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Introduction. Damage to the musculoskeletal system in multiple traumas occurs in 80–90 % of cases, in 10–15 % of victims they are leading and define life prognosis [2]. Out of injuries of the locomotor system, hip fractures are one of the most significant and life-threatening, their treatment is difficult. The severity of these injuries, difficulties of using conservative methods of treatment for multiple and combined fractures, frequent development of complications when using standard methods of osteosynthesis often lead to unsatisfactory results [4]. In this regard, the search continues for the optimal treatment of bilateral hip fractures in patients with polytrauma. The aim of our study was to determine the optimal methods of surgical treatment of bilateral hip fractures in patients with multiple injuries. Materials and methods. To perform our study, we analyzed the data of 75 patients with bilateral fractures of the hip and polytrauma, who were treated at the Kyiv Municipal Clinical Emergency Hospital between 2006 and 2015. There were 59 men (78.7 %) and 26 women (21.3 %). The average age of victims was 38.2 ± 1.1 years. Results. On admission to the hospital, diagnosis of bilateral hip fractures was carried out, with subsequent stabilization of vital functions. Bilateral hip fractures were found in 48 (64.0 %) of the victims. One open and the other — closed fractures were observed in 16 (21.3 %) of patients. Both open fractures were diagnosed in 11 (14.7 %) of the victims. After stabilization of patient’s state, we have conducted replacement of external fixation device (EFD), plaster splints and skeletal extension by internal fixation in different ways depending on the type and location of fractures, as well as taking into account the general condition of patients. Reasons for changing the method were the development of contractures in adjacent joints, inappropriate position of fracture fragments in EFD, the risk of inflammation around the rods and the possibility of infection of bone or soft tissues. 13 (17.3 %) patients had two supracondylar or transcondylar fractures (33 А 1–3, С 1–3). These individuals underwent extramedullary minimally invasive osteosynthesis using plates with angular stability (locking compression plates — LCP). In 23 (30.7 %) patients, we have detected a combination of distal and diaphyseal femur fractures. For the treatment of these patients, a combination approach was used: at the first stage, diaphyseal fracture was fixed with the help of intramedullary nailing, and the second stage was the fixation of distal fracture using minimally invasive external osteosynthesis with LCP. Conclusions. At the early hospital stage, when treating bilateral hip fractures in polytrauma, it is necessary to stabilize fractures using EFD that makes it possible to anesthetize, to reduce the fracture and to mobilize the patient. At the hospital stage of treatment, there is a need to change the method by internal fixation according to indications, depending on the location and type of a fracture, with the aim of final reposition, stable fixation and mobilization of adjacent joints. Using an integrated differentiated approach to the treatment of bilateral hip fractures in patients with polytrauma made it possible to obtain positive outcomes in 94.6 % of cases.

Kondisi nyeri banyak ditemukan pada sebagian besar kasus seperti pada kondisi luka bakar, luka tusuk, luka robek serta pada kondisi fraktur, baik fraktur terbuka maupun fraktur tertutup. Setiap individu yang mengalami nyeri mempunyai respon yang berbeda dalam menyikapi kondisi nyeri yang dialaminya seperti berteriak, meringis, memejamkan mata dengan kuat, menggigit bibir, meniup, memegang dan menggosok area yang mengalami nyeri. Tujuan dari dilakukannya penelitian ini adalah untuk melakukan identifikasi terhadap respon apa saja yang dilakukan oleh penderita fraktur dalam menyikapi nyeri yang dialaminya di wilayah Kabupaten dan Kota Provinsi Sumatera Selatan Tahun 2017. Penelitian ini merupakan penelitian deskriptif kuantitatif dimana peneliti melakukan identifikasi terhadap respon yang dilakukan penderita fraktur di wilayah Kabupaten dan Kota Provinsi Sumatera Selatan. Sampel dalam penelitian ini adalah penderita yang mengalami fraktur berjumlah 78 orang yang dipilih dengan menggunakan tehnik Accidental Sampling serta memenuhi kriteria yang telah ditentukan. Data dalam penelitian ini di dapat dengan melakukan identifikasi langsung terhadap respon penderita yang mengalami fraktur. Hasil identifikasi dicatat dan selanjutnya dilakukan entry data ke dalam program SPSS versi 19. Penelitian ini dilaksanakan pada bulan Januari-Juni 2017 bertempat di wilayah Kabupaten dan Kota Provinsi Sumatera Selatan. Berdasarkan hasil penelitian diketahui jika respon penderita yang mengalami fraktur cukup banyak dan bervariasi, respon terbanyak yaitu dengan meringis sebanyak 17 orang responden (21.8%), menangis sebanyak 15 orang responden (19.2%) berteriak dan menjerit masing-masing sebanyak 7 orang responden (9.0%). Beberapa respon dilakukan oleh penderita fraktur seperti melakukan kompres, relaksasi/mengatur pola pernafasan dan memegang area fraktur, respon yang bersifat mandiri tersebut dilakukan oleh penderita dengan tujuan untuk meminimalisir intensitas nyeri fraktur yang sedang dialaminya.

