European Journal of Molecular & Clinical Medicine

Injuries to the popliteal artery from blunt or penetrating trauma are routinely found in trauma centres. Early detection of the possibility of arterial injury is crucial for the limb salvage.
Material and methods: We retrospectively reviewed the records of the patients who were managed for popliteal artery injury at our institution during the study period (2020-2022). 30 Patients were treated during the study period 2020-2022. Information extracted and analysed included demographic data, clinical presentation, physical examination, blood investigation, colour Doppler. Surgical data included vessel injury, technical aspects of repair, associated complications and outcomes.
Results: There were 30 patients: 22males (73.3%) and 8 females (26.6%). Mean age ± SD was 24.7 ± 5.8 years. Most patients (90%) were under the age of 30 years. Blunt trauma was the common cause of popliteal artery injury (60%) and penetrating trauma accounted for 40% which included traumatic and iatrogenic injuries during orthopaedic procedures. All the patients had associated skeletal injury. Concurrent popliteal vein injury with popliteal artery injury was seen in 36.6% of patients. All patients had undergone popliteal artery bypass with reverse great saphenous vein graft harvested from the contralateral lower limb and popliteal vein injury was managed with vein ligation. Mean ischemia time at presentation was 9.26 hrs ±3.91. Five patients had delayed presentation. Seven patients (23.3%) underwent amputation. Of these 5 sustained tibial plateau fractures and 2 both bone fracture associated with severe soft tissue injury. There were no intraoperative or in-hospital deaths. Associated skeletal injury was managed by orthopaedic department.
Conclusion: Popliteal artery injury represents a great challenge due to their complexity and low frequency. Early diagnosis and surgical repair is recommended. Despite technical improvements in management of popliteal artery injury, a high amputation rate is still seen, especially in patients with extensive soft-tissue injury, associated skeletal trauma especially with tibial plateau fracture. Liberal use of fasciotomies, perioperative anticoagulation, antibiotics and presence of orthopaedician for skeletal fixation play an important role to achieve acceptable outcome.

The therapy of intertrochanteric fractures in older patients presents a
significant problem for today's orthopaedic surgeons. Extramedullary implants, such as
dynamic hip screws, have given way to intramedullary implants, such as PFNA2 nail
types. This represents an evolution in the implants. Early mobilisation of the patient is
the primary objective of treating such fractures, which almost never result in
complications such as non-union. This is done to avoid the consequences that can arise
from being bedridden for an extended period of time.
Materials and procedures: From 2015 and 2020, the current study comprised a total of
100 different patients. The PFNA and PFNA2 nails treatment was administered to a
total of 50 individuals. Current study took note of patients' ages and sexes, as well as the
nature of their injuries, any concomitant ailments, and any comorbidity. There was a
classification of fracture patterns.
Results: When compared to the PFNA implant, our findings showed that the PFNA2
procedure resulted in reduced intraoperative blood loss and improved outcomes with
regard to the rates of nonunion.
Conclusion: The PFNA2 implant is superior to other options in terms of the
intraoperative issues it causes, the amount of blood it requires, and the union rates it
achieves.

Most clavicle fractures are treated conservatively. Treatment of medial clavicle fractures is still controversially discussed in the community of upper extremity surgeons. An increasing number of symptomatic non-unions following conservative treatment of displaced fractures led to the development of various surgical approaches. Aim of this study was to evaluate the clinical and radiological outcome following operative treatment of displaced medial end clavicle fractures.
Methods: Patients who presented with a displaced fracture of the medial clavicle between March 2021 and December 2022 were prospectively enrolled in this study. All patients were operatively treated with open reduction and internal fixation (ORIF) using an anatomically precontoured locking compression plate (LCP) originally designed for the lateral clavicle. Functional outcome was recorded using the Disability of the Arm, Shoulder, and Hand (DASH) score; Constant–Murley score; visual analog scale (VAS) score; and complications.
Results: The patients were regularly followed up after the operation, and functional parameters were assessed over time. At a mean follow-up of 28.1±2.0 months, each fracture had solid bone union. The mean shoulder forward fexion was 159.3°±7.9°, and the mean DASH score was 8.8±5.1. The mean Constant–Murley score was 88.9±7.9, with six cases assessed as excellent and one case assessed as good. The mean VAS score was 1.0±1.5, and the mean patient satisfaction score was 9.3±0.8. No complications occurred, and each patient was able to resume their preinjury daily activity and was highly satisfed with their treatment.
Conclusion: Surgical treatment of displaced medial clavicle fractures using an anatomically precontoured locking plate originally designed for the lateral clavicle led to very good to excellent clinical and functional results

