Tibial shaft fractures: interlocking nail versus plating

Objective: To evaluate and compare the treatment results of tibial shaft fractures treated by two different methods, interlocking nail and plating

Study design: Randomized controlled trial

Place and Duration of study: Department of Orthopaedics and Traumatology, Lady Reading Hospital Peshawar, from February 2014 to February 2017.Methodology: A total of 50 patients with closed tibial shaft fractures were randomly assigned to two equal groups [one treated with closed interlocking nail and the other with plating]. Postoperative results were assessed at one year follow up with Ekeland and Thoresen criteria and graded as excellent, good, fair and poor. Complications like infection, delayed union, nonunion and knee pain were assessed and compared for each groups

Results: Mean age of interlock group was 36+/-10.6 year and plating group 35.1+/-9.9 year. Plating achieved excellent results in 72% patients while interlocking in 44% [p value = 0.04]. Postoperative infection, delayed union, knee pain and screw breakage were 20%, 24%,11% and 20% [ p value = 0.05] respectively in interlocking nail group but none in plating group

Conclusions: Tibial shaft fractures treated with plating gave excellent results with minimal postoperative complications than interlocking nail. We therefore recommend plating as a treatment of choice for treating such fractures

Evaluation of results of interlocking nails in femur fractures due to high velocity gunshot injuries

Femoral shaft fractures are common in adult population due to vulnerability to road traffic accident and firearm injuries. There are various treatment modalities to treat the femur shaft fracture i.e. Plating and screws, Intramedullary nailing, External fixator and Interlocking nails. Comminuted fractures due to gun shot injuries are a challenging problem for orthopaedic surgeons. The objective of this study is to evaluate the role of interlocking nailing in the management of femoral fractures due to high velocity gunshot injuries. This descriptive study was conducted on 68 patients at Orthopaedic unit Postgraduate Medical Institute, Lady Reading Hospital Peshawar, from March 2002 to March 2004. The patients of each gender from age fifteen years onward having femoral shaft fracture due to high velocity gunshot injuries who had not previous surgical intervention were included in the study. The exclusion criteria were intertrochanteric, supracondylar femoral fractures and those who failed the follow-up. All the patients were treated with close or open interlocking nails. The outcome measures were graded excellent, good and poor according to radiological and clinical results. Follow-up was for eighteen months and in some cases up to thirty months. Out of 68 patients 64 [94.12%] were male and 4 [5.88%] were female patients. The age range was from 15 to 65 years [average age of twenty nine years. The close interlocking nails were done in 64 patients [94.12%] and open interlocking nails were done in 4 patients [5.88%]. The static interlocking nailing was performed in 58 patients [85.29%] while dynamic interlocking nailing was performed in 10 patients [14.71%]. Knee flexion contracture in 5 cases [7.35%] and limb shortening of less than 2 Cm in 2 patients [2.94%]. Non-union were in 4 cases [5.88%]. Excellent results were in 42 patients [61.76%], good in 18 patients [26.47%] and poor in 8 patients [11.77%]. Interlocking nailing is one of the best options for the management of femoral shaft fractures due to high velocity gunshot injuries

Infection in orthopedic implant surgery, its risk factors and outcome

Infection in orthopedic surgery is a disaster both for the patient and surgeon. Although its incidence has been reduced due to modern theatre facilities and aseptic measures but in developing countries its prevalence is still high. It is better to prevent infection rather than to treat it. The objective of this study is to know the frequency of infection in orthopedic implant surgery in a public hospital and to evaluate the risk factors, causative organism, complications and treatment. This prospective study was conducted in orthopedic unit-B Ayub Teaching Hospital, Abbottabad, from 1[st] April 2007 to 30[th] October 2007. Close fracture cases admitted for internal fixation devices were included. The exclusion criteria were soft tissue surgery, wounds and open fractures needing external fixation devices. The follow up was done for six months. Infection developed in 6 patients [5.76%], out of which superficial and deep infections were 2 [1.92%] and 4 [3.84%] respectively. There were 2 infection cases in each stage of the infection i.e. early, delayed and late. The staphylococcus aureus was the commonest organism, i.e., 3 [50%] out of 6. The age of the patients was more than 60 years in 3 [2.88%] patients, 30 to 60 years in 2 [1.92%] patients and below 30 year in 1 [0.96%] patient. The smoking history was in 2 [1.92%] patients. Infection rate in our study was quite high and needs proper measures to control it because it had great financial burden on patient and on hospital resources and could lead to morbidity and mortality in patients. We could not find significant risk factors in our small sample size study although the infection was relatively more common in patients with advanced age, prolonged surgery time, smoking and skin abrasion at fracture site. Commonest organism was Staphylococcus aureus

Modified Turco's postero medial release for congenital talipes equino-varus

Talipes Equino-Varus [TEV] is one of the most common congenital anomaly. It is managed by various methods i.e. conservative and surgery. Objective of this study was to determine the efficacy of modified Turco's postero-medical release in children's having congenital TEV. This descriptive observational study was conducted from June 2004 to June 2008 in the Orthopaedics Unit of Lady Reading Hospital [LRH] Peshawar. The inclusion criteria were children of age 6 months to 3 years of age having moderate and severe club foot. The exclusion criteria were clubfoot secondary to some other disorders such as cerebral palsy, arthrogryphosis multiplex congenita, myelodysplasia or congenital dislocation of the hip. The deformity was treated by modified Turco's one stage release. Follow-up was for one year. Results were graded according to modified McKay rating system. A total 70 patients were included in this study with the age range of 6 months to 3 years with moderate to sever deformity. Thirty-eight were male [54.2%] and 32 patients [45.72%] were female, twenty three patients [32.85%] had bilateral club foot while the rest of 47 patients [67.15%] had unilateral deformity. Positive family history of club foot was in 10 patients [14.2%]. Results were concluded on 52 patients who completed one year follow-up. Excellent results were observed in 34 patients [65.38%], good in 9 patients [17.30%], fair in 2 patients [3.84%], and poor in 7 patients [13.46%]. Children up to three years age with congenital TEV can be successfully treated in almost all the cases by modified Turco's one stage postero-medial release