ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the effectiveness of Judet's quadricepsplasty for treatment of knee contractures and to identify the effect of local infiltration of epinephrine on blood loss associated with this procedure.</p><p><b>METHODS</b>A retrospective cohort study was conducted in which all cases of knee contractures managed with Judet's quadricepsplasty from 1st January 2009 to 31st December 2013 were included and were divided into two groups. The epinephrine group included patients who were infiltrated with diluted epinephrine (1:400,000) along with xylocaine, around the operative field 15 min prior to the incision time, while the control group did not receive any infiltration. Judet's outcome, blood loss, drop in hemoglobin and required blood transfusion were noted for all patients and compared between both groups.</p><p><b>RESULTS</b>Most common preceding pathology identified for the development of knee contractures was periarticular fracture while ilizarov application was the most common etiology. Both groups were found similar in all preoperative characteristics except preoperative flexion contracture (p = 0.02). All functional outcome measures including Judet's outcome were similar in both groups. In contrast, duration of surgery (p = 0.01), blood loss (p = 0.02), drop in hemoglobin (p = 0.01) and number of transfusions (p = 0.03) were significantly reduced in epinephrine group.</p><p><b>CONCLUSION</b>Judet's quadricepsplasty is a useful procedure to increase the range of motion of rigid knees and local infiltration of epinephrine is effective in decreasing the amount of subsequent blood loss and transfusion requirements.</p>
ABSTRACT
Children with erb's palsy have significant functional disability, mainly related to the shoulder. The objective of this study was to analyze the functional outcome of tendon transfers performed for restoration of shoulder motion in patients with Erb's palsy. This descriptive case series was conducted at Aga Khan University Hospital from May 1999 to December 2003. Ten patients who had functional deficit of shoulder elevation were operated by a single surgeon. The surgical procedure; modified Sever L'Episcopo procedure was uniform in all cases. The data was collected through patient interviewing and medical records maintained through Health Information Management System [HIMS]. Mallet class was recorded preoperatively and postoperatively. Ten patients; seven females [70%] and three males [30%], with average age of 75 months at operation were included in this series. Right shoulder was affected in seven cases [70%] while left in three cases [30%]. Preoperative mallet class for global abduction improved from 3 to 4; for global external rotation from 2 to 4 and for ability to bring the hand to mouth and neck from 1 to 3. Post operatively mallet class improved in all aspects to 4 and 5; statistically significant on paired t-test with p value of less than 0.005. There was a significant improvement in abduction, forward flexion and external rotation as compared to preoperative values; statistically significant on paired t-test with p value of less than 0.005. Tendon transfer improves the functional status of shoulder in late cases of Erb's Palsy with significant improvement in mallet class, cosmesis and patient satisfaction. A motivated patient, compliance and aggressive rehabilitation are important outcome parameters
Subject(s)
Humans , Male , Female , Shoulder Joint , Tendon Transfer/methods , Child , Hospitals, UniversityABSTRACT
To determine the functional outcome of free scapular flaps performed for reconstruction of complex upper extremity defects. Design: Case series. Place and Duration of Study: The Aga Khan University Hospital, from 1998 to 2001. Subjects and All those patients in whom free scapular flap was done for reconstruction of upper extremity defects, were included. The important variables included demographic data, etiology of soft tissue defects, site and size of defect, complications, percentage of wound coverage by flap. Patient satisfaction, objective assessment of flap and range of motion of involved joints was determined. There were 9 males and 2 female patients with mean age of 31.54 +/- SD11.86 years. The causes of tissue defects were road traffic accident in eight cases, bomb blast injury in 2 and industrial injury in one case. Eight scapular flaps were performed to reconstruct the defects over the hand, wrist and forearm; two flaps for defects of arm and shoulder and one for elbow coverage. Average defect size was 18cm long and 11cm wide. Donor site was closed primarily in all cases. Based on cosmetic appearance, coverage of required defect, performance of activities of daily living and functional range of motion of involved joints, 7 cases were graded excellent and 4 cases were good. Scapular flap provided good robust coverage, which helped to do an early reconstruction and rehabilitation in our cases. Scapular flap can be considered workhorse for reconstruction of upper extremity defects