Causes of hand impairment

The objective of this study was to identify the causes leading to impairments of hand. Descriptive case series. This study was conducted at Rehabilitation Medicine department of Combined Military Hospital, Abbottabad from July 2010 to June 2011. 100 patients diagnosed to be having hand impairments were sampled by convenience sampling and through a face-to-face interview. Data was collected and analyzed using SPSS 10. Frequencies and descriptive statistics were calculated for the various variables. 84% [n=84] of the participants were males whereas 16% [n=16] were females. Mean age of study participants was 37.36 years [SD +/- 16.18 yrs]. Among these patients 94% [n=94] were right-handers and 6% [n=6] were left-handers. Dominant hand was affected in 51% [n=51] of patients, non-dominant hand was affected in 37% [n=37] of patients while in 12% [n=12] of patients both hands were affected. The most common cause of hand impairment was road traffic accidents at 28% [n=28], followed by falls 16% [n=16] and firearm injuries at 12% [n=12]. Number of genetic causes, sharp injury, blast injury and overuse were 7% [n=7], 6% [n=6], 6% [n=6] and 5% [n=5] respectively. Carpal tunnel syndrome, electric shock, infection, iatrogenic injury and sports injury were 3% [n=3] each. While cubital tunnel syndrome, and occupational injury were found to be 2% [n=2] each and Neuroma was 1% [n=1]. A large number of patients had hand impairments resulting from trauma. At the top of the list of causes of impairment was road traffic accidents followed by falls. Traumatic causes of hand impairment were 75% while non-traumatic causes were 25%

Intramedullary nailing for open fractures of the tibial shaft

Interlocking intramedullary nailing has become a popular method of fixation for closed tibial fractures, and a series of reports has confirmed excellent results with this technique. However, the use of intramedullary nails for open tibial fractures is controversial. The standard treatment for these injuries has been external fixation, particularly for fractures associated with more severe soft-tissue injuries. The purpose of the present study was to compare the clinical and radiographic results of intramedullary nailing of open fractures of the tibial shaft after reaming with those of nailing without reaming. This was followup comparative study. This study was conducted at the Department of Orthoaedic, Shaikh Zayed Hospital, Lahore from Jan. 2009 to Dec. 2011. Thirty patients who had thirty-four open fractures of the tibial shaft were randomized into two treatment groups. Sixteen fractures [nine type-I, three type-II, two type-IIIA, and two type-IIIB fractures, according to the classification of Gustilo et al.] were treated with nailing after reaming, and eighteen fractures [ten type-I, four type-II, two type-IIIA, and tye-IIIB fractures] were treated with nailing without reaming. The average diameter of the nail was 10 millimeters [range, nine to eleven millimeters] in the group treated with reaming and 9 millimeters [range, eight to ten millimeters] in the group treated without reaming. No clinically important differences were found between the two groups with regard to the technical aspects of the procedure or the rate of early postoperative complications. The average time to union was 30 weeks [range, thirteen to seventy- two weeks] in the group treated with reaming and 29 weeks [range, thirteen to fifty weeks] in the group treated without reaming. Two of the fractures treated with reaming and three of the fractures treated without reaming did not unite. There were two infections in the group treated with reaming and one in the group treated without reaming. More screws broke in the group treated without reaming four, per cent] than in the group treated with reaming [Three; 9 per cent]. The functional outcome, in terms of pain in the knee, range of motion, return to work, and recreational activity, did not differ significantly between the groups. We concluded that the clinical and radiographic results of nailing after reaming are similar to those of nailing without reaming for fixation of open fractures of the tibial shaft, although more screws broke when reaming had not been done

Early results of Ponseti technique for idiopathic congenital talipes equinovarus

Clubfoot or congenital talipes equinovarus is one of the most common congenital anomaly affecting the lower limb. The exact cause is unknown and a number of theories have been postulated to explain its origin. Congenital talipes equinovarus affects both sexes and may be unilateral or bilateral. Clubfoot is sometimes associated with Arthrogryposis multilex congenital, spina bifida, meningomyelocele and muscular dystrophies. This study was conducted to determine the early results of ponseti technique for idiopathic congenital talipes equinovarus. Observational [Follow-up] Study. This study was conducted at orthopedic B-Unit of Ayub Teaching Hospital Abbottabad from 1[st] April 2009 to 30[th] September 2009. Thirty [30] patients from either gender with age from birth to 06 months of age attending the outpatient department of Orthopedic B-Unit of Ayub Teaching Hospital Abbottabad were included in the study. The patients were ranged in age from birth to 06 months of age, with 17 male [56.7%] and 13 female [43.3%]. In our series on follow up, fore foot adduction was detected in 06 cases [20%] and 02 cases had equines relapse [6.7%] and 03 patients had residual equines [10%] while bilateral residual equines was detected in 01 patient [3.3%] and 01 patient had recurrence of deformity [3.3%] for which posteromedial release was done. We concluded that the Ponseti method is a reliable, simple, effective and safe method for the treatment of idiopathic clubfoot deformity

Role of external fixator in the management of trochanteric fractures of the femur - damage control orthopaedics

To compare the Modified AO fixator [MAO] with sliding hip screw [SHS] in the treatment of trochanteric fractures. 68 patients of both genders presenting with trochanteric fractures at Combined Military Hospital Lahore. This was a Prospective, Randomized Study. This study was conducted at the in patient surgical Unit at Combined Military Hospital Lahore from 1st June 2006 till 30 November 2007. 68 high risk patients of ASA-IVa-c with a trochanteric fracture were selected. The mean age was 73 yrs +/- . There were 17[28%] males and 45 [72%] females. There was no delay between injury and operation when treated by external fixation [mean 3.13 days, 1 to 7]. All fractures in group I united clinically and radiologically at 24 weeks. The surgery required lesser time [mean 29.35 minutes, 20 to 45], the blood loss was minimal [mean= 33.33 ml] and required a short hospital stay [mean of 3.96 days, range 2 to 7 days] as compared to the group II. At the final follow-up, 03 [8%] patients had shortening or malrotation, 02[03%] patients had varus angulation, implant failure [pin breakage] in one patient [1.4%] and pin cut out was observed in one [1.4%]. Our results confirm that the Modified AO fixator is an effective device for treating pertrochanteric fractures and is a useful alternative to conventional fixation with the sliding hip screw