Axial myopia and its influence on diabetic retinopathy

To evaluate the correlation between axial myopia and diabetic retinopathy. Cross-sectional study. Eye Department of Postgraduate Medical Institute, Lahore General Hospital, from August 2012 to February 2013. A total of 258 participants suffering from type-2 diabetic retinopathy were included. Axial length was measured by two optometrists using contact type ultrasound biometer. Colored retinal photographs, red free retinal photographs and Fundus Fluorescein Angiography [FFA] were performed on all patients using standard fundus camera. All fundus photographs and angiograms were independently reviewed and graded by two qualified vitreoretinal fellows. Out of 258 patients, 163 were males [63.2%] and 95 [36.8%] were females. Average age of patients was 56.30 +/- 7.57 years. Average axial length of right and left eyes were 23.16 mm and 23.15 mm respectively. There was statistically significant negative correlation between axial length and severity of diabetic retinopathy in the right eye, [Spearman correlation = -0.511, p = 0.0001] as well as the left eye [Spearman correlation = -0.522, p = 0.0001]. There is a protective influence of longer axial length of globe on the stage and severity of diabetic retinopathy. This study may help in modifying the screening protocol for diabetic retinopathy amongst patients of differing axial lengths

Proximal humeral fractures: an experience with philos fixation

To evaluate functional outcomes and complications after open reduction and internal fixation of displaced proximal humerus fractures by proximal humeral internal locking osteosynthesis system [PHILOS]. Cross sectional study. Department of orthopaedics at CMH Abbottabad, From October 2011to September 2012. Patients with displaced proximal humerus fractures treated with proximal humerus locking plate were included in the study. Patients were followed for a minimum period of ten months. Neer's classification was used to group the fractures. Open fractures and infected injuries were not included in the study. Functional evaluation was done according to the Constant- Murley scoring system. Eighteen patients [M=14, F=4] were managed during the study period. Thirteen patients were between the ages of 20-45 year [M=12, F=1] and 5 patients were between 46-60 years [M=2, F=3]. Seven patients [M=6, F=1] had 2-part fractures, 5 patients [M=3, F=2] had 3-part fractures, and 6 patients [M=5, F=1] had 4-part fractures. The mean follow-up period was 10 +/- 2 months. Thirteen [72.2%] patients had excellent to good results, 16.6% [n=3] had fair, and 11.2% [n=2] had poor result. Average Constant Murley scores for 2-part [9 +/- 1] and 3-part fractures [14 +/- 2] were significantly superior to those of 4-part fractures [24 +/- 2] [p value = 0.002 and 0.018, respectively]. Difference between 2-part and 3-part fractures was not significant [p value=0.023]. There was no significant difference between younger [=45 year] and older patients [>45 year]. Complications encountered in this series were reduced shoulder movements in 11% [n=2], screw perforation in 5.5% [n=1], varus mal-reduction 11% [n=2], plate impingement in 11% [n=2], infection in 5.5% [n=1]. No non-union and malunion occurred in this study. Proximal humerus locking plate gives reliable fixation for 2-part and 3-part fractures of proximal humerus. Its' use in Neer's 4-part fractures was associated with poor clinical outcome

Dynamic condylar screw fixation for comminuted proximal femur fractures

To evaluate the success of dynamic condylar screw [DCS] fixation for comminuted proximal fractures of femur in adults. Case series. Orthopedics Department CMH Lahore, from October 2009 to September 2010. This study included 20 males and 9 female patients with age ranging 25 to 65 year [mean 44 year] who presented with closed comminuted proximal femur fractures [Evan's classification type I c to e and type II]. All the patients underwent indirect fracture reduction on a standard orthopedic traction table under C-arm guidance and this was followed by inter-fragmentary stabilization with dynamic condylar screw construct [AO Synthes]. Functional outcomes were assessed using the Harris hip score. Post operative patients' evaluation was continued for 12 months. The average time to full weight bearing was 14 weeks. [range 12-16 weeks]. The mean time to union was 16 [range, 13-22] weeks. The included non-union, delayed atrophic union, implant failure, limb length discrepancy, and knee stiffness. According to the Harris hip score, functional results were excellent in 21 and good in 7, whereas one patient showed poor result. The mean Harris hip score was 88 [range 80-99]. Our results of DCS fixation for comminuted proximal femoral fractures indicated that it is a very practical and a satisfactory method of fixation. Minimal striping of the soft tissues and gentle fragmentary manipulation intra operatively remained the pivotal factors for good fracture healing and functional outcome

Results of only using reamed bone graft obtained during interlocking nailing as an osteo-inducer, while treating tibial shaft aseptic nonunion after plating

To analyze the outcome of only using cancellous bone graft as an osteo-inducer, obtained during reaming, for intramedullary nail stabilization in treating tibial shaft aseptic nonunion after plating. An analytical study. Combined Military Hospital Peshawar, during a period of 20 months, between March 2005 to October 2006. This study included a total of 21 patients with tibial shaft aseptic nonunion after plating. Of the total patients nineteen were males and two females. All were treated initially with bone plating for their diaphysial tibial fractures in various peripheral hospitals. Reamed interlocking nailing was carried out in all these patients in the second stage. Following the first stage operation of plate removal, no additional iliac bone grafting was used. Twenty one patients were followed up between 7 to 15 months postoperatively. Eight patients were lost to follow up after 7 months. All the tibial nonunion healed uneventfully. The median union period was 4.5 months [range, 3.0-7.5 months]. Knee range of motion showed evident improvement after operation. The ankle range of motion also had some improvement and all the patients could walk without aid postoperatively. There were no deep infections, rotational [>10degree] or angular [>10degree] deformity, or shortening [>2 cm]. We recommend the use of reamed intramedullary nails without additional bone grafting in all suitable cases, so as to achieve a high success rate in management of tibial shaft aseptic nonunion after failed plating

Giant cell tumor of first metacarpal

Giant cell tumor [GCT] or osteoclastoma is a locally aggressive tumor with an inclination for local recurrence. 85-90 percent of cases occur in the long bones, whereas only 2 percent of cases occur in the hand, and here too, metacarpal involvement is a rare occurrence with only few cases reported in the literature so far. A case of GCT of 1st metacarpal in a 28-year-old female is presented in this case report