Relationship of preoperative surgical delay to mortality after hip fracture in elderly patients

To determine whether a delay in surgery for hip fractures affects postoperative mortality among elderly patients. Descriptive case-series Orthopedic department KGMC/PGMI Hayatabad Medical complex Peshawar, from January 2010 to December 2010. This is a retrospective study of 160 patients who underwent surgical treatment of a hip fracture. Postoperative mortality rates were measured in relation to the delay in the surgery and the acute medical comorbidities on admission. Total mortality following the hip fracture surgery was 16.3%, [in-hospital 5.6% and 30-days 10.6%]. When compared pre-operative delay in patients who had surgery within 2 days, those who were operated within 2-4 days and those who waited >4 days, the mortality rates were 1.3%, 5.6% and 9.4% respectively [with significant p value of 0.042]. In patients with acute medical comorbidities, the 30-days mortality was 2.5% in those operated between 2-4 days and 3.7% in those where surgery had been delayed >4 days [insignificant p value 0.56]. Patients with acute medical comorbidities that required treatment prior to the surgery had 1.6 times risk of death in 30-days as compared to those patients who had been initially considered fit for surgery. Mortality was increased when surgery was delayed for more than 2 days for patients who were otherwise fit for hip fracture surgery

Suprascapular nerve block in the treatment of frozen shoulder

To determine the effectiveness of suprascapular nerve block in the treatment of frozen shoulder. Quasi experimental study. Department of Orthopedic Surgery Hayatabad Medical Complex Peshawar, from March 2010 to December 2010. Patients with frozen shoulder received a single suprascapular nerve block. Shoulder pain and disability index [SPADI] were used as main outcome measure of pain and disability. To determine the effectiveness of suprascapular nerve block in the treatment of frozen shoulder. There were total of 64 patients in this study. The mean age was 65.3 +/- 10.1 year. Using SPADI, the mean baseline total, subscale pain and disability scores were 70.9 +/- 6.8, 72.3 +/- 6.9 and 69.5 +/- 8.5 respectively which improved to 24.6 +/- 5.6, 22.3 +/- 5.3 and 27.5 +/- 6.6 respectively at 4 week of suprascapular nerve block of the affected shoulder with p value of 0.000 each. Suprascapular nerve block is safe and effective treatment for relieving pain and decreasing disability in frozen shoulder

Supracondylar fracture of humerus; radiological assessment of closed reduction by Baumann angle

To assess closed reduction by Baumann angle in supracondylar fractures humerus treated by closed reduction and percutaneous pinning. This prospective study of 50 patients who presented with displaced supracondylar fracture of humerus in children between ages 1-12 years were admitted to Orthopedic and Trauma unit of Hayatabad Medical Complex Peshawar over period from January 2008 to July 2009. Closed reduction and percutaneous pinning were performed under general anesthesia and postoperative reduction was assessed by Baumann angle. All patients were followed for one year. Mean age of the patients was 7.02 years +/- 2.25 SD. Loss of Baumann angle in injured side was range from 2° to 8°. Loss of carrying angle in injured side was range from 3° to 9°. When Baumann angle and carrying angle of both sides were compared the mean Baumann angle loss and carrying angle loss were 5.360 +/- 2.22 SD and 4.320 +/- 1.52 SD respectively. Using Flynn's criteria 36 [72%] patients out of 50 patients with carrying-angle loss considered to be excellent results and 14[28%] good results. Neither of the patient developed cubitus varus deformit y after one year of follow-up. Baumann angle of the humerus is a simple and reliable measurement of closed reduction that can be used to predict final carrying angle in supracondylar humeral fractures in children

Awareness and practice of thromboprophylaxis among surgeons in tertiary care hospitals of Khyber Pukhtunkhwa

To find out the awareness and practice of thromboprophylaxis among surgeons working in teaching hospitals of Khyber Pakhtunkhwa. This was a descriptive study carried out in Hayatabad Medical Complex, Khyber Teaching Hospital, Lady Reading Hospital Peshawar and Ayub Teaching Hospital Abbottabad. Consultants from General and Orthopaedic surgery in four teaching hospitals working as senior registrar or above grades were included in the study and were interviewed using proforma about use of thromboprophylaxis. The results were analysed using SPSS version 10.0. A total of 48 consultants participated in this study. 20 of these were orthopaedic surgeons and 28 were general surgeons. Thirty two [66.6%] of the consultants were using thromboprophylaxis but out of these, only 7 [22%] were following the national guide lines. Out of the 16 [33.4%] who were not using thromboprophylaxis, 10 [62.5%] consultants had the impression that it is not necessary while 4 [25%] thought that it increased the risk of bleeding and 2 [12.5%] consultants had the impression that it is expensive. Eight [16.7%] consultants said that they have departmental policy for thromboprophylaxis. Although majority of surgeons were using throboprophylaxis, however few were well versed about the guidelines and very few were following these

Effectiveness of intra-articular corticosteroid injection in the treatment of idiopathic frozen shoulder

