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The use of transfixing wires in the treatment of difficult cases of supracondylar fractures of the humerus in children is especially useful for patients who have such extensive swelling about the elbow, when first seen, that immobilization in acute flexion, following a closed reduction, cannot be carried out. Olecranon-wire traction is not necessary, since the transfixing wires maintain the original reduction until union occurs. The danger of Volkmann's ischaemia is lessened, since splinting in acute flexion is not necessary. Ten patients, first seen from two to six days following the injury, have been successfully treated by this method of blind pinning.

Background : The olecranon approach has been the gold standard for surgical approaches to fracture fixation of distal articular surface of humerus. Although it provides a good exposure, it also has disadvantages of delayed union, nonunion and implant related complications at the osteotomy site. Objective: The aim of this study was to determine the functional outcome of displaced intra-articular distal humerus fracture fixation using an alternative approach: the Bryan and Morrey approach. Materials and methods: Twenty patients with twenty AO type C 1 and C 2 intercondylar fractures of the distal humerus had bicolumnar fixation of the distal humerus with two contoured reconstruction plates and screws on the dorsal surface or various combinations of a single reconstruction plate, screws and K-wires using a Bryan and Morrey approach. Twelve of the patients were male and eight were female. The average age of the patients was 44.8 years. Eleven patients had sustained the injury as result of fall and nine of the patients had sustained it in road traffic accidents. Right elbow was involved in fifteen patients and left in five. All patients were followed up for 12 months post operatively. Results: All twenty fractures had united at 4 months follow-up. The mean fixed flexion deformity was 9.0° (range 0°-15°) and the mean arc of motion was 115.0° (range 85°-130°). All patients had grade 4 triceps strength and stable elbows at the end of 12 months follow up. One patient had deep seated wound infection resulting in necrosis of the triceps tendon requiring a second operative procedure. Conclusions: Bryan and Morrey approach is a simpler, easier and better approach as compared to the other posterior approaches to the elbow joint, and therefore, can be used as the approach of choice for fixation of fractures of the distal articular surface of humerus. Key words: Fracture; Intercondylar Humerus; Osteosynthesis DOI: 10.3126/kumj.v8i2.3549 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 154-157

Anterior dislocation of the shoulder joint with ipsilateral humerus shaft fracture is a very rare injury. Until July 2006 only 18 cases have been reported in the literature. Here we report a case of Anterior Shoulder dislocation with greater tuberosity and shaft of humerus fracture. The patient was treated by Open reduction and internal fixation of the shaft fracture followed by closed reduction of the dislocation. A post-operative rehabilitation program was instituted for complete rehabilitation of the shoulder function. Key words: Shoulder dislocation, Ipsilateral, Humerus, Fracture, Open reduction. doi: 10.3126/kumj.v6i4.1743 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 502-504