ABSTRACT
To determine the etiology of precocious puberty in children and to compare the clinical and laboratory parameters of central and peripheral precocious puberty. Cross-sectional study. Endocrine Clinic at National Institute of Child Health, Karachi, from January 2009 to December 2011. Children presenting with precocious puberty were included. The age of onset of puberty was documented. Clinical evaluation, Tanner staging, height, height SDS, weight, weight SDS, body mass index, bone age, pelvic USG, plasma estradiol level and GnRH stimulation were done. Ultrasound of adrenal glands, serum level of 17 hydroxyprogesterone, ACTH, Renin, aldosterone and testosterone were performed in children with peripheral precocious puberty. MRI of adrenal glands and gonads was done in patients with suspected tumor of that organ and MRI of brain was done in patients with central precocious puberty. Skeletal survey was done in patients with Mc Cune-Albright syndrome. CAH [81.8%] indentified as a main cause in peripheral percocious puberty and idiopathic [67.74%] in central precocious puberty. Eighty five patients were registered during this period. The conditions causing precocious puberty were central precocious puberty [36.47%], peripheral precocious puberty [38.82%], premature pubarche [10.58%] and premature thelarche [14.11%]. There was a difference in the age of onset of puberty in case of central precocious puberty [mean=3, 2-6 years] versus peripheral precocious puberty [mean=5.25; 3.62 - 7.0 years]. Children with central precocious puberty showed higher height SDS, weight SDS, FSH, LH than those with peripheral precocious puberty. Etiology in majority of cases with peripheral precocious puberty was congenital adrenal hyperplasia and idiopathic in central precocious puberty. Central precocious puberty children showed higher height SDS, weight SDS, FSH, LH than peripheral precocious puberty
ABSTRACT
OBJECTIVES: To compare the functional outcome and the complications of plaster cast and orthofix in the management of distal radius fracture
SETTING: Department of orthopaedic surgery and truamatology [DOST] Liaquat University of Medical and Health Sciences [LUMHS] Jamshoro
STUDY DESIGN: Comparative Study
DURATION OF STUDY: 18 months from 2[nd] March 2012 to 1[st] September 2013
MATERIAL and METHODS: A total of 40 patients fulfilled the inclusion criteria were included in this study. Patients were randomized allocating to either treatment with conventional closed method [group I] or orthofix [group II]. After one week of the initial treatment, patients of either group were followed in the orthopaedic wards and OPD. Clinical and radiological assessment was carried out and recorded. Subsequently, patients were advised for follow up for six weeks
After removal of either plaster or orthofix; patient was reviewed at monthly interval to access the wrist function. Data was collected on Performa
RESULTS: There were statistically significant differences between the orthofix group and plaster cast group on the average, regarding radial length, radial angle, palmar tilt, p value was calculated 0.05, 0.004 and 0.0005 respectively
All patients in orthofix group achieved union and maintained good reduction after closed reduction of the fracture. Complications were seen among both the groups; Mal-union, Stiff hand and Non union, Pressure sore, Shoulder stiffness were not significant between groups
CONCLUSION: it is concluded from this study that external fixator one of the best tool have over edge on plaster cast in the treatment of distal radius fracture Department of Orthopedic
ABSTRACT
Objective: The aims and objectives of the study are to compare the results of tibial plateau fracture treated by plaster of paris cast and percutaneous screw fixation. Study design: Comparative study. Place and duration of study: Study was carried out at the Orthopaedics Unit-II, Liaquat University Hospital Hyderabad / Jamshoro, from January February 2010 to october 2011
Methodology: Between February 2010 to october 2011, 31 men and 9 women aged 20 to 40 years with means 28.25 years underwent plaster of paris and percutaneous screw fixation for schatzkar type I closed tibial plataue fracture in Orthopaedics Unit-II, Liaquat University Hospital Hyderabad / Jamshoro. Data was analyzed through SPSS software version 16.0
