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Introduction: The pulled elbow is one of the common conditions in children that bring them to an emergency. Children present with not being able to move their forearms. Methods: We conducted a prospective study of patients presented with a history suggestive of the pulled elbow. Here we study demographic character, clinical presentations, and reduction technique. Results: There were a total of 96 patients with the pulled elbow. The mean age of the patient was 29.62 ± 13.14 months, with boys 27 (28.1%) and girls 69 (71.9%). The left side was commonly involved 67 (69%). History of traction injury is the most common mode of injury. The success rate of reduction by supination-flexion is 87.5%, whereas the success rate of hyper pronation is 95.83%. There was no significant difference between the two methods of reduction (p-value > 0.05). Conclusion: The pulled elbow is common at 2 years, with female children predominant. Click in the region of radial head palpable during reduction confirms the diagnosis and signs of successful treatment. Hyper-pronation was easy, more effective at the first attempt, and the most successful reduction technique.

Introduction: Tibial pilon fractures are difficult fractures mostly secondary to high-energy trauma. There are various options to treat these fractures, but the priority is always an anatomic reduction and articular congruity with good soft tissue handling. The aim of the study was to analyze the functional outcome of tibial pilon fractures managed with a hybrid external fixator as definitive management. Methods: We evaluated 28 patients with tibial pilon fractures with a mean age of 34.8 years. All patients who fulfilled the inclusion criteria were taken to the operating room for debridement and application of a hybrid external fixator. Results: The most common mechanism of injury was road traffic accidents and most of our patients had comminuted fractures. The fibula was fractured in 23 (82.14%) of our patients. The fractures united on an average of 15.28 weeks. Based on the Ovadia & Beals objective scoring system 75% of our patients scored excellent or good on objective scoring and subjective scoring 82.14% of our patients scored excellent or good. We had 12 cases of pin tract infection, 2 cases of delayed union, and 2 cases of malunion but no incidence of non-union, osteomyelitis, or septic arthritis. Eight of our patients had ankle joint stiffness. Conclusion: Hybrid external fixator is an effective method of treatment for tibial pilon fractures with comparable union rate and complications to other modalities.

Introduction: Shoulder dislocations are considered one of the most common joint dislocations. These dislocations are often associated with other injuries. Most of these reductions are done in the emergency department but some may require sedation or general anesthesia. The ideal method should be easy, simple, rapid, painless, effective, atraumatic, and should cause no additional injury to the shoulder joint, nerves, vessels, or musculoskeletal structures. Methods: Fifty-four patients with anterior shoulder dislocation were divided into 2 groups and reduction was done with or without hematoma block. Patients between 18 and 75 and dislocations within 24 hours were enrolled in the study. Spaso method was used to reduce dislocation in all the patients. Demographic data, dislocation side, dominant side, cause of injury, number of dislocations, pre-and post-reduction neurovascular examination findings, reduction time, duration of stay in the emergency department, the presence of a tuberculum majus fracture, and any complications during the pre-and post-reduction period were recorded for all patients Results: Age and gender distributions of patients were similar between both the methods. The majority of the patients were right-handed, and dislocation was in the dominant arm in 74.07 % of patients. The side, number of dislocations, cause of dislocation, presence of tuberculum majus fracture, pre-reduction neurological status, and the success of reduction were similar among both the groups. VAS score was better among the group with the hematoma block though not significant. Conclusion: We suggest that the hematoma block is an effective method to reduce the pain in the treatment of anterior shoulder dislocations as they facilitate pain reduction, muscle relaxation, co-operation from the patient, thus, increasing the success rate and comfort of the patient.

Introduction: Acromioclavicular (AC) joint dislocation is one of the most common shoulder injuries accounting for approximately 9-12% of all shoulder girdle injuries. Rockwood classification of AC joint dislocation is the most widely accepted classification system which classifies the injury into six types. Surgical management with open reduction and fixation with clavicular hook plate without the repair of coracoclavicular ligament has proved to be one of the best treatment options for Type III AC joint dislocations. Methods: Twenty-three patients with Rockwood Type III AC joint dislocation were included in the study. Open reduction was done and the fixation was done with the clavicular hook plate. The functional outcomes were assessed before and two months after the implant was removed using the Constant- Murley Score. Results: A total of 23 patients were included in the study with the mean age of 30.74 years. The plates were removed on an average of 6.43 months and mean follow up was 8.83 months. The functional outcome was assessed using the Constant- Murley Shoulder score. The pain scores were significantly better after the implant removal was done (p= 0.007). The final mean constant score was 74.6 ± 4.11 before removal and 93.91 ± 2.71 after implant removal and all the 23 patient had excellent result (>90 points). Conclusions: The pre-contoured clavicular hook plate has proved to be a good implant option in the fixation of Rockwood Type III AC joint dislocation without the need of any ligamentous repair