Adverse fetomaternal outcome among pregnant overweight women

To compare the adverse fetometernal out come in overweight and normal weight pregnant women. This comparative cohort study was conducted from 1[st] October 2010 to 30 September 2012. Total 200 gravid women 100 were overweight and 100 normal weight pregnant women with gestational age for 08-40 weeks were included. Women having BMI [25 - 29.9 Kg/m[2]] were measured overweight and included in group A and 100 women having normal BMI of 18.5 to 24.9 as controls were in-group B. Chi-square test was applied to compare the proportion of maternal and fetal outcomes. Significant P - value of < 0.05 was considered. The age range was between 30 to 45 years with mean age of 30 +/- 4.1 years in both groups. Overweight pregnant women had significantly high frequency of pre-eclampsia [27% versus 9% in controls], PIH [24% versus 8% in controls], gestational diabetes mellitus [22% versus 5% in controls], prolonged labour [4% versus 6% in controls], Caesarean section [44% versus 16% in controls], Wound infection [3% versus 2% in controls] and Postpartum Hemorrhage [5% versus 2% in controls]. P-value < 0.001 was considered significance. Fetal complications in overweight pregnant women compared to controls i.e. Still birth [13% versus 2%], Early neonatal death [11% versus 1%], shoulder dystocia [5% versus 1%] and NICU admission [47% versus 10%]. Results were statistically significant except shoulder dystocia. We conclude that the result of present study indicates obesity exerts deleterious effect, both on fetal and maternal outcome

Detection of osteoporosis by dual energy X-ray absorptiometry

An early detection of osteoporosis through DEXA procedure will not only improve the disease management practices but also would help in impeding national productivity losses by mass screening and awareness. Our objective was to measure efficacy of DEXA procedure in early detection of osteoporosis and prevention of its complications. This case series observational study was designed to confirm the bone mineral density by dual energy x-ray absorptiometery [DEXA]. The duration of study was three years from November 2010 to October 2013. Subjects aged between 30 [when the risk of osteoporosis is low] to 60 [when osteoporosis is almost sure to be found]. Three hundred thirty patients were evaluated. There were 23 [6.96%] male and 307 [93.03%] female. Normal male were 09 [39.10%], osteopenia 11 [47.80%] and osteoporosis 3 [13%]. Normal females were 72 [23.50%], osteopenia 140 [45.60%] and osteoporosis 95 [30.90%]. P-value was more then 0.005 and not significant. Mean age was 48.73, minimum 30, maximum 60 and SD 7.247. Population category distribution was 243 [76.6%] from urban and 87 [26.4%] rural. In urban areas normal were 56 [23%], osteopenia 113 [46.50%] and osteoporosis 74 [30.50%]. In rural areas normal 25 [28.70%], osteopenia 38 [43.70%] and osteoporosis 24 [27.60%]. P-value was 0.567. Out of 330 there were 81 [24.54%] normal, 98 [29.69%] osteoporosis and 151 [45.75%] osteopenia. Osteopenia was the most common diagnosis mostly in younger age group and early diagnosis of this problem can help prevent osteoporosis

Outcome of corticosteroid injection in de quervain's tenosynovitis

BACKGROUND: De Quervain's tenosynovitis is a stenosing tenosynovitis of the first dorsal compartment of the wrist. The diagnosis is made by history and physical examination. Finkelstein's test is positive in typical cases

OBJECTIVE: To assess the clinical effect of local corticosteroid injections for de Quervain's tenosynovitis

MATERIAL and METHODS: Fifty De Querven's Tenosynovitis patients were included in the study

All had a mean of 6 weeks of treatment of the condition with oral and local NSAIDs and had shown no response. The severity of tenderness on first dorsal compartment and pain felt on Finkelstein test was recorded on Visual analogue scale. A mixture of 1 ml [10mg] of triamcinolone acetonide and 1 ml of 1% lidocain hydrochloride was injected in first dorsal compartment of involved wrist. Patients were followed for clinical assessment fortnightly for 24 weeks

Outcome measure was reduction in pain and tenderness on the radial side of wrist and negative Finkelstein test subsequent to local triamcinolone acetonide injection

RESULTS: Out of 50, thirty-five patients [70%] after 1st injection were symptoms free at two weeks, fifteen patients who showed no improvement were given second injection two weeks after the first. 42 [84%] patients at four weeks, and all patients at six weeks were symptoms free and fully satisfied with the therapy. All the 50 patients were followed for 24 weeks and no recurrence was found

The adverse reaction of steroid was seen in 18/50 [36%] of patients, which were subsided in 20 weeks. There was no incidence of nerve injury, tendon rupture, or infection

CONCLUSION: We conclude that one or two local steroid injections in the first dorsal compartment leads to significant improvement in patients with de Quervain's tenosynovitis

Subtrochanteric femoral fractures treated by condylar plate, a study of 56 cases

Objective of this study: to analyze the result of A.O. condylar blade plate for the treatment of sub trochanteric fractures and to assess the union of the fractures after the definitive surgical management

Material and methods: a prospective study of 56 sub trochanteric femoral fractures treated by 95o A.O condylar blade plate was conducted in Department of Orthopedic Surgery, Liquate University of Medical and Health Sciences Jamshoro from March 2005 to February 2008. The follow- up period ranged from 6 - 36 months [average 12 months]. Fractures were included according to Siensheimer's classification type IIA, B and C and III A and B with their subtypes. Type I, IV and V were excluded from this study. The age of the 56 patients ranged between 25 to 55 years average age 37.6 years. There were 39[69.64%] male and 17 [30.35%] female patients. Male to female ratio was 2.9: 1

