ABSTRACT
Flexor tendon injury is one of the most common hand injuries. This initial treatment is of the utmost importance because it often determines the final outcomes; inadequate primary treatment is likely to give poor long term results. Various suture techniques have been devised for tendon repair but the modified Kessler's technique is the most commonly used. This study was conducted in order to know the cause, mechanism and the effects of early controlled mobilization after flexor tendon repair and to assess the range of active motion after flexor tendon repair in hand. This study was conducted at the department of Plastic Surgery, Pakistan Institute of Medical Sciences, Islamabad from 1[st] March 2002 to 31[st] August 2003. Only adult patients of either sex with an acute injury were included in whom primary or delayed primary tendon repair was undertaken. In all the patients, modified Kessler's technique was used for the repair using non-absorbable monofilament [Prolene 4-0]. The wound was closed with interrupted non-absorbable, polyfilament [Silk 4-0] suture. A dorsal splint extending beyond the finger tip to proximal forearm was used with wrist in 20-30 [degree sign] palmer flexion, metacarpophalangeal [MP] joint flexed at 60[degree sign]. Passive movements of fingers were started from the first post operative day, and for controlled, digits were studies. 94% of the patients had right dominated hand involvement. 51% had the complete flexor digitorum superficialis [FDS] and flexor digitorum profundus [FDP] injuries. Middle and ring fingers were most commonly involved. Thumb was involved in 9% of the patients. Zone III [46%] was the commonest to be involved followed by zone II [28%]. Laceration with sharp object was the most frequent cause of injury. Finger tip to distal palmer crease distance [TPD] was <2.0 cm in 71% cases [average 2.4cm] at the end of 2[nd] postoperative week. Total number of patients was 34 at the end of 6[th] week. TPD was <2.0 cm in 55% patients and <1.0 cm in 38% cases [average 1.5 cm] at the end of 6[th] week. Total 9 patients were lost to the follow up at the end of 8[th] week. TPD was <1.0 cm in 67% [average 0.9 cm] at the end of 8[th] postoperative week. No case of disruption of repair was noted during the study. Early active mobilization programme is essential after tendon repair. Majority of the patients [92%] had fair to good results at the end of 2[nd] week which increased to 97% at the end of 8[th] week to good to excellent
Subject(s)
Humans , Treatment Outcome , Range of Motion, Articular , Splints , Postoperative Care , RehabilitationABSTRACT
Phalangeal fractures are approximately 10% of all the fractures of skeletal system. Most fractures are functionally stable. Surgical treatment is necessary when fracture is displaced and reduction is not possible. This study was conducted in order to study the aetiology, features and management of the phalangeal fractures of hand. This descriptive study was conducted in the department of Plastic Surgery, Pakistan Institute of medical Sciences, Islamabad from June 1[st] 2002 to July 31[st] 2003. Adult patients of either sex with acute injury presenting in the out-patient department and emergency department were included whereas patients below the age of 13 years and patients with amputated digits were excluded. The site and side of fracture were noted. All patients were X-rayed pre-operatively. These patients were divided into two groups. Group A comprised of those patients in whom only closed reduction was done. Group B comprised of patients in whom operative procedure was carried out. Various modalities used were percutaneous Kirschner wire fixation, open reduction and internal fixation with K-wires, screws, microplates and dental wires/ after operation, immobilization of fracture site was done for 3 - 4 weeks. Chi square test was used for statistical analysis of complications in both the groups. 51 fractures were seen in 43 men and 8 fractures in 8 females. Mean age of the patients of group A was 35.6 years as compared to 29.5 years of group B. 31% fractures were associated with soft tissue injury. Ring finger was the commonest to be involved in 36% patients. Left hand [64%] was commonly involved. Left proximal phalanx [31%] was the most frequently injured part. Intraarticular fractures were seen in 10% cases. 15 fractures were treated conservatively and some kind of operative modality was used in 44 fractures. Crush injury remained the commonest cause. In 36% patients fractures were fixed with K-wire using open reduction and internal fixation technique. In 22% patients, only percutaneous K-wire was used. In two patients, dynamic traction device was used. One case of post operative infection was noticed in group B. Whereas only one case of malunion and one case of limited joint movement and stiffness was noted in group A. Results of both the closed reduction and open reduction and internal fixation were equally good [p < 0.05]. If there is any soft tissue injury, it is advisable to use open reduction and internal fixation technique
ABSTRACT
Doxazosin, a quinazoline derivative, is a selective alpha 1-inhibitor that reduces calculated coronary heart disease risk by lowering blood pressure while favorably affecting blood lipid levels. The aim of this study was to cases efficacy and safety of Daxazosin in patients with mild to dolerite essential hypertension. This was an open non-comparative study. The study subjective were 31 patients with essential hypertension. The study involved 2 weeks baseline period followed by 10 weeks titration/maintenance period in which patients received Doxazosin 1mg to once daily. Mean blood pressure of 31 patients was 152 mm H[g] systolic and 98 mm H[g] diastolic at baseline. After to weeks of Doxazosin therapy, the mean systolic and diastolic blood pressure dropped to 135 mmH[g] and 82 mmH[g] respectively. The mean reduction in systolic and diastolic blood pressure was 17 mmH[g] and 16 mmH[g] respectively. These reductions were found to be statistically significant. This confirms the established antihypertensive affect due to vasodilatation. At baseline the mean values for total cholesterol was 192.2 mg/dl, for HDL-c 41.2 mg/dl, for LDL-c 105.1 mg/dl, and for triglyceides was 257.2 mg/dl. At the end of the study the mean values for total cholesterol was 179.1 mg/dl, for HDL-c was 40.6mg/dl, for DL-c 106.7 mg/dl and for triglycerides was 192.2 mg/dl. Thus doxazosin produced a favorable but statiscally insignificant [P> 0.05] effect on lipid parameters. No patient required dose reduction or discontinuation of therapy because of side effects. The global assessment of efficacy of once daily Doxazosin therapy was excellent for 24[77.4%] patients and good in 7[22.6%] patients. The overall assessment of toleration as assessed by the investigator was excellent in 29[93.5%] patients and good in 2[6.5%] patients. it is concluded that Doxazosin is a well-tolerated and effective antihypertensive drug with a favorable effect on blood lipids. Doxazosin provides an alternative first ling drug for the treatment of mild to moderature essential hypertension