Outcome of peroneus brevis tendon transfer for augmentation of repair of old complete tear of achilles tendon

Background: Repair of complete tear achilles tenden is a challenge for orthopedic surgeons

Objective: To assess the outcome of peroneus brevis tendon transfer for augmentation of repair of the old tear of the Achilles tendon

Methodology: Study Design: Prospective case series study. Place of Study: Orthopaedic Complex, Quaid e Azam Medical College/ B. V. Hospital, Bahawalpur, Pakistan. Study duration: 1st October 2013 to 30th September 2017. A total of 52 patients [42 males and 10 females], age range 38 to 52 years who underwent repair of old tear of Achilles tendon augmented by peroneus brevis tendon transfer, were included. All patients were having closed rupture. Postoperative follow up evaluation was done for a period of 12 months by using modified Rupp score. Data analysis was done by using SPSS version 17

Results: 52 patients were operated of which 5 suffered minor skin complications which recovered subsequently. No patient suffered repeat tear of the repaired tendon. Subjective postoperative evaluation was done by modified Rupp score questionnaire while objective follow up evaluation was done on the basis of ankle range of movements, ability for raising over the tip toes and sensory/motor status over the foot. At 12 months follow up 25 [48%] patients has excellent, 16 [30.7%] patients has good, 7 [13.4%] patients has fair while 4 [7.10%] patients had poor functional outcome

Conclusion: The peroneus brevis tendon transfer for augmentation of repair of old tear of Achilles tendon achieved good to excellent functional outcome in majority of the patients

Comparative study of efficacy of continuous versus partial interrupted method of midline laparotomy wound closure for contaminated cases of typhoid perforation

Background: The controversy exists in the literature about the best method of midline suturing in contaminated cases like typhoid, tuberculosis and old traumatic intestinal perforations

Objective: To compare the laparotomy wound closure techniques in contaminated cases of typhoid perforation regarding burst abdomen and wound dehiscence

Methodology: This was randomized control type of study in which all the patients fulfilling inclusion criteria were included. This study was conducted in surgical ward of Bahawal Victoria Hospital Bahawal Pur. The cases with minimal peritoneal contamination, planned laparotomies for benign abdominal lesions/ tumours and simple, non contaminated laparotomies were excluded from this study. All the cases were initially received in the general surgical emergency department and later referred for surgical consultation. A detailed history and clinical examination was conducted by two general surgeons. All the included patients had an acute presentation and required immediate intervention. The data was noted on a proforma. All included patients were divided in two groups; A and B. Patients of both groups were equal in number i.e fifty patients in each group. Patients of group A underwent continuous method of closure and patients of group B underwent interrupted closure. Outcome parameters included were time required for closure and postoperative wound dehiscence

Results: Regarding the results of study the difference in wound dehiscence was significant [ p<0.05] between the two groups, group A, 22% and group B, 4%. Results about time required for closure found less than 30 minutes 92% in group A and 62% in group B, the difference was statistically insignificant [p >0.05]

Conclusion: Continuous method has advantage of being faster and time saving but in regarding the wound dehiscence in contaminated cases it was found that more patients, with continous closure has dehiscence

Level of vitamin d in Orthopaedic Trauma among adult patients

Background: The evidence on level of vitamin D in trauma patients is scarce in the developing countries

Objective: To determine the levels of vitamin D in trauma patients above 18 years of age

Methodology: This was a cross sectional study conducted on patients admitted in the Orthopedic department of Sheikh Zayed Medical College /Hospital, Rahim Yar Khan, patients included in this study were 340. The duration of study was 21st July to 16th March 2016. Vitamin D level were measured by using vitamin D kits [Roche]. Patients less than 18 years were not included in the study. Data was analyzed by using SPSS version 16

Results: A total of 340 patients admitted in orthopedic department were included in this study. Overall 92.6% patients have deficient or insufficient level of vitamin D. Most of the patients [68.8%] were less than 45 years of age. Majority of the patients were male [71.8%]. Most of the patients [72.4%] were not smokers. Majority belonged to rural areas [56%], and have no history of steroid intake

Conclusion: This study confirmed that majority of the trauma patients were vitamin D deficient or insufficient. This highlights that trauma surgeons should consider vitamin D in the armamentarium of orthopaedic treatment

Outcome of wound coverage around ankle joint with sural artery flap

Background: Trauma is the most common cause of fractures and majority of these fractures involve the foot. So the early coverage is mandatory to prevent the complications, it is challenging to the orthopaedic, plastic and reconstructive surgeons. Sural artery reversible flap is one of the options

