Lateral epicondylitis; comparison of autologous blood and corticosteroid in the treatment. A prospective, randomized, controlled trial

With aging, chemical hormonal and vascular factors have their part to play in lateral epicondylitis. The objective is to compare results of autologous blood injection and corticosteroid injection in treatment of lateral epicondylitis. Out Patient Department of Peshawar Institute of Medical Sciences, Peshawar from March 2013 to February 2014. Material and A prospective randomized control trail conducted on 58 patients fulfilling inclusion criteria. DASH score and VAS score used as outcome measures and both were recorded before injections and at each follow up made at 2 weeks, 6 weeks, 12 weeks and 24 weeks interval. P-value was calculated where applicable. Out of 79 patients 65 met the inclusion criteria. Mean age was 41.43 years +/- 13.43. 36 were females and 29 males. Dominant elbow involved in 39 patients. Mean duration of symptoms was 7.1 +/- 2.9 months. 7 patients lost in follow up. DASH score improved in both groups. but when compared there was no significance difference between the two groups [P value 0.33 at 12 weeks and 0.09 at 24 week follow up]. Similarly Mean VAS improved at 12 and 24 week follow up] in both groups but when compared the difference was non-significant [P value. 071 at 12 weeks and 0.12 at 24 weeks follow up. Both steroid and autologous blood injection has shown improvement in pain and physical activity and provide acceptable results although none superior to other significantly

one year review of various complications in fracture shaft of femur managed with closed intramedullary interlocking nail

To determine the frequency of complications in fractures shaft of femur managed by close antegrade intramedullary interlocking nail. It was a descriptive cross sectional study of one year duration from March 2010 to March2011 held at department of Orthopedics and Traumatology, Lady Reading Hospital Peshawar. Forty four consecutive patients with femoral shaft fracture fulfilling the inclusion criteria were managed with closed antegrade interlocking nail. Complications in terms of infection, angulation, rotation, non-union, shortening and knee stiffness were measured. The mean age of the patients was 33.70 +/- 14.53 years. Twelve patients [27.3%] were females and 32 [72.2%] were males. Thirty five [79.5%] had road traffic accident, 3 [6.8%] sustained fractures due to fall from a height and 6 [13.6%] were due to fire arm/bomb blast injury. Thirty five [79.5%] had close and 9 [20.5%] had open fracture. There were four cases [9.1%] of infection; [two superficial and two deep wound infection]. 40 patients [90.9%] regained full range of motion [0[0] - >130[0]] in knee and 4 patients [9.1%] had 0[0]-120[0] range of motion. There was only one case [2.3%] of up to 2.5cm limb shortening. 42 [95.4%] patients achieved union. Two [4.5%] patients had non-union. These patients were treated by standard protocol of exchange nailing after reaming and ultimately achieved union. Three cases [6.8%] had angulation of > 10[0] [dorsal or ventral]. None of our patients in this study had rotation deformity. Most common early complication with closed antegrade intramedullary nailing was infection and late complication was non-union

Treatment of segmental tibial bone loss by distraction osteogenesis

To assess the clinical outcome of reconstruction of segmental tibial defects by the technique of bone transport. This prospective, quasi-experimental study was conducted in Lady Reading Hospital and private hospitals of Peshawar, Pakistan from October 2009 to September 2011. Segmental losses of tibia diaphysis in 32 patients were 'regenerated' by bone transport. Radiological results were excellent in 24 [75%], good in 3 [9%], fair in 4 [12%] and poor in 1 [3%] patient. Clinical results were excellent in 19 [59%], good in 7 [22%], fair in 5 [16%] and poor in 1 [3%] patient. During follow-up there were 9 obstacles of pin/wire infections and 7 problems which required surgical intervention. At the last follow-up there were 6 true complications. The average fixator time [external fixator index] was 25.9 weeks and the average bone healing time was 26.1 weeks. Distraction osteogenesis may be the best biological method of restoring the integrity of a bone in segmental bone loss

experience of the treatment of unstable inter-trochanteric fractures with the Ao/Asif proximal femoral nail

To evaluate the use of local-made proximal femoral nail in the treatment of unstable inter-trochanteric fern oral fractures. This descriptive study was conducted in the Department of Orthopaedics, Lady Reading Hospital, Peshawar, from February 2009 to June 2010. Sixty-two patients with unstable inter-trochanteric femoral fractures, admitted through the Accident and Emergency Department were included in this study. All patients were treated with AO/ASIF proximal femoral nail and followed at least till fracture consolidation which takes minimum of 6 months. The mean age of the patients was 74.27 +/- 5.84 years. Two patients died and thirteen patients were lost to follow-up. The results are thus based on a sample of 47 patients. There were no complications in 81% [n=38] patients and they achieved fracture consolidation within six months. Three patients underwent revision surgery due to non-union; two had lag screw penetration into the hip joint, three patients developed deep wound infection while one patient developed superficial wound infection. The mean pre injury mobility score was 6.8 +/- 2.5 while the mean post-operative mobility score was 6.48 +/- 2.7 [p=.000]. The advantage of immediate stability in difficult and unstable fractures, and the relatively few complications serve to recommend the wider use of AO/ASIF proximal femoral nail

External fixator in the treatment of open fractures of tibia

To evaluate the outcome of external fixator used as a definitive mean of fixation in open fracture of tibia. This cross sectional study conducted at Orthopaedics Unit District Headquarter Hospital Timergara from December 2005 to September 2008 included 40 patients with grade II, grade IIIA and IIIB open fractures of tibia. Patients with grade I, grade IIIC open fractures and the patients who needed amputation for their injuries were excluded from the study. Patients with insufficient follow up were also excluded. In all these patients an aggressive approach of early initiation of treatment, radical debridement and irrigation was adopted. All the fractures were stabilized with AO external fixator, and early soft tissue coverage was provided in these patients. On removal of the external fixator Sarmiento functional brace was used till the time of union in all these patients. The mean age of the sample was 28.80 +/- 9.87. The most common mechanism of injury in these 40 patients was road traffic accidents. Pin tract infection the commonest complication, noted in 10[25%] patients, deep wound infection in 4[10%] patients, delayed union in 4[10%] patients, and mal union, non union in none of them. Dynamisation of the fixator was done in 12[30%] patients and prophylactic bone grafting was performed in 4[10%] patients. The average time of fracture consolidation was 18 weeks. External fixator can be effectively used as definitive mean of fixation in open fractures of tibia with extensive soft tissue damage