Lateral epicondylitis; comparison of autologous blood and corticosteroid in the treatment. A prospective, randomized, controlled trial

With aging, chemical hormonal and vascular factors have their part to play in lateral epicondylitis. The objective is to compare results of autologous blood injection and corticosteroid injection in treatment of lateral epicondylitis. Out Patient Department of Peshawar Institute of Medical Sciences, Peshawar from March 2013 to February 2014. Material and A prospective randomized control trail conducted on 58 patients fulfilling inclusion criteria. DASH score and VAS score used as outcome measures and both were recorded before injections and at each follow up made at 2 weeks, 6 weeks, 12 weeks and 24 weeks interval. P-value was calculated where applicable. Out of 79 patients 65 met the inclusion criteria. Mean age was 41.43 years +/- 13.43. 36 were females and 29 males. Dominant elbow involved in 39 patients. Mean duration of symptoms was 7.1 +/- 2.9 months. 7 patients lost in follow up. DASH score improved in both groups. but when compared there was no significance difference between the two groups [P value 0.33 at 12 weeks and 0.09 at 24 week follow up]. Similarly Mean VAS improved at 12 and 24 week follow up] in both groups but when compared the difference was non-significant [P value. 071 at 12 weeks and 0.12 at 24 weeks follow up. Both steroid and autologous blood injection has shown improvement in pain and physical activity and provide acceptable results although none superior to other significantly

Autologous blood injection in the treatment of lateral epicondylitis

Objective: to know the results of autologous blood injection in lateral epicondylitis. Out Patient department of Peshawar Institute of Medical Sciences, from March 2013 to December 2013

Material and Method: it is a prospective descriptive study conducted on 66 patients with lateral epicondyHt1s, fluffing the inclusion criteria presenting in DASH [Disability of the Arm, Shoulder and Hand] score was used as primary outcome measure and Thomsen provocative test to elicit pain and Nirschl score to evaluate pain function as secondary outcome. VAS score was used to measure pain. 2ml of autologous venous blood mixed with 1 ml of lignocaine 2% solution and injected by introducing the needle into lateral epicondyle of humorous at site which is most tender by peppering technique. Patients were followed up at 2 weeks, 6 weeks, 12 weeks and 24 weeks interval. Patient DASH score, VAS pain score and Nirschl score was recorded before autologous injection and at 12 and 24 weeks post injection. P-value of< 0.05 deemed to indicate statistical significance and was calculated where applicable

Results: mean age of the patients was 39.68 years +12.77. 32 of these patients were females And 34 were males. Dominant elbow was involved in 42 patients. Mean duration of symptoms was 8.9+3.2 months. During follow up 10 patients were lost [6 females and 4 males]. DASH score of patients improved from 86 to 64 at 12 weeks and to 49 at 24 weeks [P value <0.0001]. Mean VAS improved from 7 .63 to 3.89 and 1. 77 respectively at 12 and 24 week follow up [P value <0.0001]. Nirschl score of the patients receiving autologous blood injection improved to 3.69 and 1.66 at 12 and 24 weeks: follow up respectively from 5. 8 score of pre-autologous blood injection [P value <0.0001]

Conclusion: autologous blood injection has shown improvement in pain and physical activity and provide acceptable short to long term results

Treatment of segmental tibial bone loss by distraction osteogenesis

To assess the clinical outcome of reconstruction of segmental tibial defects by the technique of bone transport. This prospective, quasi-experimental study was conducted in Lady Reading Hospital and private hospitals of Peshawar, Pakistan from October 2009 to September 2011. Segmental losses of tibia diaphysis in 32 patients were 'regenerated' by bone transport. Radiological results were excellent in 24 [75%], good in 3 [9%], fair in 4 [12%] and poor in 1 [3%] patient. Clinical results were excellent in 19 [59%], good in 7 [22%], fair in 5 [16%] and poor in 1 [3%] patient. During follow-up there were 9 obstacles of pin/wire infections and 7 problems which required surgical intervention. At the last follow-up there were 6 true complications. The average fixator time [external fixator index] was 25.9 weeks and the average bone healing time was 26.1 weeks. Distraction osteogenesis may be the best biological method of restoring the integrity of a bone in segmental bone loss

one year review of various complications in fracture shaft of femur managed with closed intramedullary interlocking nail

