MID-shaft clavicle fractures; surgical management

To study the time to union and complications after open reduction and internal fixation of mid-shaft clavicle fractures. Retrospective. Midlands Orthopedic/ Sports Injury Clinic, Bahawalpur. 2003 to December 2012. The medical record of the patients operated for mid-shaft clavicle fractures was searched to find out the time to union and occurrence of complications during this period. The time to union was 4.6 months and there were two complications. A prominent implant had to be removed and one non-union required additional bone grafting procedure. This small series shows that the rate of complications is low and a larger study is needed to expand the indications for operative fixation of clavicle fracture safely

Assessment of elbow function after stable fixation of AO type C fractures of the distal humerus in adults

Thirty five patients AO Type C fractures of the distal humerus reporting to Orthopedic Department were studied over a period of three years from January 2000 to March 2003. Close fractures and Gustilo Grade I and II fractures were included in the study. Age ranged from fifteen years to sixty years. all the patients were operated under general anaesthesia. A comparison b/w transolecranon approach [1] and Shahane and Stanley approach [2] was done. At a follow-up of six months the results using the Jupiter's modification of Cassebaum's rating system[3]. According to it thirteen results were rated excellent, eleven good, six fair and five poor. Complications included tourniquet palsy, infection, stiff elbow and prominent hardware

Skin coverage of the lower leg by fasciocutaneous island flaps

Fourteen cases presenting to our unit with skin loss over the lower 1/3rd of leg including the ankle and heel are presented. The skin loss was the result of roadside accident or was due to diabetic ulcers. Coverage of the wounds was done with fasciocutaneous island flaps based on the perforators of anterior tibial artery, posterior tibial artery peroneal artery and medial plantar artery. These patients would have ended up either in amputation or referral to other specialized units increasing financial cost and mental trauma. There was male predominance [71%] and most of the injuries were the result of roadside accidents [92%]. All the wounds except those resulting from diabetes mellitus were labelled as Open Grade IIIB according to the Gustilo classification of open fractures. The wounds were debrided within twelve hours of injury [10 patients]. The fractures were stabilized with either external fixator or were internally fixed [one case]. Three wounds [21%] were covered with flaps based on the perforators of anterior tibial A., eight wounds [57%] posterior tibial artery perforators and one each on rural A., peroneal A perforators and medial plantar artery. There was superficial necrosis in two patients and deep necrosis occurred in one patient for whom split thickness grafting was done. The results have been encouraging and we are now using fasciocutaneous island flaps for coverage in the area of lower leg, ankle and heel regularly due to the excellent results and easy technique