OBJECTIVE To assess the direct costs of distal radius fracture volar plate (VP) fixation and to create a model to examine the effect of these cost drivers. MATERIALS AND METHODS Retrospectively, 744 distal radius fractures treated with open reduction and internal fixation (ORIF) were identified. The outcomes assessed included (1) the direct costs related to distal radius ORIF and (2) if a VP alone was amenable. Costs were represented as a cost ratio relative to the average cost of distal radius ORIF, where the average value is set as 1.0. Simulation models were run with all cost drivers (sex, age, open fracture, intra-articular fracture, and ancillary fixation) and with only ancillary fixation as a cost driver. RESULTS The cost ratio ranged from 0.61 to 1.81 and ancillary fixation was associated with increased implant costs in multivariable analysis. In the simulations, the cost ratio ranged from 0.96 to 1.23 when all cost drivers were included and from 0.99 to 1.20 if only ancillary fixation was included as a cost driver, a reduction of the range by 22.2%. Older patients, females, closed fractures, and extra-articular fractures were more amenable to VP fixation alone. CONCLUSIONS Eighty-three percent of the surgically treated distal radius fractures were treated with VP fixation alone. A disposable kit could help limit cost variance per case by roughly 22%, as only ancillary fixation varies these costs. Closed fractures and extra-articular fractures in older patients or female patients are more amenable to VP fixation alone. LEVEL OF EVIDENCE Economic Level III. See Instructions for Authors for a complete description of levels of evidence.

Introduction: Closed fractures of leg are common following RTA, which requires immobilization and leg elevation above heart level to reduce oedema formation and increase of compartment pressure leg elevation is routine in pre operative and post operative period to reduce intra compartment pressure whereas optimum height of elevation has not been standardized till now. Inadvertent elevation of leg decreases venous oedema whereas chances of muscle ischemia increases with prolonged and inappropriate elevation of leg. So determination of appropriate level of leg elevation above heart level by invasive method by white side’s method will help reduce muscle ischemia and discomfort to the patient. Purpose: To determine optimum height of leg elevation above heart level to reduce intra compartmental pressure.Methods: Patients at KLES Dr. Prabhakar Kore Hospital with closed fractures of leg. Anterior compartment pressure measured with Whiteside’s invasive method .Patients were randomly divided into two groups Group A: 15 cm of leg elevation and Group B:30 cm of leg elevationResults: In this study 60 patients with closed fractures of tibia were selected for intra compartmental pressure monitoring and randomised for different weights of leg elevation i.e., Group A 15 cm above heart level and Group B 30 cm above heart level. The mean age of leg fractures in our study was 40.1 years. Male subjects were 85% (mean = 53) and female were 17% (mean = 7) of total of 60 patients.The measurement of compartment pressure of normal leg was 9.4 ± 2.5 mm Hg. Pressure were measured within 5 cm of fracture site at 0 hr, 12 hr, 24 hr and 48 hr interval using Whiteside’s method. The mean values at 0 hr were 29.17 ± 5.95 mm Hg, at 12 hr interval it was 29.97 ± 5.46 mm Hg, at 24 hr interval it was 23.36 ± 3.8 mm Hg and at 48 hr interval it was in Group A. The mean values at 0 hr were 32 ± 7.8 mm Hg, at 12 hr interval it was 32.33 ±57.65 mm Hg, at 24 hr interval it was 26.48 ± 3.5 mm Hg and at 48 hr interval it was in 25.19 ± 2.56 mm Hg in Group B. In our study 5 patients out of 60 underwent fasciotomy. All patients had differential or delta pressure below 30 mm Hg before fasciotomy.Conclusion: Tibia fractures are commonest cause of compartment syndrome of leg. Whiteside’s method is a reliable and safe method of measuring intra compartment pressure when sophisticated methods are not available. Inappropriate levels of leg elevation causes muscle ischemia. Elevation of leg to 15 cm leads same clinical results as 30 cm with the advantage of avoiding muscle ischaemia. There is further need for evaluation of different heights of leg elevation and review about our practice of leg elevation.

