Exchange nailing for delayed or non union of diaphyseal femoral fractures

To determine the effectiveness of exchange nailing for delayed or nonunion of diaphyseal femur fractures. Descriptive case series. Department of Orthopaedics Jinnah Postgraduate Medical Center Karachi, from March 2009 to February 2012. All patients with delayed or hypertrophic nonunion of diaphyseal femur fractures diagnosed on clinical and radiological examination, were included. Patients with infective nonunion, segmental fractures or fractures with bone loss and open fractures were excluded. Exchange nailing was performed. A total of 36 patients were managed which included 27 males and 9 females. Twenty-four [66%] patients were between 30 - 40 year of age. Left femur was predominantly involved [56%]. The non union involved middle third in 61% cases. Following surgery union was achieved in 33 [92%] cases. In 14 patients union occurred between 4 to 6 months. Superficial infection occurred in 2 patients. Exchange nailing is the one of best options for delayed or nonunion of femoral diaphyseal fractures.

Functional outcome of the minimally invasive plate osteosynthesis for the supracondylar fractures of femur using dynamic condylar screw

To assess the functional outcomes of minimally invasive plate osteosynthesis [MIPO] for the extra-articular and undisplaced intra-articular supracondylar fractures of femur using dynamic condylar screw [DCS]. Descriptive case series. Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre Karachi, from April 2009 to October 2011. Patients were enrolled from accident and emergency and OPD. OPD follow-ups were carried out at 2nd, 6th, 12th, 18th, and 24th weeks, then every 2nd month for the assessment of rate of union and range of motion of knee joint. A total of 83 patients were included. There were 55 males and 28 females. Male to female ratio was 1.96:1. Patients were 25-50 year of age. Seventy four [89.2%] of the injuries were caused by road traffic accident and 9 [10.8%] due to fall from height. Forty six [55.4%] patients had fractures on right side and 37 [44.6%] on left side. Radiological union was achieved in 79 [95.2%] patients at an average period of 19.05 weeks. The radiological bony union was achieved in 16-18 weeks in 25[30.1%] patients. Four patients developed nonunion for which bone graft from iliac crest was placed after 24 weeks. Two achieved union in one year follow up while two were lost to follow up. At end of one year, forty-three [51.8%] cases had knee flexion from zero to 90° - 120°, 25 [30.1%] cases had knee flexion of > 120° and remaining 15 [18.1%] cases had knee flexion of <90°. At the end of one year satisfactory [knee motion > 90°] functional outcome as achieved in 68 [81.9%] cases. High rates of both radiological union [95.2%] and satisfactory [knee motion > 90°] functional outcome [81.9%] were achieved in large number of cases

Giant cell tumours in hand bones

To describe the clinical features of Giant cell tumour of hand, in terms of aggressiveness, multicentricity and radiological grading at presentation, surgical procedures and final outcome. A case series. Jinnah Postgraduate Medical Centre [JPMC], Karachi, from January 1990 to January 2009. Seven cases of Giant cell tumour of hand bones were diagnosed in last 19 years and included in this study. Patients with infections in hand and procedure performed at other centre were excluded. Clinical and radiographic features were analyzed, definitive operative procedures performed and follow-up of the patient were studied and updated. Two hundred ten cases of Giant cell tumour of bones were seen in last 19 years at JPMC, Karachi; 7 cases were of GCT of hand bones which constitutes around 3.3% of all GCT. Four patients [57%] were male and 3 [43%] female with mean age of 24.28 +/- 5.7 years. Four [57%] cases were in metacarpal and 3 [43%] in phalanges. Average duration of symptoms was 5.78 +/- 3.26 months; all presented with radiological stage 3 lesions. One case of multicentric lesion presented after treatment of primary GCT of distal radius. Excision of the tumour and reconstruction by autogenous graft was performed in 6 cases and ray amputation in one case. No complication or recurrence noted in any case on an average of 4.5 years [ranging from 1.5-8 years] follow-up. Giant cell tumour in hand bones is rare tumour and shows specific clinical and radiographic features with early involvement of entire bone, more aggressive behaviour and multi centricity. The treatment of choice is resection of the tumour with reconstruction or ray amputation