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Background: A fracture of the clavicle is common traumatic injury. It can be classified into middle third, medial third, and distal third fractures. Around 10-15% of clavicle fractures occur in the distal third. The ideal method of fixation in distal third clavicle fracture remains controversial till date. Aims and Objectives: The clinical outcome of the patients having fracture of the distal end clavicle using rigid fixation with tension band wiring (TBW) with Kirshner wires and SS wire to be assessed instead of other conventional procedures. Materials and Methods: Eight patients of Neer type II closed distal-third clavicle fracture of <3 weeks of duration were included in our study. The fractures were reduced by open reduction and fixed with TBW with two K-wires and SS wire. Results: The mean average age of patients was 41.87 years. All fractures united clinically and radiologically. The mean average time of union was 12 weeks. There was two case of hardware prominence, no fracture related complications. One case of superficial infection was found in study. All of them regained near normal range of motion, and the mean average constant Murley score for distal clavicle fracture at the end of 1 year was 88. At the end of 1 year follow-up, all patients had reached their pre-injury performance levels. Conclusion: There was an encouraging result with TBW in distal third clavicle fracture in our study. This technique is simple with lesser need of expertise and is also cost effective. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented based on the topic of diagnosis of sexually transmitted diseases syndrome-wise in a subdivision level hospital of rural West Bengal, India.

Background: The ideal management of thalassemia involves a multidisciplinary therapeutic team approach and should be preferably done at a comprehensive thalassemia care center with all sorts of specialists and the backup of a well-equipped blood bank. However, in developing country like ours, these facilities are not available in rural set up. So, a situation where conservative therapy with regular blood transfusion is the only choice left to innumerable thalassemic children., Objective: To evaluate the existing conservative management protocol of Beta-thalassemia major patients in the setup of a subdivision level Government Hospital of rural West Bengal, India., Materials and Methods: The study was performed between December 2009 and December 2011. Beta-thalassemia major patients, registered in blood bank for moderate transfusion regimen, were taken in study. All the patients were screened for Transfusion Transmittable Infections at the time of registration and thereafter periodically every six months. Iron chelation therapy was given simultaneously with transfusion at a dose of 20 to 40 mg/kg/day for six days. The patients were advised to follow up with chelation therapy at home by daily infusion with a goal of maintaining serum ferritin level below 1000 ng/ml. Over this long period of study, the patients were periodically evaluated for complications., Results: The average blood requirement (ml/kg/year) in 1-5 years, 6-10 years, and 11-15 years were 110, 150, and 180, respectively. Incidence of Hepatitis C Virus infection in 1-5 years and 6-10 years were 1.75% and 2.08%, respectively. It is well seen that serum ferritin level increase with ascending age as does the blood consumption., Conclusion: Conservative management may be the best alternative and at times the only hope for patients in developing country like ours. However, in order to decrease the disease load, steps need to be taken to introduce preventive measures.

Revision surgeries in failed proximal femoral pathologies following osteosynthesis or some kind of replacements pose a challenging task. These can be well managed by distally well fitted extensively coated hydroxyapatide long non-cemented interlocked Reef-Dupuy stem. Here a short series of 10 cases with average follow-up of 3 years is being presented.

Management of non-united neck femur fracture in young patients is still a challenge for orthopaedic surgeons. In this study 35 patients with non-united fracture neck femur were treated by valgus osteotomy and fixation with dynamic hip screw over a period of 4 years. Union was achieved in 30 patients (86%) after an average period of 20 weeks. Among them avascular necrosis of femoral head was seen in 4 patients. Average limb length shortening in the affected limb after union was 1 cm. Valgus intertrochanteric osteotomy and fixation by dynamic hip screw is an effective, cheap and relatively easy method for treatment of non-united fracture neck femur in young patients.