Clavicle fractures are one of the most common fractures seen in outpatient department they occur due to fall on outstretch hands, RTA. Most of the times clavicle fractures are treated conservatively. The surgical treatment is indicated in patients with tenting of skin over the fracture site, open fractures, nonunion and if neurovascular deficit is present. Patients who are treated conservatively will require 3 weeks of immobilization followed by shoulder strengthening exercises. The surgical treatment is in the form of plate fixation and immediate mobilization of the shoulder joint.

Proximal humerus fracture are common both in young and elderly patients, which occurs due to either trivial fall or due to RTA. In all age groups the proximal humerus fractures are treated by open reduction and internal fixation with locking plate through delto pectoral approach. The aim of fixation is to achieve good range of movements and quick recovery. The most common complication encountered are stiffness of the shoulder for which prolonged physiotherapy is advised. Other complications include avascular necrosis of the humeral head which may require joint replacement surgery at a later date.

Simple fractures of shaft of humerus are commonly treated by Open reduction and internal fixation through delto pectoral approach, which is a gold standard method followed till now. In situations of segmental comminuted fractures of humerus, minimal invasive surgery is indicated in the form of interlock nailing. Fixation of humerus fractures gives us the opportunity to mobilize the shoulder and elbow joint early and stiffness is avoided. All the patients are immediately subjected to physiotherapy so that the stiffness the joints is avoided. However, the most common complication in humerus fracture fixation is radial nerve palsy which usually recovers over a period of time.

Fractures around the elbow are notorious fractures which results in stiffness of the elbow which is very difficult to treat. Most common mode of treatment for distal humerus fractures is open reduction and internal fixation with contoured locking plates through posterior either Campbell’s approach or olecranon osteotomy. Extra articular distal humerus fractures are treated with either special locking plates or Ender’s nails and additional plate fixation. After surgery the patients are advised immediately to do physiotherapy in the form of active and passive elbow mobilization.

The fractures of the radial head, olecranon and coronoid process and associated elbow dislocations are constituted to the group of terrible tried. The results of fixation of these fractures are not encouraging to the surgeon, since the result in severe stiffness of the elbow. The radial head fractures are fixed with either Herbert’s screws or contoured locking plates. Olecranon fractures are usually treated with tension band wiring principle. The coronoid process is fixed through medial approach using fiber wires, suture anchors. The stiffness of the elbow which is a commonest problem is treated by open arthrolysis through posterior approach.

Fractures of the forearm are considered as intra articular fractures and hence radius and ulna fractures are best treated by open reduction and internal fixation with dynamic compression plates. The radius fracture is approached by volar Henry’s approach and through dorsal incision ulna fracture is exposed and fixed with plates. Forearm fractures are immediately mobilised after fixation and in comminuted fractures iliac crest bone grafting is advised.

Distal radius fractures are named as Colles fractures if they occur in elderly patients. Colles fractures are treated usually by closed reduction and either plaster application or percutaneous k-wire fixation. The wrist joint is immobilised in plaster for a period of 6 weeks followed by rigorous physiotherapy. The most common complications are wrist stiffness, pintrack infections, malunion, dinner fork deformity and shoulder hand syndrome. Wrist stiffness and shoulder hand syndrome are best treated by aggressive physiotherapy. Young patients usually present with comminuted fractures and volar bartons fractures which are treated with plate fixation through volar approach.

Fractures of scaphoid is the most commonest fracture seen in the wrist. Undisplaced fractures are usually treated with scaphoid cast application for a period of 3 weeks. If the fracture is displaced, they are treated by either percutaneous or open Herbert’s screw fixation. The most common complication seen in scaphoid fractures is avascular necrosis and nonunion which usually necessitates the need for repeated procedures. Other common injuries around the wrist are perilunate dislocations which are treated by open reduction and K-wire fixation through volar and dorsal approaches. Wrist stiffness is common after these procedures which require aggressive physiotherapy.

Apex Hospital’s is a tertiary referral centre and manages all complicated open fractures of upper limb. Since Coimbatore is a hub of many textile industries, patients usually presents with severely crushed and mangled extremity. They need multi disciplinary approach which includes anaesthetic, plastic and orthopaedic team available round the clock inside the hospital premises which makes us to take care of this injuries effectively. The main key element of success in this mangled extremity management is immediate effective debridement and primary plate fixation for the upper limb fractures. The soft tissue defects are usually treated either by free flaps or abdominal flap cover. The bony defects are usually reconstructed by free fibula graft.

Pelvic fractures often result due to a very high velocity injuries like road traffic accidents, fall from height. Most commonly they are associated with either upper limb or lowerlimb injuries or both. Patient usually presents in a state of shock characterized by hypotension, tachycardia, difficulty in breathing and they can be associated with chest or abdomen injuries. They need immediate proper resuscitation in the form of I.V. fluids (colloids & crystolloids), emergency stabilization of pelvis with external fixator. Pelvic fractures are often associated with high mortality and morbidity. All the patient with pelvic injuries are subjected to whole body CT scan to rule out other systemic injuries. Once the patients general condition is stabilized, both anterior and posterior ring stabilization is done in the form of plate fixation. After surgery patients are mobilized after a period of 6 weeks.