Management of congenital club foot

Aims and Objectives: To determine the effectiveness of Ponseti technique with the kite method in the management of congenital club foot

Study Design: It was a prospective interventional study

Place and Duration of Study: The study was conducted in the department of Orthopedic Surgery Foundation University Medical College and Fauji Foundation Hospital Rawalpindi from 1st October 2009 to 31st June 2010

Results: Total of 46 patients with grade 2 deformity was included in the study who meets the inclusion criteria. Patients were randomly divided into two groups of 23 each. Majority of the patients [65%] were between 05-09 weeks of age. The mean age was recorded as 7.7 weeks with S.D of 5.21. TEV is a predominantly male's disease as 65% patients in this study were males, while 35% were females in group-A. Similarly in group-B, males were 78% and 22% were female. Outcome of both the procedures was recorded at three months follow up. In group-A success rate was recorded 74% as compared to group-B in which 87% patients were found in satisfactory range with more than 25 passive range of dorsiflexion at ankle joint

Conclusion: Conservative Ponseti method is the best option for the management of Congenital Talipes Equino Varus [clubfoot] for grade 2 deformity, when starts early. This not only corrects the deformity, preventing surgical intervention but also lessens the financial burden over the parents as well as on the health system

Treatment of type III supracondylar fracture of humerus in children, Backslab vs. no Backslab after open reduction internal fixation

To compare the results of application of pop back slab Vs no back slab after open reduction internal fixation in type III supracondylar humeral fracture. Randomized controlled trial. Department of orthopedics, Fauji Foundation Hospital Rawalpindi Duration: From 01 August, 2008 to 3ljuly, 2009. Patients with type III supracondylar humeral fracturers aged between 05 to 12 years were recruited from the outpatient and emergency department of Orthopaedic surgery Fauji Foundation Hospital [FFH], Rawalpindi. Open reduction internal fixation was done, Kochers approach was used and fixation was secured with two k-wires. Of total 70 patients, 52 [74.28%] were males and 18 [25.72%] were females. Forty two [60%] of the patients had age range between 05 to 08, and 28 [40%] were between 09 to 12 years old. In 51 [72.85%] left elbow was involved while right elbow was involved in 19 patients [27.15%]. Outcome of the procedure was analyzed according to Flynn's criteria showing excellent results in 21 patients [60%], good in 9 [25.71%], fair in 04 [11.43%] and poor in 01 [2.86%] in Group-I [with back slab] while in Group-II [without back slab] the results were excellent in 22 patients [62.85%], good in 7 [20%], fair in 04 [11.43%] and poor in 02 [5.72%]. By comparing patients with and without back slabs after OR1F of supracondylar fractures, we found no additional benefit in terms of stability, instead achieving early rehabilitation period, avoids extra cost and save valuable time of the surgical team without compromising any functional and cosmetic difference

Frequency of ventricular arrhythmias during first 24 hours of acute myocardial infarction in patient thrombolysed with streptokinase

To assess the frequency of ventricular arrhythmias during first 24 hours complicating first episode of Acute Myocardial Infarction in patients thrombolysed with Streptokinase. Cross-sectional, prospective, observational and qualitative study. This study was conducted at Sialkot Medical Complex for six months from March 2010 to August 2010. 200 consecutive patients with acute myocardial infarction who received Streptokinase were assessed for ventricular arrhythmias. Monitoring of the patients for ventricular arrhythmias for 24 hours from the time of admission was done. Arrhythmias from the cardiac monitor's memory noted and documented. Ventricular arrhythmias studied were ventricular fibrillation [VF], sustained ventricular tachycardia, accelerated idioventricular rhythm, non-sustained ventricular tachycardia and premature ventricular beats > 10 beats per hour. Findings were recorded on a specially designed proforma. The data were then entered in the computer for analysis and conclusions were drawn. Reperfusion arrhythmias were observed in 20% of the patients [40/200] in first 24 hours after thrombolytic therapy presenting with first acute myocardial infarction. All the patients included in the study showed the ECG criteria of STEMI and positive quantitatively Troponin T test. Inferior wall MI was the most common type of acute MI. All the patients received IV Streptokinase as thrombolytic agent. The patients with sustained VT [33%] received cardioversion and IV amiodarone. Non-sustained VT were managed by observation only [77%]. A total of 35 patients survived in first 24 hours, five died. Reperfusing arrhythmias are commonly observed in first 24 hours after Streptokinase therapy for acute myocardial infarctions. Most of the non-sustained reperfusion arrhythmias are left untreated and requires observation only but sustained ventricular arrhythmias [VF, VT] can be life-threatening and therefore must be considered for treatment, Electrical cardioversion is preferred over pharmacological treatment in case of sustained ventricular arrhythmias. Survival can be maximized if these arrhythmias are recognized and managed efficiently