We used the Ilizarov circular external fixator to treat 16 patients with persistent nonunion of the diaphysis of the humerus despite surgical treatment. All patients had pain and severe functional impairment of the affected arm. In ten, nonunion followed intramedullary nailing. We successfully treated these by a closed technique. The nail was left in place and the fracture compressed over it. The fractures of the other six patients had previously been fixed by various methods. We explored these nonunions, removed the fixation devices and excised fibrous tissue and dead bone before stabilising with the Ilizarov fixator. In five patients union was achieved. Bone grafting was not required. In the single patient in whom treatment failed, there had been a severely comminuted open fracture. All except one patient had reduction of pain, and all reported an improvement in function.

W e used the Ilizarov circular external fixator to treat 16 patients with persistent nonunion of the diaphysis of the humerus despite surgical treatment. All patients had pain and severe functional impairment of the affected arm. In ten, nonunion followed intramedullary nailing. We successfully treated these by a closed technique. The nail was left in place and the fracture compressed over it. The fractures of the other six patients had previously been fixed by various methods. We explored these nonunions, removed the fixation devices and excised fibrous tissue and dead bone before stabilising with the Ilizarov fixator. In five patients union was achieved. Bone grafting was not required. In the single patient in whom treatment failed, there had been a severely comminuted open fracture. All except one patient had reduction of pain, and all reported an improvement in function.

Introduction:The tibia is the most commonly fractured long bone in the body and understanding of the mode of injury, fracture pattern is necessary to decide an operative management. Tibia shaft fractures are commonly managed by interlocking nail. This study is to assess the surgical management and assess the functional outcome of tibia shaft fractures. Materials and Method:The study consist of 50 patients with tibia shaft fracture treated with tibia interlocking nail. Clinical outcome and function results were evaluated by Alho & Ekland's criteria. Result: In this study, we have operated a total 50 cases with tibia interlocking nail in tibial shaft fractures. The average union time was 17.68 weeks. The study yielded about 82 % of excellent result. Conclusion:The present study shows that closed fractures of the tibia shaft treated with interlocking intramedullary tibia nailing involves minimal surgical trauma and negligible blood loss. It provides the advantages of early ambulation, lower rates of infection and non-union. A significant advantage of interlocking nail in addition to early joint mobilisation, is early weight bearing which allows earlier return to work. Hence the study concluded that closed interlocking intramedullary nail is the treatment of choice in closed tibia shaft fracture.

Introduction:The proximal humerus fracture is of great importance when it affects the young and middle age groups of the population as it leads to temporary disability and loss of working hours. Restoration of the function of the limb becomes the primary goal of its treatment. Principle of fixation is reconstruction of the articular surface, including the restoration of the anatomy, stable fixation, with minimal injury to the soft tissues preserving the vascular supply. The present study was conducted to analyze the occurrence, mechanism of injury and displacement of various types of proximal humerus fractures and further evaluate the functional outcome of different modalities of its management. Methods: The following study was conducted at C U Shah Medical College and Hospital, Surendranagar, Gujarat during the period of June 2012 to June 2014. Total 50 patients, 22 males and 28 females with proximal humerus fractures treated with different modalities were selected for the study and assessed by Constant and Murley scoring system with at least 1 year follow up. Results: The average age of patients was 55.6 years out of which 56% were female. Domestic fall was the most common mode of injury (64% patients). Two part surgical neck fractures (Neer's) accounted maximum number of the patients (34%). All One parts and most of the two part fractures treated conservatively. Most of the three part fracture treated with Open reduction and proximal humerus anatomical locking plates. Most common complication was malunion whereas one patient had implant loosening as complication. The average constant score at final follow up for all conservatively treated patients was 75.69, for patients treated by close reduction and percutaneous K wire fixation was 82.79 and for patients treated by open reduction and internal fixation with anatomical locking plate was 73.6. Conclusion: Early Open Reduction and Internal fixation prevents complications like shoulder stiffness, malunion, and late osteoarthritis. Open reduction and rigid internal fixation with proximal humerus plates becomes the choice of treatment for young adults with displaced fractures, whereas fractures in old aged patients with osteoporosis gave good outcome with conservative modality of management. There is also a direct relationship between displaced proximal humerus fractures, fracture severity and eventual results.

Introduction: Nonunion of femoral shaft fractures continues to hinder the successful outcome femur fracture treatment in spite of increased understanding of biomechanics and improvements of implant design. Nonunion of femur fracture presents a difficult treatment challenge for the surgeon and a disastrous personal and economic hardship for the patient. Method and Material: 20 consecutive cases of fractures shaft of femur non-union were admitted to the Orthopaedics Department, Dhiraj Hospital, Waghodia were included in this study. All patients underwent revision surgery in form of exchange nailing with autologous cancellous bone graft with plate augmentation in required cases. Results: Out of 20 patients maximum belonged to the age group of 31-40(8). 13 (65%) patient had hypertrophic non-union and 7 (35%) had atrophic non-union. Average follow up of patients was upto 14 months post operatively. Out of 20 patients, 14 (70%) patient achieved union at their last follow up. Radiological signs of bone union was observed at a average of 7.5 months (5.5 to 11 months). Discussion and Conclusion:The use of plate augmentation and bone grafting for the treatment of femoral shaft nonunion, along with exchange interlocking intramedullary nail, to remove the rotational instability of the nonunion site increased the chances of union. Bone grafting performed simultaneously filled the bony defect and stimulated healing.