To determine the frequency of complications in fractures shaft of femur managed by close antegrade intramedullary interlocking nail. It was a descriptive cross sectional study of one year duration from March 2010 to March2011 held at department of Orthopedics and Traumatology, Lady Reading Hospital Peshawar. Forty four consecutive patients with femoral shaft fracture fulfilling the inclusion criteria were managed with closed antegrade interlocking nail. Complications in terms of infection, angulation, rotation, non-union, shortening and knee stiffness were measured. The mean age of the patients was 33.70 +/- 14.53 years. Twelve patients [27.3%] were females and 32 [72.2%] were males. Thirty five [79.5%] had road traffic accident, 3 [6.8%] sustained fractures due to fall from a height and 6 [13.6%] were due to fire arm/bomb blast injury. Thirty five [79.5%] had close and 9 [20.5%] had open fracture. There were four cases [9.1%] of infection; [two superficial and two deep wound infection]. 40 patients [90.9%] regained full range of motion [0[0] - >130[0]] in knee and 4 patients [9.1%] had 0[0]-120[0] range of motion. There was only one case [2.3%] of up to 2.5cm limb shortening. 42 [95.4%] patients achieved union. Two [4.5%] patients had non-union. These patients were treated by standard protocol of exchange nailing after reaming and ultimately achieved union. Three cases [6.8%] had angulation of > 10[0] [dorsal or ventral]. None of our patients in this study had rotation deformity. Most common early complication with closed antegrade intramedullary nailing was infection and late complication was non-union

experience of the treatment of unstable inter-trochanteric fractures with the Ao/Asif proximal femoral nail

To evaluate the use of local-made proximal femoral nail in the treatment of unstable inter-trochanteric fern oral fractures. This descriptive study was conducted in the Department of Orthopaedics, Lady Reading Hospital, Peshawar, from February 2009 to June 2010. Sixty-two patients with unstable inter-trochanteric femoral fractures, admitted through the Accident and Emergency Department were included in this study. All patients were treated with AO/ASIF proximal femoral nail and followed at least till fracture consolidation which takes minimum of 6 months. The mean age of the patients was 74.27 +/- 5.84 years. Two patients died and thirteen patients were lost to follow-up. The results are thus based on a sample of 47 patients. There were no complications in 81% [n=38] patients and they achieved fracture consolidation within six months. Three patients underwent revision surgery due to non-union; two had lag screw penetration into the hip joint, three patients developed deep wound infection while one patient developed superficial wound infection. The mean pre injury mobility score was 6.8 +/- 2.5 while the mean post-operative mobility score was 6.48 +/- 2.7 [p=.000]. The advantage of immediate stability in difficult and unstable fractures, and the relatively few complications serve to recommend the wider use of AO/ASIF proximal femoral nail

Management of supracondylar fracture of humerus in children by close reduction and immobilization of the elbow in extension and supination

A Supracondylar fracture of the humerus is the most common fracture in children around the elbow and is also called first decade injury. If not treated properly it may lead to disability due to elbow stiffness, and sequel of neuro-vascular injuries like Volkmann ischemic contracture etc. This study was undertaken to determine the outcome of close reduction and immobilization of the elbow in extension and supination in displaced supracondylar fractures of the humerus in children. This Quasi-experimental study was conducted in the Department of Orthopaedics, Postgraduate Medical Institute, Lady Reading Hospital Peshawar, from January 2007 to December 2007. The inclusion criteria was Gartland Type III [completely displaced] supracondylar fractures of the humerus and the exclusion criteria was open or closed Gartland type-III fracture associated with neurovascular injury. Close reduction under general anaesthesia was done and the elbow was immobilized in extension by the application of 2 plaster slabs according. The follow up is based on the overall rating using the modified Flynn global criteria. Out of 70 cases, in 56 cases [80%], reduction was acceptable; while in 14 cases [20%] it was unacceptable. Those with unacceptable reduction, 2nd attempt of close reduction were done but only eight were successful and the other six children required open reduction and internal reduction. Those with acceptable reduction went in to union with the carrying angle +/- 5 of the contra-lateral side and full range-of-motion. Excellent result were achieved in 35 cases [50%], good in 15 cases [21.43%], fair in 4 cases [5.71%] and poor in 6 [8.75%] patients. The extension method of close reduction and immobilisation with two slabs is safe method and give better cosmetic results in uncomplicated type III injures as compared to the flexion method

External fixation in close comminuted femoral shaft fractures in adults

To evaluate the role of external fixation in the management of highly comminuted femoral shaft fractures in adults. Design: Descriptive study. Place and Duration of Study: Agency HQ Hospital, Landikotal and Saidu Group of Hospitals, Swat, from April 1999 to March 2002. Patients and Fourteen adults with close Winquist Type III and IV comminuted fractures of the shaft of the femur were treated with external fixation. The fixator was applied until the fracture became stable and was followed by the application of a femoral cast-brace till consolidation. All patients were followed for a minimum period of one year after the index procedure. Thirteen patients [93%] achieved fracture consolidation in an average time of 5.2 months [range 4-8]. Eight patients had pin-tract infections and 3 developed shortening and 11 lost an average of 34 [0-75] degrees of range-of-motion in their knees. On the basis of this loss, there were 4 excellent, 6 good, 3 fair and 1 poor result. Ocular emergencies predominantly affected the males in this series. Trauma related OE are almost as common as non-traumatic. Majority of OE need surgical intervention and the average hospital stay is longer than routine admissions