To determine the efficacy of intra-articular corticosteroids in the treatment of idiopathic frozen shoulder. Quasi experimental. Department of Orthopedics Surgery Hayatabad Medical Complex Peshawar, from February 2010 to October 2010. In this study, 113 cases of idiopathic frozen shoulder were selected by non-probability consecutive sampling technique at the outpatient department. Patients received a single intra-articular injection of corticosteroid [methylprednisolone] followed by physiotherapy for four weeks. Shoulder pain and disability index [SPADI] was used as main outcome measure of pain relief and disability. Mean age of the patients was 49 +/- 9.3 year. Using SPADI, the mean baseline pain and disability scores were 81 +/- 7.2 and 79.5 +/- 7.6 respectively which significantly improved to 14.5 +/- 7.4 and 25.6 +/- 18.2 at 4th week of intra-articular injection in the affected glenohumeral joint with p value of 0.000 and 0.040 respectively. Intra-articular steroid injection is an effective and reliable modality of treatment for relieving pain and decreasing disability in idiopathic frozen shoulder.

Comparison of single versus double plate fixation in inter and supracondylar fractures of distal humerus in adults

To compare the outcome of supracondylar and intercondylar fractures of humerus treated by single and double plates. Comparative study. This study was conducted in the Department of Orthopaedics, Lahore General Hospital, Lahore and Department of Orthopaedic and Trauma Hayatabad Medical Complex Peshawar. Thirty patients of intercondylar and supracondylar fractures of distal humerus were divided randomly into two groups. Fifteen cases were managed by single plate and K wire and 15 cases by bicondylar plate fixation. All patients were operated through posterior transolecranon approach. Elbow exercises were started at second postoperative day. Patients were followed at two weeks and thereafter monthly, with clinical examination and x-rays. The mean age of the patients was 40.3 years. The healing time was sixteen weeks in both the groups. The final grading of the results showed better resulted with double plate fixation with excellent to good results in 13 [86.6%] and fair to poor in 2 [13.3%]. The outcome in single plate was excellent to good in 6 [40%] and fair to poor in 9 [60%]. The results of dual plate fixation is better than single plate fixation in intercondylar and supracondylar fractures of humerus

Comparison of the two methods of percutaneous K - wire fixation in displaced supracondylar fracture of humerus in children

To compare the effectiveness and safety of fractures treated by percutaneous medial-lateral cross K-wire fixation and 2-lateral K-wire fixation. Randomized controlled trial was conducted from January 2008 to July 2009 in Orthopedics unit of Hayatabad Medical Complex Peshawar. A total of 50 patients of displaced supracondylar fracture of humerus presenting between age 1-12 years were randomly allocated in two groups of 25 patients in each group and were subjected to medial lateral cross K wire fixation and 2 lateral K wire fixation. Mean age of patients was 7.02 +/- 2.25 years.72% of patients with carrying-angle loss was excellent results and 28% good results. The mean loss of elbow flexion and loss of elbow extension were 8.38° +/- 3.10 and 7.26° +/- 3.22 respectively. In Patients with med-lat cross K-wire fixation group 72% were excellent results and 28% good results, while similar results were found in 2-lateral K- wire fixation group. The 4% iatrogenic ulnar nerve injuries occurred with the med-lat cross K-wire fixation group, while no neurological injury occurred with 2 lateral K wire fixation with p value of 0.312. Hence, there was no significant difference in the incidence of ulnar nerve injury between the two groups of patients. Both techniques appear to be effective, 2 lateral K-wire fixation is as effective in term of stability as medial-lateral cross K- wire fixation but with less chance of iatrogenic ulnar nerve injury

Comparison of below the elbow cast with above the elbow cast in treating distal third forearm fractures in children

To compare the effectiveness of below the elbow cast with above the elbow cast in treating distal third forearm fractures in children. Comparative study. Orthopedic Department, PGMI Hayatabad Medical Complex Peshawar, from March 2010 to June 2011. This study was designed to compare above and below elbow casts for distal forearm fracture in patients aged 4-12 year. A total of 108 patients were managed during the study period. They were randomized into two groups of 54 each; group A above-elbow and group B below-elbow cast. The mean age of the children was 7.10 +/- 2.18 year. Males were 59.3% and females 40.7%. The right side was the dominant limb in both the groups. 19.6% of children in the above-elbow group required remanipulation as compared to 26.4% in the below elbow group with p value of 0.381. The time from injury to manipulation was not significantly different in the 2 groups. Differences between radius and ulna translation and angulation in the anteroposterior and lateral views of the x-rays were not significant. Twenty three children with above elbow cast and 19 children of below elbow cast had complications but the difference was not significant [p 0.324]. Three patients were lost to follow up. Below-elbow casts was as good as above-elbow cast in maintaining reduction of fractures in the distal third of the forearm in children

Iatrogenic ulnar nerve injury after percutaneous pinning of displaced supracondylar fractures of the humerus