Results: In both groups 31[77.5%] men and 9[22.5%] women with male: female ratio of 3.4:1 and aged 20 to 40 years with means 28.25 years. Union time range 10 to 24 weeks in both groups[p value 0.001]. The mean healing time in PSF group was 11.6 weeks while in POP group it was 13.9 weeks. The complications seen in this study were pain during walking [5 [25%] patients in POP VS 3 [15%] patients in PSF group], knee stiffness [4[20%] patients in POP VS 2 [20%] patients in PSF group ], ankle stiffness [3[15%] patients in POP VS 1[5%] patients in PSF group], delay union [2[10%] patients in POP VS 1[5%] patients in PSF group ], non union [2[10%] patients in POP VS 0[0%] patients in PSF group ] P value 0.040. The longer duration of hospital stay about -10-20 days in 13[65%] of POP patients as compared to PSF cases where majority 16[80%] were discharged within 1 to 10 days[ p value 0.148]. The patients with complications had still longer stay in both group. The mean hospital stay in POP group was 14.6 days and PSF group was 8.4 days. The clinical results seen in this study were excellent [5[25%] patients in POP VS 13[65%] patients in PSF group], good [8[40%] patients in POP VS 5[25%] patients in PSF group], fair [5 [25%] patients in POP VS 2 [10%] patients in PSF group ] and poor [2[10%] patients in POP VS 0 [00%] patients in PSF group
Conclusions: We conclude that percutaneous screw fixation gives better results in type I schatzkartibial plateau fracture compared to plaster of paris cast. The complications were seen higher in POP cast
ABSTRACT
Objective: To compare blood pressure lowering effects of angiotensin II type I receptor blocker candesartan cilexetil in comparison with calcium channel blocker amlodipine in essential hypertensive patients
Study design: Randomized, open-labeled, prospective comparative study
Place and duration: The study was carried out in the department of pharmacology and therapeutics, Basic Medical Sciences Institute [BMSI], Jinnah Post Graduate Medical Centre [JPMC], Karachi from July 2007 to January 2008
Subjects and methods: In this study [80] newly diagnosed essential hypertensive patients were enrolled and divided into two groups [DR1] and [DR2] respectively. DR1 patients received candesartan 16mg once a day and DR2 patients received Amlodipine 10mg once a day for 3 months duration
Results: The mean systolic blood pressure of DRI was 162.23 on day 0 which decreased to 141.05 on day 90, versus DR2 which decreased from 160.12 on day 0 to 140 on day 90. The mean diastolic blood pressure decreased significantly for DR 1 group from 99.87 mmHg to 87 to 89. mmHg, versus DR2 which decreased from 98.5 to 86.25. All values of blood pressure have been taken in mmHg. The results of this study were observed statistically significant
Conclusions: Candesartan cilexetil is a newer and safer alternative for the treatment of essential hypertensive patients in comparison to conventional antihypertensive treatment
ABSTRACT
Objective of this study: to analyze the result of A.O. condylar blade plate for the treatment of sub trochanteric fractures and to assess the union of the fractures after the definitive surgical management
Material and methods: a prospective study of 56 sub trochanteric femoral fractures treated by 95o A.O condylar blade plate was conducted in Department of Orthopedic Surgery, Liquate University of Medical and Health Sciences Jamshoro from March 2005 to February 2008. The follow- up period ranged from 6 - 36 months [average 12 months]. Fractures were included according to Siensheimer's classification type IIA, B and C and III A and B with their subtypes. Type I, IV and V were excluded from this study. The age of the 56 patients ranged between 25 to 55 years average age 37.6 years. There were 39[69.64%] male and 17 [30.35%] female patients. Male to female ratio was 2.9: 1
