Dynamization versus static antegrade intramedullary interlocking nail in femoral shaft fractures

Objective: to compare the primary dynamic interlocking technique with static interlocking method for femoral shaft fractures in terms of bony union

Study design: quasi experimental study

Place and Duration of study: department of Orthopaedic Surgery, Ziauddin University Hospital Karachi, from March 2012 to August 2013

Methodology: all patients with closed femoral shaft fractures were treated by closed reamed intramedullary [IM] interlocking nail. They were divided into two equal groups. Group I [Dynamization group] patients underwent primary dynamization and in Group II [Static group] patients the static nail was used. Both groups were divided into subgroups on the bases of post reduction intrafragmental gap less than or more than 3mm on x-ray.The surgical procedure and postoperative protocols were same for both the groups, with the exception of interlocking mode. The outcome was measured using Thorensen clinical criteria. Bony union, time of union, delayed union, nonunion, implant breakage and leg shortening were recorded

Results: a total of 64 patients were included, 32 in each group. Mean time of union was same in dynamic group and static group with post reduction intrafragmental fracture gap < 3mm. In the dynamic group with post reduction intrafragmental fracture gap=3mm, one case of nonunion was noted. In static group two cases of delayed union and one case of nonunion were noted in sub group with post reduction intrafragmental fracture gap=3mm

Conclusion: dynamization significantly shortened the mean time to union in femoral shaft fracture with intrafragmental gap =3mm, though it did not significantly affect the union rate of the femoral shaft fractures as compared to static close intramedullary interlocking nailing

Local infilteration of steroid in conjunction with coccygel manipulation as a treatment of coccydynia

To asses the efficacy of local infiltration of steroid in conjunction with coccygel manipulation as a treatment of coccydynia. Interventional study. Department of Orthopaedic Surgery, Ziauddin Hospital Karachi, from December 2000 to December 2008. All selected patients who did not improve three to six month of conservative treatment, were enrolled. The patients were treated with local infiltration of steroid in conjuncation with coccygel manipulation and followed for up to 2 years. A total of 172 patients were diagnosed with coccydynia. The average age of the patients was 38.3 year. There were 138 [80.2%] males and 34 [19.8%] females. Trauma was responsible for pain in 118 [68.6%] cases. Of the total patients, 97 [56.4%] recovered with conservative management and remaining 75 [43.6%] underwent manipulation of coccyx under sedation with local infiltration of steroid. Fifty three [70.7%] patients had excellent results, 14[18.7%] had good response and 8 [10.7%] had fair outcome on first visit. In 2 year follow up 60 [80%] patients showed good response. Second injection was given in 5[6.7%] patients and 3[rd] injection was needed in one [1.3%] patient. Nine [12%] patients were lost to follow up. We recommend manipulation along with local infiltration of steroid in all patients of coccydynia. This approach is less invasive and carried out under sedation as a daycare procedure.

Outcome of total knee replacement in 232 cases

To evaluate, clinically and radiologically, the outcome of total knee replacement [TKR] in our institute. Design and Descriptive, prospective study conducted from Jan. 1999 to Dec. 2003.Ziauddin Medical University Hospital, Karachi.All patients who underwent TKR at our institute.: All patients who underwent TKR were evaluated clinically and radiologically on the basis of modified INSALL knee scoring system prior to surgery and postoperatively between one to three years after surgery. Pre and post operative scores were then compared for each patient to find improvement, both functional and radiological. Amongst the 232 patients that were included in the study, there were 83 males and 149 females, with ages ranging from 58 to 80 years. The preoperative INSALL Knee Scores were between zero to 30 for 87% of patients. Postoperatively 90% of patients had scores greater than 90 and most of them achieved 120 degrees of flexion.Total knee replacement is an excellent modality of treatment for patients suffering from severe arthritis of knee joints with regards to pain, range of motion and stability

Upper extremity deep vein thrombosis

A case of deep vein thrombosis of axillary vein [Paget-Schroetter syndrome] is described in an 18 years old male. Patient presented via emergency with a one week history of pain and swelling of arm. Duplex imaging showed deep vein thrombosis of third part of left axillary vein and venae comitantes of brachial artery. Patient's condition resolved on conservative treatment