Outcome of nonunion femur with Ilizarov technique

Objective: to find the outcome of Ilizarov technique in nounion femur patients

Study design: descriptive case series

Place and Duration of study: department of Orthopaedic Surgery Dow University of Health Sciences / Civil Hospital Karachi, from 1999 to 2014

Methodology: all patients with nonunion of femur with and without bony defect were included in this study. Bone loss cases because of other reasons like congenital causes and bone tumors, were excluded

Results: forty-eight patients with nonunion femur were included in this study. The number of males was 44 and females 4. The mean age of patients was 27 year [range: 07 year to 59 year]. The mode of injury was road traffic accident in fifteen patients, firearm injury in five, crush injury in earthquake in one, postsurgical implant infection in nineteen and chronic osteomyelitis in seven. Nonunion was in proximal femoral segment in three patients, midshaft in sixteen and distal femur in twenty-nine cases. Segmental bone loss was present in thirty-one patients. Preoperative shortening was in noted in thirty-four patients. Ilizarov external fixator yielded excellent and good outcome in majority of the patients for the gap nonunion of femur. Bone transport was needed in few cases

Conclusions: Ilizarov external fixator yielded excellent and good outcome in majority of the patients for the gap nonunion of femur. Bone transport was needed in 10 cases

Role of single dose antibiotic prophylaxis in clean orthopedic surgery

To compare the proportion of early postoperative infection in clean orthopedic surgery after single dose of prophylactic antibiotic and multiple doses of prophylactic antibiotic. Interventional quasi-experimental study. Department of Orthopedics, Abbasi Shaheed Hospital, Karachi from April 2004 to March 2005. Two hundred patients of either age and gender, undergoing clean orthopedic surgery were equally divided into two groups A and B. Group A was given single dose of prophylactic antibiotic, while group B was given multiple doses of prophylactic antibiotic. Follow-up period was 28 days. All cases were evaluated for postoperative wound infection. Sampling technique was non-probability convenience. Mean age was 35.51+20.79 years in group A and 26.17+19.79 years in group B. However, there was a significantly higher proportion of male patients in group B than in group A [p=0.006]. Statistical analysis showed no significant difference in the proportion of early postoperative infection cases between the two groups[p=0.270]. Staphylococcus aureus was the commonest organism cultured from the wound discharge in our study followed by E. coli. Eight of our cases having postoperative wound infection showed no growth, out of which 7 were superficial and 1 was deep. There was no significant difference between the two groups regarding mean operating time and duration of stay in hospital. There was no statistically significant difference in the proportion of early postoperative infection cases between the two groups

Assesment of risk factors of osteoporosis

To assess the risk factors of osteoporosis. Descriptive study. OPD of Abbasi Shaheed Hospital, KMDC Basic health unit and Zubaida medical centre from August 2005 to November 2005. 231 persons of either sex were included in the study. Pattern of life style and dietary intake was studied using a questionnaire. Bone mineral density [BMD] was measured using quantitative ultrasound. Weight in kg was recorded. Males below 60 years and females below 40 years of age were excluded from the study. Also persons with incomplete information were excluded from the study. Out of 231 persons, 179 were females and 52 were males. Mean weight in males was 67.40+12.8 kg and in females 64.04+13.1 kg. A significantly high proportion of persons [71.3%] living in joint families had osteopenia or osteoporosis [p<0.031], compared to persons in nuclear families [60.4%]. There was no significant relationship between BMD and profession [p=0.563], sex [p=0.463], intake of calcium [p-=0.664], observing veil [p=0.789] and exposure to sunlight [p=0.356]. In our study, significantly higher percentage of persons living in joint families had osteopenia or osteoporosis. However, no statistically significant association was found between BMD and dietary intake pattern, early marriage, observing veil or exposure to sunlight in our study

Anxiety assessment in orthopedic patients

Orthopedic specialty is a very versatile specialty, it deals with a wide variety of conditions like degenerative joint disorder, deformities of spine and limbs, including congenital and acquired both, bones and joint infections and of course traumatology which is a major part of orthopedic patient. We did a study to assess pre operative anxiety in orthopedic patients. All the patients above the age of 12 years, admitted to orthopedic unit II of Abbasi Shaheed Hospital, were asked to fill a performa designed to assess different aspects of anxiety- associated problem. The subjects were also inquired about their knowledge of imminent surgery being, its out come and the time period required to get back to their daily activities. Fifty eight percent of patients were anxious about their upcoming surgery, They were anxious due to different reasons like surgery. anesthesia, pain, the risk of complications and of becoming dependent on others. Our study showed a significant proportion of orthopedic patients undergoing surgery as being anxious. In this regard, social and occupational therapist can play a major role in reducing the anxiety of our patients by doing detailed counseling and making the patients maximally aware of their surgery

Epidemiologic triad of dog bite [a study of 81 cases]

Dog bite accounts for a significant number of traumatic injuries, which often needs medical treatment .Although agent, host and environment characteristics of dog bite have been well documented internationally but it is not done in Pakistan. A study was planed to find Agent, host and environment characteristics of dog bite in local population.The study setting was Emergency Department of Abbasi Shaheed Hospital. Patients were enrolled in July 2004,on a Performa designed to get different features of epidemiologic triad. Performa contain features of agents [type of animal, nature of attack and vaccination status of animal]host features [Age .gender, body part involved in bite and vaccination] environmental features [Time of bite and site of accident].Performa was filled by Doctors after interviewing each patient individually. Total 81 cases were registered in this study. Male were dominating with 80% [66] cases .Children and adolescent were the main target 65% [53] of the dog bite victims were less than 15 year of age .Mostly lower limbs were involved in the accident and it accounted for 68 % [55] cases.The highest frequency of dog bite were reported from Orangi town 31 % [25], a thickly populated area belonging to very low socioeconomic group