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Objective To describe the epidemiological features of major joints fracture‐dislocations between 2015 and 2019. Methods This retrospective study enrolled patients with majorintra‐articular fracture‐dislocations who were treated in the third hospital of Hebei Medical University from January 2015 to December 2019. A total of 582 patients (389 [66.84%] males and 193 [33.16%] females) were identified. The distribution characteristics of intra‐articular fracture‐dislocations involving shoulder, elbow, wrist, hip, knee, and ankle joints were included. The potential associations between fractures with concomitant dislocations and related factors, such as age, gender and sites were explored. Results There were 92 cases (15.81%) of shoulder joints, 67 cases (11.51%) of elbow joints, 45 cases (7.73%) of wrist joints, 181 cases (31.10%) of hip joints, 42 cases (7.22%) of knee joints, and 155 cases (26.63%) of ankle joints. The overall male‐to‐female ratio was 2.02:1.The highest proportion age group of the six types intra‐articular fracture‐dislocations included the ages 25‐34 years. For males, the highest proportion age group was 25‐34 years, for females, it was 45–54 years. For male patients, hip was the most common, accounted for 35.48%, but ankle fracture‐dislocation was the most common for females, accounted for 30.57%. The highest proportion age group of shoulder fracture‐dislocation included the ages 55‐64 years(22.83%), with a male to female ratio of 1.24:1. While the age group with the highest risk of elbow, wrist, hip, knee and ankle fracture‐ dislocation was 25‐34 years (28.36%) with a male to female ratio of 2.19:1, 25‐34 years (31.11%) with a male to female ratio of 8:1, 45‐54 years (27.07%) with a male to female ratio of 3.21:1, 15‐24 years (45.24%) with a male to female ratio of 0.75:1, 25‐44 years (43.87%) with a male to female ratio of 1.63:1, respectively. The most common site of joint fracture‐dislocation in different age groups was corresponding as follows, 0‐14 years(elbow), 15‐24 years(knee), 25‐34 years(hip), 35‐44 years(hip), 45‐54 years(hip), 55‐64 years(ankle), 65‐74 years(shoulder), ≥75 years(shoulder). Conclusion Major joints fracture‐dislocations were most common in the hip and the least common in the knee, and there were more men than women. Hip was the most common affected joint in men while ankle in women. Age and sex factors can significantly affect the location of intra articular fracture and dislocation. The current study could aid orthopaedic surgeons in a better understanding of this injury and help to implement targeted preventive measures., The current study revealed the age and gender epidemiological characteristics of major joints fracture‐dislocations, which could aid orthopaedic surgeons in a better understanding of this injury and help to implement targeted preventive measures.

Objective Minimal invasive temporary spanning plate (SP) fixation of the wrist has been described as an alternative treatment method in complex distal radius fractures (DRFs). The purpose of this study is to conduct an outcome analysis of all consecutive DRFs treated by SP fixation representing the so far largest published patient cohort outside the United States. Methods Indication for SP fixation included DRFs with severe metaphyseal comminution, radiocarpal luxation fractures with concomitant ligamentous injuries and very distal intra-articular fractures lacking the possibility of adequate plate anchoring. All consecutive patients undergoing SP fixation of DRFs were prospectively included in a single level I trauma centre between 01/01/2018 and 31/12/2020. Post-operative assessments included radiological, functional and patient-rated outcomes at a minimum of 12 months follow-up. Results In the mentioned timeframe, a total of 508 DRFs were treated operatively of which 28 underwent SP fixation. Average age was 58.1 years (range 22-95 years). The fracture type ranged from AO/OTA type B1.1 to C3.3 and included 8 fracture dislocations. SP removal was performed on average 3.7 months after the initial operation (range 1.4-6.5 months). The mean follow-up time was 14.5 months (range 12-24 months). Radiological evidence of fracture healing appeared on average 9.9 weeks (range 5-28 weeks) after the initial operation. One patient experienced oligosymptomatic non-union. Complications included 2 patients with tendon rupture and one patient with extensor tendon adhesions needing tenolysis at the time of plate removal leaving an overall complication rate of 12%. There was no implant failure and no infection. Mean satisfaction score was 8 (range 0-10) and mean visual analogue scale for resting pain was 0.9 (range 0-9). The mean PRWE score was 17.9 (range 0-59.5) and the mean DASH score was 16.6 (range 0-60.8). Grip strength averaged 23kg (range 4-74kg) amounting to 68% of the opposite side. Mean radial inclination, volar tilt and ulnar variance at 1 year were all within the acceptable limit predictive of symptomatic malunion. Conclusion The radiological, functional and patient-rated outcomes in this study are remarkably good considering the complexity of the included fractures. Therefore, this method represents a valuable alternative for the treatment of complex DRFs in selected patients.

Aims We report the long-term outcomes of the UK Heel Fracture Trial (HeFT), a pragmatic, multicentre, two-arm, assessor-blinded, randomized controlled trial. Methods HeFT recruited 151 patients aged over 16 years with closed displaced, intra-articular fractures of the calcaneus. Patients with significant deformity causing fibular impingement, peripheral vascular disease, or other significant limb injuries were excluded. Participants were randomly allocated to open reduction and internal fixation (ORIF) or nonoperative treatment. We report Kerr-Atkins scores, self-reported difficulty walking and fitting shoes, and additional surgical procedures at 36, 48, and 60 months. Results Overall, 60-month outcome data were available for 118 patients (78%; 52 ORIF, 66 nonoperative). After 60 months, mean Kerr-Atkins scores were 79.2 (SD 21.5) for ORIF and 76.4 (SD 22.5) for nonoperative. Mixed effects regression analysis gave an estimated effect size of -0.14 points (95% confidence interval -8.87 to 8.59; p = 0.975) in favour of ORIF. There were no between group differences in difficulty walking (p = 0.175), or on the type of shoes worn (p = 0.432) at 60 months. Additional surgical procedures were conducted on ten participants allocated ORIF, compared to four in the nonoperative group (p = 0.043). Conclusion ORIF of displaced intra-articular calcaneal fractures, not causing fibular impingement, showed no difference in outcomes at 60 months compared to nonoperative treatment, but with an increased risk of additional surgery. Cite this article: Bone Joint J 2021;103-B(6):1040–1046.

