Preoperative two dimensional echocardiography in patients with lower limb fractures; its relationship with time of surgery, postoperative ambulation and hospital stay

Objective: To determine the effect of two dimensional echocardiography on time of surgery, post-operative ambulation and hospital stay among patients with lower limb fractures. Study Design: Descriptive cross sectional study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Sep 2015 to Dec 2015

Patients and Methods: A total of 123 patients were included in study based on non-probability convenient sampling who presented with lower limb fractures. The patients were divided into two groups, group A included those who underwent only electrocardiogram [ECG] for assessment and group B included those patients who were further assessed by echocardiography

Results: There was significant delay in group B patients from time of admission to surgery [p=0.0001] as well as post-operative ambulation [p=0.0001] and mean hospital stay was also longer [p=0.0005]. However the postoperative complications were similar in two groups

Conclusion: Pre-operative cardiac evaluation by echocardiography is associated with delay in surgery and increases overall hospital stay. The implementation of the American College of Cardiology/American Heart Association guidelines may prevent unnecessary cardiac consultations which can minimize use of preoperative resources, delay in time of surgery and early post-operative recovery

Anterior Cruciate Ligament Avulsion injuries in military soldiers: a tertiary care experience

Objective: To evaluate the clinical outcome of fixation of anterior cruciate ligament avulsion injuries in Military Soldiers

Study Design: Descriptive case series

Place and Duration of Study: Orthopedic department, Combined Military Hospital [CMH] Rawalpindi, from Jun 2015 to Jun 2016

Material and Methods: Open reduction and screw fixation was done in 30 soldiers presenting with McKeever type III and IV avulsion fractures of anterior cruciate ligament. Outcome evaluation was carried out at 3 and 6 months. Lachman test was used for stability. Standard AP and Lateralx-rayswere taken to monitor bony healing. Lysholm score was used for functional evaluation

Results: All 30 patients showed complete healing at 3 months. Three patients revealed residual laxity. Mean extension loss was 5 degrees. Lysholm score improved from pre-operative mean of 29.97 [SD +/- 5.46] to postoperative mean of 95.67 [SD +/- 1.47]

Conclusion: This study demonstrated operative fixation of Grade III and IV anterior cruciate ligament avulsion injuries as a successful surgical option in Military soldiers

Modified suture anchors for open Bankart repair

To evaluate the efficacy of cancellous screws as suture anchors, in open Bankart repair. Case series. Department of Orthopaedics, Combined Military Hospital, Rawalpindi, from March 2009 to October 2010. Fourteen patients with recurrent anterior dislocation were included in the study. Through anterior approach three 4 mm partially threaded cancellous screws were placed at the anterior Glenoid rim. Prolene-1 suture was tied around these screws which acted as anterior anchors and was used to re-attach the capsule and labrum back to bone. The mean duration of follow-up was 8 months. The patients were evaluated at 3 monthly intervals with a physical examination, radiographs, the modified shoulder rating scale of Rowe and Zarins and American Shoulder and Elbow Surgeons score. The mean operating time was 58 minutes. There was no immediate/early postoperative complication. At the last follow-up none of the patients had recurrence or radiological evidence of hardware failure/complication. Eleven patients [79%] had a score of 90 points on the scale of Rowe and Zarins and 12 patients [85.7%] had a score of at least 90 points on the scale of the American Shoulder and Elbow Surgeons scale. Ten patients [71%] had full range of motion in all planes. Use of cancellous screws as a suture anchor is a safe and cost-effective substitute of commercially available suture anchors in open Bankart repair

Frequency of DVT after total knee replacement in Pakistani population by employing color duplex scan

To determine the frequency of Deep Vein Thrombosis [DVT] by Color Duplex Scanning [CDS] after total knee replacement [TKR] in Pakistani population. Interventional study. Department of Orthopaedic Surgery, Combined Military Hospital Lahore, from 1st Sep 2007 to 1st Sep 2008. Thirty five patients, both male and female, age 50 to 80 years, ASA physical status II and III scheduled for total knee replacement [TKR] were subjected to preoperative and postoperative color Doppler to determine the presence of asymptomatic DVT in both legs. None of the patients were administered anticoagulant. DVT was not detected in any case after TKR. One patient developed nonfatal pulmonary embolism on 10th postoperative day. CDS did not pick DVT in this patient. CDS is a useful investigation tool to determine the presence of DVT in total knee replacements surgery. In the West all patients undergoing TKR are administered anticoagulant therapy. This practice is however, not universally accepted in Pakistan. Few studies conducted in Pakistan are equivocal. Present study was done to detect asymptomatic DVT in our patients after TKR. Our study does not show any evidence of DVT as picked up by CDS. The difference could be due to racial factor or the sample size was too small or the yield of CDS may not be very high

Orthopaedic management of earthquake victims in a tertiary care teaching hospital - CMH Rawalpindi

This study is based on the orthopaedic management of casualties coming from earthquake area after 8[th] October 2005. 03 Months. All the patients requiring orthopaedic managements were subjected to major and minor operations including internal fixation, external fixation and conservative approach. A total 811 major orthopaedic operations were performed by all three orthopaedic teams at CMH Rawalpindi. 192 patients underwent soft procedures and 35 fasciotomies were carried out. 466 fixations were carried out including internal and external and rests were other procedures. It is concluded that proper triage, initial management of wounds and selection of implant playa major role for better .outcome in case of disaster casualties

Orthopaedic surgery in civil war-one year experience at Pak UNOSOM Hospital Somalia

The conduct of civil war and utilization of medical resources is different from those of conventional wars. This paper addresses the nature of orthopaedic and trauma cases treated at a level three base hospital in a period of one year during the civil war in Somalia. This is an observational study/ surgical audit of 217 orthopaedic cases treated at Pak UNOSOM hospital, Mogadishu. Three different categories of cases were treated in the hospital, the majority being war related missile injuries to the extremities which required debridement and external fixation. In addition to fresh war trauma, the case mix also included old war injuries like post-traumatic osteomyelitis, mal-unions and infected non. unions. The second group included non-combat casualties and required definitive internal fixation as in any civil setup. The third group included routine orthopaedic cases like degenerative, infective and neoplastic diseases of musculoskeletal system. The trauma surgeon should be well trained in the use of external fixator, internal fixation and other routine orthopedic diseases. He should be prepared to handle neglected trauma and his armament must include an adequate supply of implants and external fixator. In addition, he should be prepared to perform laparotomy, thoracotomy, craniotomy and vascular repair. The administrative, logistic, security and medical evacuation also require special training

Experience with hammer external fixator system in treating compound limb fractures in somalia

This is a retrospective study of the use of Hammerfix external fixation system in treating compound fractures in war like conditions in Somalia. This device was used as a definitive implant and gave a union rate of 88% in 30 patients. Major complications occurred in 4 patients which were related either to the injury or the technique. The Hammer System was found to be extremely versatile, rigid and stood to the mechanical challenges. There was no incidence of implant failure. Its use is recommended in similar war like conditions