Dynamization in the treatment of delayed union of Femur Fracture

Objective: To assess the outcome of dynamization in delayed union of femoral shaft fractures treated initially with static interlocking nailing

Study Design: The descriptive case series study

Place and Duration of Study: The study was carried out at the Department of Orthopedic Surgery Jinnah postgraduate medical centre Karachi, from May 2016 to Feb 2017

Material and Methods: Forty-two patients were included in this study who showed delayed healing of femur fractures from six weeks to six months after initial treatment with static interlocking nailing. Full weight bearing was allowed immediately after dynamization. Rests of the cases were treated with exchange nailing or cancellous bone grafting with or without lengthening and achieved satisfactory outcomes. The patients were followed up for at least 9 months and serial radiographs were taken

Results: Most of the patients [71.4 percent] were between 15 to 30 years of age. The average age of the patients was 26.6 +/- 9.6 years [both males and females]. Out of 42 patients, 30 [71 percent] patients were male and 12 [29 percent] were female with 2.5:1 male to female ratio. The mean age for males was 25.05 +/- 7.5 years whereas the mean age for females was 28.14 +/- 6.4 years. Twenty six patients [62 percent] achieved a solid union with a union period of 21.67 +/- 2.5 weeks after dynamization. 6 of 26 patients who achieved solid union developed femoral shortening of 1 cm to 2cm

Conclusion: Dynamization is a simple, day case method that can be tried to improve fracture healing in femoral shaft fractures that show delayed healing after interlocking nailing with a less developed problem of 1 to 2 com shortening

Aneurysmal bone cyst of ischiopubic ramus: a rare location with literature review

Aneurysmal bone cyst [ABC] is a locally destructive lesion of the bone rather than a true neoplasm. The pelvis is not an unusual site for an ABC; approximately 12% of cases occur in this location. We present a case of aneurysmal bone cyst [ABC] in ischiopubic ramus in a 22 years old male who presented with right inguinal swelling and pain. He was evaluated with X-ray and Magnetic Resonance Imaging MRI of pelvis. A review of literature regarding this rare site of ABC with radiological features is also described in this case report. ABC of ischiopubic ramus is an uncommon entity hence diagnosis of such a case requires proper clinical, radiological and histopathological evaluation to rule out other differential diagnoses of an expansile, osteolytic lesion. This will help in selecting a proper treatment plan

Efficacy of steroid injection in the treatment of trigger finger

Objective:To assess the efficacy of local steroid injection in trigger finger

Materials and Methods:This prospective study was conducted at department of Orthopaedics,Civil Hospital, Dow University of Health Sciences, Karachi, from March 2012 to 2013. Males and females with complain of trigger finger were included in this study during the specified period. All patients were injected depomedrol with plain xylocaine at the nodule site and functional outcome was assessed with respect to pain relief and finger movement

Results: Study included 43 patients with trigger finger.29 were males and 14 were females. Right hand fingers were involved in 24 patients, remaining had left hand fingers involvement. 10 involved the index finger,7 middle finger, 4 ring finger,10 little finger and 12 thumb. 9 patients had associated rheumatoid arthritis and 15 were known cases of diabetes. Remaining patients were primary with no known co-morbid. All patients had pain relief initially and regained movement of finger. 10 patients required repeated injection after 3 months. Maximum pain relief and regaining of movement after steroid injection was 4 months

Conclusion:Local steroid injection provides excellent symptomatic pain relief and regained movements without any complication in patients with trigger finger

Radial head fracture mason type III and IV treated with K-wire Fixation

Objective: To assess the functional outcome of radial head fracture Mason type III and IV treated with K-wire fixation

Materials and Methods:This prospective study was conducted at Department of Orthopaedics,Civil Hospital,Dow University of Health Sciences Karachi from 2013 to 2015. Patients with Radial head fracture type III and IV were included in the study

Results:A total of 42 patients were included in this study. Out of these 36 were males and 6 were females. Right side was injured in 18 patients and left side in 24 patients. 32 patients were with Mason type III radial head fracture and 10 were Mason type IV fractures. All fractures were fixed with open reduction and internal fixation with K-wire. Lateral approach was used in all fractures. In Type IV elbow was reduced with close technique. Outcome was measured on the basis of Morrey elbow scoring system. 22 patients with type III radial head fracture had excellent results while10 with type III had good result. All patients with radial head fractureType IV had good results

Conclusion:Assessment of functional outcome of radial head fracture Mason type III treated with K-wire fixation showed excellent outcome in majority of patients while Type IV had good outcome.Mason type III radial head fractures should be reduced and fixed with K-wire. It maintains the stability of elbow joint and elbow function

Outcome of nonunion femur with Ilizarov technique

Objective: to find the outcome of Ilizarov technique in nounion femur patients

Study design: descriptive case series

Place and Duration of study: department of Orthopaedic Surgery Dow University of Health Sciences / Civil Hospital Karachi, from 1999 to 2014