Background and Purpose. Trauma is a significant burden on causes of death, disability, and financing in least developed or "third world" countries. Fracture healing, especially in wounds and tissues, begins with a hemostatic and inflammatory phase triggered by inflammatory mediators such as cytokines, particularly IL-1β and TNF-. The purpose of this study was to determine the difference in levels of interleukin-1β in open and closed fractures of long bones in PadangMethod. This type of research is analytic observational with cross sectional design with primary data. The data were taken from the examination of IL-1β levels in long bone fracture patients at RSUP Dr. M. Djamil, RSKB Ropanasuro and RST Reksodiwiryo Padang for 4 months starting from March 2021 to July 2021. The sampling technique in this study used non-probability sampling with the consecutive sampling method. The analysis was carried out using the Independent sample T-Test to see the difference in mean IL-1 which would be calculated for open fractures and closed fractures of long bones.Results. The results showed that most (92.9%) of the patients were male, 50% had open fractures, and 50% closed fractures. The mean value of the patient's age was 34 years and the mean level of IL-1β was 555,951 pq/L. Most of the fracture sites in patients were tibia and fibula (35.7%) and femur (35.7%) and 28.6% were radius and ulna. The results showed that there was a significant difference in the mean levels of IL-1β in patients with open and closed fractures of long bones (p-value = 0.007)Conclusion. There are differences in the levels of interleukin-1β in open and closed fractures of long bones in Padang. This research is expected to provide consideration to support examinations in health services, in this case in fracture patients

Background The aim of this study is to evaluate risk factors for infection as well as infection rates after open reduction and internal fixation for distal tibia fractures with a distal tibia locking plate and/or isolated screws. Methods This is a retrospective and descriptive study based on 55 patients treated in our Major Trauma Centre from January 2009 to December 2016. All patients were classified by age, sex, open or closed fracture, injury mechanism, comorbidities, fixation and time from injury to surgery. 22 extraarticular fractures AO/OTA 43-A and 33 intraarticular (14 cases 43-B and 19 43-C) were recorded. High energy trauma was related in 27 patients, while open fractures were observed in 10 patients. Splint until surgery was applied routinely while temporary external fixation (EF) was performed in 21 patients (7 extraarticular and 14 intraarticular). Patients were treated by 5 different consultant surgeons performing isolated screws (SC) in 20% of the surgeries, antero-medial locking distal tibia plate (AM) and anterolateral (AL) were used in 47% and 33% of the patients respectively. After assessing normality and homogeneity of the subgroups, statistical contrast tests were performed. Results Infection rate was 31.5%, mainly caused by S. aureus. We obtained a statistically significant correlation between greater age and infection rate. In the same way, a positive statistical trend between infection and AL plating was found. The use of EF followed by ORIF was not observed as a risk factor for infection compared with splint followed by internal fixation, however, the group of patients in which a splint was used, a positive relationship was found between the infection rate and shorter time until the definitive fixation. No statistically significant associations were found between extra/intraarticular fracture pattern, use of corticosteroids or open fractures and infection rate. Conclusion Greater age was a predisposing factor for infection. The use of external fixation before definitive ORIF seems to be a safe procedure regarding risk infection, and if an external fixation is not used, we recommend longer waiting time until definitive ORIF. Screw fixation or antero-medial plates, if allowed by fracture pattern, can be an option to avoid infection.

