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CASE: We present a case of 19-year-old male patient with right sided comminuted metadiaphyseal distal femur fracture. Fixation was done using distal femur condylar locking plate. Washers were used with the screws to shimming the plate to achieve the coronal alignment and prevent stress over the screws. 2-year follow-up shows good alignment, radiological union and functional outcome without any complications. "Shimming" a locking plate with washers helps to achieve the better coronal alignment in comminuted metadiaphyseal distal femur fractures with coronal malalignment. It reduces the stress over screws and prevents implant-related complications.
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BACKGROUND: Fractures of the proximal humerus represent approximately 4% of all fractures and 26% of humerus fractures. Proper reduction, stable internal fixation and early initiation of physiotherapy help to achieve a good functional outcome. Aim of this study was to evaluate varus fixation/malunion of proximal humerus fractures and its relation to functional outcome. MATERIALS AND METHODS: We retrospectively evaluated 32 patients with proximal humerus fractures who were surgically treated between 2015 and 2017 at tertiary care hospital. We divided the patients into three groups on the basis of the neck-shaft angle as valgus group, normal group and varus group to observe the influence of neck-shaft angle on efficacy. Patients were evaluated for functional outcome using the Constant-Murley score. RESULTS: Two-part fractures had better functional outcome (Constant score = 75.15) compared to three parts with the moderate functional outcome (Constant score = 68.81) and the four-part fracture had poor functional outcome (Constant score = 52.66). After 6 months of follow-up, 13 patients had a neck-shaft angle of less than 126°. The functional outcome is significantly better among patients with normal neck-shaft angle and had a mean Constant score of 76.63 as compared to patients with varus deformity had a mean Constant score 60 (p = 0.001). 10 patients did not have medial support, in which 08 patients had neck-shaft angle less than 126° and 2 had a normal neck-shaft angle. CONCLUSION: High fracture comminution, improper restoration of medial continuity causes varus deformity of the humeral head and it leads to poor functional outcome. The small sample size is the limitation of our study.
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INTRODUCTION: Autologous bone graft is a commonly used procedure in orthopaedic surgery. Autologous bone is used to promote bone healing in fractures and to provide structural support for reconstructive surgery. Iliac bone is one of the common sites for harvesting autologous bone graft. Hernia through an iliac crest defect following bone graft harvesting is a major but very rare complication. CASE REPORT: An 80-year-old female patient operated for left subtrochanteric femur fracture with dynamic condylar screw and iliac bone graft. Ten months after the surgery, the patient came with the complaints of reducible swelling in the left flank over the incision site. On the basis of clinical examination and investigations, the swelling was diagnosed as an incisional hernia from the defect in the iliac bone graft site. CONCLUSION: Hernia through an iliac crest defect following bone graft harvesting is very rare but a major complication. Attention should be paid while harvesting bone graft to avoid this complication.