Results: total 56 patients were evaluated; excellent results were achieved in 27 [48.21%], good in 17 [30.35%], and poor in 12 [21.42%]. Out of 56 patients 34 [60.71%] were type II and were distributed in subtypes as 18 [52.94%] IIA, 7 [20.58%] IIB, and 9 [26.47%] IIC. The 22 [39.28%] type III cases were distributed in subtypes as 14 [63.63%] IIIA and 8 [36.36%] IIIB. The union time ranged between 3.5 to 12 months [average time 4.6 months]. The rate of non-union in this study was 12.5%. In this series 5 cases were complicated by malunion, 3 patients unacceptable Varus angulation of more than 15 degree was noted, and in remaining 2 cases Varus less than 15 degree was noted. Malunion rate in this study was 8.92%

Conclusion: we conclude that the choice varies from place to place, and depends on fracture morphology, expertise available, and whether it is cost effective. We feel condylar plate will find its use in selected cases and certain situation for many years to come

Clubfoot treatment by ponseti method

Objective: To document the outcome of Ponseti method in the treatment of clubfoot

tudy Design: Observational-descriptive study

Place and Duration: Department of Orthopedic Surgery and Traumatology, Liaquat University of Medical and Health Sciences [LUMHS] Jamshoro, Sindh - Pakistan, from January 2007 to December 2010 [4-years]

Methodology: Clubfeet were treated by Ponseti technique. Pirani score was recorded for all subjects at the time of presentation and a foot was considered fully corrected when scored 0- 0.5. Immediately after the removal of last cast, foot abduction braces were used. Follow-up pattern was at two weeks, at three months, then at four month interval up to 3-years age, then at six month interval up to 4- years age, and then once a year. Any relapses were treated accordingly. Tenotomy was repeated in equines, whereas castings were repeated in adduction of forefoot, intoeing and cavus

Results: During the study period 49 children presented 71 clubfeet with 27 [55.1%] unilateral and 22 [44.9%] bilateral cases. The mean Pirani score at the time of presentation was 5.44. Majority [63.38%] feet required casting up to 5-weeks and in 69.01% feet complete correction was acquired by five casts [mean 5.6 casts]. Achilles tenotomy was performed in 65 [91.55%] feet. Pirani score of 0-0.5 was achieved in 69 [97.18%] cases within 1-year follow-up. Thirteen [18.31%] cases of relapse were reported. Among these, 2 [2.82%] cases of equinus underwent repeat tenotomy; whereas 7 [9.86%] cases of adduction, 3 [4.23%] cases of cavus and 1 [1.41%] case o intoeing were treated by repeat casting

Conclusion: Ponseti method can be used in our setup with excellent correction of clubfoot deformity, and surgical complications can be minimize by this technique

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

Serum calcium levels in skeletal tuberculosis

Objective: to evaluate the serum calcium levels in the patients suffering from tuberculosis of various bones and joints

Design: observational case series

Place and duration of the study: the Department of Orthopedics Unit-I Liaquat University of Medical and Health Sciences Jamshoro from December 2006 to November 2007

Patients and methods: forty-one patients, age 06-75 years, of either gender suffering from tuberculosis of various bones and joints were evaluated for the serum calcium levels. There were 14 males and 27 females with male-female ratio of 2:3. The involved bones and joints included knee [19.51%], dorsal spine [17%], elbow [14.63%], ankle [14.63%], wrist [12.19%], hip [9.75%], shoulder [7.31%] and ilium [4.87%]

Results: serum calcium level range was 1.7-mg/dl, minimum 5.50 mg/dl and maximum was 7.20 mg/dl. Mean +/- SD calcium level was 7.50 +/- 0.92 mg/dl, median 7.50 mg/dl and mode was 7.40 mg/dl

Conclusion: the serum calcium levels in patients suffering from skeletal tuberculosis appear to be low

Anterior decompression, fusion and plating in cervical spine injury: our early experience

To evaluate the efficacy of anterior cervical decompression, fusion and titanium plate fixation in sub axial cervical spine injuries in respect of neurological outcome, postoperative stability and early rehabilitation. The Descriptive case series study was conducted at Department of Neurosurgery, Liaquat University Hospital, Jamshoro, Sindh Pakistan during year 2005 to 2007. Patients with cervical spine injuries were admitted during study period were included in this study. All cases were evaluated for their clinical features. During initial phase, level and degree of neurological injury was assessed using ASIA impairment scale. Cervical traction was applied to all patients. Operative and post operative record with x-rays and MRI were maintained. Patients with Injury to C3-6 underwent decompression, fusion and local titanium plate implant fixation by anterior approach. The follow-up ranged from 6 to 12 months with clinical and radiological assessment. 37 cases of sub axial cervical spine injuries included in this study during year 2005 to 2007. Out of these, 28 [75.67%] were males and 9 [24.32%] females. Age range was 8-60 years mean [32-40%]. Common mode of injury was fall. Post operative follow up showed good clinical and radiological outcome, bony fusion and favour early rehabilitation. No immediate complication found except temporary dysphagia. Anterior decompression, fusion and titanium plate fixation is an effective method with good neurological and radiological outcome