Calcium channel blockers (CCBs), which are widely used in the treatment of hypertension, have been shown to influence bone metabolism. However, there is little information on whether CCBs also influence the process of fracture healing. Therefore, the effect of the CCB amlodipine on bone healing was studied in a stable closed fracture model in mice using intramedullary screw fixation. Bone healing was investigated by radiology, biomechanics, histomorphometry and Western blot analysis 2 and 5 weeks after fracture healing. Animals were treated daily (post operatively) per per os using a gavage with amlodipine low dose (1 mg/ kg body weight, n = 20), amlodipine high dose (3 mg/kg body weight, n = 20) or vehicle (NaCl) (control, n = 20) serving as a negative control. At 2 and 5 weeks, histomorphometric analysis revealed a significantly larger amount of bone tissue within the callus of amlodipine low-dose- and high-dose-treated animals when compared to controls. This was associated with a smaller amount of cartilaginous and fibrous tissue, indicating an acceleration of fracture healing. Biomechanics showed a slightly, but not significantly, higher bending stiffness in amlodipine low-dose- and high-dose-treated animals. Western blot analysis revealed a significantly increased expression of bone morphogenetic protein (BMP)-2 and vascular endothelial growth factor (VEGF). Moreover, the analysis showed a 5-fold higher expression of osteoprotegerin (OPG) and a 10-fold elevated expression of the receptor activator of NF-κB ligand (RANKL), indicating an increased bone turnover. These findings demonstrated that amlodipine accelerated fracture healing by stimulating bone formation, callus remodelling and osteoclast activity.

Background. Fractures of the distal leg bones in children, due to the peculiarities of localization, the presence of a growth zone, the proximity of the joint and the involvement of the ligamentous apparatus in the pathological process, present a difficult problem in the choice of treatment and rehabilitation. Aims: In order to our aims we create the diagnostic and treatment algorithm in the system of early rehabilitation after fractures in the distal part of the shin bone in adolescence. Methods. Our clinical investigation based on the treatment of 56 patients in the age 8–17 years. Cohort of patients consist from three age groups: 8–11 years ( n =13), 12–14 years ( n =28) and 15–17 years ( n =15). Examination was done with X-rays, CT and Ultrasound, specialy in the cases where the damage of ligamentous apparatus was suspicious. The main method of treatment was surgical — osteosynthesis by pins, plates and screws. In the rehabilitation period the legs were immobilized by Plaster of Paris for 4–6 weeks. Results. In majority of cases the outcomes in the period of 6–8 weeks after trauma were good and satisfactory. The method of laser Doppler fluometry was performed in 16 cases in follow up period after trauma for examination of the regional blood circulation as a argumentation of regeneration process. Conclusion. The different choice in treatment of compound fractures of the distal part of the shin bones according to morphological changes in adolescence permits to aid good results in majority of caces.

Resumo Objetivo O presente estudo visa analisar os resultados clínicos do tratamento cirúrgico das fraturas de colo do metacarpo com fixação intramedular retrógrada utilizando parafusos canulados sem cabeça (tipo Herbert). Métodos Estudo retrospectivo de 21 fraturas fechadas desviadas do colo do metacarpo em 21 pacientes operados entre abril de 2015 e novembro de 2018. Resultados A casuística incluiu 19 homens e 2 mulheres. Os mecanismos causadores do trauma foram soco, queda ao solo e acidente com veículo motorizado (n = 14, 5 e 2). Os metacarpos acometidos foram o V, III e II (n = 19, 1 e 1). As indicações cirúrgicas foram angulação colo-diáfise do metacarpo > 30° para os II e III metacarpos e > 40° para o V metacarpo, encurtamento ≥ 5mm, desvio rotacional e o desejo do paciente de não utilizar imobilização gessada. No pós-operatório imediato, os pacientes permaneceram sem imobilização e orientados a mobilizar os dedos conforme tolerância. Todos os pacientes ficaram com mobilidade ativa total > 240° e retornaram às suas antigas ocupações. Todas fraturas consolidaram e não houve reintervenções. Discussão As grandes vantagens da técnica com parafuso sem cabeça são sua baixa morbidade, estabilidade suficiente para não precisar de imobilização externa e reprodutibilidade com baixo custo. Conclusão Esta é uma técnica fácil, rápida, e que apresenta ótimos resultados para o tratamento cirúrgico das fraturas deslocadas do colo dos metacarpos.

