Management of closed tibal shaft fractures with reamed inter locking nail

The objective of the study was to evaluate the results of closed reamed interlocking nail in the management of closed tibial shaft fractures. Descriptive Observational study Place and Duration: This study was conducted in the Department of Orthopedic, Khyber Teaching Hospital Peshawar, from Jun 2007 to December 2008. A total of 32 patients above the age of 18 years were included in the study. Patients were admitted through accident and emergency department. Written informed consent was obtained from all patients. Detailed history was asked, every patients was assessed clinically and radiographycally. Reamed interlocking intramedullary nailing was done as per protocol. Patients were followed for 1 year, and were evaluated for union, infection, range of motion of knee and ankle and implant problems. 2 patients were lost to follow up and the study was completed on 30 patients. All the fractures united without any need for bone graft. Simple fractures united in average period of 12.5 weeks while comminuted and segmental fractures took longer by four weeks, and united in an average of 16.5 weeks. Two patients developed superficial infection at the site of screws which were treated accordingly with drainage and antibiotics and removal of the distal screw. All the patients had full range of knee movement while 28 patients had full range of ankle movements. The remaining two patients had 15-20 degree loss of ankle dorsiflexion. Nail breakage was not observed in any patient while two had breakage of the proximal and two had breakage of distal screws. We concluded that closed intra medullary nailing for closed diaphyseal fracture of the tibia is a safe and rewarding technique which has high rate of union and relatively low complications rate, there is early return to activities

Results of type-III supracondylar fracture humerus with open reduction and internal fixation in children after failed closed reduction

Supracondylar fracture of humerus is the second most common fracture in children which account for 60-75% of all fractures around the elbow. There are various treatment modalities for type-III fracture, i.e., closed reduction and casting, skeletal traction, close reduction and percutaneous pinning and open reduction and internal fixation. This study was conducted to see the outcome of open reduction and internal fixation after failed closed reduction. This study was conducted in the Orthopaedics Departments of Khyber Teaching Hospital Peshawar and Ayub Teaching Hospital Abbottabad from February 2007 to Nov 2007 on 30 children. Patients included were of either gender with age range from 5-12 years with displaced supracondylar fracture [type-III] after failed closed reduction. All fractures were fixed with two cross K-wires by open reduction and internal fixation. The patients were assessed both clinically and radiologically and results were tabulated according to Flynn criteria. Twenty-eight patients had excellent results while two had good results according to Flynn criteria. None of the patients had either fair or poor result. Open reduction and internal fixation is a good and reliable method after failed closed reduction and gives stable fixation with anatomical alignment

Nonunion of fracture clavicle; Treatment by compression plate and bone graft

To evaluate the of surgical treatment of nonunion fracture clavicle by compression plate and bone graft. Material and This study was conducted in the department of orthopaedic and Trauma Khyber Teaching hospital Peshawar from December 2001 to December 2003. Fifteen cases of non-union of the clavicle fracture after conservative treatment were included in the study. Non-union of clavicle resulting from other mode of treatment like primary open reduction and internal fixation were excluded. The nonunion was excised and fixed with 3.5 mm dynamic compression plate. The site was grafted with cancellous bone graft. We have been successful in all 15 patients with early return to normal mobility of the joints. The consequent narrowing of the shoulder girdle is fully acceptable for appearance and activities of the shoulder girdle. We obtained bony union within 4 months in all these cases. We have found this method a useful treatment for the nonunion of clavicle after conservative treatment has failed. The technique is simple and does not require any special instrument. It facilitates an early return to normal activities of shoulder girdle and gives a quick recovery from non-union