Fractures of distal radius account for 20% of all fractures treated in emergency department. These fractures result from low energy injuries in elderly population and high energy injuries in young adults. Most of these fractures are relatively uncomplicated and are effectively treated by closed reduction and casting. However, fractures that are unstable intra-articular can jeopardize the integrity of the articular congruence and kinematics of articulations resulting in high prevalence of complications. So to overcome these above complications, there is a shifting trend towards surgical management.

Clavicle fractures contribute approximately 2.6% among other fractures of the body and account for approximately 44% to 66% of all fractures around shoulder.Middle 1/3rd of the clavicle is most prone for fracture because this area is weakest.Many studies which has been done till now has stated the effectiveness of open reduction internal fixation with plating for displaced clavicle fractures and it was noted to have high union rate and lower risks of complication.Usually locking compression plate are used to get a satisfactory results with low risks of complication in cases of majority of complex clavicle fracture.

The most common hip fracture is an intertrochanteric femur fracture, which is more likely in older population with osteoporotic bones and with a male preponderance. The proximal femoral nail (PFN), developed by the AO/ASIF group, has demonstrated its stability as an implant in femoral fractures with peritrochanteric, intertrochanteric, or subtrochanteric fractures [6]. So, the current study was conducted with the aim of assessing the role of proximal femoral nail in the management of intertrochanteric femur fracture and its functional outcome.
Methods: The Department of Orthopaedics at Sree Uthradam Thirunal Academy of Medical Sciences Hospital, Thiruvananthapuram, Kerala, South India, undertook this current prospective cohort study from January 2021 to June 2022. On the basis of predefined inclusion and exclusion criteria, a total of 48 patients were included in present study. A pretested questionnaire was used to record patient details such as age, gender, type of fracture, time period of union of fracture in open and closed reduction, complications and functional outcome. The Boyd and Griffin classification was used to classify intertrochanteric fractures. Patients were followed up at 3, 6, and 12 weeks and finally at 6 months postoperatively for functional outcome as assessed by Kyle’s criteria. The statistical tests were considered if P value was <0.05.
Results: In our study, an aggregate of 48 patients were enrolled, male patients predominated (n=32) the study and there were 16 female patients. The mean age of patients was 48.57±8.13 years. In our study, Type I fracture were 4.1%, Type II fracture were 66.7%, Type III fracture were 6.3% and Type IV fracture were 22.9%. The difference in the time taken for union for fracture approached via closed and open reduction technique was not significant (p>0.05). In our study, the postoperative complications were screw failure (12.5%), and varus malalignment (4.2%). The functional outcome as excellent was enhanced as it was 20.8% at 3 months and 33.3% at 6 months.
Conclusion: Before being used by an orthopaedic surgeon, all latest implants and instrumentations must undergo a rigorous assessment. In our study, the proximal femoral nail, which was made use of to treat intertrochanteric fracture, achieved good results in terms of both functional and radiographic performance.

Background: To assess results of distal femur fracture fixation with a lateral locked plate.
Materials and Methods: Seventy- six adult patients of distal femur fracture of both genders were treated with distal femur locking plate. Parameters such as muller classification, HSS score, average time to union (months), average range of flexion (degree), knee score (mean), functional score (mean) and complications were recorded.
Results: Out of 76 patients, males were 46 and females were 30. Muller typeA1 was seen in 29 A3 in 15, C1 in 20 and C2 in 10 patients. The mean knee score was 96.2, mean functional score was 92.5, average time to union was 3.4 months and average range of flexion was 112.4 degrees. HSS was excellent in 58, good in 12, fair in 6. Complications were wound infection in 2 and 4 and non- union in 1 patient. The difference was significant (P< 0.05).