OBJECTIVES To identify a group of ballistic tibia fractures, report the outcomes of these fractures, and compare them with both closed and open tibia fractures sustained by blunt mechanisms. We hypothesized that ballistic tibia fractures and blunt open fractures would have similar outcomes. DESIGN Retrospective cohort study. SETTING A single Level-1 trauma center. PATIENTS/PARTICIPANTS Adult patients presenting with ballistic (44), blunt closed (179), or blunt open (179) tibia fractures. INTERVENTION Intramedullary stabilization of tibia fracture. MAIN OUTCOMES Unplanned reoperation, soft tissue reconstruction, nonunion, compartment syndrome, and fracture-related infection. RESULTS Compared with the blunt closed group, the ballistic fracture group required more operations (P < 0.01), had a higher occurrence of soft tissue reconstruction (P < 0.01), and higher incidence of compartment syndrome (P = 0.02). Ballistic and blunt closed groups did not significantly differ in rates of unplanned reoperation (P = 0.67), nonunion (11.4% vs. 4.5%, P = 0.08), or deep infection (9.1% vs. 5.6%, P = 0.49). In comparison to the blunt open group, the ballistic group required a similar number of operations (P = 0.12), had similar rates of unplanned reoperation (P = 0.10), soft tissue reconstruction (P = 0.56), nonunion (11.4% vs. 17.9%, P = 0.49), and fracture-related infection (9.1% vs. 10.1%, P = 1.0) but a higher incidence of compartment syndrome (15.9% vs. 5.0%, P = 0.02). CONCLUSIONS Ballistic tibia fractures require more surgeries and have higher rates of soft tissue reconstruction than blunt closed fractures and seem to have outcomes similar to lower severity open fractures. We found a significantly higher rate of compartment syndrome in ballistic tibia fractures than both open and closed blunt fractures. When treating ballistic tibia fractures, surgeons should maintain a high level of suspicion for the development of compartment syndrome and counsel patients that ballistic tibia fractures seem to behave like an intermediate category between closed and open fractures sustained through blunt mechanisms. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: Open tibial plafond fractures (Orthopaedic Trauma Association and AO Foundation [OTA/AO] 43) are associated with severe complications, including deep infection (closed fractures, 20%; open fractures, 30%), amputation (3%-14%), and nonunion (up to 25%). Circular external fixators (CEFs) can minimize soft tissue injury. This study aimed to report the rate of union and occurrence of severe complications in patients with open tibial plafond fractures treated with CEFs. Methods: A retrospective review of case series was conducted at 3 level I trauma centers. The study included patients older than 18 years with open tibial plafond fractures treated with CEFs. The reported outcomes included union rate, deep infection, operative complications, and limb alignment. The radiographic measurements of anatomic alignment were obtained. Fifty-two patients were included in the study. Results: The primary union rate was 79%. No deep infection occurred in the majority (92%) of patients. No patient required amputation of the affected limb or free flap coverage. Conclusion: Definitive fixation of open tibial plafond fractures with CEFs avoided severe soft tissue complications but resulted in variation in final radiographic alignment. Level of Evidence: Level IV, case series.

This study evaluated the risk of radioulnar synostosis after fracture of both forearm bones at the same level. We hypothesized that (i) the incidence of synostosis in both-bone forearm fractures at the same level is low with intramedullary nailing (IMN); (ii) the type of fracture (open/closed) and type of reduction (open/closed) affect time to union. Seventy-eight patients who had been treated with IMN for fracture of both forearm bones and had at least 1 year of follow-up were included in the study retrospectively. All the patients were treated by IMN following closed reduction or open surgery. Patients were followed clinically and radiologically. Age, open or closed fracture, time to union, and occurrence of synostosis were documented. The mean age of the patients was 33.4 years. Fifty-three (68%) patients were male. Forty-eight (61.5%) patients had high velocity injuries. The mean follow-up was 26.4 (12-46) months. According to the Grace and Eversmann scoring system, 95% had good or excellent outcomes. The mean DASH score was 10.5 (0-56). Union rate was 100%. Only one patient (1.2%) had a radioulnar synostosis at middle third level. IMN is a safe method that yields a high union rate and contributes to a low incidence of synostosis. Open fracture and open reduction during surgery have no effect on time to union.