Methodology: all patients with nonunion of femur with and without bony defect were included in this study. Bone loss cases because of other reasons like congenital causes and bone tumors, were excluded

Results: forty-eight patients with nonunion femur were included in this study. The number of males was 44 and females 4. The mean age of patients was 27 year [range: 07 year to 59 year]. The mode of injury was road traffic accident in fifteen patients, firearm injury in five, crush injury in earthquake in one, postsurgical implant infection in nineteen and chronic osteomyelitis in seven. Nonunion was in proximal femoral segment in three patients, midshaft in sixteen and distal femur in twenty-nine cases. Segmental bone loss was present in thirty-one patients. Preoperative shortening was in noted in thirty-four patients. Ilizarov external fixator yielded excellent and good outcome in majority of the patients for the gap nonunion of femur. Bone transport was needed in few cases

Conclusions: Ilizarov external fixator yielded excellent and good outcome in majority of the patients for the gap nonunion of femur. Bone transport was needed in 10 cases

Outcome of intraarticular communicated fractures distal radius treatment with orthofix external fixators

Background: Assess the outcome of intraticular comminuted fracture distal radius treated with orthofix external fixator

Methods: Prospective study with inclusion criteria of Comminuted intraarticular fractures distal radius, 20 to 60 years age, close and open fractures and exclusion criteria of patient above 60 years, extraarticular fracture, volar and dorsal barton fractures, more then 10 days old fracture

Results: From Januarry 2012 to sept 2014, 63 patient with intraarticular comminuted fracture distal radius treated with orthofix external fixator included in this study. Functional outcome was assessed on Gartland and Wesley scoring system. 40 [63%]male and 23[37%] female patients, 35[56%] road traffic accident and 28[44%] have fall. AO C1, were 32[51%], C2 ,19[30%], C3, 12[19%] patients. Additional kwire fixation applied in 54 patients.Fixator removed at 6 weeks. Functional result were excellent in 26 patient[41%], good 32[51%], satisfactory in 4 patient[6%], poor in 1[2%]. Complication observed were, minor and major pin track infection 30[65%], tethering of external indicis tendon 3[7%] patient, k wire loosening 10[22%] and sudecks atrophy 3[7%] patients

Conclusion: Orthofix external fixator application in intraarticular comminuted fracture distal radius is recommended because it is minimal invasive technique ,have excellent to good outcome . Most of the times needs additional kwire fixation for the fragment stabilization

Functional outcome of the minimally invasive plate osteosynthesis for the supracondylar fractures of femur using dynamic condylar screw

To assess the functional outcomes of minimally invasive plate osteosynthesis [MIPO] for the extra-articular and undisplaced intra-articular supracondylar fractures of femur using dynamic condylar screw [DCS]. Descriptive case series. Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre Karachi, from April 2009 to October 2011. Patients were enrolled from accident and emergency and OPD. OPD follow-ups were carried out at 2nd, 6th, 12th, 18th, and 24th weeks, then every 2nd month for the assessment of rate of union and range of motion of knee joint. A total of 83 patients were included. There were 55 males and 28 females. Male to female ratio was 1.96:1. Patients were 25-50 year of age. Seventy four [89.2%] of the injuries were caused by road traffic accident and 9 [10.8%] due to fall from height. Forty six [55.4%] patients had fractures on right side and 37 [44.6%] on left side. Radiological union was achieved in 79 [95.2%] patients at an average period of 19.05 weeks. The radiological bony union was achieved in 16-18 weeks in 25[30.1%] patients. Four patients developed nonunion for which bone graft from iliac crest was placed after 24 weeks. Two achieved union in one year follow up while two were lost to follow up. At end of one year, forty-three [51.8%] cases had knee flexion from zero to 90° - 120°, 25 [30.1%] cases had knee flexion of > 120° and remaining 15 [18.1%] cases had knee flexion of <90°. At the end of one year satisfactory [knee motion > 90°] functional outcome as achieved in 68 [81.9%] cases. High rates of both radiological union [95.2%] and satisfactory [knee motion > 90°] functional outcome [81.9%] were achieved in large number of cases

Exchange nailing for delayed or non union of diaphyseal femoral fractures

To determine the effectiveness of exchange nailing for delayed or nonunion of diaphyseal femur fractures. Descriptive case series. Department of Orthopaedics Jinnah Postgraduate Medical Center Karachi, from March 2009 to February 2012. All patients with delayed or hypertrophic nonunion of diaphyseal femur fractures diagnosed on clinical and radiological examination, were included. Patients with infective nonunion, segmental fractures or fractures with bone loss and open fractures were excluded. Exchange nailing was performed. A total of 36 patients were managed which included 27 males and 9 females. Twenty-four [66%] patients were between 30 - 40 year of age. Left femur was predominantly involved [56%]. The non union involved middle third in 61% cases. Following surgery union was achieved in 33 [92%] cases. In 14 patients union occurred between 4 to 6 months. Superficial infection occurred in 2 patients. Exchange nailing is the one of best options for delayed or nonunion of femoral diaphyseal fractures.