Hemihamate arthroplasty is an established method of managing difficult Pilon fractures of the proximal interphalangeal (PIP) joint. We present our experience in 30 patients, whose injuries were further complicated by severe comminution and late presentations. Several modifications were utilized, including preoperative distraction, use of smaller size grafts and functional release of collaterals. The average follow-up period was 28 months (range 18 to 28). Postoperatively, the average range of flexion at the PIP joint improved from 30° (range 20° to 45°) preoperatively to 104° (90° to 110°) at the final follow-up. The average extension lag was 6° (0° to 20°). Five patients required secondary procedures and no patient had a recurrent dorsal dislocation. We propose these modifications in the use of hemihamate arthroplasty for the management of difficult PIP joint fractures. Level of evidence: IV

Objective: It is to compare the radiological and functional outcome of two different fixation methods for displaced intra articular distal radius fracture (DRF): open reduction and internal fixation with anatomical plate and closed reduction with percutaneous K-wires. Methodology: A randomized controlled trial was conducted in Orthopaedics department, Shaikh Zayed Hospital, Lahore for one year; from April 2017 to March, 2018. Total 90 patients were selected in the study by ‘non-probability, consecutive sampling technique’ with 45 patients in each group of the study; Group-A (fixation method: Open reduction with internal fixation with volar plate) and Group-B (Fixation method: Kirschner-wire known as K-wire). Results: The mean age in the group A and group B was 53.7 ± 11.8 years and 55.2 ± 12.3 years respectively. There were 58 male and 32 females in the study. The differences in volar tilt, radial inclination, radial length and modified Mayo score were significantly better in group A than group B (p-value < 0.05). The differences were not significantly different for articular step off in the two study groups (p-value > 0.05). Conclusion: Open reduction with internal fixation using volar locking plates yielded significantly better radiological and functional outcomes than percutaneous fixation using K-wire in the 6 months’ postoperative period.

Background: A preferred surgical approach to distal femur intra-articular fractures is still controversial. Objectives: In the current study, we assessed the outcome and complications of three different surgical techniques, including screw fixation, Retrograde Intramedullary Nailing (RIN), and Locking Compression Plate (LCP). Methods: A total of 63 patients with distal femur intra-articular fractures were included in this retrospective study. AO/OTA fracture and dislocation classification was used to categorize patients. Type B fractures were treated with screw fixation and type C fractures were treated using LCP and RIN. Outcome measures, including the knee range of motion (ROM) and pain level, were Results: The mean±SD age of patients was 36.7±15.7 years. The fracture types B and C were detected in 22 (32.4%) and 46 (67.6%) patients. The mean follow-up period was 27.2±15.9 months. Mild knee pain was the only complication of screw fixation that was observed in 21% of patients. LCP was associated with some complications, including pain (19.4%), infection (9.7%), limited ROM (47.4%), malunion (47.4%), and nonunion (6.5%). RIN was also associated with several complications, including pain (44.4%), infection (11.1%), limited ROM (33.3%), and malunion (41.2%). A comparison of the outcome in matched fracture types of LCP and RIN groups revealed no superiority of each technique. Conclusion: Screw fixation alone results in a satisfactory outcome in the treatment of type B distal femur intra-articular fractures. LCP and RIN are associated with a variety of complications with no superiority over each other.

Introduction: Management of displaced intraarticular fracture of calcaneum is controversial. Non-operative management often have unsatisfactory result due to subtalar arthritis and abnormal foot morphology. Objective: The objective of the study was to evaluate clinical and radiological outcome of patients with displaced intra-articular fracture of calcaneum treated by open reduction and internal fixation(ORIF) with plates and screws through extensile lateral approach. Methodology: This was prospective clinical study conducted in Nobel Medical College between November 2016 to December 2019. The patients were treated by ORIF with calcaneal plates and screws through extensile lateral approach. Patients were followed up for minimal one year. Patients were evaluated clinically by using AOFAS hind foot score and radiologically by measuring Bohler’s and Gissane angle and calcaneal height and width. Results: Out of total 26 cases, fifteen were sander’s type II, eight were type III and three were type IV. The mean age of patients was 33.92 years. The mean delay of surgery due to swelling was 8.65±1.95 days. The averagefollow-up period was 17 months. The mean AOFAS hind foot score was85.08±7.67. Tenpatients (38.46%) had excellent, twelve patients(48.61%) had good and four patients(15.38%) had fair outcome.There were significant association between improvement in Bohler’s and Gissane angle and functional outcome measured by AOFAS hind foot score. Conclusion : Open reduction and internal fixation of displaced intraarticular fracture of calcaneum with calcaneal plates and screws through extensile lateral approach produce good clinical and radiological result.

Introduction: The selection of the stage where fibular plate was performed in two-stage surgery of the intra-articular distal tibiofibular fractures with soft tissue injury is still controversial. The aim of the study was to compare the complications, radiological and functional outcomes between the patients who had fibular plate at initial or second phase during surgical management of such fractures. Materials and Methods: In this study, medical records of 47 patients who underwent a two-stage surgical procedure for intra-articular distal tibia fractures accompanying soft tissue injury were retrospectively examined. Delta frame was applied in all cases within 24 hours following admission to the emergency department in accordance with AO principles. Those cases where fibular plate was applied during the initial stage and the second stage were classified as Group 1 and Group 2 in order to compare recorded data between the two groups. Results: According to the results of the study, there were 25 cases in Group 1 and 22 cases in Group 2 in which fibular plate was applied at the first stage and the second stage, respectively. The mean follow-up was found as 27.7±7.0 months in Group 1 and 28.2±6.2 months in Group 2 (p=0.778). No difference was found between the two groups in terms of the age, sex, hospital stay, the time between two surgical procedures, tibiofibular angle and AOFAS scoring (p>0.05).These two groups were also similar in mechanism of injury, Denise-Weber or AO classification, rates of tibiofibular malalignment on post-operative CT, fibular rotation, intra-articular tibial step-off, tibial varus-valgus duration of union, rate of infection, fibular angulation and the presence of the flap/graft/debridement (p>0.05). Conclusion: In conclusion, two-stage surgical procedure in intra-articular distal tibiofibular fractures may be an effective method decreasing soft tissue complications. The timing of the open reduction and internal fixation of the fibula at different stages may not necessarily have an impact on the success of the post-operative tibial reduction, the total duration of surgery, syndesmosis malalignment or soft tissue complications.

