ABSTRACT
Background: Fractures of the proximal humerus have been a challenge to orthopaedic sugeons with treatment modalities changing from time to time. Locking plates have revolutionised the treatment of these fractures. Currently proximal humeral locking plates (PHLP) and proximal humeral interlocking osteosynthesis (PHILOS) are two types of locking plates available for fixation of these fractures. Aim of this study was to evaluate the results of proximal humeral locking plate (PHLP) for Neers’s two and three part proximal humerus fractures. Material and methods: Neer’s two and three part fractures treated by open reduction and internal fixation with proximal humeral locking plate from August 2012 to April 2014 were retrospectively evaluated for complications, time to radiological union and final functional outcome using Constant Murley Score (CMS). Results: Twenty (12 male; 8 female) patients with 8 Neer’s 2-part and 12 neer's 3- part fractures managed by open reduction and internal fixation with proximal humeral locking plate (PHLP) with an average follow up of 23.2 months were evaluated. All the fractures united at an average of 16 (12 to 20) weeks. Eight complications were seen in 5 (25%) patients, namely, inadequate anatomical reduction (n = 1), superficial wound infection (n = 1), deep infection (n = 1), subacromial impingement (n = 1), axillary nerve neuropraxia (n = 1), adhesive capsulitis (n = 1) and secondary varus collapse (n = 2). There was no patient who developed avascular necrosis (AVN), non- unioun, primary or secondary screw perforation, implant failure and vascular injury. Average Constant-Murley Score at final follow up was 84.75 ± 11.6. 85% patients had very good and Good functional results. No patient had poor functional results. Conclusion: Proximal humeral locking plate (PHLP) is an excellent implant in Neer’s two and three part fractures of the proximal humerus. Complications can be minimized by meticulous Surgical technique and proper placement of screws and plate. In case of medial comminution, use of PHILOS with placement of medial support screws and bone grafting should be preferred to prevent varus collapse.
ABSTRACT
To determine the frequency of thrombocytopenia in Plasmodium vivax [P.vivax] malaria cases at two hospitals. Cross-sectional descriptive study. The study was conducted at the departments of Pathology, Combined Military Hospitals Malir and Sibi, Pakistan from Jul 2011 to Mar 2012. A total of 2709 samples were collected from febrile patients for detection of malaria parasite [944 from CMH Malir and 1765 from CMH Sibi]. Cases having infection with P. falciparum alone or having mixed infection with P. vivax and P. falciparum were excluded from the study. Both thick and thin film microscopy and immunochromatographic method [OptiMAL-IT] were used for detection of malarial parasite. Platelet counts were done using automated haematology analyser [Sysmex KX 21] with re-evaluation of low counts with manual methods. Total of 170 patients were found positive for P. vivax malaria [44 from CMH Malir and 126 from CMH Sibi]. Platelet counts ranged from 21 - 457 x loyi with a mean of 134 x loyi. Ninety five [2.1%] from CMH Malir and 4.2% from CMH Sibi out of 170 patients had thrombocytopenia, and the difference in thrombocytopenia at the two hospitals was insignificant [0.017]. Thrombocytopenia in patients with P. vivax infection is equally prevalent in the two hospitals, representing a widely different geographical area and should prompt a more thorough search for malarial parasite
ABSTRACT
Acute osteomyelitis in infants, which was known for high mortality and morbidity in the pre-antibiotic era can be managed conservatively by intravenous antibiotics and supportive therapy if the condition is detected and treatment started early in the course of the disease. Infantile osteomyelitis is separate entity from the one seen in older children in terms of vascular anatomy, pathogenesis, radiological changes and natural history. We present a neonate with acute haematogenous osteomyelitis of femur with preceding respiratory tract infection that was managed conservatively without surgical intervention despite severe radiographic changes. The child recovered without any residual deformity and final radiographs did not show any trace of the disease though early radiographs had exuberant involucrum formation and sequestration of entire diaphysis giving it a “bone within bone” appearance. Infants have excellent capacity of re-sorption of sequestrum and remodelling of involucrum such that no trace of disease is left in the adulthood.