Introduction: Tibial fractures type V and VI are complex injuries usually treated with ORIF (Open Reduction and Internal Fixation) which have increased risk of wound complications. The hybrid external fixer helps to mitigate these complications by permitting early mobilization and bearing of weight, minimal soft tissue damage, and stable fixation. Aim: To analyzethe functional outcome of hybrid external fixator-treated tibial plateau fractures (Schatzker type 5 and 6). Methods: The study included 30 patients who hadtibial platform fractures of Schatzker Type V and type VI. Patients offered informed consent and a 2 years follow-up following surgery was done. We have applied K’wire or minimal open reduction with cancellous screw and universal external fixator. The analyses were performed with Neer's Rating System for Knee. Results: Out of 30 patients, 26 patients were males, and 4 patients were females. Mean age was 42.34 years. Based on outcomes, 40% of the study population had an excellent and good effect, 17% had fair outcome, 3% had a poor outcome. Based on the type of fracture, 12 patients had Schatzker type V, 18 patients had Schatzker type VI, 10 patients had closed fracture, 20 patients had a compound fracture. Based on mode of injury, 85% had a road traffic accident, 10% had assaulted, 5% had fall injury. Based on complication, 23% had pin tract infection, 17% had knee stiffness, 3% had malunion, 3% had shortening, and 10% had wound infection. Conclusion: In this report, we have concluded that a promising alternative therapy for high-energy plateau fractures is a hybrid external fixator. Without high complication rates, it permits a safe fixation of fraction fragments, early joint recovery and the treatment of related soft tissue injuries.

Background: Tibial shaft fractures are third most common type of long bone fractures in children after femur and forearm.Aim: The purpose of the study is to evaluate the functional and radio logical outcome results of Closed reduction or open reduction of tibial fractures and fixation using locking plate as supra cutaneous external fixator in children.Methods: In this observational study 32 children with tibial fractures having soft tissue injury underwent external fixation with locking plates. There were 22 male and 10 female children with mean age of 10.59years (range 6 to 15 years) who sustained fracture in RTA. 84.4% cases had closed fractures, and 15.6% cases had open fractures. Out of the cases with open fractures, 60% had grade 1 injury, and 20% each had grade 2 and grade 3b injury respectively. Results: 7, 9, 11, 13 Holed LCP were used in 34.4%, 25%, 25% and 15.6% patients respectively. Screw tract infections were observed in two patients who had serious discharge and was relieved with oral antibiotics. No deep infections were reported. All the fractures united by the end of 24 weeks after bone grafting. In all most all the patients skin condition was found to be good in follow up.Conclusion: The present study though in small number (32) shows that use of LCP plate as supra cutaneous external fixator is an effective method in terms of stability of fixation, utilisation as permanent fixation method and less complication rate.

Introduction: For dorsally displaced lower end radius fractures percutaneous pinning fixation and insome studies fragment specific fixation shows their advantages. For volarly displaced fracturesvolarly plate fixation traditionally showed good results. The volar locking plates with their inheritanceability to provide absolute stability are attractive for their advantages. Objective: To assess thefunctional outcome of treating the distal end radius fractures with the use of volar lockingcompression plates. Materials and methods: Study of a total of 30 patients was conducted in thedepartment of orthopedics at G K General Hospital, Bhuj, Gujarat. All 30 patients with closedfractures were included in the study. All patients were treated with open reduction and internalfixation with the use of a volar locking compression plate. The patients were followed up at one, two,three, and up to six months. Mayo wrist scoring system was used to assess final functional outcomesof treatment. Results: At the final functional assessment, as per mayo wrist scoring out of a total of30 patients, 17 of them achieved excellent, 7 achieved good outcomes, with 5 patients exhibitingfair results and one patient had the collapse of fixation at the 3-month review. No, any patient haddiminution of functional outcome. On radiological assessment, 70% of patients had callus formationand no clear fracture line was seen, 18% had callus formation but a visible fracture line was presentand 12% of patients had clear visible fracture line up to final follow up. Conclusion: Open reductionand internal fixation with volar locking compression plating is a safe and effective treatment forunstable especially volarly displaced fractures of distal end radius with satisfactory functionaloutcome.

