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Injury-related morbidity and mortality have been one of the most common causes of loss in productivity across all geographic distributions. It remains to be a global concern despite a continual improvement in regional and national safety policies. The establishment of trauma care systems and advancements in diagnostics and management have improved the overall survival of severely injured. A better understanding of the physiopathological and immunological responses to injury led to a significant shift in trauma care from “Early Total Care” to “Damage Control Orthopedics.” While most of these algorithms were tailored to the philosophy of “life before limb,” the impact of improper fracture management on disability and societal loss is increasingly being recognized. Recently, “Early Appropriate Care” of extremities has gained importance; however, its implementation is influenced by regional health care policies, available resources, and expertise and varies between low and high-income countries. A review of the literature was performed using PubMed, Embase, Web of Science, and Scopus databases on articles published from 1990 to 2020 using the Mesh terms “Polytrauma,” “Multiple Trauma,” and “Fractures.” This review aims to consolidate on guidelines and available evidence in the management of extremity injuries in a polytraumatized patient to achieve better clinical outcomes of these severely injured.

Double segmental femur shaft fractures are rare and are challenging in terms of closed reduction and intramedullary nailing. These fractures are further complicated by non-union and malalignment. Here, we present two such cases with a technical note, pre- and postoperative radiographs, perioperative illustrations and the successful management of non-union (in one case).

NASA LS (1)-0417 is an airfoil profile widely used in vehicle design especially in aircrafts for subsonic and transonic speed regimes. Performance of the airfoil is mainly determined by stall aerodynamic characteristics during flight. Further increase in stalling angle of the airfoil, the engineers adopts a single or multiple flaps in the trailing edge region of the main airfoil. The present study deals with a new attempt to achieve the post-stall or increased lift characteristics of NASA LS (1)-0417 airfoil beyond the stalling angle. The airfoil’s surface parts are subjected to allow the air to flow freely over and into the airfoil with increase in lift. The modified airfoil is designed from the base airfoil using the commercial design software and imported to the computational domain with boundaries around the model and meshed properly for solving the problem using the analysis software. The aerodynamic characteristics are compared with the baseline NASA LS (1)-0417 airfoil.

The complexity of acetabulum fractures has always been challenging to the operating surgeon. In the past 50 years, following pioneering work by LeTournel and Judet, there is better clarity to the treating surgeon regarding the management of these fractures. 3D computerized tomography imaging has helped surgeons understand the fracture better andit remains the investigation of choice. Roof-arc angle measurements and the percentage of the fracture involving the superior dome are important determinants in deciding whether to operate or treat conservatively. Nonoperative management is mainly for undisplaced fractures and patients not fit for surgery. Fluoroscopy under anesthesia to check for hip joint stability and percutaneous screw fixation are new upcoming management modalities. The approaches described by LeTournel and Judet – Kocher-Langenbeck, Ilioinguinal, Iliofemoral, and extended Iliofemoral – remain the “gold standard” for appropriate fractures, but the availability of newer alternative approaches have expanded over time thereby facilitating surgeons to operate better. Keywords: Acetabulum fracture, 3D computerized tomography, roof-arc angle, Kocher-Langenbeck approach.

Ankle fracture subluxation is associated with anterior tibiofibular ligament injury. When there is avulsion of the ligament, the torn fragment can prevent reduction of the syndesmosis. On reexploration and removal of fragment, the syndesmotic reduction is achieved and normal anatomical configuration is restored.

Objective: The purpose of this study is to analyze the radiological and functional outcome of complex proximal humerus fractures treated by open reduction and plate fixation, and how radiological parameters correlate with functional outcome. Design: Retrospective study. Setting: Level-1 trauma center. Patients/methods: One hundred twenty-seven patients were analyzed, with a mean follow-up of 5 (3–7) years. Outcome measurements: Radiological parameters studied were neck-shaft angle (NSA), greater tuberosity (GT) to articular surface (AS) distance, medial hinge reduction, and presence (or absence) of calcar screw. Functional outcome evaluated by DASH and Constant–Murley (C-M) score. Results: The mean age is 53.8 years. All patients had a union in 14 (12–18) weeks. The mean NSA is 135° (112–155°). One hundred and thirteen patients with an NSA of >120° had a good functional outcome. Fourteen patients with NSA ≤120° had shoulder abduction 4 mm and without calcar screw, varus collapse is observed. All patients had a good outcome on DASH score and 122 patients had good to excellent outcome on C-M score. Five patients with poor outcome on C-M score had NSA 4 mm, and absence of calcar specific screw. This “terrible triad” of proximal humerus fracture should be avoided during operative fixation.

Rapidly-progressive spontaneous progression of the osteolysis following internal fixation of pathological fracture in patients with Paget's disease has not been previously reported. We describe two patients, aged 59 and 65 years, respectively, who had pathological subtrochanteric fractures in Pagetic femora fixed internally using an interlocked intramedullary nail, and who developed spontaneous rapid osteolysis. Both patients responded favourably to long-term treatment with alendronate, with resultant fracture union and resolution of osteolysis.

In this study, a modified blade profile configuration has been suggested to improve the low-performance levels of the classical Savonius wind turbine. Numerical investigation of both the classical and modified Savonius rotor has been carried out using ANSYS FLUENT 14.0. The proposed design has been observed to prevent the negative static torque coefficient that has occurred in the classical rotor at certain rotor angles relative to the wind direction. The performance of both the classical and the modified designs have been examined and compared at three different Reynolds Numbers. Results indicate better performance of the modified rotor when compared with that of the classical rotor. The improvement was found to be due to the higher overlap flow velocity for the modified Savonius rotor than that of the classical Savonius rotor. Moreover, significant improvement was observed in the torque and power coefficients as the free-stream Reynolds number increases.