Dynamic hip screw [DHS] evaluation of stable and unstable intertrochanteric fracture of femur fixed

Objectives: To analyze the comparative results of dynamic DHS fixation in stable and the unstable intertrochanteric fractures at LUH. Study Design: Comparative study. Setting: Orthopedic unit I of LUH Jamshoro. Period: 26[th] May 2010 - 25[th] August 2011

Methodology: All 40 patients with femur intertrochanteric fracture were enlisted. All cases isolated in 2 groups every having 20 patients, group A stable fracture and group B unstable fractures. After complete physical examination, examinations and fracture arrangement evaluation, patients were readied for operation. Fracture table was used in each operation. Fracture reduction was initially attempted by close manipulation and was successful in 30 [75%] cases. Lateral approach for proximal femur was used in every case. All fractures, whether stable or unstable, were reduced anatomically without any type of osteotomy and then fixed with 135o dynamic hip screw

Results: Mean age was 62.8.2 years of the cases. Gender ratio was 3:1. According to mode of injury were found RTA in 21 [70%] patients. Postoperative complications were recorded as; superficial infection noted in 2 [5%] patients and there was no case of deep infection. Average stay of hospital found 16.5 days in 17 [42.5%] patients belongs to stable group and 06 [15%] patients belong to unstable group. All [n=40] patients were pain free on their discharge from hospital. In all [n=40] patients we achieved union and there was no case of delayed union or non-union. We assessed functional outcome of our patients on the base of Stinchfield Hip Assessment system. According to SHAS 28 [70%] patients were excellent, 05 [12.5%] patients were good, 04 [10%] were fair and 03 [7.5] were poor. We had not found mortality in our patients

Conclusions: According to our conclusion DHS is the best implant for intertrochanteric fracture fixation. No matter; whether fracture is stable, unstable and fresh or old

To see the work related musculoskeletal disorders among college teachers

Objective: To determine the prevalence of work related musculoskeletal disorders among college teachers of Karachi and Hyderabad

Study Design: Observational / descriptive / Cross sectional study

Place and Duration of Study: This study was conducted at the Department of Physiotherapy and Orthopaedic, Liaquat University Hospital Hyderabad from January 2013 to June 2013

Materials and Methods: We selected college teachers from both gender by convenient sampling. Those selected, were subjected had a work experience of about one year in teaching. Nordic questionnaire was used to determine the work related musculoskeletal disorders. The questionnaires were sent to 400 intermediate teachers and 342 completely filled questionnaires were returned back. Analysis was done through SPSS

Results: The highest prevalence of work related pain was found neck, shoulder, lower back, and knees and pain starts when they perform their work. 50% participants responded that they keep their neck in bending position and shoulders elevated while using black board

Conclusion: The results concluded that neck, shoulder, lower back, and knees are mostly affected regions. The use of ergonomically rules can help to alleviate the problem

Functional outcome of external fixator in grade 11 and 111 open fractures of tibia in children

Objective: To assess the functional outcome of external fixator in children with open tibial fracture in the department of Orthopaedics Surgery of LUH Hyderabad/ Jamshoro

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the Orthopaedic Department of LUMHS from June 2014 to March 2015

Materials and methods: In this study, 60 children [younger than 12 years] suffering from Gustilo grade II and III open fracture of tibia were admitted at the emergency department of the center and evaluated. All the cases were treated with external fixation, after complete counseling their parents or their attendants. While the children were admitted at the emergency department of the hospital, they underwent prophylaxis using antibiotic. All patients underwent washing and primary debridement operation at the emergency department. According to the attending surgeon, the patients were treated either using external fixator after hospitalization. After management union of the fracture was assessed through clinical examinations such as lack of pain, tenderness, and radiography of both lateral and anteroposterior [AP] views during the follow-up period

Results: In this study mean age was found 10.3 +/- 3.6 years, male were found in majority 42[80.67%]. Road traffic accident was the most common cause of mechanisms of injury was in 35[67.31%]. Cases with grade III type of fracture found in majority 57.69%. union after management was achieved 98.8% of the cases, superficial infection was found in 06[11.53%] cases, while deep infection, Malunion and delayed union were found 03[5.76%], 07[13.46%] and 05[9.61%] respectively. While non-union was found only in one case

Conclusion: External fixator is very safe, insignificant intrusive, get short surgical time, following by short hospital duration as well as can be applicable as unequivocal and effective administration of open fractures of tibia among children

Functional outcome of frozen shoulder treated with physiotherapy vs. intrarticular injection of corticosteroid

