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