In the past few decades man has taken traveling to high speeds with flexed knee joint with much of impacts taken first by patella then femoral condyles and tibial condyles in different positions and proportions and with vast increment in technology, travel modalities and industrialization there have been advantages and disadvantages too like easier and faster traveling but road traffic accidents too. Such accidents and falls resulting in loss of lives and disabilities. In recent years with the advancement of technology and facilities, wide use and trend of open reduction & internal fixation has been apparent. This study evaluated the functional outcome of treatment for distal femur fractures. Patients were operated from 5 days to 35 days. Mean injury to surgery duration was 13.24 days patients were operated between 80 min to 160 min with mean time for operative procedure was 112.4 minutes, Open fractures were seen in 14(56%) closed fractures were seen in 11(44%). There were 14(56%) intra articular fractures and 11(44%) extra articular fractures. Comminution was present in 16(64%) fracture patterns in our study. All patients were operated with distal femur condylar locking compression plate. AO type C 3 fractures 7(28%) were most common type of fractures. Knee mobilization was started as early as within 2 weeks. Average time was 7.68 weeks. Functional outcome was analyzed according to the NEERS knee scoring system, 10(40%) observed excellent result, 5(20%) observed good results, 7(28%) observed fair result and 3(12%) observed poor results.

PurposeMany treatment methods for intra-articular fractures of the proximal interphalangeal (PIP) joint are described in the literature without a consensus on the most effective approach. The purpose of this study was to investigate the methods of treatment of PIP joint fractures being used by trauma surgeons in the Republic of Ireland currently and the timing of referral to therapy.Design/methodology/approachA cross-sectional descriptive study methodology was used to survey trauma surgeons, occupational therapists and physiotherapists in Ireland. An online platform was used. A total of 21 surveys were returned by surgeons and 37 by therapists. Descriptive statistical analysis was used to present the results.FindingsBuddy strapping was reported as the primary treatment method for stable PIP joint fractures. All levels of fracture severity were reported to be treated using traction constructs, which include static and dynamic fixation and orthoses. Unstable fractures were managed using open reduction with internal fixation by 50 per cent of surgeons. Early timing of referral to therapy is reported by more surgeons than therapists. The majority of therapists indicated that they did not have the resources to see patients at the optimal time.Originality/valueTo the authors’ knowledge, this study provides the first description of the management of PIP joint fractures across the Irish health service. The findings of this study suggest that additional therapy resources are required within the health service executive to facilitate the desired early referral to therapy and to enable service development for this category of hand fractures.

Background The proximal interphalangeal (PIP) joints of the fingers are extremely important for gripping things with hands, more specifically, what is called the ‘power grip’. Aim of the Work To compare the different modalities of repair of intra-articular fractures of PIP joint. Materials and Method A systematic review and meta-analysis were performed in accordance to the recommendations of the “Preferred Reporting Items for Systematic Reviews and MetaAnalyses” (PRISMA). PRISMA is reporting checklists for the authors, the editors, and the reviewers of Meta-analyses of the interventional and the observational studies. According to the International committee of medical journal association (ICJME), the reviewers must report their findings according to each of the items listed in those checklists. Results The results of this study includes the search results and data extraction results which includes summary characteristics and baseline characteristics of the included Studies, outcome measures and Complications of the included studies. Conclusion There is no consensus regarding the most effective technique for management of unstable PIPJ fractures. The extension block pinning, closed reduction and percutaneous pinning of the fracture fragments, dynamic distraction and external fixation, open reduction and internal fixation, and hemihamate reconstruction arthroplasty are safe and reliable and reduce the risk of iatrogenic damage when used to treat unstable dorsal fracture-dislocations of the PIP joint.

When treating patients presenting with knee trauma or intra-articular fracture, clinicians should maintain a high index of suspicion for lipohemarthrosis. Diagnosis of lipohemarthrosis can be accomplished via visualization of a fat-fluid level. Increased fluid and pressure build-up within the joint space may lead to compartment syndrome, which requires emergency compartment fasciotomy. In this paper, we discuss the importance of identifying lipohemarthrosis in patients presenting with intra-articular fracture, as well as the necessity of frequent patient re-evaluations in order to monitor the onset of compartment syndrome.

Purpose Comminuted intra-articular fractures and fracture dislocations of the metacarpophalangeal (MCP) and interphalangeal joints are challenging. Dynamic external fixation, permitting early joint motion while still minimizing forces across the healing joint, can result in acceptable postoperative active range of motion (AROM). However, some fractures are not initially stable enough for early dynamic motion; further, many available dynamic external fixation systems are costly and cumbersome. We reviewed our experience using an external fixator made from a 1-mL syringe and K-wires and report outcomes using it as a static fixator, dynamic fixator, or configured as a static fixator and then converted to a dynamic fixator in the clinic. Methods Patients with intra-articular fractures and fracture dislocations of the MCP and proximal interphalangeal (PIP) joints treated between 2014 and 2020 using syringe external fixators were retrospectively reviewed. We reviewed demographics, mechanisms, treatment types and durations, and postoperative AROM, as well as complications including infection, pin loosening, nonunion, hardware failure, and need for further surgery. Patients were analyzed by the level of joint injury (MCP versus PIP) and by treatment pattern. Results After excluding 23 patients with 25 joint injuries who were lost to follow-up or had inadequate outcome data, 27 patients with 29 joint injuries were reviewed. The average follow-up was 171 days after surgery. The postoperative AROM at the MCP level averaged 55° for static fixation and 30° for static-to-dynamic fixation. The postoperative AROM at the PIP level averaged 64° for static fixation, 66° for static-to-dynamic fixation, and 80° for dynamic fixation. Three pin site infections and 2 loose pins were reported. Conclusions The syringe external fixator is an inexpensive, effective, and customizable treatment for intra-articular MCP and interphalangeal fractures and fracture dislocations, and results in acceptable postoperative AROM outcomes and complication rates. Type of study/level of evidence Therapeutic IV.