Conclusion: Lateral locking plate was best choice for management of distal femur fractures

^{Superior dislocation of hip with rectus bony avulsion is a rare condition which mainly happens due to domestic fall and high velocity trauma of motor vehicle accidents. Rectus femoris avulsion fracture leads to pulling of fragment and it lies close to hip joint. X-ray will usually show the presence of the fragment near the hip joint. Avulsion injury of the rectus femoris usually results due to sudden powerful contraction of the muscles of rectus femoris or sometimes it can be due to sudden knee flexion with traction.
Case Report: 41 Year old male developed pain in left hip area and unable to move the left hip joint after an episode of domestic fall. On Physical Examination tenderness was present in the left hip area with hip joint restricted range of motion. There was no distal neurovascular compromise. Patient was primarily immobilised using Thomas Splint. Imaging done using X rays and CT of the pelvis suggestive of superior dislocation of the hip with bony avulsion at the site of rectus insertion. Patient was planned for relocation of the hip with open reduction and internal fixation with cortico-cancellous screws.
Post operatively the limb was immobilised in Thomas splint for 3 weeks followed by start of Range of motion of the hip joint as per pain tolerance. Partial weight bearing was started after 3 months of the surgery.}

Background: Deaths due to fall from height are the second leading cause of injury-related deaths. The fatalities of the injuries depend not only on the height of fall but also on the landing position and impact surface². Additionally, diversity of the injuries and the complexity of the patterns involved in these injuries, emphasizes the need for study in this area. A prospective autopsy study of deaths due to fall from heights was carried out in the Department of Forensic Medicine & Toxicology attached to Government Kilpauk Medical College & Hospital, Chennai – 10, Tamil Nadu for the year 2021 from 01-01-2021 to 31-12-2021. Among the total 2825 cases autopsied during the study period, 84 cases (2.97 %) were deaths due to fall from height. Maximum deaths were seen in males (77.38%). Maximum number of fall from height cases were seen in the age group of31-40 Years (55.95%). Maximum case of fall from height was seen in construction workers (38.09%). Maximum cases of fall from height were seen in low socioeconomic status (73.80%). Maximum cases of death due to fall from height were married (73.80%).  Maximum cases of fall from height were seen with a distance below 20 feet which constitutes (40.47%). The impact surface was maximum with fall over a hard surface (46.42%). The cause of death in maximum cases was attributed to Cranio Spinal Injuries (44.04%). The most common manner of death was accidental in nature (80.95). We concluded that fall from heights carry a significant morbidity and mortality and to decrease the incidence of these deaths, it is important to employ certain vital strategies. These include creating awareness amongst workers, increasing parental supervision of toddlers during their play at heights and psychological counselling for students.

Background:The procedure has fewer successful outcomes in aged, osteoporotic individuals, and in highly comminuted fractures, and is consequently deemed inappropriate for these situations. Some authors, however, still advocate for its use because of how easy it is to implement and how little disruption it causes compared to other approaches like external fixation. Objectives:  To compare the functional outcome of extra articular distal radius fracture treated with plaster immobilization versus percutaneous pinning. To study the complications faced, the time taken for fracture union in treating both groups. Methodology: It was a Descriptive Cohort study conducted in a tertiary centre for a period of 18 months duration. The study participants were patients of both the genders with age between 40 years to 65 years with closed extra-articular distal radius fracture admitted during the study period. Results: fracture union time is better in Percutaneous pinning group compared to plaster immobilisation group and association is statistically significant (P<0.05) Percutaneous pinning group has better VAS score compared to Plaster immobilization group at 3rd and 6th month and the association is statistically significant (P<0.05), Functional outcome is better in percutaneous pinning compared to Plaster immobilization group and association is statistically significant (P<0.05). Conclusion: Displaced fractures of the distal radius are considered to be unstable when alignment cannot be maintained in a forearm cast after closed reduction, but this definition applies retrospectively. Previous studies have attempted to identify risk factors for instability.in the present study following were the findings Mean fracture union time is better in Percutaneous pinning group compared to plaster immobilization group Percutaneous pinning group has better SF36 score compared to Plaster immobilization group at 1st, 3rd and 6th month and the association is statistically significant (P<0.05).

