The purpose of this prospective study was to assess the functional outcome in thoracolumbar vertebra fractures that were treated nonsurgically.

From 1999 to 2005, seventy-four patients with single-level nonpathologic fractures, with angle of kyphosis less than 20° and with no or minor neurological impairment and without neurological deterioration were managed non-operatively. A custom-made thoracolumbosacral orthosis was worn by all patients for six months and early ambulation was recommended. The average follow-up period was 34 months (range, 14 to 59 months). Functional, pain, and employment status were assessed using the Denis system. Radiographic evaluation of vertebral kyphosis, local kyphosis angle, anterior body compression, and sagittal index were performed at time of injury, and final follow-up. Paired t test and Wilcoxon signed rank test were used for statistical analyses.

At final follow-up, 63 patients (86.3%) were rated P1 (no pain), 8 patients (11%) were rated P2 (occasional pain), 2 patients (2.7%) were rated P3 (moderate pain), and 0 patients (0%) were rated P5 (constant severe pain). Sixty-five patients (90%) were able to work at the same level (W1) and the rest was W2 and no W3,4,5. According to radiographic evaluation although all the results showed statistically significant differences, these were too small to be important clinically. The initial local kyphosis angle averaged 14.73° (sd 5.08), and at follow-up it averaged 15.99° (sd 4.98). The initial sagital index averaged 16.1° (sd 5.69), and at follow-up it averaged 16.79° (sd 5.63).

As conclusion nonoperative treatment of selected patients with thoracolumbar vertebral fracture predictably leads to acceptable functional and radiographic results. Conservative management resulted in minimal loss of work potential in these patients and no correlation was found between fracture type and clinical outcome.

For operative treatment of trochanteric femoral fractures extramedullary or intramedullary stabilization options exist. The intramedullary systems especially proximal femoral nail (PFN) presents biomechanical advantages compared to existing conventional systems.

This prospective study was performed to understand the clinical results after 57 patients having trochanteric femoral fractures managed with the AO/ASIF PFN from January 2003 to March 2004. There were 11 male and 46 female patients and the mean age was 74.7. The most fractures (73.7%) were unstable according to AO/ ASIF classification. The patients were preoperatively evaluated as ASA grade 3 or 4. The operation was performed within 6 days after the injury. The patients were followed up for a minimum of 6 months. Immediate full weight bearing was permitted in 47 patients.

Six patients died due to cardiopulmonary complications within 3 months after the operation. Of the surviving 51 patients 7 had cut-outs because of using too short proximal gliding screws. In remaining 43 patients fractures united within 4 months. The patients were evaluated by Salvati and Wilson hip function scoring system. At the final follow up 72 % of the patients had score more than 20 points (out of 40 points).

In conclusion PFN is useful and minimal invasive device in the treatment of trochanteric femoral fractures. Femoral nail positioning is critical but biomechanically stable construct can be performed with careful management and early weight bearing is allowed.

Supracondylar fractures of the humerus are the most common type of elbow fractures in children. The unique anatomy of the elbow and the high potential for complications associated with elbow fractures make their treatment difficult. Although the current trend in the literature is to treat them by closed reduction and per-cutenous pinning, open reduction and cross pinning is an alternative treatment especially in the case of technical insufficiencies.

This retrospective study was performed to understand the clinical results after open reduction and cross pin fixation in 205 children (mean age 7.4 years) with completely displaced supracondylar fractures of the distal humerus between 1994 and 2002. The operation was performed within 5 days after the injury. The posterior skin approach was used but bone was reached through both sides of triceps muscle which was kept intact. The results were assessed according to Flynn’s cosmetic and functional criteria after 48 months of mean follow up.

No patient had neurological or circulatory complication. All the fractures healed and none of them had rotation, recurvation or cubitus valgus deformity. Four children had mild cubitus varus deformity. There were 190 (93%) excellent, 15 (7%) good cosmetic outcome and 170 (83%) excellent, 21 (10%) good, 8 (4%) average, 6 (3%) weak functional outcome.

We still prefer open reduction and cross pinning in the management of unstable supracondylar humeral fractures in children. We find it safer and believe this approach avoids unpleasant complications. Also excellent results can be achieved without being exposed to high doses of radiation.