Results of type-III supracondylar fracture humerus with open reduction and internal fixation in children after failed closed reduction

Supracondylar fracture of humerus is the second most common fracture in children which account for 60-75% of all fractures around the elbow. There are various treatment modalities for type-III fracture, i.e., closed reduction and casting, skeletal traction, close reduction and percutaneous pinning and open reduction and internal fixation. This study was conducted to see the outcome of open reduction and internal fixation after failed closed reduction. This study was conducted in the Orthopaedics Departments of Khyber Teaching Hospital Peshawar and Ayub Teaching Hospital Abbottabad from February 2007 to Nov 2007 on 30 children. Patients included were of either gender with age range from 5-12 years with displaced supracondylar fracture [type-III] after failed closed reduction. All fractures were fixed with two cross K-wires by open reduction and internal fixation. The patients were assessed both clinically and radiologically and results were tabulated according to Flynn criteria. Twenty-eight patients had excellent results while two had good results according to Flynn criteria. None of the patients had either fair or poor result. Open reduction and internal fixation is a good and reliable method after failed closed reduction and gives stable fixation with anatomical alignment

Management of closed tibal shaft fractures with reamed inter locking nail

The objective of the study was to evaluate the results of closed reamed interlocking nail in the management of closed tibial shaft fractures. Descriptive Observational study Place and Duration: This study was conducted in the Department of Orthopedic, Khyber Teaching Hospital Peshawar, from Jun 2007 to December 2008. A total of 32 patients above the age of 18 years were included in the study. Patients were admitted through accident and emergency department. Written informed consent was obtained from all patients. Detailed history was asked, every patients was assessed clinically and radiographycally. Reamed interlocking intramedullary nailing was done as per protocol. Patients were followed for 1 year, and were evaluated for union, infection, range of motion of knee and ankle and implant problems. 2 patients were lost to follow up and the study was completed on 30 patients. All the fractures united without any need for bone graft. Simple fractures united in average period of 12.5 weeks while comminuted and segmental fractures took longer by four weeks, and united in an average of 16.5 weeks. Two patients developed superficial infection at the site of screws which were treated accordingly with drainage and antibiotics and removal of the distal screw. All the patients had full range of knee movement while 28 patients had full range of ankle movements. The remaining two patients had 15-20 degree loss of ankle dorsiflexion. Nail breakage was not observed in any patient while two had breakage of the proximal and two had breakage of distal screws. We concluded that closed intra medullary nailing for closed diaphyseal fracture of the tibia is a safe and rewarding technique which has high rate of union and relatively low complications rate, there is early return to activities

Intertrochanteric fracture of femur; outcome of dynamic HIP screw in elderly patients

Intertrochanteric [IT] fracture is common in elderly population. The dynamic hip screw is widely accepted in the treatment of IT fractures of the proximal femur. To determine the outcome of dynamic hip screw in intertrochanteric fracture of femur in elderly patients. A descriptive observational study Department of Orthopaedic Khyber Teaching Hospital, Peshawar. Period: From 7[th] Jan 2008 to 7[th] Jan 2009. 113 consecutive patients with intertrochanteric fracture of the femur treated with dynamic hip screw. All patients were investigated and optimized for surgery. An accurate close reduction was done under fluoroscopic control. A dynamic hip screw [DHS] was inserted by a standard technique. Patients were reviewed clinically and radiographically on 2nd, 6th, 12th and 24th weeks. We studied 113 Patients of intertrochanteric [IT] fracture, 13 patients were lost to follow up and the study was completed on 100 patients. Forty seven [47.0%] patients were male and 53 [53.0%] were female. Postoperatively seven patients [7%] suffered from infections, 3 [3.0%] patients suffered from restricted hip joint movements. There was shortening of lower limb in 3 [3.0%] patients, 2 [2.0%] patients developed non union of the fracture site, 1 [1.0%] patient develop varus deformity. Seven [7.0%] patients had implant failure, 3 of which have lag screw cut-out through superior cortex, 3 patients have broken leg screw at barrel shaft junction and 1 patient has broken leg screw at 3 sites. 77 [77.0%] healed without complications. It is concluded that the Dynamic Hip Screw is safe, suitable and reliable method of fixation for Boyd and Griffin type I and type II intertrochanteric fracture of femur

Wound infections and culture sensitivity pattern in pediatric burn patients

To identify common organisms causing burn infection and their antimicrobial sensitivity pattern. A retrospective study of sixty patients with burn wound infection was carried out at burn unit of Khyber Teaching Hospital Peshawar from September 2006 to August 2007. Children who received burn injuries with signs and symptoms of septicemia were included in this study. Age, sex, percentage of burn wound and etiology of burn wounds was recorded. Culture and sensitivity tests were performed from burn wounds of those patients who were having fever and other features of septicemia by tissue culture of all patients[from infective sites] and their results were noted. Out of sixty patients, fourty were male and twenty were female pediatric burn patients. The most frequent organism isolated was staphylococcus aureus [25%], followed by pseudomonas [21.6%]. Other organisms included mix pseudomonas and staphylococcus aureus [23.5%], E-coli [13%], proteus [3%], Klebsiella [3%]. All these organisms were resistant to most routine antibiotics. This study highlights that staphylococcus aureus [25%] and pseudomonas [21.6%] are the most common organisms and cefoperazone/sulbactam and imipenem/cilastatin are the most effective empirical therapy in our setup