Aim: The purpose of the research was to evaluate the fracture resistance of conventional full coverage crowns and two different designs of overlay restorations with margins located 2 and 4 mm above the gingival level.
Methodology: CAD/CAM lithium disilicate (IPS e.max CAD for CEREC/HT A1 C14, Ivoclar Vivadent) restorations (15 specimens/group) with 1.5 mm occlusal thickness and 1.0 mm chamfer were designed and fabricated with a chairside CAD/CAM system (CEREC, Dentsply Sirona). The restorations were prepared in three different designs: (1) full coverage crowns, (2) overlays with the margin located 2 mm above the gingiva, and (3) overlays with the margin located 4 mm above the gingiva. Restorations were cemented using conventional resin luting cement (Multilink, Ivoclar Vivadent) then finally loaded with a steel indenter until failure. Scanning electron microscopy observations of fractured surfaces were also conducted. Group results were analyzed with one-way analysis of variance, and the medians were evaluated independently with Kruskal-Wallis.
Results: The fracture force of CAD/CAM lithium disilicate restorations was significantly different (p < 0.001) depending on the design of the restoration. Full coverage crowns showed significantly higher force to fracture (1018.8 N) than both 
types of overlays (p = 0.002 for overlay 2.0 mm and p < 0.001 for overlay 4.0 mm above gingiva).
Conclusion: Full coverage chairside CAD/CAM lithium disilicate premolar crown showed higher fracture resistance than overlay restorations

Background: Supracondylar humerus fractures are one of the commonest fractures in the paediatric age group. Displaced fractures of these kind, that is, Gartland type III are treated by closed or open reduction and k wire fixation. Cross k wire and lateral wires are the commonest configurations used for fixation. The present study aims to evaluate the difference between the two configurations in terms of surgical technique, functional outcome and complications. Objectives: To compare the functional and radiological outcome of lateral and cross pinning of displaced supracondylar humerus fractures of children METHODOLOGY:This was a prospective comparative study of 40 paediatric patients with supracondylar fracture humerus in the department of Orthopaedics in a Tertiary care Centre after the inclusion & exclusion criteria were met. Immediately after admission , a detailed neurovascular examination was done. Anteroposterior & Lateral Radiographs of the elbow were taken & type of fracture was noted. Informed and written consent was taken from the parent/guardian. Then 20 patients were treated with Lateral K- wire technique  (Group A ) and another 20 patients with Cross K- wire (Group B) pinning technique of fixation. Results: The average follow-up period for patients in lateral K wiring technique  was 12.23 ± 1.9 months while that for patients in cross K wiring technique was 11.26 ± 2.5 months. This difference was not found to be statistically significant.  As per the Flynn criteria, 13 patients in group A had excellent results, 5 patients  had good results and 2 patient  had fair result. In group B, 12 patients had excellent results, 7 patients  had good results and 1 patients (20.0 %) had fair results. No patients in either group had a poor result. Conclusion: Both lateral and cross k wire fixation are similarly effective techniques for stabilising supracondylar humerus fractures, with comparable functional, radiological, and aesthetic results.

Background: Olecranon fractures are one of the common fractures around the elbow, they constitute around 37% of all fractures occurring around the elbow joint. Olecranon fractures are common and account for 10% of upper extremity injuries. Simple displaced transverse fractures account for approximately 85% of all adult fractures. These fractures are traditionally managed operatively with operatively with open reduction and internal fixation using tension band wiring. Open reduction internal fixation with plate is advocated in the presence of comminution or fracture dislocation Objective: to compare the functional outcome between tension band wiring versus plating in olecranon fractures. Methods: A prospective study of 42 patients among which 21 patients were treated with tension band wiring and 21 were treated with plating was conducted in dept of orthopaedics MMCRI, Mysore from February 2021 to August 2022. Before subjecting the patients for investigations and surgical procedures consent was obtained and patients were followed up at 6 months interval and were assessed using Mayo Elbow Performance index. Results: Patients were assessed using Mayo elbow performance score .Out of total 42 patients, 21 were operated with TBW and 21 were operated with plating. Out of 21 operated with tension band wiring on follow up 10 showed excellent results 8 had good results and 3 had fair results. 21 Patients operated with plating 14 showed excellent and 3 good results and 4 showed fair results Conclusion: Best modality of the treatment for fracture depends upon the type of fracture. We could conclude that both plate and TBW is equally effective for management of olecranon fractures. However , plate has a slight advantage over TBW in terms of early mobilization and less  complications