Objectives: To determine the outcome and various complications in the management of comminuted intra articular fractures of distal radius in adults treated with closed reduction associated with Percutaneous Pinning. Study Design: Observational study. Setting: Department of Orthopaedic PUMHS, Nawabshah. Period: January 2017 to December 2018. Material and Methods: 45 consecutive cases of closed comminuted intra articular fractures of distal radius matching the inclusion criteria, all patients were adult aged between 23 – 38 years having Gartland and Werly type II and III fractures of 6 to 7 days duration. After initial resuscitation, thorough clinical examination done and all base line laboratory investigations and x-rays were obtained. The demographic and clinical data was recorded on a proforma. The patients were informed about the study and surgery and a written consent was taken and all of the patients were gone for closed reduction with percutaneous K – wiring. Functional outcome like union, healing and any complication were assessed. Patients were also checked for the range of movements. After 6 weeks, the K – wires and cast were removed and the procedure of physiotherapy started. After six weeks all the patients were advised for follow up at an interval of 3 months and 6 months. The data collected was statistically analysed and the results were tabulated. Results: 45 cases of closed intra articular fractures of distal radius were assessed, out of these 20 cases have Gartland type II and 25 cases have Gartland type III fractures. The age of patient was ranged between 23 – 38 years (mean 34+ 4.63), majority (55.6%) of patients were male. The left side of fractures were present in 66.3% of cases. All the patients checked for complications and that were seen in only 07 cases consisting of pin tract infection, reduced grip strength and finger stiffness. At the end of study period the range of movements in different directed were checked and evaluation was done according to modified Demerit scoring system. Conclusion: Closed reduction of distal radius with percutaneous pinning in comminuted intra articular fractures gives promising excellent results, it is a simple and minimal procedure providing anatomic reduction, fixation of fracture and maintenance of reduction with an suitable technique of immobilization.

Objective This study was performed to analyze the outcomes of calcaneal fractures using a minimally invasive internal fixation method with a thin plate and bone grafting. Methods This retrospective analysis included 21 patients treated using our minimally invasive approach. The outcome measures were the change in the Bohler and Gissane angles and the calcaneus width after fixation. The clinical outcomes were evaluated by the Maryland foot scoring system and assessment of soft tissue complications. Results The follow-up time was 12 to 18 months. The Bohler angle, Gissane angle, and width of the calcaneus were significantly different between the preoperative and postoperative periods. The rate of excellent and good outcomes was 85.7% according to the Maryland foot scoring system. The incidence of soft tissue complications was 14.3%. Conclusion Treatment of calcaneal fractures using a minimally invasive internal fixation method with a plate and bone grafting provides good to excellent clinical outcomes with few soft tissue complications.

Tibial plateau fractures are one of the commonest intra articular fractures. Results from indirect coronal or direct axial compressive forces. Among Tibial plateau fractures, Schatzker type V and VI tibial fractures are complex injuries, usually treated with open reduction and internal fixation (ORIF) using LCP plates.AIM: This study was done to determine functional outcome and the complications of Schatzker V and VI tibial plateau fractures treated with LCP plates with a regular follow-up of 18 months.Materials and Methods: Total 30 cases of tibial plateau fracture type V and VI treated with dual plating were studied from FEBRUARY 2017 to NOVEMBER 2018 in Sanjay Gandhi Institute of trauma and orthopaedics, Bangalore. The follow up duration ranged from 6 months to 15 months. The patients were operated through an anterolateral approach for lateral plate and a medial column plate was put through a minimally invasive medial approach or an open posteromedial approach.Results: Total 30 patients were evaluated postoperatively thoroughly for functional and radiological outcomes by Modified Rasmussen Assessment criteria which showed 17 patients (56.7%) had excellent, 8 patients (26.7%) had good,3 patients (10%) had fair and 2 patients (6.7%) had poor outcomeConclusion: We concluded open reduction and internal fixation of high-energy tibial plateau fractures with LCP excellent to good functional outcome with minimal soft tissue complications. Thus, a minimally invasive approach should be used which helps in preventing soft tissue problems and helps in early wound healing. Fixation done by Dual plating is important for early mobilization of knee joint. Early mobilization leads to better range of movements and thereby better functional outcome.

Displaced intra-articular calcaneal fractures are severe, complex injuries that can cause significant long-term functional impairment. Despite the controversies of whether these fractures should be treated operatively or nonoperatively, functional improvement can be seen with confounding variables that can be controlled by the surgeon. This article reviews prognostic factors that are associated with good functional outcomes following operatively treated displaced intra-articular calcaneal fractures.

Surgical treatment of displaced articular fractures of the calcaneus is currently recommended by most authors. Different surgical procedures are described in literature. The purpose of this study is to evaluate the functional and anatomic results of articular fractures of the calcaneus surgically treated with the modified Palmer method and precise the place, the conditions, and the advantages of this technique for articular fractures of the calcaneus. This is a retrospective study assessing the outcomes of surgical treatment of articular calcaneal fractures surgically treated using the modified Palmer technique. Twenty-two patients underwent this surgery for 6 years. All patients have diabetes and/or smoking history, and physical examination revealed a severe swelling within the hindfoot. Sanders classification Type II was found in 6 cases, whereas 18 cases fell below Type III. The mean preoperative Bohler angle was about −2.7°. An extended lateral approach was performed, and the void caused by elevating the intra-articular surface was filled by an iliac crest graft firmly impacted in all cases. Additional limited fixation was performed in 71% of patients. On follow-up, the functional and anatomic results were analyzed, respectively, by Kitaoka and Babin's quotations, and the radiological assessment was based on Bohler angle. No cutaneous or infectious complications were observed after surgery. The mean postoperative Bohler angle was 21.9°, and it was 19.8° at the last follow-up with a significant difference. At follow-up, the mean functional Kitaoka score was 75; it was considered as excellent in four cases, good in ten, fair in eight, and poor in two patients. The modified Palmer technique is a simple surgical procedure to treat intra-articular calcaneal fractures. It provides encouraging results. This method is recommended in the case of Sander's II and III calcaneal fracture for patients with a high risk of cutaneous complications to avoid infection and cutaneous complications.

Objective: To assess the radiological and functional outcome of external fixator inthe treatment of intar-articular fractures of distal radius. Study design: Descriptive case series.Place and duration of study: Orthopaedic unit District Headquarter Hospital Temargarha LowerDir from March 2013 to March 2014. Material and methods: Twenty five patients of intra-articularfracture distal radius fulfilling the inclusion criteria were treated with AO external fixator byligamentotaxis. Preoperative and postoperative radiograph measurements were taken of radialinclination, radial tilt, and radial length, and fractures were classified according to the AO system.The fixator was removed after 6-8 week and functional assessment was done using Gartland andWerely point system at monthly interval for six months. Results: Eighteen male (72%) and 7(28%)females mean age 43.1 years with intra-articular distal radius fractures were treated with externalfixator. Preoperative mean radial inclination(10.5 degree) radial tilt(29 degrees dorsal) and radiallength(6.3 mm) were reported postoperatively as 18.8 degrees,8 degrees volar and 10 mmrespectively at final follow up visit. The functional evaluation by Gartland and Werley's pointsystem reported excellent (60% patients) ,good(20%) and fair(12%) at final follow up visit. One(4%) patient could not achieve union while one (4%) malunion was reported. Conclusions:Bridging external fixator(static) yields excellent radiological and functional results in majority ofintra-articular distal radius fractures.

