Acute septic arthritis: open drainage versus needle aspiration

This study aimsto compare the effectiveness of open drainage with needle aspiration in acute septic arthritis in our local population. Randomized controlled trial. This study was conducted in Orthopedics and Trauma unit, Khyber Teaching Hospital, Peshawar from Feb 2009 to Jan 2010. There a total of 114 patients that were randomly assigned to group A and B with 57 patients in each group. Group A was subjected to open drainage and Group B to needle aspiration. The effectiveness of intervention was assessed by the reduction of at least one grade of pain from the baseline on 7[th] post-operative day. In group A 26 [45.61%] and 31 [54.38%] patients had Grade 2 and Grade 3 pain respectively whereas in group B 28[49.12%] and 29[50.88%] patients had Grade 2 and Grade 3 pain respectively[p value 0.0025].Open drainage and needle aspiration in group A and B were effective in 49 [85.96%] and 39[68.42%] patients respectively [p value 0.0025]. Open drainage is more effective than needle aspiration in patients with acute septic arthritis

External fixator; functional outcome in open tibial fractures

Open Tibial shaft fractures are one of the most common fractures of long bones. External fixation is method of choice for the treatment of open tibial shaft fractures. The subcutaneous location of tibia makes it suitable for the application of external fixator. This study was done on 50 patients at Orthopaedics and Trauma unit "B" at Khyber Teaching Hospital, Peshawar, from Jan 2008 to Feb. 2009 to determine functional outcome of A.O. external fixator in open tibial fractures in terms of knee and ankle mobility, pain and gait on full body weight bearing. The data of all patients was entered in standardized proforma and analyzed on SPSS 10. There were 43 [86%] males and 7 [14%] females. There were 17 [34%] type-II and 20 [40%] type IIIA and 13 [26%] type III B fractures. Knee mobility was full [100%] in 49 [98%] cases, 75% in 1[2%]. 43 [86%] cases retained 100% ankle joint mobility while it was 75% in 4 [8%], 50% in 2 [4%] cases and 25% in 1[2%] cases. On full body weight bearing, 42[84%] patients were pain free, and moderate pain was in 4[8%] cases. In 42[84%] cases the gait was completely normal on full body weight bearing while 3[6%] cases showed significant limping. The excellent functional results in our series show that external fixation of tibia is safe and effective in terms of restoring functions of tibia

Effectiveness of local corticosteroids in carpal tunnel syndrome

Carpal tunnel syndrome [CTS] is one of the most common entrapment peripheral neuropathy manifested by signs and symptoms of irritation of the median nerve at the level of the carpal tunnel in the wrist. Carpaltunnel syndrome has been treated by local corticosteroid injection but its effectiveness remains unknown in our set up. To assess the effectiveness of 40 mg methylprednisolone with 10 mg lignocaine injection proximal to the carpal tunnel in patients with the carpal tunnel syndrome. Descriptive Cross Sectional Study. This study was done at Department of Orthopaedics and Traumatology, Khyber Teaching Hospital, Peshawar from February, 2012 to February, 2013. This study comprised of 32 patients. Local steroid injection consisting of 10 mg lignocaine and 40 mg methyl prednisolone was injected at the volar aspect of the forearm close and proximal to the carpal tunnel. The effectiveness was determined in terms of decrease in at least one base line grade of pain and numbness at affected hand during 4 and 12 weeks follow up. There were 4 [12.50%] males and 28 [87.50%] females with mean age of male and female was 30.75 +/- 6.23 and 33.42 +/- 7.07 respectively. In patients with severe pain, the effectiveness was 90.90% and 100% at 4 and 12 weeks respectively. Among the patients with mild numbness, the success rate was 83.33% and 91.67% at 4 and 12 weeks respectively while in case of moderate numbness, the effectiveness was 100% at 4 and 12 weeks follow up in patients. A local single injection of steroids in carpal tunnel syndrome is effective in relieving pain and numbness in short terms

Outcome of intramedullary kirschner wire fixation in children

To know the functional outcome of Intramedullary Kirschner Wire fixation of unstable Radius-Ulna fractures in children. Descriptive study. 27/03/2009 to 26/03/2010. Department of Orthopedic and Trauma, Khyber Teaching Hospital, Peshawar. All patients were admitted from OPD. Children less than 16 years with Unstable Radius-Ulna fractures were included in the study. Patients with open fractures and adults with polytrauma were excluded from the study. Unstable Radius-Ulna fractures were treated by Intramedullary Kirschner Wire fixation under general anesthesia and tourniquet control. Follow up till radiological and clinical union was done. K-wires were removed after healing of fractures. Patients were assessed functionally and radiologically and results were graded according to Price et al Criteria. A total of 64 children with unstable radius and ulna fractures were included in the study. The age range was 6 to 15 years with average age of 10.41 years. 47 were male and 17 were female. The average time of radiological union was 7 weeks and K-wires were removed at 8 weeks time. At final assessment there were 47 Excellent, 10 Good and 7 Fair results. Excellent results can be achieved by Intramedullary K-Wires fixation. In children with unstable Radius-Ulna fractures. It should be the method of choice for treating these fractures

Results of type-III supracondylar fracture humerus with open reduction and internal fixation in children after failed closed reduction