ABSTRACT
Isolated tuberculosis of foot is a rare entity. Plenty of literature is available on osteoarticular tuberculosis but literature on tuberculosis of foot is limited. Additionally the condition mimics variety of other foot pathologies which can delay diagnosis and add to morbidity. We present a twelve year old boy who presented clinically with swelling, pain and discharging sinus of foot with a cystic lesion in medial cuneiform on radiography. Though histopathology and Ziehl Nielsen staining later on established the diagnosis, but initially it was mistaken as a case of mycotic osteomyelitis. Tuberculosis of foot, though rare, should always be one of the differential diagnoses in a patient presenting with bony lesion on radiography irrespective of absence of constitutional symptoms and negative tests for tuberculosis. If battery of tests fails to establish diagnosis, open biopsy with curettage and histopathology should be considered to work out the final diagnosis.
ABSTRACT
To compare the effectiveness and complications of Rubber Band Ligation [RBL] with Injection Sclerotherapy [IST] in the treatment of 1st degree and 2nd degree hemorrhoids. Randomized Controlled Trial. CMH Rawalpindi, from 1st Feb to 30 Sep 2007. A total of 120 patients were selected for study. 60 patients with 1st degree haemorrhoids were placed in group I and 60 patients with 2nd degree haemorrhoids were placed in group II. These patients were then randomly divided into two sub-groups 'A' and 'B' through Random Allocation by Table of Random Numbers. Group 'IA' had 30 patients of 1st degree haemorrhoids and group 'IIA' had 30 patients of 2nd degree haemorrhoids. Similarly group 'IB' had 30 patients of 1st degree haemorrhoids and group 'IIB' had 30 patients of 2nd degree haemorrhoids. Then groups 'IA' and 'IIA' were subjected to RBL and Groups 'IB' and 'IIB' were subjected to IST. The outcome measures were relief of symptoms, recurrence rate and complications. Male to female ratio was 11:1. Among patients subjected to RBL, 58.3% were from age group 2 [31-50 yrs] with mean age 42.90 +/- 11.74 yrs and mean duration of symptoms was 6.24 + 4.91 months. Among patients subjected to IST, 55% were from age group 2 [31-50 yrs] with mean age 45.62 +/- 12.49 yrs and mean duration of symptoms was 7.03 + 4.76 months. Important immediate complication was pain, but majority of patient were pain free. In group IA 36.7% patients had slippage of ligature but none of the patients undergoing IST developed Prostatitis. Visible bleeding was the main complication in group 'IA' 4th week [p < 0.05]. Response to IST among 1st degree haemorrhoids was significant at 4th week i.e. 90%, as compared to RBL, i.e. 63.3% [p <0.05]. IST is treatment of choice for 1st degree haemorrhoids, but for 2nd degree haemorrhoids, both RBL and IST are equally effective
ABSTRACT
To find out the frequency, pattern and factors influencing red cell immunization secondary to multiple blood transfusions in patients of beta thalassaemia major. A cross-sectional study. Armed Forces Institute of Transfusion, Rawalpindi, in November 2002. One hundred and sixty-one patients suffering from beta-thalassaemia major and on regular blood transfusions were included in the study. Their blood samples were tested for blood grouping, direct antiglobulin test and antibody screening/identification using reagents of DiaMed-ID Gel microtyping system. The total rate of red cell immunization was found to be 6.84%. Red cell alloantibodies were detected in 4.97% patients, and belonged mainly to Rh system, with one example each of anti-K, anti-Js b and anti-Jk a. Direct antiglobulin test was positive in 3 patients [1.87%] with increased hemolysis. Two had warm panreactive IgG antibodies suggesting red cell autoimmunization. Red cells of the 3 rd patient showed sensitization with c-3d, with presence of an autoreactive cold agglutinin in the serum having a titre of 1:4. The red cell alloantibody formation was not influenced by age at first transfusion, number of blood transfusions and ethnicity. The rate of red cell alloimmunization in beta-thalassaemia major is relatively low in our setup and may be related to red cell homogeneity between the donor and recipient population. Routine pre-transfusion matching of blood, other than ABO and Rh "D" antigens is not recommended because of low rate of red cell alloimmunization, and high costs associated with such testing. Hyperhaemolysis, due to acquired red cell autoantibodies was found to be an important complication. Patients who develop this complication should be tested for presence of underlying alloantibodies and considered for immunosuppressive treatment