Background A fracture of the calcaneus can be a painful and disabling injury. Treatment modalities may be conservative or operative. Surgical treatment strategies include open reduction and internal fixation (ORIF) techniques, as well as a variety of minimally invasive methods. The aim of this study was to evaluate the treatment options and post-treatment complication rates for intra-articular calcaneal fractures at the Traumacenter Linz over a 9-year period. Methods All patients with calcaneal fractures treated at the Traumacenter Linz between 2007 and 2015 were included in this study. The patients records were retrospectively reviewed, and the data, including demographic parameters, cause of injury, and the time between injury and operative treatment were analyzed. The number of secondary operative interventions due to soft-tissue complications, hardware removal, and the long-term arthrodesis rate were evaluated. Results A minimally invasive 2-point-distractor method was used in 85.8% (n = 182) of all operatively managed calcaneal fractures (n = 212) in our department. The majority of the operations (88.7%) were performed within 2 days after the accident. The secondary operation rate resulting from wound complications was 2.7% in the 2-point distractor group and 16.7% in the ORIF group. A secondary arthrodesis was performed in 4.7% (n = 9) of the subtalar joints in the entire study population. Conclusions Our data supported the assumption that severe wound complications would be less likely to occur after minimally invasive treatment compared to ORIF treatment. The rate of secondary arthrodesis in the study cohort was comparable to that in the literature. Level of evidence IV

A 34-year-old man, a nurse with no medical history, non-smoking, and right-handed, admitted to the emergency service after a right elbow trauma. He falls on an outstretched hand on his house stairs. The patient couldn´t move his joint. The examination found a swelling and painful right elbow. Motion attempts were remarkably painful. Bony landmarks of the elbow were normal. There were no vascular or nervous abnormalities. The right wrist and shoulder exam were satisfying. Elbow X-rays revealed an articular displaced fracture of the distal humerus. 3D reconstruction affirmed the fracture. This frontal fracture takes the capitulum and the hole trochlea; It´s a was a Bryan and Morrey Type IV intra-articular fracture. Due to the displacement of this articular fracture, the staff decided to operate the patient. Within 24 hours after the trauma, the patient was in the operating room. Under loco-regional anesthesia, per operative examination of lateral ligaments was normal. An orthopedic surgeon performed the gesture by a combined approach (lateral and medial). The fragment was reduced and fixed par two Herbert screws. The articular congruity was satisfying. After three weeks of immobilization by a posterior splint, the patient debuted functional rehabilitation who been initially passive than active based on flexion-extension motion and pronation-supination motion. At 14 months following up, the patient had no pain. Ranges of motion were 150° of flexion, -10° of extension, 90° of pronation, and 80° of supination. Morrey score was 95. The limitation of extension motion had no impact on the usual activities of patient life.

Background: In this study, we assessed functional outcomes among olecranon fixation techniques used following transolecranon approach in patients with comminuted fracture of distal humerus. Methods: The study included 37 elbows that underwent olecranon osteotomy due to distal humerus fracture. Functional outcomes were assessed among patients who underwent fixation via tension band technique, plate, or screw fixation. Results: The implant irritation was seen in 18% of patients who underwent K-wire plus tension band fixation, in 75% of patients who underwent olecranon plate plus screw fixation, and in 18% of patients who underwent cancellous screw fixation. The rate for implant removal was 2.6 folds lower in K-wire plus tension band fixation when compared to olecranon plate plus screw fixation. Conclusion: We concluded that K-wire plus tension band technique and cancellous screw fixation performed in accordance with technical principles caused less skin problem when compared to other techniques. In olecranon fixation, both methods with enhanced stability by tension band can be preferred.

Aim: To examine whether the application of intra-articular lavage during arthroscopic joint fracture surgery can disturb fracture union and cartilage healing. Metods: Twenty New Zealand rabbits were then randomly divided into 3 groups; these groups consisted of 2 surgical groups including eight rabbits and a control group consisting of 4 rabbits. After both rear limbs exposed with a medial parapatellar incision, medial femoral condyle was fractured. Four groups were created by doing anatomic reduction or non-anatomic reduction and making irrigation or no irrigation. (Group 1: Fixed by creating a gap and no Irrigation; Group 2: Fixed by creating a gap and irrigation; Group 3: Fixed with complete reduction and no irrigation; Group 4: Fixed with complete reduction and irrigation) X-rays of both knees of all rabbits were taken at the end of the second week and at the end of the eighth week. The operated knees were collected for histopathological analysis. Results: Radiological data show a significant difference in the level of ossification between the groups in the 2nd week; however, this difference was lost in the 8th week. Histopathologically, at the end of week 8, it was observed that the subchondral bone tissue was incompletely renewed in all the groups. The cartilage tissue of the joint surface was not fully formed and renewed and that it did not completely coalesce with the old cartilage tissue in all of the groups. Compared with the other groups, the group that fracture was anatomically reducted with no irrigation (Group 1), the cartilaginous tissue layer formed was thicker while the surface of the tissue was flatter. Conclusion: There were no adverse effects of intra-articular lavage on fracture union and cartilage healing in an in vivo environment. Nonetheless, the findings of this study should be confirmed with a larger sample size.

Die Eckpfeiler der Behandlung von Gelenkfrakturen sind einerseits der schonungsvolle Umgang mit den Weichteilen und andererseits eine anatomische Rekonstruktion der Gelenkflache mit stabiler Fixation, die eine funktionelle Nachbehandlung ermoglicht. Hierdurch konnen zufriedenstellende funktionelle und radiologische Ergebnisse mit niedriger Komplikationsrate selbst bei komplexen Gelenkfrakturen erzielt werden. Je nach einwirkender Energie entstehen mehr oder weniger komplexe Frakturmuster. Der behandelnde Unfallchirurg muss die Personlichkeit der Fraktur erfasst und verstanden haben. Vor allem die lokale Weichteilsituation ist von entscheidender Bedeutung. Nicht umsonst gilt der Spruch: „Eine Fraktur ist eine Weichteilverletzung, bei der auch der Knochen gebrochen ist“. Die korrekte Interpretation der Gesamtsituation und die sich daraus ableitenden Handlungen entscheiden uber Erfolg oder Misserfolg der Therapie. Daher ist die sorgfaltige Planung eine unabdingbare Pramisse der operativen Frakturbehandlung. Einzelentscheidungen bezuglich des optimalen Operationszeitpunkts, einer Strategie fur die Gelenkrekonstruktion, des chirurgischen Zugangs, der Repositionstechnik sowie der Implantatwahl sind die Grundbausteine der erfolgreichen Behandlung und mussen im Kontext individuell auf das jeweilige Frakturmuster sowie auf den Patienten selbst abgestimmt werden. Der vorliegende Beitrag gibt einen Uberblick uber die Taktik und die Technik der osteosynthetischen Versorgung artikularer Frakturen; hauptsachlich werden repositionstechnische Aspekte genau erlautert.

