Percutaneous needle decompression of acute compartment syndrome of leg

Thirty patients with acute compartment syndrome of legs were managed with percutaneous needle decompression of compartments with help of size 18 gauge needle under aseptic technique. The recovery was quick and avoided complications of two fasciotomy incisions, Percutaneous needle decompression may be considered an alternative to open fasciotomies for acute compartment syndrome

Prevalence of ocular manifestations in patients of rheumatoid arthritis

To study the prevalence of ocular manifestations in patients of rheumatoid arthritis

Material and Methods: 104 Patients of rheumatoid arthritis were studied during five years period at AL-KHIDMAT teaching hospital Mansoora, Lahore. Ocular examination included best corrected visual acuity, slit lamp examination, tear film breakup time, Schirmer test, fluorescence staining and fundus examination

Results: Dry eye was the most common association encountered. It was present in 31 patients. Severe dry eye with Schirmers test value less than 5mm was observed in 10 patients. Moderate degree of dry eye was present in 21 patients. Scleritis was observed in two patients. Fluorescene staining revealed corneal ulcer in four patients. Temporary eye patches results in healing in three patients while one patient needed lateral tarsorraphy to get relief from ulcer. Cataract due to steroid intake was seen in four patients. Steroid induced glaucoma in two patients. Age range was between 23-74 years and mean age of 46 years. There were 13 males and 91 females

Conclusion: Dry eye was the most common finding in patients with rheumatoid arthritis mainly in females. Cataract and glaucoma are due to inappropriate use of steroids. Scleritis and scleromalacia perforans are very rare

Intramedullary nailing for open fractures of the tibial shaft

Interlocking intramedullary nailing has become a popular method of fixation for closed tibial fractures, and a series of reports has confirmed excellent results with this technique. However, the use of intramedullary nails for open tibial fractures is controversial. The standard treatment for these injuries has been external fixation, particularly for fractures associated with more severe soft-tissue injuries

Objective: The purpose of the present study was to compare the clinical and radiographic results of intramedullary nailing of open fractures of the tibial shaft after reaming with those of nailing without reaming

Material and Method: This was follow-up comparative study. Thirty patients who had thirty-four open fractures of the tibial shaft were randomized into two treatment groups. Sixteen fractures [nine typeI, three type-II, two type-IIIA, and two type-IIIB fractures, according to the classification of Gustilo et al.] were treated with nailing after reaming, and eighteen fractures [ten type-I, four type-II, two type-IIIA, and two type-IIIB fractures] were treated with nailing without reaming

Result: The average diameter of the nail was 10 millimeters [range, nine to eleven millimeters] in the group treated with reaming and 9 millimeters [range, eight to ten millimeters] in the group treated without reaming. No clinically important differences were found between the two groups with regard to the technical aspects of the procedure or the rate of early postoperative complications. The average time to union was 30 weeks [range, thirteen to seventy-two weeks] in the group treated with reaming and 29 weeks [range, thirteen to fifty weeks] in the group treated without reaming. Two of the fractures treated with reaming and three of the fractures treated without reaming did not unite. There were two infections in the group treated with reaming and one in the group treated without reaming. More screws broke in the group treated without reaming four, per cent] than in the group treated with reaming [Three; 9 per cent]. The functional outcome, in terms of pain in the knee, range of motion, return to work, and recreational activity, did not differ significantly between the groups

Conclusion: We concluded that the clinical and radiographic results of nailing after reaming are similar to those of nailing without reaming for fixation of open fractures of the tibial shaft, although more screws broke when reaming had not been done

Intramedullary nailing for open fractures of the tibial shaft

Interlocking intramedullary nailing has become a popular method of fixation for closed tibial fractures, and a series of reports has confirmed excellent results with this technique. However, the use of intramedullary nails for open tibial fractures is controversial. The standard treatment for these injuries has been external fixation, particularly for fractures associated with more severe soft-tissue injuries. The purpose of the present study was to compare the clinical and radiographic results of intramedullary nailing of open fractures of the tibial shaft after reaming with those of nailing without reaming. This was followup comparative study. This study was conducted at the Department of Orthoaedic, Shaikh Zayed Hospital, Lahore from Jan. 2009 to Dec. 2011. Thirty patients who had thirty-four open fractures of the tibial shaft were randomized into two treatment groups. Sixteen fractures [nine type-I, three type-II, two type-IIIA, and two type-IIIB fractures, according to the classification of Gustilo et al.] were treated with nailing after reaming, and eighteen fractures [ten type-I, four type-II, two type-IIIA, and tye-IIIB fractures] were treated with nailing without reaming. The average diameter of the nail was 10 millimeters [range, nine to eleven millimeters] in the group treated with reaming and 9 millimeters [range, eight to ten millimeters] in the group treated without reaming. No clinically important differences were found between the two groups with regard to the technical aspects of the procedure or the rate of early postoperative complications. The average time to union was 30 weeks [range, thirteen to seventy- two weeks] in the group treated with reaming and 29 weeks [range, thirteen to fifty weeks] in the group treated without reaming. Two of the fractures treated with reaming and three of the fractures treated without reaming did not unite. There were two infections in the group treated with reaming and one in the group treated without reaming. More screws broke in the group treated without reaming four, per cent] than in the group treated with reaming [Three; 9 per cent]. The functional outcome, in terms of pain in the knee, range of motion, return to work, and recreational activity, did not differ significantly between the groups. We concluded that the clinical and radiographic results of nailing after reaming are similar to those of nailing without reaming for fixation of open fractures of the tibial shaft, although more screws broke when reaming had not been done

Ocular affects of hydroxychloroquine treatment in rheumatoid arthritis patients

Hydroxychloroquine is an antimalarial drug which is used as a part of combination DMARD therapy in patients with Rheumatoid arthritis. Eye toxicity because of the accumulation of the drug in the Retina is the most serious adverse effect. The purpose of this study is to detect ocular affects of hydroxychloroquine treatment in low risk patients [without renal or liver disease] for longer duration

Material and Methods: sixty two patients were studied who were taking hydroxychloroquine 200mg/day, after every six months. Best corrected visual acuity, color vision testing with ishihra chart, Amsler grid testing, slit lamp examination and fundus examination using 90D was done on each visit. Automated perimetry and ocular coherence tomography was done in suspected patients. The duration of treatment was four years. The patients selected were not having any renal or hepatic disease. Those suffering from diabetes mellitis were also excluded. The age limit was up to sixty year

Results: out of sixty two patients studied over a period of seven years, only forty eight patients got their follow up examination completed for four years. All patients were females. Two patients suspected after amsler grid testing were further investigated with automated perimetry and ocular coherence tomography. These patients were found normal. Treatment in these patients was continued for four years

Conclusion: the recommended dose of Hydroxychloroquine 200mg/day given in RA patients is safe in low risk patients for a period of as long as four years