The aim of this study is to study outcome in posteromedial and posterolateral displaced supracondylar fracture humerus post operatively. All procedures and protocols used in this study had been approved by the medical ethics committee of our institution. Children with fractures are usually first seen in the casualty unit. The orthopaedic doctor on call will examine the child, assess the vascular and neurological status, and review the radiographs of the elbow. Evaluation of the neurology and vascular status was repeated in the ward. After obtaining the informed consent for the study and surgery, the patients would be kept fasted for surgery.
Result: There were only 10 patients in whom the result was rated as fair: 08 had posteromedial displacement and 02 had posterolateral displacement. 02 patients rated as poor, had posteromedial displacement.
Conclusion: From this prospective study, we concluded that high rates of neurovascular complications in supracondylar humerus fracture in children demand High index of suspicion in this fracture especially in POSTEROMEDIALLY displaced fractures. Posteromedialy displaced supracondylar fracture humerus should be considered as a red flag sign for neurovascular complications. Also better functional outcome is associated with cross k-wire fixation in Posterolateral displaced fracture.

Background:Nose is most prominent part of face and nasal bones are most commonly fractured during road traffic accident or accidental trauma. Many patients with nasal bone fracture do not take treatment so fracture may go undiagnosed. Nasal bone fracture leads to structural & functional abnormality of nose.
Aim & Objective:Aim of study was to evaluate operative outcome after close reduction according to type of nasal bone fracture.
Method:Study was conducted in Mahaveer Medical College, Bhopal Department of ENT. Total 157 patients were selected with fracture nasal bone, from February 2021 to 2022 (01 years), all underwent closed reduction.
Results:Post-Operative CT image showed 94 patients with excellent result, 49 with good result, 10 subject with fair result & 4 patients showed poor reduction of fracture nasal bone. 
Conclusion:Fracture nasal bone reduction immediate after CT-Scan showed better result in FI, LI, LII type than FII and C Type.
 

Introduction: Fractures of the distal end radius are the most common fractures of the upper extremity, encountered in practice and constitute 17% of all fractures and 75% of all forearm fractures. The fundamental principle of fracture treatment is to obtain accurate fracture reduction and then use an immobilization method that will maintain and hold that reduction. The most common surgical treatment of closed distal radius fractures is by Kirschner-wires (K-wires) or volar locking plates, with the latter gaining popularity these days. In this study, we compared functional outcomes of K-wires with those of volar locking plates.
Methods: A prospective comparative study of 50 patients with dorsally displaced distal radius fractures treated with K-wiring and volar locking plates (25 cases in each group) was performed. An initial clinical evaluation was done pre-operatively followed by fracture fixation and was further evaluated functionally and radiologically post-operatively. Functional results were analyzed by the modified Demerit point system of Gartland and Werley, anatomical results were analyzed by Sarmiento’s modification of Lindstrom criteria, and radiological assessment was done as per criteria given by NANA et al.
Results: Radiologically and anatomically volar plate had better results as compared to k-wire, during the initial follow-up of fractures of the distal radius. The volar plate also dominated over k-wires in terms of functional results but at 6 months there was very little difference seen functionally. Both techniques provide great clinical results, without a clear superiority of either fixation method for the surgical management of distal radius fractures.
Conclusion: We conclude that locking plates offer no functional advantage over the older and economical method of Kirschner wire fixation for patients with displaced fractures of the distal radius.

Introduction: There is a debate about the choice of operative intervention in humerus shaft fractures requiring surgical intervention. A prospective, comparative study of management of acute humeral shaft fractures treated by antegrade interlocking nail fixation and dynamic compression plating was undertaken over a period of three years. Twenty patients of interlocking nailing and sixteen patients of plating were included after considering the inclusion and exclusion criteria. Functional scoring criteria were used for postoperative assessment and the average follow-up period was one year. A higher rate of excellent and good results and a tendency for earlier union was seen with the plating group in our series.

