Supracondylar fracture of humerus in children treated with closed reduction and percutaneous cross pinning vs. two lateral pinning

OBJECTIVE: To analyze and determine anatomical restoration by using percutaneous cross pinning v/s two lateral pinning, functional outcome in these modalities, assess the complications in these methods of treatment and compare patient acceptance of each method

METHODOLOGY: This was a comparative cross sectional study carried out in the department of Orthopeadic Unit-I, Liaquat University Hospital [LUH] Hyderabad from 01-11-2010 to 31-10-2012

This study consisted of 40 patients admitted through the out patient department as well as casuality department. Detailed clinical examination of the patient was done and recorded in proforma

All patients underwent base line and specific investigations especially x-ray

RESULTS: In this study percutaneous cross pinning group 17[85%] were male and 3[15%] female

In two lateral pinning group 18[90 %] were male and 2[10 %] female. There was wide variation of age ranging from a minimum of 3 years to 13 years in both groups. The mean age was 7.25+3.22 years. The major cause of fracture in this study was fall while playing in 21 patients [52.5%], followed by fall from bicycle in 11 patients [27.5%] and in 8 patients [20%] were due to fall from tree [5 to 7 feets height]. In our study, we have 26[65%] patients with postero-medial displacement and 14 [35%] patients with postero-lateral displacement. The complications were seen Superficial pin tract infection [0%] patients in Percutaneous Cross Pinning VS 1[05%] patients in Two Lateral Pinning group, Non Union 1[05%] patients in Percutaneous Cross pinning VS 2[10%] patients in Two Lateral Pinning group group], K-wire migration 1[05%] patients in Per Cutaneous Cross pinning VS 2 [10%] patients in Two Lateral Pinning group group]. Outcome according to flynn criteria were seen in this study, carrying angle loss 2[10%] patients in Per Cutaneous Cross pinning VS 4[20%] patients in Two Lateral Pinning group] and loss of motion 3[15%] patients in Per Cutaneous Cross pinning VS 5[25%] patients in Two Lateral Pinning group

CONCLUSION: The management with percutaneous cross pinning is better method of treating Supra-condylar fractures of humerus and more predictable as compare to that of two lateral pinning

Fracture of distal radius treated by orthofix v/s plaster cast

OBJECTIVES: To compare the functional outcome and the complications of plaster cast and orthofix in the management of distal radius fracture

SETTING: Department of orthopaedic surgery and truamatology [DOST] Liaquat University of Medical and Health Sciences [LUMHS] Jamshoro

STUDY DESIGN: Comparative Study

DURATION OF STUDY: 18 months from 2[nd] March 2012 to 1[st] September 2013

MATERIAL and METHODS: A total of 40 patients fulfilled the inclusion criteria were included in this study. Patients were randomized allocating to either treatment with conventional closed method [group I] or orthofix [group II]. After one week of the initial treatment, patients of either group were followed in the orthopaedic wards and OPD. Clinical and radiological assessment was carried out and recorded. Subsequently, patients were advised for follow up for six weeks

After removal of either plaster or orthofix; patient was reviewed at monthly interval to access the wrist function. Data was collected on Performa

RESULTS: There were statistically significant differences between the orthofix group and plaster cast group on the average, regarding radial length, radial angle, palmar tilt, p value was calculated 0.05, 0.004 and 0.0005 respectively

All patients in orthofix group achieved union and maintained good reduction after closed reduction of the fracture. Complications were seen among both the groups; Mal-union, Stiff hand and Non union, Pressure sore, Shoulder stiffness were not significant between groups

CONCLUSION: it is concluded from this study that external fixator one of the best tool have over edge on plaster cast in the treatment of distal radius fracture Department of Orthopedic

Evaluation of risk of lag screw cut out in unstable intertrochanteric fractures

Object: To evaluate the risk of lag screw cut out in unstable intertrochanteric fractures

Material and Methods: This study was conducted in the Department of Orthopedic Surgery and Traumatology [DOST] Liaquat University of Medical and Health sciences Jamshoro from January 2006 to December 2009. Unstable intertrochanteric fractures type A2 and A3 of AO classification fixed with DHS in stable [anatomic and wayn county] reduction, were included in study. All patients were assessed on six months follow up x-rays for cut out failure in different positions for placement of screw in femoral head. For placement of screw, femoral head was divided in 9 columns/zones on antero-posterior and lateral plane x-rays

Results: Out of total 66 study subjects 45 [68.1%] were males and 21 [31.8%] were females, 56 [84.8%] were of A2 and 10 [15.2%] of A3 type. Mean age was 65.41 years. Forty [60.6%] patients were fixed in anatomical reduction and 26 [39.3%] in wayn county reduction. The screw placement was 24 [36.3%] in central -central, 9 [13.6%] in central -inferior, 17 [25.7%] in posteriorinferior and 16 [24.2%] in remaining off central [unsatisfactory] zones. The cut out was in 2 patients [8.3%] in central-central , 0% in central inferior position , 3 patients [17.6%] in posterior inferior and 4 patients [25%] in remaining off central zones [all cut out were in superior zones of femoral head]

Conclusion: We conclude that placement of lag screw in inferior on AP and central on lateral view in femoral head gives excellent results after achieving stable reduction, having maximum bone to plow for cut out. But it is difficult and time consuming so if it is aimed in lower half on AP and central on lateral view in femoral head it will give better results