Pattern of bony injuries among civilian gunshot victims at tertiary care hospital in Karachi, Pakistan / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Firearm injuries impose a continuous economic burden on society and hospital resources. The aim of this study was to assess the pattern of bony injuries among victims of gunshots.</p><p><b>METHODS</b>A retrospective study was conducted in the Department of Orthopedics, Dow University of Health Sciences and Civil Hospital Karachi from January 2011 to December 2012. Patients with isolated bony injuries were included while patients with other systemic injuries were excluded.</p><p><b>RESULTS</b>There were 90 cases and the majority of them were male (84.4%). Mean age was (32.52 ± 10.27) years. Most of the patients (72.2%) belong to the younger age group. A low velocity weapon was used in 61 (67.8%) cases and a high velocity weapon was used in 29 (32.2%) cases. Armed robbery (64.4%) was the cause of conflict in more than half of the cases. Lower limb was involved in 72.2%. Fifty eight (64.4%) patients remained hospitalized for 15-20 days and others for more than 20 days. Internal fixation with intramedullary nailing was done in 35 patients while K-wire was used in 5 patients. Fifty patients were managed with external fixation, either uniplanar or multiplanar ilizarov. Deep wound infection and nonunion were observed more often in high velocity injuries.</p><p><b>CONCLUSION</b>Armed robbery was the leading cause of gunshot bony injuries in our hospital. Young males were victimized in a majority of cases. High velocity injuries were associated with more complications.</p>

Vacuum assisted closure- utilization as home based therapy in the managementof complex diabetic extremity wounds

Vacuum assisted closure is a reported technique to manage complex wounds. We have utilized this technique by using simple locally available material in the management of our patients on outpatient basis. The objective of this study is to present our experience. This study was conducted from June 2011 to June 2013 at Dow University Hospital and Aga Khan University Hospital, Karachi. There were 38 patients managed with vacuum assisted closure. Mean age was 56 +/- 7.8 years. Twenty three patients presented with necrotizing fasciitis and 15 patients with gangrene. Lower limbs were involved in majority of the patients. Debridement or amputations were done. Vacuum dressing was changed twice weekly in outpatient department. Wounds were closed secondarily if possible or covered with split thickness skin graft in another admission. All the wounds were successfully granulated at the end of vacuum therapy. Mean hospital stay was 7.5 days. Vacuum dressing was applied for a mean of 20 days. There was reduction in the size of the wound. Thirteen patients underwent secondary closure of the wound under local anesthesia, 18 patients required coverage with split thickness skin graft and 7 patients healed with secondary intention. Vacuum assisted closure appeared to be an effective method to manage complex diabetic wounds requiring sterile wound environment

Fracture shaft of femur; management outcome in children between 10 to 14 years of age treated by intramdullary rush nail

In school going children surgical treatment is favoured with the introduction of elastic intramedullary nails. The aim of this study was to determine the management outcome of fracture shaft of femur in children between 7-14 years of age by intra medullary rush nail. This study was conducted at department of orthopedic surgery, Dow University of health science and civil hospital Karachi. Duration of study was 12 months from 01-09-2011 to 31-8-2012. Children with closed fracture shaft of femur age 7-14 years of either sex meeting the inclusion criteria were included. Children were diagnosed clinically and confirmed on X ray, open reduction and internal fixation with appropriate size rush nail was done by senior orthopedic surgeon. Thereafter patients were followed every month and the final outcome was measured at the end of third month post operatively. Male were 58% while female were 42%, the average age of the patients were 11.78+/-1.40 years. Management outcome of fracture shaft of femur in children by intra medullary rush nail showed that 100% children fracture were healed. We found a very high success rate in the management of closed fracture shaft femur with intramedullary rush nail. This surgical procedure is simple, technically less demanding, and suitable in peripheral rural hospital in developing countries

Management of type-II open fracture shaft of femur with intramedullary interlocking nail

To find out frequency of fracture healing with the use of interlocking intramedullary nailing in type-II open fracture shaft of femur. Descriptive case series. Orthopaedic Surgery, Unit I Civil Hospital, Karachi, from August 2009 to August 2010. Sixty-five patients who sustained type-II open fracture of shaft of femur, were selected. All patients underwent fracture stabilization by locking intramedullary nail. The main outcome measure was fracture healing [i.e. callus formation] on x-ray at six months of follow-up. The SPSS version 13 was applied used to analyze data. Majority of the patients [44.6%] were between 18-30 years of age. Males were affected more than females with male to female ratio of 4:1. Road traffic accidents were responsible for these fractures in 73.8% of cases. Healing [i.e. callus formation] was achieved in 61[93.8%] patients radiographically at the end of six-months. Mean time to union was 18.5 weeks. Intramedullary interlocking nail was safe and effective in the management of type-II open fractures of femur shaft with excellent healing rates

Is open diaphyseal femur fracture managed by delayed interlocking intramedullary nail: a prudent choice?