Introduction: Calcaneal fractures are comparatively rare injuries, which occur in 2% of all fractures According to the recent literature, 60% to 75% of these fractures are considered to be displaced and intraarticular, which evidences the difficulty of the treatment. This type of injury is more common in men compared to women because it commonly occurs as occupation associated.
Methodology: In this study of prospective design 40 patients with calcaneum fracture treated by ORIF with plates between JAN 2019 to DEC 2021 were reviewed at a tertiary centre. The
patients were called for a final follow up evaluation and the latest functional outcome assessed as for the AOFAS score and results were analysed.
Results: Young patients showed significantly better outcome with ORIF with plating. The timing of the surgery is the most important detriment for the outcome. The final functional outcome assessed with AOFAs score is encouraging with 77.1%.
Conclusion: Operatively treated calcaneum fractures with ORIF with plates gives a good functional outcome when surgical principle are strictly adhered to, proper patient selection, appropriate timing for surgery, strict asepsis, proper approach for rising full thickness flaps, accurate anatomic reduction and proper post-operative protocol with follow up which minimizes complications.

Aim: To evaluate the diagnostic accuracy of ultrasonography in detecting nasal bone
fractures compared with CT as the reference standard.
Methodology: A cross-sectional study was conducted in the Department of Radiology,
Maharshi Medical College & Hospital, Kumarhatti, Dist. Solan, Himachal Pradesh, pin code
173229 for the period of 1 year. The study group consisted of 100 patients with nasal bone
fracture who were investigated by physical examination. These patients were then examined
by conventional radiography and sonography. Physical examination was considered as the
gold standard for the diagnosis of nasal bone fracture. All patients were investigated
radiographically by a lateral and a Waters view X-ray at the beginning. The results were
evaluated by a radiologist. The reports were then recorded as either “positive” or “negative”
according to the existence of nasal bone fracture. Then, patients were examined by
sonography. Soft tissue edema and subperiosteal hematoma was also examined as a possible
predictor to differentiate an acute from a chronic fracture. The negative and positive
likelihood ratios (LR- and LR+), NPV and PPV were calculated and used for determining the
diagnostic accuracy. The LR-of ultrasonography was lower than radiography. The LR+of
sonography for the diagnosis of nasal bone fracture was 65.20 [9.28-390.10] which represents
a large and conclusive increase in the likelihood of the fracture in the presence of positive
findings. Furthermore, LR of sonography was 0.14 [0.10-0.21] which proposed a large to
moderate decrease in the likelihood of the fracture, in the presence of negative findings. LR+
of radiography was 6.20 [2.87-6.27] which showed a small increase of the likelihood of
fracture in positive results and the LR¯ of x-ray was 0.36 [0.21-0.42] which proposed a small
decrease in the likelihood of the fractures when the findings were negative.
Results: In this study, 100 patients who had nasal bone fracture in their physical examination
were investigated by sonography and radiography. Of these patients, 31 were women and 69
were men. The mean age of patients was 24.7 years. 37 (37%) patients were between 20-30
years and 28 (28%) were between 30-40 years, and 5 (5%) patients were < 20 years of age
group, while 7 (7%) were > 50 yearsand 23 patients were between 40-50 years of age group.
The youngest patient included in the study was a 12 year old male child and the oldest
patientwas a male of 60 years of age. Of the 100 patients, 78 had nasal bone fracture
(according to physical examination) and 22 patients were found normal but were investigated
due to legal issues. Out of the 78 clinically proven nasal bone fracture cases, conventional
radiography showed a fracture line in 65 cases.

Background: Measuring the density of the bone plays a vital role in the analysis of the
human bone health. The present study was conducted to assess role of bone mineral
density in assessment of osteoporosis.
Materials & Methods: 75 patients age ranged 30-60 years of both genders were
included. The BMD estimation of these patients was done by quantitative
ultrsonography of the calcaneal bone and the analysis done on the basis of T –scores. R
Results: Age group 30-40 years had 26, 40-50 years had 30 and 50-60 years had 19
patients. clinical presentation was backache in 35%, bone pain in 48% and fracture in
17%. osteopenia was seen in 45 and osteoporosis in 30 patients.
Conclusion: osteoporosis was seen in maximum subjects. Hence there is need to look
after bone calcium and phosphate level especially in age subjects.

