Outcome of mesh envelope bone grafting for traumatic segmental bone defects

Background: Long bone defects treatment is a technically demanding procedure in orthopedic surgery and may require bone graft pieces, which are loosely applied to the bone and few pieces can spill over in the surrounding area, resulting in failure in obtaining beneficial effects. The vicryl mesh envelope around the bone graft may be a solution

Objective: To determine the role of mesh regarding bone graft containment and union in long bone defects of > 4cm

Methodology: This experimental study was conducted in orthopedic department of Lahore General Hospital, Lahore from 1[st] January 2012 to 31[st] December 2014. Total 28 cases were included in the study and randomized into two equal groups. Fourteen patients were managed with vicryl mesh [group A] while 14 patients were treated routinely without the use of vicryl mesh envelope [group B]. Data was entered and analyzed by using SPSS version 18.0

Results: The mean age of all the patients was 29.11+/-6.16 years. The mean age of patients in group A was 29.71+/-6.56 years and in group B was 28.50+/-5.92 years. There were 20 [71%] male patients and only 8 [29%] female patients presented with long bone defects. Most of the patients were managed with dynamic compression plating i.e. 20 [71.43%]. In group A, 1 [7.1%] patient developed infection and re-operation was done while in group B 6 [42.9%] patients has infection and reoperation was executed to eradicate it. The difference was significant for post-operative infection between both groups [pvalue= 0. 029]

Conclusion: This study concluded that there was significant difference between both techniques in graft containment, consolidation and graft failure. Patients managed with vicryl mesh have better outcome than without vicryl mesh

Outcome of wound coverage around ankle joint with sural artery flap

Background: Trauma is the most common cause of fractures and majority of these fractures involve the foot. So the early coverage is mandatory to prevent the complications, it is challenging to the orthopaedic, plastic and reconstructive surgeons. Sural artery reversible flap is one of the options

Objective: To determine the outcome of sural artery flap for wound coverage around ankle

Methodology: A total of 24 patients were included in this interventional study. All the patients having wound around the ankle due to any cause and of either sex presenting in emergency department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1st June 2014 to 30th April 2016 were included in this study. Outcome was measured as "Good", "Fair" and "Poor". The data was entered and analyzed by using SPSS version 16

Results: In this study 24 patient were operated, 41.66% were children and 54% were male. In 50% heel region was involved and in 25% melleolar region and 12.5% dorsum of foot and in 12.5% above ankle joint. Outcome noted was "Good" 83.3% "Fair" 8.3% and "Poor" 8.3%

Conclusion: Sural artery flap for the coverage around ankle is simple, safe and can be performed by orthopedic surgeon at any center without the requirement of special instrumentation and special test, with good outcome

Comparison of outcome of fractures of inferior pole of patella

Background: Fractures of patella are common and it constitutes about significant proportion of all skeletal injuries resulting from either direct or indirect trauma

Objective: To evaluate the outcome of inferior pole fractures of patella treated with tension band wiring and resection of avulsed fragment and re-attachment of ligament to patella

Methodology: This was an comparative study, carried out in Department of Orthopaedic surgery of Lahore General Hospital, Lahore from 16[th] June 2012 to 15[th] June 2014. A total of 20 patients were included in this study. These patients were randomly divided into two groups. In Group-A patients were treated with open reduction and internal fixation with tension band wire and in Group-B patients were treated by resection of the avulsed fragment and reattachment of the patellar ligament to the patella. Patients were followed up for surgical site infection and functional outcome at 1[st], 7[th], 15[th], day one month, three months and six months post operatively. Final outcome was assessed by using Bostman criteria. Data entry and analysis was done by using SPSS version 17

Results: Mean age of all 20 patients was 34.20 +/- 12.13 years. Although both treatment groups had statistically same rate of surgical site infection from 1[st] day till 15[th] day post operatively. From 1[st] month till 6[th] months follow up time period none of the patients had surgical site infection in both treatment groups. At 1[st] month and 6[th] month post operatively in Group-B outcome was statistically better as compared to Group-A patients. But at 2[nd] month outcome of patients was statistically same in both treatment groups

Conclusion: Resection of the avulsed fragment and reattachment of the patellar ligament to the patella had good outcome according to the Bostman criteria as compared to open reduction and internal fixation with tension band wire

Outcome of tissue sparing conservative surgery in blast injuries to limbs

Background: Blast injuries are common in countries affected by conflict

Objective: To evaluate the outcome of conservative surgical intervention in the blast injuries of limbs in civilian population

Methodology: Study Design: Cross sectional study. Place and Duration of Study: Department of Orthopedic Surgery, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1[st] September 2011 to 31[st] March 2013. Fifty patients suffering from blast injuries to upper and lower extremities in civilian population regardless of age and sex were enrolled. Those patients who already had been treated after injury at some other centers were excluded from the study. Only clinical evaluation was used to check the vascular status and viability of the remaining attached tissues. Patients were operated either under general or regional anesthesia. Repeated debridement's followed by skin coverage in the form of split thickness skin graft or rotational flaps were the treatment option for soft tissues and exposed bone respectively. Post operative antibiotics were given for a period of one week at least. Rehabilitation exercises were continued up to six months after discharge from the hospital. The data was entered and analyzed by using SPSS version 15

Results: Mean age of the victims in this study was 22 years. Twenty nine patients had some sort of traumatic amputation at presentation resulting from original injury. Original injuries occurred were as follows; loss of limb below knee 7[14%], loss of limb at ankle region 05[10%], mid foot amputations 08[16%], and hemi foot amputation in 05[10%]. In upper limb injuries pattern was as follows; 01[2%] mid palmer amputation, 02[4%] two fingers amputation, and 04[8%] had soft tissue involvement of hand. Infection rate was 22% in patients who did not have wound dressing by the primary physician while it was 10% in patients who had wound dressing by primary physician before presenting to this institution, the collective infection rate was 32%

Conclusion: Conservative wound debridement, early skin coverage, preserving maximum soft tissues and bone results in functionally and cosmetically better limb in blast injuries

Outcome of surgical treatment of de-quervains disease

Background: De Quervains disease causes significant pain among patients

Objective: The purpose of this study was to evaluate the outcome of surgical treatment of de-Quervains disease

Material and Method: This cross-sectional study was conducted in Sheikh Zayed Medical College/Hospital Rahim Yar Khan from 1[st] January, 2009 to 31[st] December 2011. Patients with de Quervains disease who did not respond to conservative treatment with analgesics, splintage and local steroid injections for four to six months, were operated under local anesthesia. The tendons of abductor pollicis longus and extensor pollicis brevis were released in separate compartments. Patients were followed for a minimum of 4 months to assess the outcome of procedure. The data was analyzed by using SPSS version 15

Results: A total of 20 patients were included in study.Female to male ratio was 8:1. All females were house wives, exposed to manual work, four of them had rheumatoid arthritis. The age range was 35-50 years with mean age of 39 years. Results of surgical treatment were excellent with 94% patients being completely relieved of symptoms

Conclusion: Surgical release of first dorsal compartment [abductor pollicis longus and extensor pollicis brevis] of wrist has excellent results in patients with resistant De-Quervains disease