Surgical fixation of clavicular fractures outcome and complications

To determine the outcome of K-wire fixation of Clavicular fracture in terms of union rates and complication profile. Retrospective case series study. This study was carried out at DHQ teaching hospital Abbottabad and Mansehra from March 2009 to Feb 2011. Forty five adult patients with displaced mid clavicular fractures treated with K-wire fixation in a standard Supine position were included in this study. Out of 45 patients, non union occurred in only two, Implant failure occurred in the same two cases. Most of the complications were of minor nature consisting of superficial wound infection 2, delayed union 4 and pin prominence at insertion site 10. No major nerve or vascular injuries occurred. Intra medullary K-wire fixation of displaced mid clavicular fracture with protection in early post operative period is a safe and simple procedure, achieving good union rates without major complications

audit of undescended testis treated at DHQ hospital Abbottabad

Undescended testis or cryptorchidism which occurs in 2% of boys born at term, is one of the most common congenital abnormalities, Cryptorchidism is associated with impaired fertility and is a risk factor for testicular cancer. There is evidence that post natal germ cell development deteriorates in the undescended testis after the first year and perhaps for this reason, the risk of infertility increases with age. The question of whether the age at treatment has any effect on the risk of testicular cancer is controversial. Primary management of cryptorchidism is surgery which is usually performed in infancy. A retrospective study. This study was conducted at DHQ Hospital Abbottabad from Oct 1998- Dec 2008. Total of 159 patients were treated during this period. Children of allages were included. The patients were divided into different age groups. Patients were investigated with physical examination, ultrasonography, CT scan and MRI. All patients were treated with open surgical orchidopexy. Pre operative complications were evaluated. Patients were followed up and complications were noted. The common age group was above 05 yrs 80 patients [50%].Rt side was involved in 82 cases [52%] and Lt side in 54 cases [34%]. Inguinal hernia was the most common associated finding 76 cases [48%] with cryptorchidism. The results indicate that age at orchiopexy has an effect on the risk of testicular cancer in boys with an undescended testicle. The risk among those treated at 13 years of age or older was twice the risk among those who were treated at younger ages. Failure of the testicle to descend through the inguinal canal during the fetal life may be related to enough of a specific type of maternal hormones, failure of testis to respond to inadequate pull from the gubernaculum, or various other factors. Ultrasound can help to identify testicle located in the inguinal canal, but is of limited use for intra abdominal testis. MRI and CT scan can be useful for intra abdominal testis, but they are often difficult to use on small children and have a high rate of false negative results. Many men who were born with undescended testes have reduced fertility, even after orchiopexy in infancy. The most effective treatment is surgery which is usually performed in infancy. Hormonal treatment has the advantage of avoiding anesthesia and being minimally invasive. HCG is the drug of choice. However success rates have been reported to be as low as 10%. The principal major complication of all types of orchiopexy is loss of the blood supply to the testis, resulting in the loss of the testis due to ischemic atrophy or fibrosis

Desarda repair - a new method of tension free repair for inguinal hernia - experience of 77 cases at DHQ hospital Abbottabad

To determine the frequency of patients with inguinal hernia in whom Desarda repair can safely be accomplished and study the morbidity and mortality in such cases. Inguinal hernia is a common disorder in males which requires corrective surgery to lead a comfortable life. Tension free surgery is aim of the surgeon to avoid recurrence of the disorder. Mesh repair has been the most widely performed surgery for inguinal hernia. A new technique of inguinal hernia repair has been developed which utilizes the normal tissue of the patient to create a tension free repair. A prospective study. This study was conducted at DHQ Hospital Abbottabad from September 2009 -June 2011. A prospective study was conducted at DHQ Hospital Abbottabad on 77 patients having inguinal hernia. All patients above the age of 15 years were included. Patients having recurrent inguinal hernia were excluded from study. Most common age group was [56-65 yrs]. Out of 77 patients 64% were of indirect inguinal hernia while 36% were of direct inguinal hernia. Common age group with direct hernia was above 50 years. Post operative complications, hospital stay and return to routine activities were evaluated. Hematoma formation and wound infection in two cases were only complications noted. Patients were free of post operative pain. Desarda repair is simple, very safe technique of inguinal hernia repair free from any complications

