Distraction osteogenesis in segmental bone defects in tibia by monoaxial external fixator

To evaluate the results of segmental bone transport using monoaxial external fixator in patients with non union of the tibia with segmental bone loss. This descriptive study was carried out at orthopedic unit of Hayatabad Medical complex Peshawar from July 2004 to January 2007 with 32 patients of tibial non union with segmental bone loss. Locally made "Naseer-Awais" uniplanner external fixator was applied and osteotomy performed. Distraction started at tenth post operative day. Patients were followed fortnightly. Check radiographs were taken on every visit. At the end of consolidation phase fixtor was removed. Results were assessed using Association for the Study and Application of the Method of ILIZAROV [ASAMI] scoring system. Out of 32 patients 29 were male and 3 were female. Eighteen patients had road traffic accidents, 10 fire arm injuries and 4 bomb blast injuries. Average length of bone transport was 7cm. Average duration of fixator was 8 months and average follow up was 25 months. Eight[25%] patients had some additional procedure in form of fibular osteotomy, fasciocutaneous flap and bone grafting. Twentyeight[87.5%] patients had pin tract infection. Repositioning of pins was done in 18[56.25%] patients. External fixator was changed in 10[31.25%] patients. Four patients developed mal-alignment which required fixator resetting. Four[12.5%] patients had re-osteotomy. Five[15.62%] patients developed persistent equinus deformity. Nine[28.12%] patients had to modify their profession. Distraction osteogenesis can be achieved with locally made Naseer Awais fixator in non union of tibia with segmental bone loss

Adverse events after local anesthesia in a day care orthopedic surgery

Each type of anesthesia has its own complication but the day care surgery under local anesthesia has minimized most of them. Different types of local anesthesia can be used in day care surgery. This study was conducted to determine the frequency of adverse events after local anesthesia. This descriptive study was conducted on 48 consecutive patients who underwent day care surgery under local anesthesia in Orthopedic Department of Hayatabad Medical Complex Peshawar from 2006 to 2008. Bupivacaine Hydrochloride was used as a local anesthetic. After two hours of surgery, patients were assessed by surgeon and subsequently discharged home [score of 9 or more] using post anesthetic discharge scoring system [PADSS] after taking notes on postoperative nausea and vomiting, post operative pain, difficulty in movements and resumption of normal diet. Out of 48 patients 20 were female and 28 were male. Average age was 23 years. The procedure performed were 7[14.58%] knee arthroscopy, 10[20.83%] excisional release of trigger finger, 9[18.75%] release of carpal tunnel, 19[39.58%] removal of foreign body and 3[6.25%] excision biopsies. Postoperative nausea and vomiting was noted in 3[6.25%] patients, post operative pain requiring parenteral analgesics in 12[25%], difficulty in movements in 7[14.58%] and not resuming normal diet in 2[4.16%] patients. Although local anesthesia was associated with minor adverse events, however the patients could resume normal diet and daily activities quickly