ABSTRACT
Background: Orthopaedic fractures and traumatic injuries are a growing concern for healthcare systems worldwide. Road Traffic Accidents (RTA) are among the top five causes of illness and mortality in South East Asian nations. Trauma caused by other factors, such as accidents at work or home, falls, and assaults, significantly contribute to overall mortality and morbidity. This study aims to investigate the occurrence of traumatic injuries with associated factors and find significant orthopaedic fracture patterns. Material & Methods: This study was a retrospective observational study that was conducted on 208 patients who were admitted to the department of orthopaedics at Dhaka Medical College and Hospital during the study period between April 2004 and June 2007 those who fulfilled the selection criteria were enrolled in this study. All data were processed and analyzed with the help of SPSS (Statistical Package for Social Sciences) version 25. The data were expressed as frequency and percentage in tables and graphs. Results: During the study period total number of study patients were 208 where 131 (62.98%) patients were male, and 77(37.02%) were female. The majority, 53 (25.48%) of the patients, were aged between 31-40 years. RTAs were responsible for 92 cases (44.23%) of all traumatic orthopaedic injuries and followed by falls accounting for 42 patients (20.19%) of injuries. Majority 46(22.12%) of the patients had fractures in femur, second majority 38(18.27%) patients had fracture in tibia/fibula. The most common fracture site being the lower limbs (58 cases, 27.88 %). Conclusion: The study concluded that the incidence of traumatic orthopaedic injuries was higher in young male adults compared to all other study groups. The three most frequent causes of injuries were falls, RTAs, and assaults were the most prevalent form of injury. The most frequently damaged bones are the femur and tibia/fibula.
ABSTRACT
One of the most commonly employed methods of treatment for Lumbar disc herniation with leg pain is epidural steroid injection. Of the three routes being deployed, inter-laminar approach is preferred as needle entry can be directed more closely to the assumed site of pathology, requiring less volume than the caudal route and it is less risky compared to the trans-foraminal approach. For effective placement of the spinal needle in the epidural space, use of C-arm is a must. But, the operation theatre and C-arm is not available in most of the health centers in the developing countries especially in rural settings. Time taken to set up is another issue. To improve the success rate of needle placement in “blind method” of ILESI, we have developed a technique of using digital X-ray of lumbo-sacral spine, which is available universally nowadays, to measure the depth of the epidural space and level of the targeted inter-vertebral space. Objective: To assess the effectiveness of measurements in plain roentgenograms of lumbo-sacral spine in guiding needle placement into epidural space. Methods: A prospective study was taken up in the Dept. of PMR, JNIMS during the period May 2017- Feb 2018. 56 consecutive clinically diagnosed prolapsed PIVD patients were enrolled. Lengths of spinous process and skin thickness were measured using a caliper. A 22G Quincke needle was advanced to the expected depth given by digital xray measurement. 1 ml of Iohexol dye was injected. Position of needle was checked by C-arm x-ray. Results: Out of the total 56 subjects, 46 (82.1%) completed the treatment program. Needle was placed at proper depth in 36 cases by using Xray measurement, giving success rate of 87.8%. Mean (SD) depth of epidural space from skin was found to be 3.82 (o.74) cm as measured from X-ray and actual measurement confirmed by fluoroscopy was 3.9 (0.81) cm (Pearson’s correlation coefficient =0.86). Conclusion: Measurement of depth of epidural space using plain X-ray of LS spine improves the success rate of blind MILESI from around 50% to 87.8%. This method of non-real time imaging is cost effective in developing countries where C-arm X-ray facilities are not available