Cancelled elective general surgical operations in Ayub teaching hospital

Cancellation of operations in hospitals is a significant problem with far reaching consequences. This study was planned to evaluate reasons for cancellation of elective surgical operation on the day of surgery in Ayub Teaching Hospital, Abbottabad. From July 2006 to June 2007 the medical records of all the patients who had their operations cancelled on the day of surgery in all the three General Surgical units of Ayub Teaching Hospital, Abbottabad were audited prospectively. The number of operation cancelled and reasons for cancellations were documented. 3756 patients were scheduled for surgery during the study period. 2820[75%] patients were operated upon. 936 [25%] operations were cancelled out of which 338[36%] were cancelled due to shortage of time, 296[31.6%] were cancelled due to medical reasons, 152[16.2%] were cancelled due to shortage of beds while 55[5.8%] were cancelled due to shortage of anaesthetists. Three operation lists were lost completely. The Anaesthetist cancelled 43%, Surgeon 39% while 18% of operations were cancelled due organizational reasons. Cancellation of patients on operation lists occupy a substantial population [25%] of cases. Majority of cancellation were due to reasons other than patients medical conditions. Better management could have avoided most of these cancellations

Combined abdominal hysterectomy, cholecystectomy and appendicectomy: a study of 25 cases in Abbottabad

Gallstone disease is common in women. Many patients undergoing abdominal ultrasound for gynaecological diseases are found to have gallstones. This study was done to see the results of combined abdominal hysterectomy, mini-cholecystectomy and appendicectomy in a set up lacking facilities of laparoscopic surgery. This prospective study was conducted in Ayub Teaching Hospital, Iltaf Hospital and Shahina Jamil Trust Hospital of Abbottabad from August 1998 to July 2004. All patients undergoing combined abdominal hysterectomy and mini-cholecystectomy were exclusively studied with reference to following variables. Age, Weight, Parity, Co-morbid conditions, peri-operative and post-operative complications, blood transfusion, hospital stay and mean extra time for mini-cholecystectomy and appendicectomy after abdominal hysterectomy. There were 25 patients in the study group. The ages ranged from 35-50 years. Mean weight was 65 Kg. There were no operative complications. Mild postoperative complications occurred in 7[28%] patients. Mean extra time for cholecystectomy was 25 minutes. Mean hospital stay was 9 days. In selected women, combined abdominal hysterectomy, cholecystectomy and appendicectomy is a safe, feasible and cost effective procedure

Evaluation and management of diabetic foot according to Wagner's classification. A study of 100 cases

Wagner's classification is the most widely utilized grading system for lesions of the diabetic foot. The aim of the study was to evaluate and manage the different lesions of diabetic foot according to Wagner classification. This will help to describe the lesions we treat study and compare outcomes and also identify measures to decrease morbidity and mortality due to diabetic foot disease. The study was conducted in surgical 'c' unit of Khyber teaching hospital, Peshawar from July 2002 to June 2003. 100 patients with diabetic foot disease were included in the study. Detailed history, clinical findings and investigations were recorded. Lesions were graded according to Wagner classification and appropriate medical and surgical treatment carried out. Diabetic foot disease formed 1.04% of total admissions and 0.23% of OPD patients. 62 [62%] were males and 38 were females. Common age group was 40 ' 60 years, 6 patients had grade 0, 14 grade 1, 25 with grade 2, 30 with grade 4 and 4 with grade 5 lesions. 17 patients were managed conservatively with antibiotics alone, 33 had incision drainage and debridement while 48 needed amputation of different types. Staphylococcus aureus was the commonest organism isolated. Majority of the diabetic foot lesions were in grade 2 to 5. Lesser grade lesions responded well to conservative treatment with antibiotics and surgical debridement while those with higher grades needed amputations. Effective glycemic control, timely hospital admissions, approximate surgical / medical treatment along with patient education in foot care can decrease morbidity and mortality due to diabetic foot disease