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Background: Trimalleolar fracture is very hamstring if it not maintained accurately. It is one of the pitiful condition. Trimalleolar ankle injuries have become more common in the last decade, with up to 40 per 100,000 people affected each year. Study design: It is a prospective study conducted for the duration of six months from February 2022 to July 2022 at Islam teaching hospital, Sialkot. Material and Methods: The study was carried out on 52 patients who were admitted in tertiary care unit during a period of one year. All the patients were following inclusion criteria, those who were unable to fulfill were excluded from the study. There were 36 males and 16 females taken for study. 30 patients had injury in the right side and 18 reported left side injury. The hospital review board committee give the approval to the study. The data was collected and statistically analyzed by using the renowned software SPSS. The result were presented in the form of table. Results: The injury pattern that was frequently observed in patients was supination external rotation reported in 40 patients. While 8 had pronation external rotation and 4 had to face supination adduction pattern. There were 4 cases that complaint about superficial infection and deep infection was observed in case of 2 patients. Conclusion: It is concluded that for the fixation of Trimalleolar fractures, there is a need for proper planning and reduction of lateral malleolus fractures by a lateral plating method. Keywords: ankle fracture, operative planning and Posterior malleolus fracture.

Objective: To compare the clinical outcome of flexible intramedullary nailing (FIN) with external fixator in pediatric open tibial fractures. Subjects and Methods: In this randomized comparative study, 80 children having age 5 year to 14 years who presented with open tibial fractures were included. The study was conducted from June-2020 to June-2021 in Islam Hospital Sialkot and Allama Iqbal Memorial Hospital Sialkot. Patients were divided into two equal groups. Group A: underwent external fixation and group B: underwent flexible intramedullary nailing for the surgical management of tibial fractures. Frequency of infections surrounding pins, painful bursitis and re fracture rate within 3 months after surgery was recorded. Results: The mean age of children was 8.42±3.82 years in external fixator group versus 8.40±4.0 years in FIN group (p-value 0.97). Infection-surrounding pins occurred in 9 (22.5%) children were belonging to external fixator group and 01 (2.5%) children was belonging to FIN group (p-value 0.007). Refracture occurred in 6 (15.0%) patients in external fixator group and in no (0.0%) children in FIN group (p-value 0.01). Painful bursitis occurred 2 (5.0%) patient was in external fixator group and in 13 (32.5%) in FIN group (p-value 0.002). Conclusion: Clinical outcome is better in patients treated with FIN as compared to the external fixator for the treatment of pediatric open tibial shaft fractures. Keywords: Flexible intramedullary nails, External fixator, Tibial fractures.

Objective: To compare outcomes of interlock intramedullary nails with Dynamic compression plates for the treatment of humerus shaft fractures in terms of hospital stay time and shoulder Impingement. Subjects and Methods: In this comparative study, a total number of 74 patients having age 20-60 years who presented with closed and open Gustilo type I or II in middle third of humerus were included. Study was conducted in Islam hospital Sialkot and and Rajib Tayyip Erdogan Hospital, Muzaffargarh from June-2019 to June-2020. Group A (n=37) patients underwent dynamic compression plating (DCP) for treatment of fractures and group B (n=37) underwent interlocking intramedullary nailing (ILN) for humerus shaft fractures. We noted post-operative hospital stay, shoulder impingement and bone union rate in all patients. Results: The mean of patients included in this study was 42.45 (SD 9.89) years. There were 57 (77.03%) males and 17 (22.97%) females. The mean duration of fracture at the time of surgery was 39.98±7.23 days. Mean hospital stay was 4.72±1.23 days in in group A and 4.89±1.40 days in group B (p-value 0.60). There were 4 (10.8%) patients in group B in whom shoulder impingement occurred but there was no patient in group A with shoulder impingement (p-value 0.04). Complete union occurred in 35 (94.6%) patients in DCP group and in 34 (91.8%) patients in ILN group (p-value 0.64). Conclusion: Both DCP and ILN are associated with high bone union rates. The complications rate of ILN is higher in comparison to DCP group. Keywords: Humerus shaft fractures, dynamic compression plates, interlocking intramedullary nailing.

Objectives: To compare the complications and outcomes of lateral entry pin fixation with medial and lateral pin fixation for Gartland type III supracondylar fractures of humerus. Methodology: This prospective comparative study involving 190 patients of Gartland type III close supracondylar fractures were included. from March-2019 to Dec-2020. In all patients, initially the elbow was mobilized using the splint placed above the elbow joint at 30 to 45 degrees’ flexion. After closed reduction, lateral pinning was applied in group I and in group II lateral and medial cross pinning was applied using the standard protocol. Patients were followed for iatrogenic ulnar nerve injury, radiologic and function outcomes in-terms of loss of reduction, elbow range of motion, loss in carrying angle and functional outcomes. Results: The two groups were comparable for loss of elbow range of motion, loss of carrying angle and loss of Bauman's angle. On clinical examination, immediate post-operative ulnar nerve injury was diagnosed in 4 (4.2%) cases in group II and in no patient in group I (p-value 0.12). Satisfactory functional outcomes were achieved in 85 (89.5%) patients in group I and in 88 (92.6%) patients in group II (p-value 0.44). Conclusion: Lateral pinning provided stable fixation clinically and radiologically as compared to lateral and medial cross pinning. Keywords: Supracondylar fracture of Humerus, Iatrogenic ulnar nerve injury, Lateral pin entry, lateral and medial cross pin entry.

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Background: Fixation of Diaphyseal tibial fractures by dynamic compression plates is not considered the best option due to complications that may eventually arise; however, if principles of stability and proper surgical technique are used, it is possible to obtain fracture consolidation without major risks. Objective: To determine the outcome of dynamic compression plate in adult tibial shaft fractures. Study Design: Descriptive Study Place and Duration of Study: Department of orthopedic surgery, Khawaja Mohammad Safdar Medical College Sialkot, from September 2015 to June 2108. Methodology: We selected 51 tibial diaphyseal fractures in which open reduction was done followed by dynamic compression plate fixation using single technique by same surgical team. Fracture healing and wound infection following tibial plating was studied. Results: 51 patients were included in the study 40 patients were male and 11 were females. Mean age at the time of surgery was 43 years. 42 (82.35%) were closed fractures and 09 (17.65%) were open injuries. Patients were followed for wound infection at 14th postoperative day and union at 12 weeks. 49 (96.07%) had no wound infection and 02 (03.93%) developed wound infection. 50 (98.03%) fractures healed in 12 weeks while 01 (01.97%) went into non-union. Conclusion: Dynamic compression plate is an excellent option for the treatment of adult tibial shaft fractures and can produce good outcome if principles of stability, minimum soft tissue stripping, proper tissue handling and optimal surgical technique are applied. Key words: Tibial Diaphyseal Fractures, Adults, Dynamic Compression Plate.