effect of pamidronate on bone mineral density in primary osteoporosis in Pakistani population

Objective: To study the protective effect of Bisphosphonates [Pamidronate] in patients of primary osteoporosis in Pakistani setup. Study Design: Quasi experimental study. Place and Duration of Study: The study was carried out at department of orthopedic and spine surgery, CMH Rawalpindi, from Sep 2011 to Sep 2013

Material and Methods: A non probability convenience sample was collected from 50 patients who visited orthopaedics department with complaints of generalized aches and pains and diagnosed to have primary osteoprosis. Osteoporosis was confirmed by DEXA scan, with a T-score of more than -2.5. Pamidronate-a bisphosphonate, was given I/V on monthly basis along with oral calcium. After 6 month and one year DEXA scan was repeated to observe its effect on bone mineral densit

Results: Osteoporosis T score of DEXA scan was seen to improve by 19.3% [0.193 T score improvement] with a p-value less than 0.05

Conclusion: Pamidronate treatment increased bone mineral density in osteoprotic patients

Frequency of different level of amputations in type-2 diabetics

Objective: To determine the frequency of different levels of amputations in type-2 diabetics. Study Design: Cross sectional study. Place and Duration of study: Department of Surgery Combined Military Hospital, Peshawar, from 27 Aug 2012 to 27 Feb 2013

Material and Methods: Non probability consecutive sampling technique was used to enroll 158 type-2 diabetics undergoing amputations satisfying inclusion/exclusion criteria. Data regarding level of amputation, glycosylated Hb% and duration of diabetes mellitus [DM] was recorded followed by analysis using SPSS version 17

Results: Total 158 patients were enrolled, 102 [64.5%] male and 56 [35.44%] female, with male female ratio of 1.8:1. Mean age of presentation was 54.99 +/- 7.84 years in males and 55.14 +/- 8.99 years in females respectively, the difference being statistically insignificant [p=0.912]. Mean duration of DM was found 10.88 +/- 3.16 years in males and 10.03 +/- 2.50 years in females while mean level of glycosylated hemoglobin was 7.54 +/- 0.68 and 7.35 +/- 0.63 in males and females respectively, both values statistically insignificant. Below knee amputation [BKA] was done in 55 [34.8%] patients, above knee amputation [AKA] 34 [21.5%], Toe amputation [TA] 42 [26.6%] and foot amputation [FA] in 27[17.1%]

Conclusion: Majority of the patients underwent major amputations and most frequent level of amputation was below knee amputation

Outcome of instrumented spinal fusion for chronic low back pain: review of 100 patients

Objective of this study was to evaluate the outcome of instrumented spinal fusion in selected patients with Chronic Low Back Pain [CLBP] in our setup. Quasi-experimental study. Spine Unit, Orthopaedic Department, Combined Military Hospital, Rawalpindi, Pakistan. Jan 2002 to Dec 2007. Consecutive first one hundred patients were selected from spine unit database that underwent instrumented spinal fusion for chronic low back pain lasting more than one year, due to degenerative disease of spine. Average age was 42 years. There were 62 males and 38 females. Diagnosis included; spinal stenosis [26%], failed disc surgery [22%], spondylolisthesis [19%], degenerative disc disease [17%], and instability [16%]. Operations performed; Pedicle Screw Fixation [PSF] with Postero-lateral Fusion [PLF] in 3% patients. Trans Laminar Facet Screw [TLFS] with PLF in 24% patients. Anterior Lumbar Inter-body Fusion [ALIF] in 9% patients. Posterior Lumbar Inter-body Fusion [PLIF] in 40% patients and Trans-foraminal Lumbar Inter-body Fusion [TLIF] in 24% patients. Average follow up was for 30 months. 86% patients had full spinal fusion. 71% patients were fully satisfied with treatment, 28% were partially satisfied. Post-operatively, on average, visual analogue scale [VAS] showed 48 points significant improvement and Oswestry Disability Index [ODI] showed 53 points significant improvement. Instrumented Spinal Fusion is effective in our set up for relieving symptoms and improving functional outcome in selected patients with debilitating Chronic Low Back Pain due to degenerative disease of spine. Single fusion technique is not ideal for all types of patients and surgeon has to be versatile and trained in using different fusion techniques as the situation demands

Comparison of shoulder function, radial nerve palsy and infection after nailing versus plating in humeral shaft fractures

To compare shoulder function, radial nerve palsy and infection after interlocking nailing with plating of fractures of shaft of humerus during 30 weeks of follow-up. Experimental study. Orthopaedic Wards of Combined Military Hospital, Rawalpindi, from November 2006 to November 2008. Two groups of 30 patients each were inducted. Group A [n=30] was treated with intramedullary interlocking nailing while Group B [n=30] underwent plating with dynamic compression plate [DCP]. Shoulder function using ASES score, radial nerve palsy and infection were observed for 30 weeks. In group A, 11 patients had severe or moderate shoulder dysfunction [ASES score below 39], out of whom 8 [72%] were above 50 years. This age related disability was significant [p=0.003]. Transient palsy was observed in 3 patients [10%] and mild wound infection in 2 [6%], which was not associated with age or open fracture. In group B, only 1 patient had severe shoulder dysfunction, the difference was statistically significant between the two groups [p=0.001], especially in patients above 50 years of age. There was no statistical difference in infection and palsy rates between the two groups. Although nailing and plating are effective treatments for fractures of shaft of humerus, ante-grade nailing may not be suitable in elderly patients, as it can cause significant shoulder dysfunction

Results of surgical procedures for brachial plexus injuries due to penetrating trauma

The incidence of brachial plexus injuries is on the rise primarily due to the increase in road traffic accidents and the upsurge of violence in our society in general. Inappropriate and poorly timed management can lead to disastrous consequences, not only for the individual but also for the society as a whole. Twenty four patients who received penetrating wounds resulting in damage to the brachial plexus are presented. The time lapse between injury and surgery, level and extent of disability, mode of evaluation and the surgical procedures performed are discussed. Exploration and repair was performed in patients who presented early and in those with total lesions without evidence of recovery. Muscle transfer was the mainstay in patients who presented late and in whom some muscle groups had been spared. The results of surgery have been encouraging although the period of follow-up is relatively short. It is concluded that with the judicious use of intact muscles, nerve repair and grafting in selected cases and extensive physiotherapy useful function can be achieved even in patients with extensive post ganglionic lesions