Objective: To assess the functional outcome of frozen shoulder when treated with physiotherapy vs intrarticular injection of corticosteroid the department of Orthopaedics Surgery of LUH Hyderabad/ Jamshoro

Study Design: Observational / comparative study

Place and Duration of Study: This study was carried out in the Orthopaedic Department of LUMHS, Hyderabad/ Jamshoro from August 2013 to March 2014

Materials and Methods: In this study, 100 cases between age of 40-70 years selected after diagnosis of frozen shoulder or adhesive capsulitis. All the cases having pain into shoulder moving function for minimum 3 months of period, both gender and detected adhesive capsulitis or frozen shoulder were included in the study. Later on, subjects were isolated at random into groups, 48 cases of group A were underwent intrarticular injection of corticosteroid and the 52 cases of group B were underwent physiotherapy management. Result assessed at 4 and 8 weeks follow up continue at 16 weeks

Results: In this study mean age was found 55.23 +/- 9.8 years. In this forth week follow up visit we found more improved patients 29/69% in Interarticular Injections group out of 42 cases, and in 23/50.5% cases found improvement in physiotherapy group out of 45 cases. Similarly 4[th] and 8[th] week follow-up on 16[th] week also some cases were missed, but on this follow up visit we found physiotherapy is the superior than Interarticular Injections group. As well as in this 16[th] week follow up visit we found improvement in the majority of patients 30/81.0% in physiotherapy group out of remaining total 37 cases, and in 17/58.6% cases found improvement in Interarticular Injections group out of remaining 29 cases

Conclusion: Physiotherapy has better result in reduce pain and range of movement [ROM] exercise than Interarticular injections of cortisone plus home exercise in the long time

Diaphyseal femoral fractures; treatment by close v/s open intramedullary interlocking nail

To assess the best results of diaphyseal femoral fractures treated by closed intramedullary interlocking nail and open intramedullary interlocking nail. Cross sectional. Jan 2009 to Jan 2011. LUH Jamshoro / Hyderabad. Total 40 fractures of shaft of femur in 40 patients were treated with IMILN. All patients have same post operative follow up. Early range of motion exercises of hip and knee joint was started, pain management and 3rd generation cephalosporin intravenous antibiotics given for 5 days followed by oral antibiotics. Patients discharged as early as possible when patient's condition allowed and removal of stitches after two weeks. Patient's assessment regarding wound condition, range of movement of proximal and distal joints and fractures assessment radiologically and clinically was done every month. Majority of the cases were with the age groups of 37.5% between 21-30 years. RTA was found most common 70% of the cases. According to the AO classification oblique fractures were found most common 45%. On the assessment of final results in both close and open methods, 5% infection found in close method and 7.5% infection were in open method, less union time was found in closed group, deformity was equally found in both groups and heeling time was also less found in closed group. It is concluded that closed intramedullary interlocking nailing method is the best procedure with excellent union for the femoral fracture

Gartland's type iii supra condylar fracture of humerus in children treated with open reduction and internal fixation with cross K-wire fixation: a prospective study

To evaluate the short term results of open reduction and internal fixation with cross k-wires in type III supracondylar fracture of Humerus in children in our setup

PATIENTS and METHODS: This prospective study was conducted at Department of Orthopaedic Surgery and Traumatology, Liaquat University of Medical and Health Sciences, Jamshoro from March 2012 to March 2014. Total forty-seven patients with type III supracondylar Fracture Humerus were evaluated in this series. All were treated with open reduction and internal fixation with cross k-wires. The children followed regularly and the cosmetic and functional results assessed according to the Flynn criteria

RESULTS: The mean age in our series was 7.4 years. There were 35 boys and 12 girls

The most common mode of injury 72.34% was fall during play. In 95.75% of our cases injury was extension type and in 4.25% flexion type. Grade I pin tract infection was noted in only 3 patients. 69% cases have excellent cosmetic and functional results, 22% were having good cosmetic and functional results according to Flynn Criteria

CONCLUSION: Open reduction and internal fixation with cross k-wires produce excellent to good results in Gartland type III supracondylar fracture especially in the areas where image intensifier facilities are limited

Outcome of femural neck fracture treated by austin -moor hemiarthroplasty in elderly patients