Studies have demonstrated a decrease in the incidence of late consequences and the socio-economic burden of intra-articular fractures of calcaneum when treated by surgical fixation. Operative management of displaced intra-articular calcaneal fractures (DIACF) pose significant challenges such as technical difficulty, wound healing and long-term pain and disability. All patients presenting to the ER with DIACF over a period of 2 years and matching the inclusion criteria were enrolled in the study. Percutaneous fixation with 4 mm CC screw was undertaken with a minimally invasive sinus tarsi approach. All patients were available for a minimum follow-up of 24 months. Six radiological parameters were assessed, and functional outcome was evaluated using AOFAS score. Thirty-four patients with 42 calcaneal fractures were included in the study, and all patients were available for minimum follow-up period. All radiological parameters were attained within anatomic normal range and maintained at 24 months of follow-up. AOFAS score showed a mean value of 90.10 which is considered an excellent outcome. Superficial wound infection was seen in two patients, but no patients required a revision surgery. Displaced intra-articular fractures pose a treatment dilemma, more so in cases of soft tissue complications like open injury or blisters. Percutaneous screw fixation with limited sinus tarsi incision has shown good functional and radiological outcome with minimal complications and can be undertaken without delay.

Introduction: Fractures of distal radius remains one of the most challenging fractures treated by orthopaedic surgeons. The aim of this study is to analyse the functional outcome in intra articular distal radius fractures treated with variable angled volar locking plate. Aim of the Study: The aim of this study is to analyse the functional outcome in intra articular distal radius fractures treated with variable angled volar locking plate.Materials and Methods: From May 2016 to November 2017, consecutive patients with intra articular distal radius fractures were included in the study. All subjects were recruited, operated, and assessed at Department of Orthopaedic Surgery, RMMCH, Annamalai University, Chidambaram, Tamilnadu. The patients were followed up for a minimum of 6 months. The results were evaluated using Gartland and Werley scoring system for wrist.Results: Of the forty wrists operated, according to demerit system of Gartland and Werley, 25 cases were males and 15 cases were females of which 28 cases were right and 12 cases were left wrists, the most common mode of injury being fall on out stretched hand accounting for 80% of cases, the average time for surgery was 5 days from the date of admission, a below elbow slab was applied on the day of admission till surgery. Excellent to Good results were obtained in 38 wrists i.e. 95%. Fair results were obtained in two wrists (5%). None of the patient showed poor results. Two patients showing fair results had wrist stiffness mainly attributable to patient’s noncompliance to Physiotherapy. No major complication was noted in our study.Conclusion: Variable angled volar locking plate is the implant of choice in Comminuted Intraarticular distal radius Fractures. Use of locked variable angled plate predictably yields better patient reported outcome as per Gartland and Werley scoring system and allows earlier range of wrist motion which yields accelerated return of function necessary for our Indian population.

Tibial plateau fractures have a complicated intra articular fracture pattern, representing approximately 1.2% of all fractures. The occurrence of posteromedial fragment is relatively common in high energy tibial plateau fractures Aims and Objectives: To study the role of posteromedial plating in management of complex tibial plateau fractures with a posteromedial fragment. Materials and methods: 26 cases above 25 years of age, from the patient admitted to Rajah Muthaiah Medical College and Hospital, Annamalai University, Chidambaram with posteromedial fragment in tibial plateau fractures that were operated between May 2016 to May 2018 were undertaken for the study. Reduction can be maintained with a Kirchner wire and a pointed reduction clamp. The plate is placed directly over the area of maximal displacement at the apex of the fracture. Results: Of the 26 patients with type IV, V and VI Schatzker’s tibial plateau fractures from x ray and CT scan of knee joint, 24 had pre contoured posteromedial plate and 2 patients had recon plate where the fragment was comparatively small and comminuted. We analysed patients with Rasmussen scoring postoperatively. In our analysis among 26 patients, functional score were excellent in 20, Good in 3, Fair in two and poor in one patient. There was one patient with grade I compound injury who had developed infection that later resolved after wound wash and resuturing on the 5th postoperative day with judicial use of antibiotics. One patient had collapse due to premature weight bearing. Two patients had transient paraesthesia of the saphenous nerve; both resolved completely.

Background: Familiarity with the normal calcaneal anatomy is important for understanding fracture mechanisms and classification schemes. Clinical presentation at the time of evaluation generally includes (a) a history of a fall from a height, and (b) certain signs that aid the physician in identifying possible calcaneal fractures. Purpose: To look at the role played by the multi detector computed tomography (MDCT) in assessing calcaneus fractures and delineate the fracture fragment which help in decision making in the management of extra and intra articular fractures of the calcaneum and pre-operative planning. Patients and Methods: This study will be conducted on patients with calcaneal fractures suspected clinically or by x ray diagnosis. The patient will be referred from orthopaedic department at Ain Shams University Hospitals; the patient will be investigated using MDCT. Results: This study included 44 feet of 41 patients (three bilateral); 35 males and 6 females, representing 85.4% and 14.6% of all patients respectively, their mean age was 34.22 years, we observed that calcaneal fractures commonly occur in male than female. Conclusion: Multi detector CT is the best method of assessing calcaneus fracture in order to decide management. It delineates the fracture fragments and help in making the pre-operative planning of the fracture.