Background: A Clavicle fracture is a common traumatic injury as it positions
directly under the skin. Both conservative and operative methods are used for the
treatment of this fracture. But there is no uniform agreement on the best choice of
treatment. So, this study aims to assess the outcome of the conservative treatment
and operative treatment by using plate and screw of midshaft fracture of clavicle
and comparing the two treatment methods. Patients and methods: This study was
done at the Department of Orthopedic Surgery of Zagazig University Hospital from
April 2020 to December 2020 on 18 patients are involved then these patients were
subdivided into two groups, Group A (9 patients) for conservative treatment and
Group B (9 patients) for operative treatment by using a plate and screw fixation.
Assessment of the outcome using the constant shoulder score. Results: The time of
union was 5.33±0.70 months in the conservative group and 4.66±0.86 months in the
operative group. Constant shoulder score was in Conservative group 4 patients had
excellent score (44.4%), 2 patients had good score (22.2%), 3 patients had poor
score (33.3%) While in Operative group 6 patients had excellent score (66.6%), 1
patient had good score (11.1%), 2 patients had poor score (22.2%). Conclusion: The
non-surgical methods still the best treatment of simple nondisplaced mid-shaft
clavicular fractures. The operative methods donate a good result in active athlete's
patient with displaced or comminuted fracture.

Primary goal in management of open fractures is prevention of infection of bone and soft tissue by early debridement, irrigation of wound and administration of broadspectrum antibiotics with stabilization of fractures. The pattern of organisms found in open fractures is important in the selection of antibiotics for prophylaxis and empirical treatment. In this prospective study, 50 consecutive patients of all ages, both the sexes, with open fracture of grade IIIB as per Gustilo- Anderson classification were evaluated for bacterial isolates. Higher rate of infection was found in patients with farm injuries and leg was most common site. The most common gram negative and gram positive bacteria isolated were E.coli and S.aureus respectively (19.5% each). On analysis of the predebridement, post-debridement, and third culture, positive pre-debridement culture showed maximum growth of Gram-positive bacteria. However, majority of these patients were found to have growth of different organism in their post-debridement culture reports.

Lefort classification is the historic classification which is widely used to classify mid facial fractures. The lefort classification was given by Rene Lefort ,who classified mid facial fracture into Lefort I , II and III. Lefort 2 fracture is referred as ‘ PYRAMIDAL or SUBZYGOMATIC FRACTURE .’ Lefort 2 is a floating maxilla which runs from the thin middle area of the nasal bones down either side , crossing the frontal processes of the maxilla into the medial wall of each orbit . Within the orbit , the fracture line runs across the lacrimal bone behind the lacrimal sac to cross the infra orbital margin medial to or through the infra orbital foramen . Extends downwards & backwards across the lateral wall of the antrum below the zygomaticomaxillary suture & divides the ptyergyoid laminae .Le fort fractures are blunt trauma facial fractures which involves specific pattern of facial bones injury. Pterygoid process of sphenoid bones is involved in all Le fort fractures. Lefort fractures are classified further depending upon the involvement of zygomatic, nasal and maxillary bones. Blunt facial traumas due to motor vehicle collision, assault, falls or sports injury are the most common causes. In our case, Le fort 2 fracture resulted from motor vehicle collision.

Orbit is a conical cavity in which the base lies anteriorly and the apex directed at Optic Foramen .By Age of 5 years orbital growth is 85% complete, finalized between 7 years of age. Orbit is formed from 7 bones (Maxillary, Zygomatic, Frontal, Ethmoid, Larimal, Palatine, and Sphenoid ). It consists of Four Walls – roof, lateral, medial, floor .Medial wall and floor are thin ,While Lateral wall and Roof are Stronger. Floor of orbit is weakened due to infraorbtal Canal passing through it. In Pure blowout fracture one orbit wall is affected, without involving orbital rims. The inferior and medial walls are affected most frequently. Clinical features are diplopia, infraorbital nerve paresthesia , entrapment of soft tissue within the maxillary sinus, restriction of ocular movements and enophthalmos. CT scan is most helpful method for diagnosis of orbital fracture. For orbit reconstruction, natural and synthetic materials are available. We report a case of 21 years old man, diagnosed with orbital floor fracture after slip and fall from his two wheeler The surgical treatment involved orbital floor reconstruction with titanium mesh under general anesthesia. The outcome was satisfactory and during followup visual disturbances or paresthesia was not present.

Pan facial fractures are complex to treat and hence have to be systematically managed . Several authors have quoted several principles regarding the repair of pan facial fractures in a stepwise fashion . The most important goal is to restore the occlusal relationship at the beginning of the treatment , so that all the other structures get aligned . The folllowing is a case of a traumatic pan facial fracture and its surgical management