Results: total 56 patients were evaluated; excellent results were achieved in 27 [48.21%], good in 17 [30.35%], and poor in 12 [21.42%]. Out of 56 patients 34 [60.71%] were type II and were distributed in subtypes as 18 [52.94%] IIA, 7 [20.58%] IIB, and 9 [26.47%] IIC. The 22 [39.28%] type III cases were distributed in subtypes as 14 [63.63%] IIIA and 8 [36.36%] IIIB. The union time ranged between 3.5 to 12 months [average time 4.6 months]. The rate of non-union in this study was 12.5%. In this series 5 cases were complicated by malunion, 3 patients unacceptable Varus angulation of more than 15 degree was noted, and in remaining 2 cases Varus less than 15 degree was noted. Malunion rate in this study was 8.92%
Conclusion: we conclude that the choice varies from place to place, and depends on fracture morphology, expertise available, and whether it is cost effective. We feel condylar plate will find its use in selected cases and certain situation for many years to come
ABSTRACT
Objective: To document the outcome of Ponseti method in the treatment of clubfoot
tudy Design: Observational-descriptive study
Place and Duration: Department of Orthopedic Surgery and Traumatology, Liaquat University of Medical and Health Sciences [LUMHS] Jamshoro, Sindh - Pakistan, from January 2007 to December 2010 [4-years]
Methodology: Clubfeet were treated by Ponseti technique. Pirani score was recorded for all subjects at the time of presentation and a foot was considered fully corrected when scored 0- 0.5. Immediately after the removal of last cast, foot abduction braces were used. Follow-up pattern was at two weeks, at three months, then at four month interval up to 3-years age, then at six month interval up to 4- years age, and then once a year. Any relapses were treated accordingly. Tenotomy was repeated in equines, whereas castings were repeated in adduction of forefoot, intoeing and cavus
Results: During the study period 49 children presented 71 clubfeet with 27 [55.1%] unilateral and 22 [44.9%] bilateral cases. The mean Pirani score at the time of presentation was 5.44. Majority [63.38%] feet required casting up to 5-weeks and in 69.01% feet complete correction was acquired by five casts [mean 5.6 casts]. Achilles tenotomy was performed in 65 [91.55%] feet. Pirani score of 0-0.5 was achieved in 69 [97.18%] cases within 1-year follow-up. Thirteen [18.31%] cases of relapse were reported. Among these, 2 [2.82%] cases of equinus underwent repeat tenotomy; whereas 7 [9.86%] cases of adduction, 3 [4.23%] cases of cavus and 1 [1.41%] case o intoeing were treated by repeat casting
Conclusion: Ponseti method can be used in our setup with excellent correction of clubfoot deformity, and surgical complications can be minimize by this technique
ABSTRACT
Objective: The purpose of this study was to evaluate the results of dynamic condylar screw system in the management of subtrochanteric femoral fractures, regarding union time, implant failure rate; infection rate and functional out come
Study Design: A prospective case series
Place and duration of study: This study was carried at the department of Orthopedic Surgery and Traumatology Liaquat university of Medical and Health, sciences Jamshoro, during January 2008 to December 2009
Material and Methods: Total 52 consecutive patients with subtrochanteric fracture were studied .Four patients were lost during follow-up and total 48 patients were finally assessed. The inclusion criteria was closed subtrochanteric fractures in adults of both gender aged 20 years or above; pathological fractures and open fractures were excluded from the study. After fixation of fractures with dynamic condylar screw system patients were followed -up for 6-12 months, the mean follow up period was 8 months. Results of treatment were assessed by the Radford criteria
Results: Among 48 studied cases, males were 29[60.42%] and female 19[39.58%]. Most common mode of injury was road traffic accidents in 32 patients [66.66%] and 16 patients had fall. All the patients underwent operative treatment by fixation of DCS. Autogenous bone graft was done in 07 patients. The union rate in this series was [93.5%]. Implant failure was observed in 03[6.25%] patients, 03 [6.25%] patients developed varus deformity and infection occurred in 02 [4.66 %]. According to criteria of Radford, we achieved good to excellent results in 81 % cases, fair in 6 [12.5 %] patients, poor in 03[6.25%0] patients
