Comparison of hydrocolloid with conventional gauze dressing in prevention of wound infection after clean surgical procedures

To compare hydrocolloid with conventional gauze dressing in prevention of infections after clean surgical procedures. Randomized controlled trial. Department of Surgery, CMH Rawalpindi from 22 Jan 2010 to 22 Aug 2010. A total of 400 patients undergoing clean surgical procedures were randomly allocated in two equal groups, A and B by lottery method. In group A, simple gauze dressing was applied after clean surgical procedures while in group B hydrocolloid dressing was used. On 7[th] post operative day, patients were observed for presence of infection. Mean age of sample was 42.08 +/- 11.112 years. In group A out of 200 Patients, 14[7.0%] while in group B 10[5%] developed infection postoperatively [p=0.709]. There is no difference in the rate of infection when using a gauze dressing or a hydrocolloid dressing after clean surgical procedure

Surgical treatment of upper cervical spine injuries [C1-C2]: experience in 26 patients

To describe the spectrum of operations in unstable upper cervical spinal injuries in [atlanto-axial] region at our unit. A cross-sectional study. Spine Unit, Department of Orthopedics, Combined Military Hospital [CMH], Rawalpindi from Jan 2001 to Dec 2008. Frequency of different kind of operations in 26 patients operated for upper cervical spinal injuries was reviewed. A performa was made for each patient and records were kept in a custom built Microsoft access database. Average age of patients studied was 27 years with male pre dominance. Total 12[46%] patients had Atlanto-axial instability, 8[31%] had Hangman's fracture and 6[23%] patients had odontoid peg fracture. While 11[42%] patients had no neurological deficit according to American spinal injury association impairment scale [AIS-E] and 15[58%] had partial neurological deficit. The patients were divided into three groups. Group A had odontoid peg fracture, Group B had atlanto-axial instability and Group C had Hangman's fracture. The spine was approached posteriorly in 19[73%] cases and anteriorly in 7[27%]. Pedicle screw fixation was done in 6[23%] patients, odontoid peg screw fixation in 6[23%], Gallie's fusion in 5[19%], occipito-cervical fusion in 4[15%], posterior transarticular fixation in 3[12%], anterior transarticular fixation and decompression in others, 9[60%] patients improved neurologically postoperatively and there was no deterioration of neurological status. Nonunion in two [8%] cases and implant failure in one [4%] were complications. Upper cervical injuries [C1-C2] are rare and their management is complex, necessitating lot of experience for their management. Early diagnosis and appropriate treatment is essential for good outcome. Each injury has to be managed at its own merit and a single operation may not be appropriate in all situations. General guidelines can be drawn from our study for the management of these cases on modern lines

Outcome of instrumented spinal fusion for chronic low back pain: review of 100 patients

Objective of this study was to evaluate the outcome of instrumented spinal fusion in selected patients with Chronic Low Back Pain [CLBP] in our setup. Quasi-experimental study. Spine Unit, Orthopaedic Department, Combined Military Hospital, Rawalpindi, Pakistan. Jan 2002 to Dec 2007. Consecutive first one hundred patients were selected from spine unit database that underwent instrumented spinal fusion for chronic low back pain lasting more than one year, due to degenerative disease of spine. Average age was 42 years. There were 62 males and 38 females. Diagnosis included; spinal stenosis [26%], failed disc surgery [22%], spondylolisthesis [19%], degenerative disc disease [17%], and instability [16%]. Operations performed; Pedicle Screw Fixation [PSF] with Postero-lateral Fusion [PLF] in 3% patients. Trans Laminar Facet Screw [TLFS] with PLF in 24% patients. Anterior Lumbar Inter-body Fusion [ALIF] in 9% patients. Posterior Lumbar Inter-body Fusion [PLIF] in 40% patients and Trans-foraminal Lumbar Inter-body Fusion [TLIF] in 24% patients. Average follow up was for 30 months. 86% patients had full spinal fusion. 71% patients were fully satisfied with treatment, 28% were partially satisfied. Post-operatively, on average, visual analogue scale [VAS] showed 48 points significant improvement and Oswestry Disability Index [ODI] showed 53 points significant improvement. Instrumented Spinal Fusion is effective in our set up for relieving symptoms and improving functional outcome in selected patients with debilitating Chronic Low Back Pain due to degenerative disease of spine. Single fusion technique is not ideal for all types of patients and surgeon has to be versatile and trained in using different fusion techniques as the situation demands

Epidemiology of non-disaster spinal injuries at a spine unit

To describe the demography, types of injuries and their management in all non-disaster spinal injury patients admitted to the Spine Unit of a tertiary care hospital in Pakistan from 2001-2008. Case series. Spine Unit, Orthopaedic Department, Combined Military Hospital, Rawalpindi, from April 2001 to December 2008. Data of all new non-disaster spinal injury patient admissions, kept in a custom-built database at Spine Unit, was analyzed. Demography, type of injuries and their management was described in percentages. Five hundred and twenty one non-disaster patients were selected out of a total 671 new admissions with spinal injuries. Mean age was 39.1 years and 77% were males. Mechanisms of injury included; fall in 62% and road traffic accidents in 32%. Fracture dislocations and burst fractures were equally distributed [36% each]. Most of the injuries [43.6%] were at T11-L1 level. Forty three percent patients had complete spinal cord injury [SCI], 33% had incomplete SCI and 24% did not have any SCI. Eight patients had concomitant spinal injury at a different level. Twelve percent patients had associated other major injuries. Seventy percent patients were treated surgically. Average follow-up was for 4 years. Non-disaster spinal injury was frequent in young males usually due to fall or road traffic accident. It involved fracture dislocation or burst fracture at T11-L1, level in most cases requiring surgical treatment

Role of moss miami pedicle screw system in unstable spinal injuries

To find out the role of instrumentation with MOSS Miami [by DePuy, Johnson and Johnson] implants to treat patients with unstable thoraco-lumbar spinal fractures and dislocations in terms of stability achieved and improvement in neurological status. Quasi-experimental study. This study was conducted in orthopaedic department of Combined Military Hospital Rawalpindi from Oct 2001 to Oct 2004. 80 patients with unstable spinal injuries were operated during above time period. 48 patients underwent posterior transpedicular MOSS Miami instrumentation of thoraco-lumbar spine. Instability was defined according to White and Panjabi's criteria. Neurological deficit was defined according to American Spinal Injuries Association [ASIA] Impairment Scale [AIS]. Those with complete injury were placed in group I [29 cases] and rest were assigned group II [19 cases]. All cases were treated by open reduction and short segment internal fixation using MOSS Miami pedicle screw system. Patients were followed up 2 weeks, 6 weeks, 3 months, 6 months and yearly after operation. Patients were observed for correction of deformity, spinal fusion, improvement in neurological status, loss of reduction over time, back pain and rehabilitation. All data was put in a dedicated MS Access Data Base and analysed using SPSS. It was observed that those with complete neurological deficit only 5 cases improved out of 29 cases and the mean AIS improvement was 0.39 / case. Out of those with partial neurological deficit, all cases showed improvement. There was no deterioration in neurological status. Mean AIS improvement was 1.4 / case. Solid spinal union was observed in 45 cases out of 48 cases at the end of 3 months. 03 cases had implant related complications. The vertebral deformity was completely restored in 32 cases and incompletely in 16 cases. Loss of reduction was 2.5 [degree sign] on average. MOSS Miami pedicle screw system is safe and effective for posterior short segment fixation of unstable thoraco-lumbar fractures