To review experience of delayed intramedullary nailing of open femur diaphyseal fractures in resource limited setting and to find out frequency of complications. Patients with open diaphyseal femur fracture were admitted through accident and emergency department. After initial resuscitation of the patients, emergency wound debridements were performed. Fractures were stabilized initially by applying skeletal traction. Subsequent debridements were done when indicated. Unreamed intramedullary nailing were done when there was no evidence of wound infection. After discharge, patients were followed up in out patient department every four weeks and complications noted. All patients were followed for at least 6 months. Forty five open fracture of femur shaft were treated by delayed intramedullary nailing. There were 32 males and 13 females with a mean age of 23 +/- 7.3 years. Road traffic accident was the commonest cause of fracture in 30 patients. Delay between injury and surgery was 8.5 [mean] [SD4.8] days. Average duration of surgery was 60.2 +/- 17.6 minutes. Closed unreamed interlocking nailing was done in 38 patients, while in 7 patients open intramedullary nailing was done. In five patients postoperative infection was noted, delayed union in five and limb shortening in three patients. Knee joint stiffness was noted in 12 and metal failure in three patients. In developing countries where facilities for intramedullary nailing in emergency operation theater, are not uniformly available, delayed internal fixation with unreamed interlocking nailing is a good option for the management of open diaphyseal fracture femur

Radiological outcome of type ii open diaphyseal fractures of tibia with interlocking intramedullary nailing

To determine the fracture healing [callus formation] with the use of interlocking intramedullary nailing in type II open diaphyseal fractures of tibia. Forty patients with open type II tibial diaphyseal fracture of tibia were included in this case series study conducted in Orthopaedic Unit-1 of Civil Hospital Karachi from August 15, 2008 to August 14, 2009. All patients underwent fracture stabilization by reamed locking intramedullary nail within three days of injury. The main outcome measure was fracture healing [i.e. adequate callus formation] on X-ray at twenty four weeks. The SPSS version 13 was used to analyze data for descriptive statistics. Majority of the patients [42.5%] were between 18-30 years of age group with mean + SD age was 36.50 [12.89] years. Males were affected more than females with male to female ratio being 4:1. Adequate callus formation was achieved in 35 [87.5%] patients radiographically at the end of six-months. Intramedullary interlocking nail can be safe and effective in management of open type II diaphyseal fracture of tibia as it is associated with satisfactory healing

Pattern of serum vitamin D in OPD patients

To find out the prevalence of Vitamin-D deficiency in conditions other than osteomalcia and rickets in our part of the world. Prospective and observational study from Feb. 2005 to Dec. 2006. Multi-centric including Civil Hospital and Abbasi Shaheed Hospital, Karachi. Only those patients were included who had any structural or biochemical changes in the body. Serum Vitamin-D level of all patients was sent for estimation from a single reputable laboratory, apart from serum calcium, phosphorus, alkaline phosphatase and routine blood investigations. All data was collected and processed on SPSS Version 10. Of the total 79 patients, 58[73%] were females and 21[27%] males. Minimum age was one year and maximum 90 years, with a mean age of 41.91 and standard deviation of 19.1. Majority of the patients were seen in the 4th, 5th and 6th decades of life, and most of them were house wives. The serum Vitamin-D level was found low in 73[92%] patients and the most severe form of deficiency was seen in patients with tuberculosis. Vitamin-D deficiency was seen in 92% of our patients, belonging to all age groups and suffering from different diseases

Osteomalacia in females

This is a descriptive study conducted in Orthopaedic unit 1, Civil Hospital Karachi from January 2000 to December 2003. Two hundred female patients were included in this series of which 128 were unmarried, 52 were multipara having more than 5 children. 128 were students. Main presenting symptoms were waddling gait and generalized body pain. Serum calcium was low in 60 patients, serum alkaline phosphatase level was elevated in all cases, serum phosphorus was below normal in 108 patients, serum P.T.H. was elevated in 108 patients. Serum vitamin D2 level was decreased in 140 patients. Loosers zone was main radiological finding noted in 130 cases