Conclusion: We conclude that subtrochanteric fractures need open reduction and internal fixation to avoid complications like implant failure, nonunion, infection, and mal-union. In our circumstances we achieve good results by the use of dynamic condylar screw
ABSTRACT
Object: To evaluate the risk of lag screw cut out in unstable intertrochanteric fractures
Material and Methods: This study was conducted in the Department of Orthopedic Surgery and Traumatology [DOST] Liaquat University of Medical and Health sciences Jamshoro from January 2006 to December 2009. Unstable intertrochanteric fractures type A2 and A3 of AO classification fixed with DHS in stable [anatomic and wayn county] reduction, were included in study. All patients were assessed on six months follow up x-rays for cut out failure in different positions for placement of screw in femoral head. For placement of screw, femoral head was divided in 9 columns/zones on antero-posterior and lateral plane x-rays
Results: Out of total 66 study subjects 45 [68.1%] were males and 21 [31.8%] were females, 56 [84.8%] were of A2 and 10 [15.2%] of A3 type. Mean age was 65.41 years. Forty [60.6%] patients were fixed in anatomical reduction and 26 [39.3%] in wayn county reduction. The screw placement was 24 [36.3%] in central -central, 9 [13.6%] in central -inferior, 17 [25.7%] in posteriorinferior and 16 [24.2%] in remaining off central [unsatisfactory] zones. The cut out was in 2 patients [8.3%] in central-central , 0% in central inferior position , 3 patients [17.6%] in posterior inferior and 4 patients [25%] in remaining off central zones [all cut out were in superior zones of femoral head]
Conclusion: We conclude that placement of lag screw in inferior on AP and central on lateral view in femoral head gives excellent results after achieving stable reduction, having maximum bone to plow for cut out. But it is difficult and time consuming so if it is aimed in lower half on AP and central on lateral view in femoral head it will give better results
ABSTRACT
Background: Unstable intertrochanteric fractures pose a challenging problem. Severe communication in elderly osteoporotic patients renders internal fixation difficult. Several methods, techniques and fixation devices have been advocated for treating these difficult fractures but each one has different rate of complications. The purpose of conduction of this study was to compare the results of Wayn country [valgus] reduction with anatomical reduction by using dynamic hip screw [OHS] in unstable intertrochanteric fractures
Material and methods: This was a prospective randomized study. Forty patients of unstable intertrochanteric fractures were treated with anatomical and Wayn county reduction, fixed with DHS. AO type A2 and A3 were included. Out of 40 cases 20 were treated by anatomical reduction, 20 cases included in Wayn county reduction group. All cases were followed up for 6 months and assessed with Larson's evaluation score for hip
Results: Out of 40 patients 23 [67.5%] were male and 17 [42.5%] were female. Average age was 64.25 years having higher incidence between 60 to 70 years [23 patients], 18 [ 45%] patients had associated diseases, 33 [82.5%] patients had A2 type fracture and 7 [ 17.5%] had A3 type fractures. 36 patients out of 40 were fully followed, there was no death during hospital stay, 4 patients died during follow up. All 4 patients were of Wayn county reduction group. Average delay in surgery was 10 days, average postoperative hospitalization was 11.6 days. Average operating time was 56 minutes in Wayn county reduction and 70 minutes in anatomical reduction. Average healing time was 14 weeks in Wayn county reduction and 13 weeks in anatomical reduction group. Implant placement in femoral head 27 were central - central and 13 were posterior-inferior. Overall results were excellent and good 87% in Wayn county reduction and 80% in anatomical reduction, mechanical failure was present in 0% in Wayn county and 20% in anatomical reduction group
Conclusion: Result showed that Wayn county reduction had better results than anatomical reduction with less chance of mechanical failure, p <0.05