Early results of Ponseti technique for idiopathic congenital talipes equinovarus

Clubfoot or congenital talipes equinovarus is one of the most common congenital anomaly affecting the lower limb. The exact cause is unknown and a number of theories have been postulated to explain its origin. Congenital talipes equinovarus affects both sexes and may be unilateral or bilateral. Clubfoot is sometimes associated with Arthrogryposis multilex congenital, spina bifida, meningomyelocele and muscular dystrophies. This study was conducted to determine the early results of ponseti technique for idiopathic congenital talipes equinovarus. Observational [Follow-up] Study. This study was conducted at orthopedic B-Unit of Ayub Teaching Hospital Abbottabad from 1[st] April 2009 to 30[th] September 2009. Thirty [30] patients from either gender with age from birth to 06 months of age attending the outpatient department of Orthopedic B-Unit of Ayub Teaching Hospital Abbottabad were included in the study. The patients were ranged in age from birth to 06 months of age, with 17 male [56.7%] and 13 female [43.3%]. In our series on follow up, fore foot adduction was detected in 06 cases [20%] and 02 cases had equines relapse [6.7%] and 03 patients had residual equines [10%] while bilateral residual equines was detected in 01 patient [3.3%] and 01 patient had recurrence of deformity [3.3%] for which posteromedial release was done. We concluded that the Ponseti method is a reliable, simple, effective and safe method for the treatment of idiopathic clubfoot deformity

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

Prevalence of Hepatitis 'B' and 'C' in orthopaedics patients at Ayub Teaching Hospital Abbottabad

Hepatitis B and C is a common global health problem and is spreading rapidly in developing countries due to lack of health education, poverty and illiteracy. Both of these infections can be transmitted through blood or body fluids, tattooing, through infected instruments, unsafe shave by barbers and sexual contact. Medical personnel are most exposed to these infections. There should be proper preventive measures to prevent its spread in the community. This is a descriptive study carried out from July 2003 to July 2004 on 1630 patients admitted in the department of Orthopaedics Ayub Teaching Hospital Abbottabad. Patients of either sex, of all ages undergoing surgery were included in the study. All patients underwent screening for Hepatitis-B and Hepatitis-C and confirmed by Elisa method in positive patients. Out of 1630 patients 1205 [73.92%] were male and 425 [26.07%] were female. Hepatitis B and C was present in 84 [5.15%] patients. Out of 84 infected patients 51 [3.12%] were suffering from hepatitis C and 33 [2.02%] were suffering from hepatitis B. In 2 [0.12%] patients both hepatitis B and C infections were present. Out of 51 hepatitis C patients, 33 [64.71%] were male and 18 [35.29%] were female. Out of 33 hepatitis B patients, 28 [84.85%] were male and 5 [15.15%] were female patients. Among the predisposing factors previous history of surgery was positive in 18 [21.43%] patients, history of blood transfusion in 13 [15.47%] patients, dental procedure was in 7 [8.33%] patients, and abroad visit in 4 [4.76%] patients. The prevalence of hepatitis B and C in orthopaedic patients is quite high with the common risk factors: previous history of surgery or blood transfusion. Therefore, all patients which need surgery should be routinely screened for hepatitis B and C to prevent transmission to other patients, medical staff. There should be separate operation theatres facilities for these patients. There should be policy by the Government for protection of medical personnel who are exposed to these patients and there should be compensation for those who get infected with these infections during their service otherwise the medical personnel especially surgeons will hesitate doing surgeries on hepatitis B and C infected patients

Bilateral protrusion of femoral head into the pelvis in neglected osteomalacia

Osteomalacia is a metabolic bone disease in a mature individual, caused by lack of vitamin D or its active metabolites, on account of a number of factors. Osteomalacia is common in females and in countries with less sun shine. It typically presents with body aches, weakness, alongwith signs of bone tenderness and proximal myopathy. Diagnosis is made on the basis of clinical presentation and investigations; serum calcium, phosphorus, serum alkaline phosphates, 24 hour urine for calcium and phosphorus and skeletal radiology

Management of comminuted fractures of the olecranon by tension band wiring

Open reduction and rigid internal fixation has become the generally accepted method of treatment for displaced fractures of the olecranon in order to allow early mobilisation and to prevent contracture of the elbow. Comminuted fractures of olecranon are unstable, therefore, bone graft and tension band wiring are supposed to give good stability. Here we give an account of our experience with this procedure. We treated ten patients with comminuted fractures of the olecranon by multiple tension-band wiring and a graft from the iliac crest between 1999 and 2002 at Ayub Teaching Hospital, Abbottabad. After initial immobilization strengthening and endurance exercises were started. The patients were followed up for stability, muscle strength, active range of flexion and extension at elbow and rotation of forearm. The time to union of the fractures was 3 to 7 months. No patient reported difficulties with activities of daily living or symptoms of instability of the elbow. The median flexion was up to 135° [125° to 145°] with a median flexion contracture of 15° [range10° to 30°]. The median pronation was 70° [60° to 80°] and median supination 79° [70° to 90°]. Only three patients had mild pain and loss of strength. Five patients had excellent and 5 good results with a median Broberg and Morrey index score of 94.5 points [84 to 100]. Our results are in accordance with those reported from other centres and the technique is thought to be a practical alternative to plate fixation of olecranon fractures with extreme comminution

Interlocked nailing of comminuted fractures shaft of femur

Comminuted fracture shaft of femur are difficult to treat. Internal fixation with ordinary nail does not hold the fracture fragments while osteosynthesis with plates and screws does not always produce stable fixation and involves an increased risk of infection. Thirty six comminuted fractures shaft of femur were treated with closed interlocked nailing. There were twenty closed and sixteen open fractures. Thirty six fractures united without additional surgical intervention. Average time to union was 34 weeks [range 26 to 64 weeks]. In five patients secondary bone grafting was done. Closed Interlocked nailing is the treatment of choice for most comminuted fracture shaft of femur

Suture plication of perforated duodenal ulcer

Seventy five cases of perforated duodenal ulcer were managed by suture plication alone. Perforated acute ulcers have a better ultimate outlook in terms, of mortality and morbidity as compared with perforated chronic ulcers. It is suggested that chronic duodenal ulcer cases should have definitive surgery at the time of perforation or soon after the recovery, whereas acute ulcers should be primarily managed by suture plication alone. Where dyspeptic symptoms persist for more than 3 months in acute ulcers after suture plication difinitive surgery must be done at the earliest opportunity