To assess iatrogenic ulnar nerve injuries after supracondylar humeral fractures treated with closed reduction and percutaneous pinning. Descriptive case series. Orthopedic and Trauma Department of Postgraduate Medical Institute, Hayatabad Medical Complex Peshawar, from December 2007 to December 2010 Children between 1-12 years of age and extension-type displaced supracondylar fracture of humerus were included. Neurovascular status was assessed before operation. Closed reduction was performed under general anesthesia and confirmed with the image intensifier, followed by pinning. After surgery, a long arm back slab was applied. After the procedure, neurovascular status assessed again. The pins were removed at a mean of 5 weeks [4-6 weeks] postoperatively. The neurological complications were assessed both for sensory loss and motor loss. Clinical and electro-myographic examinations were performed at 6 and 12 weeks postoperatively in patient with ulnar nerve lesions. Eighty two patients presented during the study period. There were 62.2% [n 51] males and 37.8% [n 31] females. Left humerus was involved in 69.5% [n 57] cases. The mean age was 6.61 +/- 2.25 years. A total of three [3.7%] iatrogenic ulnar nerve injuries occurred in these patients. Electromyogram showed partial denervation and conduction blocks at the elbow at 6 weeks. Regenerative electromyogram findings were seen at 12 weeks. Sensory and motor functions in all patients returned at a mean of 8 +/- 2.34 weeks and 22 +/- 4.87 weeks respectively. In all patients nerve function returned completely. Iatrogenic ulnar nerve injury is a common complication of percutaneous pinning in displaced supracondylar fracture of humerus in children but usually it resolves spontaneously

Cost effectiveness of bilateral simultaneous versus staged knee arthroplasties

To evaluate the cost effectiveness of bilateral simultaneous knee arthroplasty in experienced hands. This descriptive study was done in the Shotley Bridge General Hospital county Durham England from 2000-2003 on 26 patients undergoing bilateral simultaneous knee arthroplasty. Patients were randomized in two equal groups. Group A included 13 patients and had staged knee arthoplasty i.e. they had the same procedure in two hospital admissions under different anesthetic session. Group B comprised of 13 patients, underwent simultaneous knee arthroplasty. Same type of knee prosthesis was used in all cases and were operated by same surgeon in same institution. In group A, 9 [69.2%] patients had osteoarthritis and 4 [30.8%] had rheumatoid arthritis while in group B twelve patients had osteoarthritis and one had rheumatoid arthritis. Only one patient had transient ischemic attack in group A while there was one case of deep vein thrombosis in group B. Average hospital stay for both groups was 15 days. The average cost for group A was Sterling [pound] 8950/-[Rs.1163500/-] and for group B was Sterling [pound] 5265/-[Rs.684450/-]. This study shows that bilateral simultaneous arthroplasty is cost effective in experienced hands and do not have increased rate of complications

Usefulness and limitations of modified Alvarado scoring system in diagnosis of acute appendicitis

To find out the validity of modified Alvarado scoring system in diagnosis of acute appendicitis in comparison with clinical diagnosis. A randomized controlled trial comparing clinical diagnosis with modified Alvarado scoring in 100 patients of acute appendicitis was under taken. The study was conducted from December 2004 to August 2005. Out of 100 patients, 50 patients were randomly evaluated with modified Alvarado scoring on a standard proforma provided with patients' history sheets. The other group of 50 patients was evaluated clinically. The gold standard was histopathology report on which the true positive or negative results were recorded. Mean age of the patients was 25.34 years with a male to female ratio of 1.2:1. The histopathology reports were positive in 47 [94%] patients operated on the basis of modified Alvarado scoring with false positive rate of 12% and a sensitivity of 88%. In the controlled group of patients operated on the basis of clinical diagnosis the histopathology reports were positive in 36 [72%] cases with a false positive rate of 24%. The sensitivity of clinically evaluated group was 76%. The modified Alvarado scoring system is an effective scoring system. It is simple, easy to apply, and reproducible. It should be used routinely in diagnosis of acute appendicitis

Cervical lymphadenopathy: diagnostic approach

To study the etiology of unexplained cervical lymphadenopathy of more than one month duration, not easily diagnosed on clinical ground or after simple investigations. This study was conducted at Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from January 2003 to June 2004. A total of 100 patients with prolonged unexplained cervical lymphadenopathies were included in this study. All the patients were evaluated through detailed history and clinical examination. Beside these, laboratory, radiological, endoscopic examination, FNAC and histopathological studies were performed. Out of 100 cases, 54 [54%] were female and 46 [46%] male. Laboratory evidence revealed tuberculous lymphadenitis in 58 [58%] cases, metastatic lymph nodes in 18 [18%] cases, lymphoma in 18 [18%] cases, infectious mononucleosis in 3 [3%] cases and leukemias in 3 [3%] cases. Histopathology of the lymph nodes gave conclusive diagnosis with 100% sensitivity rate in cases of granulomatous lymphadenitis and lymphomas. Tuberculous lymphadenitis [58%] represented the commonest infectious aetiology in present study and carcinoma is less common as compared to the western figures. It is advised that any treatment for cervical lymphadenopathy should be preceded by histological proof