Effectiveness of intra-articular corticosteroid injection in the treatment of idiopathic frozen shoulder

To determine the efficacy of intra-articular corticosteroids in the treatment of idiopathic frozen shoulder. Quasi experimental. Department of Orthopedics Surgery Hayatabad Medical Complex Peshawar, from February 2010 to October 2010. In this study, 113 cases of idiopathic frozen shoulder were selected by non-probability consecutive sampling technique at the outpatient department. Patients received a single intra-articular injection of corticosteroid [methylprednisolone] followed by physiotherapy for four weeks. Shoulder pain and disability index [SPADI] was used as main outcome measure of pain relief and disability. Mean age of the patients was 49 +/- 9.3 year. Using SPADI, the mean baseline pain and disability scores were 81 +/- 7.2 and 79.5 +/- 7.6 respectively which significantly improved to 14.5 +/- 7.4 and 25.6 +/- 18.2 at 4th week of intra-articular injection in the affected glenohumeral joint with p value of 0.000 and 0.040 respectively. Intra-articular steroid injection is an effective and reliable modality of treatment for relieving pain and decreasing disability in idiopathic frozen shoulder.

Relationship of preoperative surgical delay to mortality after hip fracture in elderly patients

To determine whether a delay in surgery for hip fractures affects postoperative mortality among elderly patients. Descriptive case-series Orthopedic department KGMC/PGMI Hayatabad Medical complex Peshawar, from January 2010 to December 2010. This is a retrospective study of 160 patients who underwent surgical treatment of a hip fracture. Postoperative mortality rates were measured in relation to the delay in the surgery and the acute medical comorbidities on admission. Total mortality following the hip fracture surgery was 16.3%, [in-hospital 5.6% and 30-days 10.6%]. When compared pre-operative delay in patients who had surgery within 2 days, those who were operated within 2-4 days and those who waited >4 days, the mortality rates were 1.3%, 5.6% and 9.4% respectively [with significant p value of 0.042]. In patients with acute medical comorbidities, the 30-days mortality was 2.5% in those operated between 2-4 days and 3.7% in those where surgery had been delayed >4 days [insignificant p value 0.56]. Patients with acute medical comorbidities that required treatment prior to the surgery had 1.6 times risk of death in 30-days as compared to those patients who had been initially considered fit for surgery. Mortality was increased when surgery was delayed for more than 2 days for patients who were otherwise fit for hip fracture surgery

Suprascapular nerve block in the treatment of frozen shoulder

To determine the effectiveness of suprascapular nerve block in the treatment of frozen shoulder. Quasi experimental study. Department of Orthopedic Surgery Hayatabad Medical Complex Peshawar, from March 2010 to December 2010. Patients with frozen shoulder received a single suprascapular nerve block. Shoulder pain and disability index [SPADI] were used as main outcome measure of pain and disability. To determine the effectiveness of suprascapular nerve block in the treatment of frozen shoulder. There were total of 64 patients in this study. The mean age was 65.3 +/- 10.1 year. Using SPADI, the mean baseline total, subscale pain and disability scores were 70.9 +/- 6.8, 72.3 +/- 6.9 and 69.5 +/- 8.5 respectively which improved to 24.6 +/- 5.6, 22.3 +/- 5.3 and 27.5 +/- 6.6 respectively at 4 week of suprascapular nerve block of the affected shoulder with p value of 0.000 each. Suprascapular nerve block is safe and effective treatment for relieving pain and decreasing disability in frozen shoulder

Supracondylar fracture of humerus; radiological assessment of closed reduction by Baumann angle

To assess closed reduction by Baumann angle in supracondylar fractures humerus treated by closed reduction and percutaneous pinning. This prospective study of 50 patients who presented with displaced supracondylar fracture of humerus in children between ages 1-12 years were admitted to Orthopedic and Trauma unit of Hayatabad Medical Complex Peshawar over period from January 2008 to July 2009. Closed reduction and percutaneous pinning were performed under general anesthesia and postoperative reduction was assessed by Baumann angle. All patients were followed for one year. Mean age of the patients was 7.02 years +/- 2.25 SD. Loss of Baumann angle in injured side was range from 2° to 8°. Loss of carrying angle in injured side was range from 3° to 9°. When Baumann angle and carrying angle of both sides were compared the mean Baumann angle loss and carrying angle loss were 5.360 +/- 2.22 SD and 4.320 +/- 1.52 SD respectively. Using Flynn's criteria 36 [72%] patients out of 50 patients with carrying-angle loss considered to be excellent results and 14[28%] good results. Neither of the patient developed cubitus varus deformit y after one year of follow-up. Baumann angle of the humerus is a simple and reliable measurement of closed reduction that can be used to predict final carrying angle in supracondylar humeral fractures in children

Iatrogenic ulnar nerve injury after percutaneous pinning of displaced supracondylar fractures of the humerus

To assess iatrogenic ulnar nerve injuries after supracondylar humeral fractures treated with closed reduction and percutaneous pinning. Descriptive case series. Orthopedic and Trauma Department of Postgraduate Medical Institute, Hayatabad Medical Complex Peshawar, from December 2007 to December 2010 Children between 1-12 years of age and extension-type displaced supracondylar fracture of humerus were included. Neurovascular status was assessed before operation. Closed reduction was performed under general anesthesia and confirmed with the image intensifier, followed by pinning. After surgery, a long arm back slab was applied. After the procedure, neurovascular status assessed again. The pins were removed at a mean of 5 weeks [4-6 weeks] postoperatively. The neurological complications were assessed both for sensory loss and motor loss. Clinical and electro-myographic examinations were performed at 6 and 12 weeks postoperatively in patient with ulnar nerve lesions. Eighty two patients presented during the study period. There were 62.2% [n 51] males and 37.8% [n 31] females. Left humerus was involved in 69.5% [n 57] cases. The mean age was 6.61 +/- 2.25 years. A total of three [3.7%] iatrogenic ulnar nerve injuries occurred in these patients. Electromyogram showed partial denervation and conduction blocks at the elbow at 6 weeks. Regenerative electromyogram findings were seen at 12 weeks. Sensory and motor functions in all patients returned at a mean of 8 +/- 2.34 weeks and 22 +/- 4.87 weeks respectively. In all patients nerve function returned completely. Iatrogenic ulnar nerve injury is a common complication of percutaneous pinning in displaced supracondylar fracture of humerus in children but usually it resolves spontaneously

Comparison of below the elbow cast with above the elbow cast in treating distal third forearm fractures in children

To compare the effectiveness of below the elbow cast with above the elbow cast in treating distal third forearm fractures in children. Comparative study. Orthopedic Department, PGMI Hayatabad Medical Complex Peshawar, from March 2010 to June 2011. This study was designed to compare above and below elbow casts for distal forearm fracture in patients aged 4-12 year. A total of 108 patients were managed during the study period. They were randomized into two groups of 54 each; group A above-elbow and group B below-elbow cast. The mean age of the children was 7.10 +/- 2.18 year. Males were 59.3% and females 40.7%. The right side was the dominant limb in both the groups. 19.6% of children in the above-elbow group required remanipulation as compared to 26.4% in the below elbow group with p value of 0.381. The time from injury to manipulation was not significantly different in the 2 groups. Differences between radius and ulna translation and angulation in the anteroposterior and lateral views of the x-rays were not significant. Twenty three children with above elbow cast and 19 children of below elbow cast had complications but the difference was not significant [p 0.324]. Three patients were lost to follow up. Below-elbow casts was as good as above-elbow cast in maintaining reduction of fractures in the distal third of the forearm in children