Reconstruction of hind foot defects; a simplified workable solution

Reconstruction of traumatic as well as non-traumatic hind foot defects is always a challenging task. We share here a simple and practical protocol [working solution] to select the most suitable method for soft tissue coverage of hind foot defects, customizable for every patient. We carried out this study, in our department on 75 cases from March 2009 to May 2012. All cases with wound/defect in hind foot area were included. Majority of cases were traumatic rest included cases of malignancy, Trophic ulcers, infection. Patient's data including age, sex, site of injury, mode of injury, extent of injury [isolated or combined], if combined structures involved, type of wound, management of wound, wound healing time and complications were noted. Once optimal wound conditions were achieved the best possible reconstructive option was selected. The various reconstructive options include VAC therapy, Skin graft, local transposition flap, perforator based flapspedicled faciocutaneous/ muscle flaps, intrinsic foot muscles, Medial plantar artery flap and distant flaps like cross leg flap and micro vascular free flaps. All patients had satisfactory and stable reconstruction. They were ambulating freely by 4-6 weeks post operatively. There were few complications like patchy graft loss, peripheral flap necrosis, flap congestion, but none was serious and did not require repeat surgery. The simplified protocol followed by us is a practical customizable solution for difficult task of hind foot reconstruction. The choice of one or multiple techniques will vary from time to time from one surgeon to another depending upon his or her experience and liking

Comparison of shoulder function, radial nerve palsy and infection after nailing versus plating in humeral shaft fractures

To compare shoulder function, radial nerve palsy and infection after interlocking nailing with plating of fractures of shaft of humerus during 30 weeks of follow-up. Experimental study. Orthopaedic Wards of Combined Military Hospital, Rawalpindi, from November 2006 to November 2008. Two groups of 30 patients each were inducted. Group A [n=30] was treated with intramedullary interlocking nailing while Group B [n=30] underwent plating with dynamic compression plate [DCP]. Shoulder function using ASES score, radial nerve palsy and infection were observed for 30 weeks. In group A, 11 patients had severe or moderate shoulder dysfunction [ASES score below 39], out of whom 8 [72%] were above 50 years. This age related disability was significant [p=0.003]. Transient palsy was observed in 3 patients [10%] and mild wound infection in 2 [6%], which was not associated with age or open fracture. In group B, only 1 patient had severe shoulder dysfunction, the difference was statistically significant between the two groups [p=0.001], especially in patients above 50 years of age. There was no statistical difference in infection and palsy rates between the two groups. Although nailing and plating are effective treatments for fractures of shaft of humerus, ante-grade nailing may not be suitable in elderly patients, as it can cause significant shoulder dysfunction