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

Influence of age on the outcome of single stage reconstructive surgery for congenital dislocation of the hip joint

This study was conducted to assess the effect of age on the ultimate outcome measures following single stage surgical procedure of soft tissue release, relocation, capsulorrhaphy, femoral shortening with varus/derotation osteotomy and pelvic osteotomy. A case series. The study with two groups of pretest-posttest design was conducted at Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre [JPMC], Karachi, from 1993 to January 2008. Patients included were having neglected, congenital dislocation of the hip joint, aged over 3 years. Patients with failed previous surgery, paralytic, teratological, traumatic or septic dislocations and patients with less than 5 years follow-up were excluded from the study. The patients were divided into two groups, 3-7 years [37 hip joints] and over 7 years [13 hip joints]. The single stage surgical procedure of open relocation, femoral shortening/derotation/ varus osteotomy and pelvic osteotomy was the dependent variable; whereas, the final clinico-radiological results based upon Tonnis grading, Severin's clinical/radiological grading, Klisic's overall rating and acetabular index were the independent variables of the study. Pre- and postoperative data was assessed for overall improvement and the difference in outcome measures between the two age groups. Significant overall improvement on all parameters was achieved after surgery. When results were compared between two age groups, there was no significant difference in the final outcome as per Tonnis grading and Severin's clinical typing as modified by Gibson [97.3% versus 84.4% normal hip joints or Tonnis grade 1 and 78.37% versus 53.85% Severin's type 1] but the results based upon Severin's radiological grading [62.16% versus 15.38%] and Klisic's overall rating [62.16% versus 15.38%] were significantly better in 3-7 years as compared to those over 7 years. There was no significant difference between the two age groups when compared for improvement in acetabular index. On further analysis, a progressive deterioration of results with increasing age was observed, yet the results in those aged over 7 years were reasonably justified surgical correction of congenital dislocation of the hip joint. Majority of the complications were seen in children operated at the age of 4-5 years. There were 7 cases [14%] of redislocation/subluxation and 6 were in 3-7 years age group. There were 4 cases [8%] of the avascular necrosis of the femoral head. Three patients had residual coxa vara and 2 had significant limb shortening. Limb lengthening was done in these 2 cases. The final results displayed progressive deterioration of clinical, radiological and functional outcome measures with aging after single stage reconstructive surgery for the congenital dislocation of hip joint. However, despite this, the results in children over 7 years were also good/excellent in most of the cases justifying surgery

Postoperative wound infections in orthopaedic surgery

To compare the effect of theatre condition on postoperative infection rate. Design of study: An observational and comparative study Place and Duration of Study: Jinnah Postgraduate Medical Centre and Mehran Clinic [Pvt] Karachi from January, 1999 till January, 2000. Subjects and Two hundred and fifty-two patients, 108 at a public hospital and 144 at a private hospital were included in the study. Only clean cases undergoing surgery were included. All were given pre and postoperative antibiotics for seventy hours intravenously. All wounds were closed with monofilament sutures. Follow-up period was twenty eight days. All cases were evaluated for postoperative fever, marginal necrosis and discharge from wound. Cultures were taken from all the cases with any of the above findings. The mean age of the patients was 30.39+21.49 years with male to female ratio of 1.7 to 1. The mean operating time was 53.4 ' 26.81 minutes, however, it was 72+34.2 minutes in cases developing wound infection. The difference was significant when compared to non infected cases. The overall rate of postoperative wound infection was 3.97%. The rate of postoperative wound infection in the public hospital was 5.55% in comparison to 2.75% in the private hospital, which is, though much higher, is statistically not significant. The higher rate may be due to the difference in the theatre environment. Eighty% of the cultured organisms were multidrug resistant strains as compared to 20% sensitive to the first generation cephalosporins. The difference was highly significant. There was no significant difference in the postoperative wound infection rate between the two groups, however, there was an association with operating time. Significantly most of infections were caused by hospital- born multidrug resistant organisms

