction and cast immobilisation remain the standard treatment for paediatric diaphyseal forearm fractures owing to their unique remodelling potential. The main concern of conservative management is re-displacement of fracture in cast resulting in the unacceptable angular deformity in the forearm. Intramedullary fixation with titanium elastic nails for paediatric diaphyseal forearm fractures is becoming the trending surgical technique in those cases that warrant surgical intervention. The purpose of this study was to evaluate the functional outcome of the management of fracture of both bones forearm in the older children with titanium elastic nailing system. METHODS This was a prospective study done among thirty patients aged 5 to 16 years admitted to the Department of Orthopaedics at GEMS & Hospital, Ragolu, Srikakulam with diaphyseal fractures of both bones forearm from September 2017 to September 2019. We treated the patients by closed / open reduction and internal fixation with elastic stable intramedullary nailing. The patients were followed-up for six months. RESULTS We evaluated the patients clinically and radiologically after surgery. We assessed the outcome using modified Anderson’s AO criteria for forearm fractures extracted from the international journal of current pharmaceutical and clinical research functions. All fractures united at an average of 9.1 weeks without any delayed or non-union. The results were excellent in 86.6 % of patients and good in 13.3 % of patients without significant complications. There were minor complications in 6 patients (20 %). CONCLUSIONS Titanium elastic intramedullary nailing is a safe, effective and minimally invasive surgical method for treatment of displaced both bones forearm diaphyseal fractures in older children. This technique gives relative stability with a three-point fixation principle resulting in secondary bone healing by promoting early callus, ideal for early mobilisation. The technique offers several advantages, including minimal incision, preservation of fracture haematoma, dynamic axial stabilisation, and shorter hospitalisation. KEYWORDS Both Bone Fracture Forearm, Titanium Elastic Nailing System, Early Mobilisation

BACKGROUND The human hand is the most vulnerable part of the body prone to a variety of injuries especially in industries, agricultural fields and adding to this increased road traffic accidents resulting in high incidence of phalangeal and metacarpal fractures particularly mutilating hand injuries, open fractures, comminuted fractures and intra-articular fractures. The purpose of the study is to evaluate the overall functional outcome of hand treated with JESS fixation for metacarpal and phalangeal fracture and to study the complications associated with their management. MATERIALS AND METHODS We have studied 30 patients with 37 fractures of metacarpals and phalanges of hand with JESS mini external fixator at Department of Orthopaedics, Rangaraya Medical College. The study was done from October 2012 to August 2014. Age of the patients range from 10-60 yrs. with most of the patients belong to 21-40 yrs. age group. The majority of the patients were male (M:F = 26:4). The sample size reflected the population visiting the trauma section of our department. Most of the fractures are caused by RTA and on right hand. Majority of the fractures are occurred in proximal phalanx, followed by metacarpal. RESULTS All patients were followed for a minimum of 6 months and the mean follow-up period was 33.77 wks. The mean fracture healing in our study was 12.77 weeks. Reviewing the literature, the average radiological healing of phalanges and metacarpals is 4-5 months, which ranges from 1-17 months. The fracture healing time in our study compares favourably with those reported in the literature. Mean duration of implant (JESS) application was 4.42 wks. Complications like pin-tract infection encountered in five patients, three pin loosening, one total stiffness and 10 of them had partial stiffness. CONCLUSION JESS fixation provides an adequate basis for bone healing is a good and simple alternative to standard treatment especially in open, intraarticular, comminuted and multiple phalangeal and metacarpal fractures.

BACKGROUNDOsteoarthritis commonly affects the medial compartment of knee giving rise to varus deformity in majority of cases. Significant varus deformity further aggravates the pathology due to medialisation of the weight bearing line osteotomy of the proximal tibia realigns this weight bearing axis, thereby relieving pressure on the damaged medial compartment. OWHTO is a promising option in this scenario because it is associated with high accuracy in correcting the deformity and less number of complications when compared to lateral closing wedge HTO or UKA. In this study, we evaluate the functional outcome of HTO in patients with unicompartmental osteoarthritis.