The aim of this work is to develop a system of surgical treatment of intra- and periarticular fractures of lower limb bones for improving the results and reducing the number of postoperative complications. Material and methods Short- and long term results of surgical treatment of 390 patients with periand intraarticular lower limb fractures treated at a trauma department 1 of hospital # 24 in the period between 2010 and 2014 were analyzed according to a similar schedule of requirements to recovery of anatomic and functional parameters of the hip, knee and ankle joint. There were 198 men (50.8 %) and192women (49.2 %). Radiological, clinical and statistical research methods were used. Statistical methods included estimation of significance of differences for parametric and non-parametric criteria, assessment of the relationship signs on the Pearson’s coefficient of linear correlation. To study the results of hip treatment the Harris Hip Score (H. W. Harris, 1969) was used, in the region of the knee – P. S. Rasmussen scale (1973), and in the ankle – of E. Mazur (2006) which include subjective and objective criteria. Results Good functional outcomes were obtained in 87.1 % of femoral neck fractures, in extra-articular fractures of the proximal femur– in 76.2 %, in intra-articular fractures of the distal femur – in 75.0 %, intra-articular fractures of the proximal tibia - in 78.3 %, intra-articular fractures of the distal tibia in 96.6 % of cases. Conclusion Implementation in the clinical practice of the system of surgical treatment of peri- and intraarticular fractures, including improved diagnostics, practical orientation of injury systematization, algorithms for clinical diagnostic search, consecutive use of external and internal osteosynthesis, rational technique of joint arthroplasty, new technologies of osteosynthesis with a differentiated choice of metal fixators, a modified proximal femoral metal fixator, approaches to joints, methods for bone defect plasty; all these factors combined with the method of perioperative management of patients and early active rehabilitation achieved the prevalence of excellent and good anatomical and functional results for each studied location of injurie in main subgroups in comparison with the control ones.

Purpose: The objective was to assess the ability of the volar locking plate to maintain the radiographic parameters over the time in elderly patients with complex intra-articular distal radius fractures. Methods: Prospective cohort of 66 consecutive patients with mean age of 68 (range 60–81) years and AO type C fractures treated with volar locking plate. Radiographic measurements were performed pre and post-operatively at each follow-up. Clinical assessment was made by Patient-Rated Wrist Evaluation scores, Disabilities of the Arm, Shoulder and Hand score, range of motion, and grip strength. Results: The mean post-operative follow-up was 31 (range, 24–47) months. The most difficult parameters to restore intra-operatively were volar tilt and radial height, while radial inclination and ulnar variance were restored in a high rate of patients. There was significant loss of reduction within four post-operative months in volar tilt (p = 0.001) and radial height (p = 0.029). Mean radiographic parameters had no changes from four months to final evaluation. At final follow-up, 50.1% of the patients had all radiographic parameters restored in comparison with the noninvolved wrist, but 83.3% had all radiographic parameters within a functional range (p = 0.001). No significant relationship between radiographic and functional outcomes was found (p = 0.474). Conclusions: This study found that volar locking plate fixation for displaced intra-articular distal radius fractures in elderly patients was an effective procedure to obtain success functional outcomes. Although reduction loss in volar tilt and radial height occurred within four first months, volar plate was able to maintain fracture stabilization with radiographic parameters within functional range over the time in most patients of these elderly patients.

Background: Intra-articular fractures of the distal part of the triquetrum within the pisotriquetral joint are uncommon, and can be associated with tears of the dorsal carpal ligaments, pisiform subluxation and/or FCU dislocation. Their diagnosis is difficult and requires a high clinical suspicion and a proper radiological examination including oblique wrist x-rays, computed tomography and MRI scan. These fractures can be delayed diagnosed due to late presentation thus leading to painful nonunion, persistent instability and late pisotriquetral arthritis. Case Report: We present a case of a 40-year-old male who complained about ulnarsided wrist pain after a fall on his extended wrist during bicycling. The diagnosis of triquetrum fracture was suspected on clinical examination and confirmed using standard and oblique radiographs and CT scan evaluation. He was immobilized in a short-arm cast for 6 weeks followed by a progressive return to wrist motion and subsequent strengthening for another 5 weeks. He reported complete resolution of pain and excellent wrist motion and function one year after the injury, demonstrating a Mayo score of 100. Conclusion: Isolated intra-articular fractures of the triquetrum within the pisotriquetral joint are rare injuries and may constitute a subcategory of body fractures other than the dorsal cortical (chip), main body and volar lip avulsion fractures. Early clinical suspicion and proper imagine can lead to a successful outcome.

Aims This study aimed to compare the change in health-related quality of life of patients receiving a traditional cemented monoblock Thompson hemiarthroplasty compared with a modern cemented modular polished-taper stemmed hemiarthroplasty for displaced intracapsular hip fractures. Patients and Methods This was a pragmatic, multicentre, multisurgeon, two-arm, parallel group, randomized standard-of-care controlled trial. It was embedded within the WHiTE Comprehensive Cohort Study. The sample size was 964 patients. The setting was five National Health Service Trauma Hospitals in England. A total of 964 patients over 60 years of age who required hemiarthroplasty of the hip between February 2015 and March 2016 were included. A standardized measure of health outcome, the EuroQol (EQ-5D-5L) questionnaire, was carried out on admission and at four months following the operation. Results Of the 964 patients enrolled, 482 died or were lost to follow-up (50%). No significant differences were noted in EQ-5D between groups, with a mean difference at four months of 0.037 in favour of the Exeter/Unitrax implant (95% confidence interval (CI) 0.014 to 0.087, p = 0.156), rising to 0.045 (95% CI 0.007 to 0.098, p = 0.09) when patients who died were excluded. The minimum clinically important difference for EQ-5D-5L used in this study is 0.08, therefore any benefit between implants is unlikely to be noticeable to the patient. There was no difference in mortality or mobility score. Conclusion Allowing for the high rate of loss to follow-up, the use of the traditional Thompson hemiarthroplasty in the treatment of the displaced intracapsular hip fracture shows no difference in health outcome when compared with a modern cemented hemiarthroplasty. Cite this article: Bone Joint J 2018;100-B:352–60.

Background: Intra-articular fractures of the distal radius represent a therapeutic challenge as compared with the unstable extra-articular fractures. With the recent development of specifically designed volar plate for the distal radius, treatment of these fractures by fragment-specific implants using two or more incisions has been advocated. Purpose: The purpose of this study was to investigate the efficacy of a fixed-angle locking plate applied through a single volar approach in maintaining the radiographic alignment of unstable intra-articular fractures as well as to report the clinical outcomes. We only excluded those with compound fracture of distal radius grade III and above. Patients and Methods: This prospective randomized study comprised 60 patients with displaced intra-articular (Frykman type IV-VIII) distal end radius fractures treated with volar locking plates. The patients were followed up at 2nd week, 6th week, 12 week, 6 months and 1 year after surgery. The assessment of pain, range of motion, grip strength and activity were assessed at each follow-up visit and scored according to the Green and O’Brien scoring system. Results: At the end of 1 years, In volar plate group out of 60 patients, excellent result was achieved in 08 patients (13%), good in 48 patients (80%), fair in 04 patients (7%). No poor outcome seen. Conclusions: Irrespective of the direction and amount of initial displacement, a great majority of intra articular fractures of the distal radius can be managed with a fixed angle volar plate through a single volar approach.

