Level of vitamin d in Orthopaedic Trauma among adult patients

Background: The evidence on level of vitamin D in trauma patients is scarce in the developing countries

Objective: To determine the levels of vitamin D in trauma patients above 18 years of age

Methodology: This was a cross sectional study conducted on patients admitted in the Orthopedic department of Sheikh Zayed Medical College /Hospital, Rahim Yar Khan, patients included in this study were 340. The duration of study was 21st July to 16th March 2016. Vitamin D level were measured by using vitamin D kits [Roche]. Patients less than 18 years were not included in the study. Data was analyzed by using SPSS version 16

Results: A total of 340 patients admitted in orthopedic department were included in this study. Overall 92.6% patients have deficient or insufficient level of vitamin D. Most of the patients [68.8%] were less than 45 years of age. Majority of the patients were male [71.8%]. Most of the patients [72.4%] were not smokers. Majority belonged to rural areas [56%], and have no history of steroid intake

Conclusion: This study confirmed that majority of the trauma patients were vitamin D deficient or insufficient. This highlights that trauma surgeons should consider vitamin D in the armamentarium of orthopaedic treatment

Outcome of wound coverage around ankle joint with sural artery flap

Background: Trauma is the most common cause of fractures and majority of these fractures involve the foot. So the early coverage is mandatory to prevent the complications, it is challenging to the orthopaedic, plastic and reconstructive surgeons. Sural artery reversible flap is one of the options

Objective: To determine the outcome of sural artery flap for wound coverage around ankle

Methodology: A total of 24 patients were included in this interventional study. All the patients having wound around the ankle due to any cause and of either sex presenting in emergency department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1st June 2014 to 30th April 2016 were included in this study. Outcome was measured as "Good", "Fair" and "Poor". The data was entered and analyzed by using SPSS version 16

Results: In this study 24 patient were operated, 41.66% were children and 54% were male. In 50% heel region was involved and in 25% melleolar region and 12.5% dorsum of foot and in 12.5% above ankle joint. Outcome noted was "Good" 83.3% "Fair" 8.3% and "Poor" 8.3%

Conclusion: Sural artery flap for the coverage around ankle is simple, safe and can be performed by orthopedic surgeon at any center without the requirement of special instrumentation and special test, with good outcome

Comparison of outcome of fractures of inferior pole of patella

Background: Fractures of patella are common and it constitutes about significant proportion of all skeletal injuries resulting from either direct or indirect trauma

Objective: To evaluate the outcome of inferior pole fractures of patella treated with tension band wiring and resection of avulsed fragment and re-attachment of ligament to patella

Methodology: This was an comparative study, carried out in Department of Orthopaedic surgery of Lahore General Hospital, Lahore from 16[th] June 2012 to 15[th] June 2014. A total of 20 patients were included in this study. These patients were randomly divided into two groups. In Group-A patients were treated with open reduction and internal fixation with tension band wire and in Group-B patients were treated by resection of the avulsed fragment and reattachment of the patellar ligament to the patella. Patients were followed up for surgical site infection and functional outcome at 1[st], 7[th], 15[th], day one month, three months and six months post operatively. Final outcome was assessed by using Bostman criteria. Data entry and analysis was done by using SPSS version 17

Results: Mean age of all 20 patients was 34.20 +/- 12.13 years. Although both treatment groups had statistically same rate of surgical site infection from 1[st] day till 15[th] day post operatively. From 1[st] month till 6[th] months follow up time period none of the patients had surgical site infection in both treatment groups. At 1[st] month and 6[th] month post operatively in Group-B outcome was statistically better as compared to Group-A patients. But at 2[nd] month outcome of patients was statistically same in both treatment groups

Conclusion: Resection of the avulsed fragment and reattachment of the patellar ligament to the patella had good outcome according to the Bostman criteria as compared to open reduction and internal fixation with tension band wire

Outcome of surgical treatment of de-quervains disease

Background: De Quervains disease causes significant pain among patients

Objective: The purpose of this study was to evaluate the outcome of surgical treatment of de-Quervains disease

Material and Method: This cross-sectional study was conducted in Sheikh Zayed Medical College/Hospital Rahim Yar Khan from 1[st] January, 2009 to 31[st] December 2011. Patients with de Quervains disease who did not respond to conservative treatment with analgesics, splintage and local steroid injections for four to six months, were operated under local anesthesia. The tendons of abductor pollicis longus and extensor pollicis brevis were released in separate compartments. Patients were followed for a minimum of 4 months to assess the outcome of procedure. The data was analyzed by using SPSS version 15

Results: A total of 20 patients were included in study.Female to male ratio was 8:1. All females were house wives, exposed to manual work, four of them had rheumatoid arthritis. The age range was 35-50 years with mean age of 39 years. Results of surgical treatment were excellent with 94% patients being completely relieved of symptoms

Conclusion: Surgical release of first dorsal compartment [abductor pollicis longus and extensor pollicis brevis] of wrist has excellent results in patients with resistant De-Quervains disease