The forensic aspects of low-energy pedestrian injury have not been adequately studied yet. The objective of the study presented is to analyze forensic criteria for identifying the mechanism of injury in low-energy fractures of the lower extremities. The study material included 347 acts of forensic medical examinations of victims with fractures of the lower extremities performed in the Kharkiv Regional Bureau of Forensic Medical Examination for the period from February to June 2018. The selection of forensic medical evaluation reports was carried out at random. The methodology included retrospective analysis, descriptive statistics. The incidence of low-energy pedestrian injury was 0.9%. This type of road traffic injury was registered in people aged 78 – 88 as a result of an alleged collision with the back of a vehicle. The main difference between high- and low-energy fractures of the long bones of the lower extremities was the severity of concomitant injuries (given the fact that closed isolated fractures of the long bones of the lower extremities in our material were accompanied by injuries of the integumentary system (abrasions, bruises, etc.), those fractures were regarded as concomitant injury. In the first case, the action of kinetic energy of significant force led to the formation of multiple fractures of the upper (94; 27.1%) and lower (421; 121.3%) limbs, pelvic girdle (83; 23.9%); concomitant injuries were characterized by the presence of moderate brain concussion (54; 15.6%), non-penetrating blunt chest trauma (102; 29.4%) with rib fractures (48; 13.8%), non-penetrating blunt abdominal trauma (51; 14.7%); all the victims had bruised and lacerated wounds, multiple abrasions, subcutaneous hematomas of various localization. Low-energy trauma was characterized by the presence of isolated fractures of the proximal femur (n = 4) and tibia (n = 3) bones (Table 2). As a concomitant trauma, damage to the integumentary system was recorded in the form of abrasions and subcutaneous hematomas in the fractured area when falling from a height of one's own height (n = 3). In terms of the strength and speed of the impact of the traumatic force, the low-energy pedestrian injury was identical to the fall of the victim from his own height onto the lateral surface of the body with the formation of bodily injuries as closed fractures of the proximal femur. The cause and mechanism of these injuries have not been identified due to the late primary forensic medical evaluation, incomplete data in the medical records on the clinical signs of traumatic injuries to the skin of the victims during the initial examination, inconclusive results of forensic examinations of clothing and footwear, and uninformative data of a technical examination. During the forensic medical examination of a low-energy pedestrian injury, the identification of traumatic injuries of the skin on the side of the fall and on the contralateral side, the place of the first contact with the car, enables to establish the fact of collision and the duration of the damage.

Aim: Operative treatment of shaft humerus fracture continues to evolve. MIPPO is one of such emerging operative procedure which does give excellent results over conventional ORIF platting. We are comparing overall functional outcome and surgical complexity of MIPPO (Minimal Invasive Percutaneous Plate Osteosynthesis) vs conventional ORIF (Open Reduction and Internal Fixation) by posterior approach in this study. Materials and Methods: A retrospective clinical study was done on 50 patients with shaft humerus fractures treated with MIPPO anterior bridge plating and posterior platting by trained single surgeon at a tertiary trauma care centre in the Department of Orthopaedics, BJ medical college, Civil hospital Ahmedabad between October 2016 and May 2018. Follow up data was collected and patients were called for clinical and radiological evaluation. Results: 24 of the 25 (96%) MIPPO patients and 22 of the 25 (88%) ORIF patients achieved union. Average union times for the MIPPO and ORIF groups were 19.3 and 16.1 weeks respectively. At the end functional outcome of both the technique is as follows: the Mayo Elbow Performance Score (MEPS; range 95–100) were 90% in 20 cases (n = 20) operated with conventional ORIF posterior plating and 20 cases operated with MIPPO plating which is excellent scores. Two cases operated with ORIF posterior plating and three cases with MIPPO plating are showing a good MEPS score. Conclusions: Even though MIPPO is surgically demanding, fracture hematoma is not disturbed in it therefore it gives better and fast union than conventional ORIF. Keywords: Conventional ORIF, MIPPO platting, Fracture, Humerus.

Highlights • Central Fracture Dislocation of the Hip is a rare condition requiring more attention in its management. • This case report presents a 57-years old female with polytrauma, abdominal blunt trauma with 7th zone liver laceration, central fracture dislocation of the left hip associated with closed fracture left acetabulum anterior column and closed fracture left neck femur. • The management for this condition has not described in many literatures. • In this case, we performed femoral head autograft and total hip arthroplasty, with promising functional outcome., Central Fracture Dislocation of the Hip is a rare condition requiring more attention in its management, caused by high-energy trauma and is often associated with other injuries. This case report presents a 57-years old female who was injured in a traffic accident and diagnosed with polytrauma, abdominal blunt trauma with 7th zone liver laceration, central fracture dislocation of the left hip associated with closed fracture left acetabulum anterior column and closed fracture left neck femur. Until now, there is no mandatory management to treat this kind of injury. Several surgical techniques were explained in previous literatures to treat this condition such as Open Reduction and Internal Fixation (ORIF) procedure and Total Hip Arthroplasty (THA). Some studies chose THA as a treatment for similar condition in older population due to high risk of nonunion and avascular necrosis of the femoral head, especially in cases of significant displacement and devitalization of the femoral head. In this case, we performed femoral head autograft and total hip arthroplasty as a definitive treatment.