To determine postoperative complications including with ambulation improvement and condition in elderly patients with fracture neck of femur treated by Austin-Moore hemiarthroplasty during 6 months period postoperatively at Peoples medical university Hospital Nawabshah. Descriptive case series study. This study was carried out at Peoples Medical University Hospital Nawabshah and Liaquat University Hospital Hyderabad from July 2012 to July 2014. Total 100 elderly patients with femoral neck fracture with the age of above 60 years were included in the study. The patients were followed for a period of 6 months postoperatively and all the postoperative complications were documented in the proforma. This study was contains total of 100 elder patients with femur neck fracture majority of male 72%. Most common 69% age group of the elder patients was 60 - 69, years of the age. Fractures were present 55% on the left sides while 45%. Majority of the cases were found with co morbidies 58%, and according to the post operative complications wound problem was found most common 21% along with implant infection 9%, 2[nd] most common complication was bed sore 11%. On the outcome excellent results were found 32.60%, good results were 42.70%, while fair and poor results were as 16.30% and 8.40% respectively. While 17%, death was recorded during 6 month of postoperative time. Austen Moor Hemiarthoplasty is the good surgical technique of the management for the fracture of the femur. It is very cost effect treatment along with very small amount of morbidity and mortality

Functional outcome of open diaphyseal tibial fracture treated by A.O fixation VS N.A fixation

To evaluate the comparative results of open diaphseal tibial fractures treated with A.O fixation and N.A fixation. Comparative and experimental study. This study was carried out at Orthopedic Department of Liaquat University Hospital Hyderabad from February 2011 to January 2013. Total 50 cases were included in this study. All the cases with diabetic mellitus and associated head and abdominal injuries were excluded from the study. All the cases were divided in two groups equally 25 patients in group A, treated by N.A fixator and 25 patients treated with A.O fixator were selected in group B. Initial resuscitation, splintage and primary care for the wound was provided in the emergency department, any bone fragments that were protruding out were covered with sterile dressing. After counseling the patient and attendants regarding the condition of injury, its importance and possible complications, also explained about the method of treatment selected [Group A or Group B] then the patients were taken to the operating room. The mean age +/- SD in group A [NAEF, n = 25] was 35.4 + 9.22 years and 32.10 +/- 9.69 years in groups B [AOEF, n = 25], Out of total cases, male were in majority. Majority of patients were found RTA in both groups. In the group A [NAEF], pin tract infection 5[20.0%] cases, pin site osteolysis 5[20.0%], pin loosening 5[20.0%], pin site inflammation were in 3[12.0%] cases, which were cured by curettage of the outer cortex and oral antibiotics for a short period, 1[4.0%] patient went in infective nonunion and converted into Illizarrov external fixator. Knee stiffness was found in 2[8.0%] and Ankle stiffness was 3[12.0%] cases, in group A [NAEF] and 3[12.0%] in group B. Five [20.0%] patients of group A [NAEF] had mild limitation of ankle motion [mainly dorsiflexion] and 3[12.0%] were with Limited Flexion, patients of group B were without limitation of knee motion with a flexion ranges of 5[20.0%]. AO external fixator is much better than Naseer Awais External Fixator. It is simple and safe to apply, cost effective and successful management of open tibial fractures

Subtrochanteric femoral fractures treated by fixation with dynamic dondylar screw system

Objective: The purpose of this study was to evaluate the results of dynamic condylar screw system in the management of subtrochanteric femoral fractures, regarding union time, implant failure rate; infection rate and functional out come

Study Design: A prospective case series

Place and duration of study: This study was carried at the department of Orthopedic Surgery and Traumatology Liaquat university of Medical and Health, sciences Jamshoro, during January 2008 to December 2009

Material and Methods: Total 52 consecutive patients with subtrochanteric fracture were studied .Four patients were lost during follow-up and total 48 patients were finally assessed. The inclusion criteria was closed subtrochanteric fractures in adults of both gender aged 20 years or above; pathological fractures and open fractures were excluded from the study. After fixation of fractures with dynamic condylar screw system patients were followed -up for 6-12 months, the mean follow up period was 8 months. Results of treatment were assessed by the Radford criteria

Results: Among 48 studied cases, males were 29[60.42%] and female 19[39.58%]. Most common mode of injury was road traffic accidents in 32 patients [66.66%] and 16 patients had fall. All the patients underwent operative treatment by fixation of DCS. Autogenous bone graft was done in 07 patients. The union rate in this series was [93.5%]. Implant failure was observed in 03[6.25%] patients, 03 [6.25%] patients developed varus deformity and infection occurred in 02 [4.66 %]. According to criteria of Radford, we achieved good to excellent results in 81 % cases, fair in 6 [12.5 %] patients, poor in 03[6.25%0] patients

Conclusion: We conclude that subtrochanteric fractures need open reduction and internal fixation to avoid complications like implant failure, nonunion, infection, and mal-union. In our circumstances we achieve good results by the use of dynamic condylar screw