Partial weight bearing; new quantitative approach

The objective of this study was to quantify scientifically the partial weight bearing advice to the patients so that the treating surgeons and treated patients know exactly how much weight they should bear on the treated limb. Descriptive study. The study was conducted at combined military hospital Sialkot and combined military Hospital Quetta from May, 2003 to Dec, 2006. We studied 150 patients who were operated for osteosynthesis in lower limb. We excluded all patients below age 10 years, poly trauma patients operated for bilateral leg fractures, and associated upper limb fractures. Patients were advised to place studied limb on weighing machine and exert required force. Depending upon implant used, quality of fixation and bone density, 5 to 10 kilogram of weight bearing was started two to three weeks after the operation. This force was gradually increased by 5 to 10 kilograms two weekly interval as union progressed. Average age of the patients was about 40 years most of them were young males, with 5:1 ratio to females. Femur was most commonly involved bone in 81 [54%] patients, while tibia in 69 [46%] patients. Road traffic accident was most common etiology in 95 [63.33%] patients, history of fall, nonunion, and field injuries were etiology in other cases. Locally made implants were used in all cases. External fixator was applied in 45 [30%] and internal fixation was done in 105 [70%] cases. Bone grafting was done in 24 cases. We achieved union in 97.3% patients. Union was achieved in mean 15.1 weeks in internal fixations and 17.3 weeks in external fixators. We had 21 [14%] minor and 8 [5%] major complications most of them in patients requiring external fixators. Quantifying partial weight bearing advice gives confidence to patient that how much weight bearing to be done depending upon fracture geometry, implant used its fixation and bone quality. By avoiding nonspecific terms toe touch, heel touch and partial weight bearing we can advise exactly to bear required weight by this simple method. The result of study shows excellent union rates even in open fractures and infected nonunion. To our knowledge this is the first attempt to quantify partial weight bearing advice. The result of this study will help in understanding the patient regarding weight bearing

Pin tract care in locally made external fixators: a new treatment protocol

To calculate the frequency of pin tract infection in locally made external fixator pins using our set protocol. Descriptive study. This study was conducted in Combined Military Hospital Sialkot and Combined Military Hospital Quetta over a period of 3 years and 6 months from May 2003 to November 2006. A total of 451 Pin tracts from 50 external fixator were studied in forty nine patients. Inclusion criteria was all external fixator pins to the limbs excluding the skeletal tractions. Local Shanz screws and Kirschner wires of two different sizes were studied. The protocol was twice a day cleaning of pin tracts with povidone iodine [pyodine], twice a week soap and water bath with soft brushing where main wound was healed. At the time of removal of fixator the pin tracts were curetted and washed with 0.9% normal saline. Average age of the patients was 32.91 years most of them were young males, 23 [47%] in 3rd and 4th decade. Only 4 [8.1%] were females. Tibia was most commonly involved bone in 38 patients [77.5%], while femur in 6 patients [12.2%] and foot and upper limb were affected in only a few cases. Road traffic accident was most common etiology in 33 [67.34%] patients either presenting as open fractures or infected nonunion. Out of 451 pin tracts, 233 [51.66%] were locally made shanz screw half pins and 218 [48.33%] were locally made Kirschner wires full pins. The mean fixator time was about 17 weeks with maximum 48 weeks and minimum 7 weeks. Maximum follow up was 12 months minimum follow up was 3 months after removal of fixator. We had 25 [10.72%] minor pin tract infections of shanz screws, 5 [2.29%] minor pin tract infections of kirschner wires. We had to remove and change 3 [1.28%] Shanz pins. We had no true complication. Standardizing a set protocol for pin tract care irrespective of wound type has shown excellent results with minimum morbidity. This simple method not requiring any expensive equipment can be tried in any hospital to avoid pin sores