Gartland type III supracondylar fracture humerus; surgical management

Objectives: the purpose of present study is: 1. To know the results of surgical intervention of Garland type III fracture Humerus in children.2. To know the early and late complication of surgical intervention

Study Design: prospective interventional study

Setting: department of Orthopedic Unit-II, Civil Hospital Karachi

Period: February 2010 to January 2012

Methods: 200 male and female patients with Gartland type III supracondylar fracture of humerus presenting within 24 hour of injury, with age limit varying between 1- 12 years were included in our study. The anteroposterior and lateral view X-rays were taken and evaluated for displacement and angulation, medial/ lateral displacement and angulation and rotation of distal fragment. After all aseptic measures, patient under general anesthesia, through posterior approach skin was incised, subcutaneous tissue dissected along the line of incision. Triceps apponeurosis was splitted and interposed soft tissue was released and fracture reduced and fixed with K-wire on both medial and lateral sides parallel to the long axis of humerus in lateral view and an angle of 30 degree - 40 degree in A/P view. Wound closed in layers, aseptic dressing applied and well-padded back slab with elbow in appropriate angle of flexion was applied and pulses were checked. Postoperatively the hand was held elevated. Plaster of parries black slab was removed after four weeks; the wires were removed after six weeks. The follow-up ranged from 3 to 6 months. All the Data regarding patient were entered on well-designed proforma. The criteria for assessing the results were based on healing period, anatomical appearance, function and radiographic appearance

Results: excellent results according to Mitchell-Adam's criteria were observed in 60%. [120/200] cases, good results were observed in 27% [54/200] cases. Overall excellent to good results were observed in 87% of cases

Conclusion: it is concluded that outcome of surgical treatment of supracondylar fractures of humerus [Gartland type III] fixed with medial and lateral placement of k- wires were excellent to good and it achieves stable fixation. As both wires were placed under vision so risk of ulnar nerve and radial nerve injuries were decreased as compared to closed reduction and percutaneous k-wiring. As this method is techinically easy, less demanding and effective for stabilization and can be applied for patients with these fractures

Malaria infection: a clinicopathology correlation

Objectives: The hematological changes associated with malaria are well recognized. This study was conducted to assess and compare the incidence and severity of hematological changes in various types of malaria in local population of Gadap city who visited the Fatima Diagnostic Laboratory of Fatima Hospital, Baqai Medical University between Jan. 2007 to Dec. 2008

Methodology: This observational study included 3,263 cases of fever who were suspected for malaria visited Fatima Hospital Laboratory of, Baqai Medical University during January 2007 to December 2008. The age, sex, place of referral and species of malarial parasites were recorded. The total number of male patients was 211 and female was 168 with a mean age group of 21 years. The diagnosis of malaria was confirmed by thick and thin film stained with LeishmanAEuro[™]s staining for malarial parasite. Slides were reviewed by hematologist and Full blood counts were performed using automated Sysmex K-1000

Result: A total of 3,263 patients were subjected for malaria testing during the study period. Three hundred and seventy nine had a positive peripheral smear. There were two hundred and eleven [55.6%] male and one hundred and sixty eight [44.3%] female patients. One hundred and fifty eight [42%] were P falciparum positive, two hundred and three [53%] were P vivax positive and eighteen [5%] patients had mixed infection of both P. falciparum and P. vivax. Two hundred and eighteen [57.5%] patients had thrombocytopenia. Out of this, One hundred and ten [50.4%] patients with thrombocytopenia were P. falciparum positive and one hundred and eight [49.6%] patients with thrombocytopenia were P. vivax positive. One hundred and fifty seven [41%] patients had anemia. Out of this, Thirty seven [23.6%] patients with anemia were P. falciparum positive and one hundred and twenty [76.4%] patients with anemia were P. vivax positive. Sixty 16%] patients had leukopenia. Out of this, Thirty three [55%] patients with leukopenia were P. falciparum positive and 27 [45%] with leukopenia were P. vivax positive

Conclusions: Malaria was found to be one of the most prevalent infections in the surveyed population and the frequency of vivax species was more as compared to falciparum malaria. The majority of falciparum malaria patients develop significant haematological complications with high frequency of thrombocytopenia and anemia as compared to vivax infection while changes in the white blood cells was less dramatic

Pattern of serum vitamin D in OPD patients

To find out the prevalence of Vitamin-D deficiency in conditions other than osteomalcia and rickets in our part of the world. Prospective and observational study from Feb. 2005 to Dec. 2006. Multi-centric including Civil Hospital and Abbasi Shaheed Hospital, Karachi. Only those patients were included who had any structural or biochemical changes in the body. Serum Vitamin-D level of all patients was sent for estimation from a single reputable laboratory, apart from serum calcium, phosphorus, alkaline phosphatase and routine blood investigations. All data was collected and processed on SPSS Version 10. Of the total 79 patients, 58[73%] were females and 21[27%] males. Minimum age was one year and maximum 90 years, with a mean age of 41.91 and standard deviation of 19.1. Majority of the patients were seen in the 4th, 5th and 6th decades of life, and most of them were house wives. The serum Vitamin-D level was found low in 73[92%] patients and the most severe form of deficiency was seen in patients with tuberculosis. Vitamin-D deficiency was seen in 92% of our patients, belonging to all age groups and suffering from different diseases

Fractures of patella

Patella, the largest sesamoid bone in the human body with its subcutaneous location is more vulnerable to injuries. The stress distribution gets disturbed if the articular surface of the patella becomes incongruous. Most of the patellar fractures occur as a result of a combination of direct or indirect trauma. Transverse, vertical and polar fractures without comminution are either due to stress or due to powerful quadriceps contraction against resistance. Good history, thorough clinical examination and high quality radiographs are mandatory for accurate diagnosis. A number of management approaches are recommended including immobilizing, excision and repair, and internal fixation. Complication of patellar fracture include infection, loss of fixation, knee stiffness and post traumatic osteoarthritis