Background For many years, the most common approach to a COMMINUTED patella was excision. As further research shed light on the biomechanical importance of the patella, more attention was paid to the complications of patellectomy. So far, numerous attempts have been made to introduce successful alternatives, since nearly 55% of all surgically treated patellar FRACTUREs are COMMINUTED (1). Nevertheless, COMMINUTED patellar FRACTUREs still pose a challenge to the orthopedic trauma surgeons around the world...

Background: COMMINUTED distal metaphyseal FRACTUREs of tibia, often pose major treatment problems. Closed reduction, leads to high rate of malunion, while open reduction is associated with high risk of wound problems, joint stiffness, and nonunion. Biological fixation of these FRACTUREs by locking compression plates (LCP) is another alternative for fixation of this difficult FRACTURE.Methods: 22 patients with COMMINUTED FRACTURE of distal metaphysic, in a two-year period were treated with percutaneous application of LCP. The cases were evaluated clinically and rediographically with an average follow-up of 11 months. Results: Union was achieved in 19.2 (15-28) weeks in all cases. No skin breakdown and no malunion were observed. Full ankle motion was observed in all but 3 patients who had restricted dorsiflexion. One case of superficial wound infection was observed. Plate prominency was seen in 3 patients that caused skin irritation in one case. All swellings subsided and blisters healed within two weeks. Conclusions: With better preservation of blood-supply in biological application of LCP plates in distal tibial metaphyseal FRACTUREs, fast healing potential with fewer complications is to be expected.

Tarsal coalition is an often unrecognised cause of foot and ankle pain and represents a congenital osseous, cartilaginous or fibrous connection between two or more tarsal bones. FRACTUREs in combination with tarsal coalitions are rarely described in the literature. We report the case of a 43-year-old male patient with a talocalcaneal coalition who sustained an open COMMINUTED calcaneal FRACTURE and a closed transverse cuboid FRACTURE. Due to the asymptomatic tarsal coalition and the already firmly fixed subtalar joint, the patient was treated with open reduction and internal fixation (ORIF) with satisfactory outcomes instead of ORIF in combination with subtalar arthrodesis. Ten months after the trauma, the patient was satisfactory and could return to his regular work. There is currently no evidence for the gold standard treatment of calcaneal FRACTUREs with combined tarsal coalitions. Due to the satisfactory results of this case, authors conclude that in case with prior asymptomatic coalitions, singular ORIF without subtalar arthrodesis may be performed.

Pediatric femoral neck FRACTURE is rare and account for less than 1% of all FRACTUREs in childhood. The proximal femur in children is extremely strong, and high-energy forces in 80-90%, following the axial force associated with hip rotation or direct blow are necessary to cause FRACTURE. In this report, the method of femoral neck FRACTURE fixation in eight-year-old girl after car accident is reported. During the operation, we noted a severe femoral neck FRACTURE that was irreparable with the available tools (pin, screw, plate and DHS), which inevitably had to be used by Transosseous method with fiber wire #2, used in proximal humeral FRACTURE fixation. Then, we obtained a fairly satisfactory result with a distal femoral pin inserting it into two-sided spica cast. Although, this kind of FRACTURE is rare, but with a qualified clinical examination, early diagnosis, proper treatment, familiarity with surgical techniques and fixation reduces the complications and this method can be effective in obtaining the desired result.

Background: Bridge plate osteosynthesis of FRACTUREs by minimal invasion and near acceptable reduction is becoming popular and acceptable entity. Management of humeral shaft FRACTURE has evolved a lot with their pros and cons. Anterior bridge plate osteosynthesis (ABPO) for humeral shaft FRACTURE is pertinent to a minimal invasive procedure, and it has evolved as a new entrant in the surgical techniques. This study was designed to carry out the results and efficacy of ABPO in the COMMINUTED FRACTURE shaft of the humerus in the manual workers. Methods: Study included the closed COMMINUTED FRACTURE of shaft of humerus in skeletally mature patients engaged predominantly in manual works, like overhead sports activity, laborers, and industrial workers. All FRACTUREs were managed by either 4. 5-mm narrow locking compression plate (LCP) or dynamic compression plate (DCP). The functional outcome for elbow was measured by Mayo's elbow performance score (MEPS) and functional outcome of shoulder was measured by UCLA (University of California at Los Angeles) shoulder score system. Results: In this study 37 patients were enrolled. Mean duration for satisfactory radiographic union was 12. 3 weeks. The mean duration of follow-up period was 14. 5 months. In respect to elbow function, the average Mayo elbow score was 92. 42 ± 2. 17 and average UCLA score of shoulder function was 34 ± 0. 34. Conclusion: The ABPO is an optimum choice for managing the COMMINUTED FRACTURE shaft of humerus in manual labors. The outcomes are favorable and reproducible with very few risks.

BACKGROUND: The treatment of COMMINUTED FRACTUREs in long bones has continued to be a problem in orthopedic surgery. Recently, fixation without exploration of the FRACTURE site, known as "biologic fixation”, has been introduced. This study was performed to assess the results and complications of this method for the treatment of COMMINUTED FRACTUREs of the tibia and femur. METHODS: The study included 41 patients with COMMINUTED FRACTUREs of the tibia and femur treated with biologic plating from 2003 to 2006 (25 femur FRACTUREs and 16 tibial FRACTUREs). After biological fixation joint motion was started but weight bearing was avoided until radiographic evidence of union was shown. RESULTS: The mean time of union in the tibial FRACTUREs was 19±2 weeks and 17±2 weeks for the femur FRACTUREs. All patients had FRACTURE union without any infection, non-union or implant failure. In one patient with a femur FRACTURE there was a 10o internal rotation deformity. Two of the femoral FRACTUREs had shortening of 1 cm, and one patient had shortening of about 2 cm. Compared to similar studies, all results were statistically significant (P<0.05). CONCLUSIONS: The biologic plating method is a safe, simple and effective method of fixation for COMMINUTED FRACTUREs of long bones. It has a high rate of union with minimal complications.

Background and Objectives: Bone grafting includes auto graft types which could and allograft be used for filling the bone defects and enhance the healing process in cases of traumatic and non-traumatic FRACTURE. Because of Limitations of the auto graft method and increasing the morbidity, allograft type of graft are more considered. The purpose of this study was to compare the autograft and allograft methods.Materials and Methods: In this study, 100 patients with long bone FRACTUREs were divided into two groups (50 patients in each groups). They were matched for age, sex and type of FRACTURE. In one group cancellous autograft was applied and the other group was treated with chips allograft. The amount and rate of union and complications were compared between the two groups.Results: Studied group, 100 patients, (37±10 years, 55 male and 45 females). Union rate in the autograft group was 92% and in allograft group was 86%, there was no significant difference between the two groups. Union duration in autograft was 3.2±0.5 months and in allograft group it was 3.4±0.8 months. The time of the union between the two groups showed no significant difference. The most important complication of autograft group was nerve injury 5 (10%) and hematom formation (14%) at the site of removal of the graft, in the allograft group, only a patient (2%) complicated with infection.Conclusion: In both methods, there is a high percentage of union and FRACTURE healing. Duration of union is similar between the two types of grafts, but the morbidity in the autograft method was higher than allograft method.