Introduction Indications for prophylactic antibiotic therapy in nonoperative, closed fractures of the orbit and zygoma remain controversial and are based on anecdotal data. The purpose of this study was to report the incidence of infectious sequelae among patients who presented to our institution with stated fractures and who were not administered prophylactic antibiotic therapy. The authors hypothesized that an increase in infectious complications would not be seen in these patients. Methods The authors conducted a prospective single site study from October 2015 to December 2019. Patients with closed, nonoperative fractures involving the orbit and/or zygoma were included. These patients did not receive prophylactic antibiotic therapy for their fracture patterns, and infectious complications including orbital cellulitis, meningitis, and bacterial sinusitis were noted if present during follow-up. Results Of 301 patients with closed, nonoperative orbital and/or zygomatic fractures, 268 were included in the study and 33 were excluded because of administration of antibiotics. The average age was 60 years, and the most common mechanism of injury was a traumatic fall. Fracture types included 100 orbital wall, 133 orbital floor, 15 orbital rim, 23 orbital roof, 48 zygoma, and 44 zygomaticomaxillary compound fractures. Infectious sequelae were not identified in any patient. Conclusions Of the 268 patients included in the study, no infectious complications were identified during the follow-up period. This outcome further supports that the use of prophylactic antibiotics is not indicated for closed, nonoperative fractures involving the orbital and/or zygoma. Prospective randomized control studies would be useful to support this outcome and better guide clinical antibiotic prescribing practices.

Objetivo: Mostrar la evolución del manejo de fracturas de las extremidades con la alternativa Fijación Externa Descartable (FED). Actualmente existe gran cantidad de dispositivos internos y externos para el tratamiento de estas lesiones, algunos, los más publicitados, son costosos para nuestro medio. El joven médico tiene la sensación, en particular para los casos graves, de que, si no los dispone, no estarían en condiciones de curarlos. Material y Métodos: Se describen las experiencias de algunos clásicos de la Ortopedia (1850) hasta las experiencias de Escuelas actuales (2020) y también, comparativamente, nuestro punto de vista con el método que denominamos Sistema FED. Se revisa el cómo y porqué de la curación de los huesos fracturados. Los casos comprenden fracturas en zonas diafisiarias, metafisiarias, y peri articulares de huesos grandes, fracturas cerradas y fracturas abiertas incluso con pérdidas óseas y grandes heridas. También el manejo de casos con deformidades o complicados atribuibles a tratamientos inadecuados. Se enfatiza que únicamente en base a clasificaciones, se puede estimar diagnósticos exactos, alcances de pronósticos y, propuestas de alternativas de tratamiento. Resultados: Los casos más variados, complejos, incluso con pérdida ósea, se resolvieron competitivamente con la técnica Sistema FED. Conclusiones: Para países en vías de desarrollo como el nuestro, donde los foráneos dispositivos son costosos, la alternativa del Sistema FED, es una opción de manejo eficiente simple y económico.

Introduction: Distal radius fractures & associated wrist injuries are common. No doubt prevails for treatment of volar fragment intraatricular injuries. For dorsal comminution extraarticular & dorsal fragment intraarticular injuries various methods available & all have various implications on optimization of the treatment. Material & Methods: We treated (n=25) patients of distal radius dorsally displaced intraarticular & extraarticular fractures with percutaneous K wires fixation with or without external fixation ligamentotaxis at our unit. All were closed fractures. Age mean was 62.5 years. Preoperatively they were classified according to Frykman classification. Results: Postoperative evaluation by Sarmiento et al. modification of demerit point system of Gartland and Werley. 8% had Excellent, 48% had Good, 32% had Fair & 12% had Poor results. Non union rate was zero (n=0).Average union time was 4.5 weeks. Conclusion: Distal radius fractures treated with percutaneous pinning yields high union rate with closed reduction benefits like fracture hematoma prevention & low infection rates. It also provides mechanical stability with some allowable micromotion as far as dorsal comminution or intararticular dorsal fractures of distal radius concern. It provides cost effective & better alternative to closed reduction & cast treatment.