ABSTRACT
Objective: The purpose of this study was to have a comparison of frequency of infection between two procedures i.e immediate intramedullary nailing and external fixation in the treatment of type II open fracture of shaft of tibia
Study Design: The study design was a randomized controlled trial
Place and Duration of Study: The study was done at the Department of Orthopedic Surgery, Sir Ganga Ram Hospital Lahore over 1-year period from January 2017 through December 2017
Methodology: This included 40 patients of both genders aged between 19-51 years with type II [Gustilo and Anderson] open fracture of shaft of tibia. These patients were randomly divided in two groups with draw methods with AandB Groups. The patients who were put in group A were treated with External fixator with two half pins on either side of the fracture and patients with Group B allocation were treated with intramedullary nailing. The Frequency of infection was noted and compared between two groups in first 4 weeks after injury. Before including each patient in study a written informed consent was taken
Results: The age of the patients ranged from 19 years to 51 years. There were 32 [80.0%] male and 8 [20.0%] female patients in the study cohort with a male to female ratio of 4:1. Infection was observed in 3 [7.5%] patients. The frequency of infection with IM nail was lower than that of external fixator [5.0% vs. 10.0%; p=0.759]. Similar insignificant difference was observed across various age and gender groups
Conclusion: Frequency of infection was lower in intramedullary nailing group as compared to external fixation group so immediate intramedullary nailing is preferred method in type II open tibial fractures
ABSTRACT
Objective: To assess the risks and benefits of surgical treatment [Open Craniotomy] of Intra-cerebral hematoma [ICH]
Methods: Twenty seven patients of ICH who underwent surgical treatment at Neurosurgical department of Sheikh Zayed Hospital, Rahim Yar Khan, from 1[st] January 2015 to 31[st] December 2015 were included in this study
The primary outcome measured was death and improvement in GCS Status among survivor's at three months
Results: Mean age of the patients was 58.4+/-10.7 and majority of patients [48.1%] were in the age range of 60-70 years. There were 22.2% patients with ICH volume of >50 ml. Six [6] patients had 8 GCS with 50ml volume, who later died in ICU. Three of the patients who expired developed post-operative pneumothorax. These patients also acquired RTI resulting in deterioration of GCS
The rest of the expired patients showed deterioration in their GCS associated with oedma on brain CT scan. One patient died as a result of re-bleed. Twenty one [21] patients were discharged from hospital, two of these patients were lost in second follow up. Rest of the patients showed a gradual improvement in GCS touching 15/15 by 2[nd] follow up visit
Conclusion: Surgical prognosis of ICH depends on the patients GCS received and size of hemorrhage at the time of presentation. Urgent surgical evacuation in patients with rapid deterioration carries good outcome, hence should be considered