The need for operative fixation of paediatric femoral fractures is increasingly being recognised in the present decade. The conventional traction and casting method for management of paediatric femoral fractures is giving way for the operative stabilisation of the fracture. We conducted a prospective study on 25 pediatric patients age group 6–14 years with diaphyseal femoral fractures, stabilised with two titanium nails of same size. Titanium nails were inserted through distal metaphyseal area 1 inch above the physis in a retrograde manner. Patients were followed up clinically and radiologically for one year.No patient was lost in the followup. Overall good results were reported with the use of TENs with minimal complications. Hospital time averaged 4.26 days in the series. All the fractures healed with an average time to union of 2.96 weeks. Return to school was early with an average of 7.8 weeks. Shortening was reported in two cases due to angulation at the fracture site. There were no delayed union or infection. The soft tissue discomfort near the knee produced by the nails ends was the most common problem encountered and thence cutting the nail ends closer to the bone is important. 5 nails had to be removed ssssubsequently after the bony union due to this problem. With proper operative technique and aftercare TENs may prove to be an ideal implant for pediatric femoral fracture fixation in the coming times.

S-I joint disruptions are high-energy injuries, often resulting in prolonged morbidity with conservative management. Operative management in contrast permits early ambulation and avoids prolonged recumbency.

Ten patients of type C disruptions of S-I Joint were managed by operative stabilization after their haemo-dynamic stabilization. While four of the patients were managed by anterior plate fixation, percutaneous lag screw was used in the remaining six to stabilize the SI joint disruption. Supplementary external fixation was used in four of the patients in addition to percutaneous lag screw. Patients were evaluated using Matta’s criteria based on parameters like pain, walking ability, range of hip movements and radiographic findings. None of the patients complained of pain and normal walking. Good radiological reduction was achieved in all the ten cases, although secondary displacement was seen in one patient of anterior plating.

Plate fixation on anterior aspect of S-I joint provides less protection from vertical instability on account of possibility of axial rotation, as there is space for only one screw on the sacral side of the joint. In contrast percutaneous screw provides adequate stability against vertical displacement, as it is placed at right angle to the direction of displacement. Supplementary external fixation provides additional stability in the horizontal direction and makes it possible to permit early ambulation. Minimal dissection and little blood loss are the other advantages of this procedure over plate fixation. However the procedure is technically demanding due to the presence of vital anatomical structures in the vicinity.