Supracondylar fracture of humerus is the second most common fracture in children which account for 60-75% of all fractures around the elbow. There are various treatment modalities for type-III fracture, i.e., closed reduction and casting, skeletal traction, close reduction and percutaneous pinning and open reduction and internal fixation. This study was conducted to see the outcome of open reduction and internal fixation after failed closed reduction. This study was conducted in the Orthopaedics Departments of Khyber Teaching Hospital Peshawar and Ayub Teaching Hospital Abbottabad from February 2007 to Nov 2007 on 30 children. Patients included were of either gender with age range from 5-12 years with displaced supracondylar fracture [type-III] after failed closed reduction. All fractures were fixed with two cross K-wires by open reduction and internal fixation. The patients were assessed both clinically and radiologically and results were tabulated according to Flynn criteria. Twenty-eight patients had excellent results while two had good results according to Flynn criteria. None of the patients had either fair or poor result. Open reduction and internal fixation is a good and reliable method after failed closed reduction and gives stable fixation with anatomical alignment

Intertrochanteric fracture of femur; outcome of dynamic HIP screw in elderly patients

Intertrochanteric [IT] fracture is common in elderly population. The dynamic hip screw is widely accepted in the treatment of IT fractures of the proximal femur. To determine the outcome of dynamic hip screw in intertrochanteric fracture of femur in elderly patients. A descriptive observational study Department of Orthopaedic Khyber Teaching Hospital, Peshawar. Period: From 7[th] Jan 2008 to 7[th] Jan 2009. 113 consecutive patients with intertrochanteric fracture of the femur treated with dynamic hip screw. All patients were investigated and optimized for surgery. An accurate close reduction was done under fluoroscopic control. A dynamic hip screw [DHS] was inserted by a standard technique. Patients were reviewed clinically and radiographically on 2nd, 6th, 12th and 24th weeks. We studied 113 Patients of intertrochanteric [IT] fracture, 13 patients were lost to follow up and the study was completed on 100 patients. Forty seven [47.0%] patients were male and 53 [53.0%] were female. Postoperatively seven patients [7%] suffered from infections, 3 [3.0%] patients suffered from restricted hip joint movements. There was shortening of lower limb in 3 [3.0%] patients, 2 [2.0%] patients developed non union of the fracture site, 1 [1.0%] patient develop varus deformity. Seven [7.0%] patients had implant failure, 3 of which have lag screw cut-out through superior cortex, 3 patients have broken leg screw at barrel shaft junction and 1 patient has broken leg screw at 3 sites. 77 [77.0%] healed without complications. It is concluded that the Dynamic Hip Screw is safe, suitable and reliable method of fixation for Boyd and Griffin type I and type II intertrochanteric fracture of femur

Evaluation of outcome of facet joints injections in low back pain

To find out outcome of short- and medium-term therapeutic efficacy of facet joint blocks. This descriptive interventional study was conducted in the Department of orthopaedic Khyber Teaching Hospital Peshawar, over a period of nine months January, 2008 to September, 2008. All patients were more than 20 years and less than 70 years with low back pain who were not responding to oral medications and Physiotherapy were included in the study. The facet joint blocks were performed under fluoroscopic guidance. The initial pain response was assessed prospectively using Mac nab and Prolo pain assessment criteria. Additional data, including short-term effect [> 1 week] and medium-term effect [at 3 months], were collected by a structured review interview. A note was made of the results of various imaging studies done in these patients. Just for exclusion and inclusion purposes and not for assessment of outcome which was exclusively based on clinical assessment. A positive effect was seen in 37 patients [74%] and 28 [56%] patients in immediate [with in one week] and short term [after 6 weeks] period respectively, while lesser effect was found in 16 patients [33%] at medium term [after 3 months]. Facet joint blocks appear to have a beneficial medium-term effect in one third of patients with chronic lower back pain and may therefore be a reasonable adjunct to non-operative treatment. However, outcome appears to depend on clinical, not the morphologic, imaging findings

Intramedullary Kirchner wire fixation of unstable radius-ulna fractures in children

To evaluate the results and outcome of paediatric unstable fractures of radius and ulna treated by Kirchner wire fixation. Prospective quasi experimental study from July 2004 to May 2007. Department of Orthopaedics and Trauma, Khyber Teaching Hospital, Peshawar. Children with displaced fractures of both forearm bones, in whom closed manipulation had failed. The children were treated with open reduction and internal fixation of both forearm bones with Kirchner wires [K wires]. Under general anesthesia and tourniquet control the fractures were fixed by retrograde method. Patients were followed every month for clinical and radiological union of fracture and for any complications. The K wires were removed after healing of fractures. The patients were assessed for symptoms such as pain, ability to participate in physical activities or sports, and physical examination was done to see range of motion of wrist, elbow and forearm, Grading of the results was done according to modified Price criteria. The total number of patients was 22. Sixteen were males and six were females. The age range was 6-12 years with an average age of 9.5 years. In most cases the middle third was involved. The average time of surgery was 65 minutes [range 50-95 minutes]. The average time for clinical and radiological union was 9.2 weeks. The mean interval between the initial surgery and removal of the K wires was 3.2 months. At final assessment there were 18 excellent, two good and two fair results. In unstable fractures involving both forearm bones, open reduction and internal fixation [ORIF] with Kirchner wires have excellent results amongst children