Introduction: Intra-articular fractures of calcaneum pose a challenge for all orthopaedic surgeons due to different treatment options and their varied eventual functional outcome. The aim of this study is to evaluate the medium term outcome of open reduction and internal fixation by extensile lateral approach using low profile anatomical locking calcaneal plate. Method: 44 cases of intra-articular fracture calcaneum in 40 patients were included in this study. These were classified based on Sanders classification system. Open reduction and internal fixation was done using extensile lateral approach and anatomical locking calcaneal plate. Functional outcome was assessed using the Creighton-Nebraska scoring system at the end of six months. Results: Excellent result was seen in 69% cases, Good result in 13% cases, Fair and Poor results were seen in 9 % cases each. Bilateral fractures showed poorer results compared to unilateral fractures. Associated injuries had a direct bearing on the eventual functional rehabilitation. Average union time was 12 weeks. Most of the patients could return to pre-injury work status by the end of six months. Conclusion: Immediate, appropriate post-traumatic soft tissue care can probably decrease the incidence of potential wound problems. Extensile lateral approach provides excellent visualization and reduction of displaced intra-articular fragments. Anatomical calcaneal plate provides stable fixation. Role of bone grafting needs further evaluation in a larger population study.

Non-articular medial epicondyle is closely related to ulnar nerve and is the point of attachment of ulnar collateral ligament. The articular surface of distal humerus makes an angle 4-8° valgus with shaft axis. The articular segment projects anteriorly to the shaft at an angle of 40°. Medial epicondyle is in projected axis of shaft while lateral epicondyle is projected slightly forward from the axis. The study was conducted in Medical College, and there were 14 cases in the study in which 9 were males and 5 females. Age of the patients ranged between 25 years and 75 years with an mean age of 48.2 years. Among the 14 cases, 8 were caused by fall (57%) and six were caused by Road Traffic accidents (43%). Among the 8 patients operated before meantime of 6 day, 7 patients (88%) had acceptable outcome (average score 86.4%) and one had unacceptable outcome (score 70%). Among the 6 patients operated after 6 days, 3 had acceptable outcome (average score 83.33%) and 3 patients had non-acceptable outcome (average score 58.3%).

We compared outcomes in elderly patients with intra-articular distal radius fractures treated by closed reduction and plaster immobilization or open reduction and internal fixation with a volar plate. Ninety-seven patients older than 60 years were randomly allocated to conservative (47 patients) or surgical (50 patients) treatment. Over a 2-year period, we assessed patient-rated wrist evaluation score, DASH (disability arm, shoulder and hand) questionnaire, pain, wrist range of motion, grip strength, and radiological parameters. The functional outcomes and quality of life were significantly better after volar plating fixation compared with conservative treatment. We found that restoration of the articular surface, radial inclination, and ulnar variance affected the outcomes, but the articular step-off did not. Twenty-five per cent of the patients with conservative treatment had secondary loss of reduction. We conclude that surgical plating leads to better outcomes than conservative treatment for elderly patients with intra-articular distal radius fractures. Level of evidence: I

We present the case of a 35-year-old female patient who was professionally active and practised recreational sports. The patient was involved in a traffic accident during which she sustained multiple trauma including an open comminuted intra-articular fracture of the proximal tibial epiphysis. As a consequence of intraoperative complications and 6-year treatment, the patient became a disability pensioner and requires community care.

Objective: The objective of the present study was to assess the functional outcome of surgically managed bimalleolar fractures of ankle joint. Material and Methods: The surgical study was conducted on twenty seven patients at Kakatiya Medical College, Warangal, Telangana, India, for a period of eighteen months. All the cases were treated by open reduction and internal fixation technique. The functional outcome was evaluated using the Baird and Jackson’s ankle scoring system. Results: In our study the operative results we achieved were good in 83.2% cases, 8.3% fair results, 8.3% poor results. Good functional results were obtained by surgical management of bimalleolar ankle fractures. Early weight bearing and mobilisation was achieved in these patients. Open reduction and internal fixation restores the articular congruity of the ankle joint. There were no intra operative complications observed in this study. Conclusions: Anatomical reduction is essential in all intra articular fractures, more so if a weight bearing joint like ankle is involved. Open reduction and internal fixation guarantee high standard of reduction besides eliminating chances of loss of reduction. Functional outcome and the results of surgery treatment were found to be good.

Background: Fractures distal femur are one of the commonest fractures encountered in high velocity trauma which are associated with high morbidity and mortality. Isolated fracture can itself lead to complications such as ARDS and pulmonary embolism. This necessitates early stabilization of fractures. Internal fixation is the choice of treatment in fractures distal femur and Locking Condylar plate. Plate has shown to give one of the best results in terms of recovery, fracture union, return to work and the functional outcome.Objectives: To study the functional results of fracture distal femur treated by open reduction and internal fixation with locking condylar plate. Methods: 20 cases of fracture distal end femur were treated by open reduction and internal fixation by Locking Compression Plate at our institution. The patients were evaluated clinically and radio logically for outcomes. All patients were followed up for an average of 12 months. Outcome was assessed using NEER’S Score. Results: In our study 20 distal femoral fractures were treated. All cases were fresh, 13 patients were males and 7 patients were females. The median age was 47years ranging from 28-70 years.15 of the fractures were caused by road traffic accidents and 3 were due to fall, 2 were due to assault. 12 patients were with fracture on right side and 8 on left side. Using Neer’s scoring system excellent is 65%, good is 15%, fair is 15% and poor is 5%. Range of motion of knee & Hip was excellent to very good. Gait and weight bearing after complete union was satisfactory. Conclusion: open reduction and internal fixation of lower end femur using locking condylar plate. It is one of the best modalities of treatment especially in intra articular fractures where the maintenance of articular congruity is crucial. Fixation with locking condylar plate showed more effectiveness in severely osteoporotic bones, shorter post-operative stay, faster recovery, earlier union rates and excellent functional outcome compared to alternative procedures in other studies.