Dual plating osteosynthesis technique used for fixation of inter - condylar distal humerus fractures via transolecranon approach

Introduction: The dual plate osteosynthesis technique for fixation of inter-condylar distal humerus fracture is now considered an accepted treatment modality. It provides a rigid fixation of fracture fragments to enable early post-operative mobilization for good outcome

Objective: The purpose of study is to assess the morbidity and clinico-radiological outcome of the dual plating osteosynthesis technique used for fixation of inter-condylar distal humerus fractures [DHF] via trans-olecranon approach

Methodology: This perspective cross sectional study was carried at Department of Orthopaedic Surgery, Dow Medical College / Civil Hospital Karachi from June 2014 to March 2016. A total of 21adult patients with comminuted inter-condylar fracture of the distal humerus operated with dual plating osteosynthesis technique via trans-olecranon approach were evaluated clinically and radiologically for functional outcome based on Jupiter criteria including alignment and fracture union after a mean follow-up of 8 months. Post surgical complications were noted. Fractures were classified according to Muller et al [AO]. Patients with polytrauma, pathological fracture, open fracture and a fracture more than 2 week old were excluded from the study

Results: Out of the 21 patients, 38% were female and 62% were male. 52.3% had left elbow while 47.6% had right elbow involvement. The mean age was 31 years [range 20 - 50 years]. Mean time between injury and internal fixation was 4.8 days. The mean follow-up period was 8 months. As per AO classification, 10 cases were C1, 7 cases C2 while 4 cases were in C3. The most common cause of fracture was road traffic accident in 13 cases. All fractures achieved anatomical restoration of articular surface and were united in average 14.6 weeks. The clinical results were evaluated for functional outcome based on Jupiter criteria. According to that criterion, satisfactory results were obtained in all patients. We had no instance of postoperative deep infection and neurological complications, only Backing of olecranon K-wires were noted in 5 patients [23.8%]

Conclusions: We conclude that dual plate osteosynthesis technique is an effective procedure for fixation of inter-condylar distal humerus fracture, achieves rigid fixation and hence, early mobilization. Additionally use of olecranon osteotomy offers best fracture exposure of distal humerus. Complications were minimal and healing satisfactory

comparison of efficacy of topical use of phenytoin and vaseline gauze dressing with vaseline gauze dressing alone in healing of diabetic foot ulcers

Objective: To compare efficacy of topical use of Phenytoin and Vaseline Gauze dressing with Vaseline Gauze dressing alone in healing of diabetic foot ulcers

Methodology: This randomized controlled trial was carried out in Surgical unit I of Benazir Bhutto Hospital from January to June 2013. Study included 60 diabetic patients with Wagner grade 1 and 2 ulcers on foot for more than 04 weeks with adequate control of diabetes. Patients with history of hepatic and renal diseases; on steroid use; or with impalpable foot arteries; were excluded. Thirty each were randomized to phenytoin and vaseline gauze dressing and vaseline gauze alone groups, respectively. At baseline and after 08 weeks, area of wound was measured using graph paper tracings and healing percentage was calculated

Results: Mean age of the sample was 53.83+/-6.66 years. Thirty six [60%] were males. Twenty five [41.67%] patients had Wagner grade 1 and 35 [58.33%] had grade 2 foot ulcers. Age, gender distribution and severity of foot ulcers according to Wagner grades were similar between two groups. In phenytoin and Vaseline group, the mean baseline ulcer area decreased from 1310+/-489.2mm[2] to 492.53+/-460.9 mm[2] at 8-weeks. In vaseline alone group, the mean baseline ulcer area decreased from 1107.53+/-486.58 mm[2] to 662.63+/-497.8 mm[2]. In phenytoin and vaseline group, the treatment was effective in 21 [70%] patients, whereas in vaseline alone group, the treatment was effective in 13 [43.3%] patients; p= 0.037

Conclusion: Phenytoin and vaseline dressings were significantly more effective as compared to vaseline alone dressings

foreign body in the ventricle of larynx

A case in which 6 cm long chicken bone was impacted in the vertical of larynx is reported. The patient presented to us after 3 months with throat discomfort and hoarseness of voice