Objective: To determine the outcome of sural artery flap for wound coverage around ankle

Methodology: A total of 24 patients were included in this interventional study. All the patients having wound around the ankle due to any cause and of either sex presenting in emergency department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1st June 2014 to 30th April 2016 were included in this study. Outcome was measured as "Good", "Fair" and "Poor". The data was entered and analyzed by using SPSS version 16

Results: In this study 24 patient were operated, 41.66% were children and 54% were male. In 50% heel region was involved and in 25% melleolar region and 12.5% dorsum of foot and in 12.5% above ankle joint. Outcome noted was "Good" 83.3% "Fair" 8.3% and "Poor" 8.3%

Conclusion: Sural artery flap for the coverage around ankle is simple, safe and can be performed by orthopedic surgeon at any center without the requirement of special instrumentation and special test, with good outcome

Comparison of stapled versus Milligan Morgan hemorrhoidectomy in hemorrhoids surgery

Background: Hemorrhoids are very widespread disease that cause pain by thrombosis, fear by bleeding and be a burden by pruritus

Objective: To compare the outcome in terms of bleeding, hospital stay, post operative pain and fecal incontinence among patients with 3[rd] and 4[th] degree hemorrhoids after stapled and Milligan Morgan techniques

Methodology: Study design: Quasist Expermintal study. Setting: Surgical unit-II Bahawal Victoria Hospital Bahawalpur. Study duration: From 1[st] June 2008 to 30[th] April 2009. Study Subject: 60 patients of 3[rd] and 4[th] degree hemorrhoids were included in this study and were divided in two groups A and B having 30 patients each. Patients of group A were treated by stapled and group B were treated by Milligan Morgan technique. Patient were followed up for 24 to 72 hours after operation and then weekly for two weeks on outdoor basis for assessment of outcome variables as relief of symptoms and development of complication. The data was entered and analyzed by SPSS version 10

Results: After treatment 28 [93%] patients of group A and 15 [50%] of group B has got relief from bleeding and other symptoms. 18 [60%] patients of stapled techniques group had hospital stay of 2 or <2 days. Only two [7%] patients of group A developed postoperative hemorrhage and a ligation of spurting vessel done, but 12 [40%] patients of the group B were found with post operative bleeding and intervention was done. Post operative pain requiring analgesia developed in 10 [33%] patients of group A and in 17 [56%] patients of group B. No. patients of any group developed fecal incontinence after treatment

Conclusion: Stapled hemorrhoidectomy has given very good results in relief of symptoms. Stapling technique can also result in severe pain, bleeding, fecal incontinence and other complications, but the chances of complications are less. Due to good relief of symptoms and less complications stapling technique should be the treatment of choice

Evaluation of union of neglected femoral neck fractures treated with free fibular graft

To evaluate the frequency of union of neglected femoral neck fractures treated with free fibular graft. Descriptive case series. Department of Orthopedics Bahawal Victoria Hospital Bahawalpur, from April 2009 to January 2010. Patients of neglected femoral neck fracture [one month postinjury] were included in the study. They were operated and internal fixation was done with concellous screws and free fibular graft placed. They were followed till the evidence of radiological union. Out of 55 patients there were 40 males and 15 females. Ages ranged from 20 year to 50 year. The duration of injury was from 4 weeks to 6 months. Fifty patients achieved complete union while five patients developed non-union with complaint of pain. There was no wound infection and hardware failure. Fracture reduction and internal fixation with use of free fibular graft and concellous screws for neglected femoral neck fractures is the treatment of choice

Pattern of prostatic disease; a histopathological survey

Analysis of the pattern of prostatic disease in Faisalabad. Case series study. Department of Pathology, University Medical and Dental College [UM and DC] and Meezan Laboratory [ML]. Duration of the study is three years. All prostatic specimens presenting to the Pathology department at the UM and DC and ML for histopathology were included. During this period 540 prostatic biopsies were examined. The mean age of the patients was 67 years. Out of these 467 [86.5%] were benign, 2 [0.3%] had prostatic intraepithelial neoplasia and 71 [13.5%] were malignant. All the cases of malignancies were adenocarcinomas. Most of them were well differentiated [Gleason's score 2-4]. The highest incidence of hyperplasia and malignancy occurred between 60-70 years of age. The incidence of prostatic cancer is on the rise and measures should be taken for early detection