Human cost of political violence

OBJECTIVE: To evaluate the cost of political violence in terms of human life and its influence on social, psychological and financial aspects of community. DESIGN: Retrospective study conducted from 1987 to 1989. SETTING: Department of Accident and Emergency, Jinnah Postgraduate Medical Centre, Karachi. SAMPLE SIZE: Nine hundred and fifty four victims including two hundred and fifty seven dead. The mean age of the victims was 27.29 +/- 9.46 years with a male to female ratio of 33:1. All ethnic groups suffered to some extent. No case of violence on religious differences was reported during this period. Firearms were frequently used. Most of the deaths [92.2%] occurred due to firearm injuries. Landhi, Korangi, Malir and Shah Faisal Colony were the worst affected areas. There was however no significant difference between them. The projected loss of life for the dead was approximately 3.15 million days. The same was difficult to assess for the injured because of multifactorial reasons. Six thousand four hundred and ninety two close family members suffered from Psychological and Physical Trauma. The number of distant members affected psychologically was estimated to be 0.566 million. Schooling of approximately five thousand four hundred thirty seven children of the victims suffered. Political violence has significant short and long term effects on the society in terms of physical and psychological trauma, financial losses, poor schooling and health, biased pattern of child development, migration of families and further division of society into identifiable communities which may prolong the conflict

Extensor mechanism sparing approach to the elbow for reduction and internal fixation of intercondylar fracture of the humerus

OBJECTIVE: To evaluate the short term results of extensor mechanism sparing approach to the elbow for fixation of intercondylar fractures of the distal end of humerus and compare it with existing Surgical approaches. DESIGN: This is a prospective study conducted from June, 1992 to June, 1997. SETTING: Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre and Mehran Clinic [Pvt.], Karachi. PRINCIPLE OF SURGICAL APPROACH: This approach is based upon the principle that by sparing the extensor mechanism, we reduce the amount of surgical trauma and help in early rehabilitation which can contribute in improving the results of this difficult fracture. There were nine type 2 fractures, eight type 3 fractures and four type 4 fractures according to Rise borough and Radin classification. Based upon the same authors criteria, there were over all 57.14% good 23.81% fair and 19.04% poor results. Adequate exposure was achieved in all of type 2 and seven [87.5%] out of eight type 3 fractures. We failed in type 4 fractures. Mean operating time was 107.38 [ +/- 24.67] minutes. The results in this series are comparable to other studies. They can however be improved with proper selection of cases, experience with the technique along with better fixation and rehabilitations

Fracture stability, quality of bone and pitfalls in surgery versus complications of fixation in inter trochanteric fractures

This is a retrospective study of 65 cases [mean age 58.83 +/- 16.36 years] based upon radiological assessment of intertrochanteric fractures developing complications of fixation. Correlation is discussed between various complications and type of fracture, bone quality, reduction, type of instability and implant type, suitability and position. The tendency for deterioration of varus was significantly high in Evan's type 1c [68.18%] and 1d [75%] fractures with medical cortical deficit [78.38%]. The tendency for proximal cut out of implant was again significantly high in Evan type 1c [54.54%] and 1d [41.66%] fractures, varus reduction [46.62%], medical cortical deficit [51.36%] and suitable implants [51.62%] in unacceptable position [50%]. The tendency of medical migration of distal fragment was high in Evan's type 1d [54.15%] and type 2 [100%] fractures with reverse obliquity and compression hip screw [88.33%]. Tendency for penetration of femoral head was again high in Evan's type [2] fractures [36.36%] with reverse obliquity. Tendency for implant breakage/bending/loosening [15 cases] was high in Evan's type 1d [37.5%] and type 2 [27.27%] fractures, normal quality bone [52.94%] and implant placed in acceptable position [52%]. The difference was non significant for other factors and complications of fixation

Venous Trauma

This is a retrospective study conducted at Jinnah Postgraduate Medical Centre, Karachi from June 1994 to June 1997. Twenty three patients with thirty injured veins [on exploration] were included in this study. There were twenty male and three female victims with a mean age of 35.56 [ +/- 11.35] years. Firearm injuries [11] and road traffic accidents [6] were the predominant causes. Twenty one had combined arteriovenous injury. Twenty four veins were completely torn. Femoral and popliteal vessels were commonly injured. Twenty veins were ligated and ten were repaired. Those repaired were monitored post operatively with Doppler ultrasound. Four patients had subtotal amputation and sixteen had arterial insufficiency. Eight patients, [three deaths and five amputations] with eleven injured veins were not evaluated for final results. One patient out of five developed mild oedema with repaired veins and five out of ten with ligated veins. The difference in the rate and severity of postoperative oedema and wound healing between the two groups was not significant. We did not observe venous insufficiency during the follow-up period [three to eighteen months] in both groups