Results of type-III supracondylar fracture humerus with open reduction and internal fixation in children after failed closed reduction

Supracondylar fracture of humerus is the second most common fracture in children which account for 60-75% of all fractures around the elbow. There are various treatment modalities for type-III fracture, i.e., closed reduction and casting, skeletal traction, close reduction and percutaneous pinning and open reduction and internal fixation. This study was conducted to see the outcome of open reduction and internal fixation after failed closed reduction. This study was conducted in the Orthopaedics Departments of Khyber Teaching Hospital Peshawar and Ayub Teaching Hospital Abbottabad from February 2007 to Nov 2007 on 30 children. Patients included were of either gender with age range from 5-12 years with displaced supracondylar fracture [type-III] after failed closed reduction. All fractures were fixed with two cross K-wires by open reduction and internal fixation. The patients were assessed both clinically and radiologically and results were tabulated according to Flynn criteria. Twenty-eight patients had excellent results while two had good results according to Flynn criteria. None of the patients had either fair or poor result. Open reduction and internal fixation is a good and reliable method after failed closed reduction and gives stable fixation with anatomical alignment

Management of closed tibal shaft fractures with reamed inter locking nail

The objective of the study was to evaluate the results of closed reamed interlocking nail in the management of closed tibial shaft fractures. Descriptive Observational study Place and Duration: This study was conducted in the Department of Orthopedic, Khyber Teaching Hospital Peshawar, from Jun 2007 to December 2008. A total of 32 patients above the age of 18 years were included in the study. Patients were admitted through accident and emergency department. Written informed consent was obtained from all patients. Detailed history was asked, every patients was assessed clinically and radiographycally. Reamed interlocking intramedullary nailing was done as per protocol. Patients were followed for 1 year, and were evaluated for union, infection, range of motion of knee and ankle and implant problems. 2 patients were lost to follow up and the study was completed on 30 patients. All the fractures united without any need for bone graft. Simple fractures united in average period of 12.5 weeks while comminuted and segmental fractures took longer by four weeks, and united in an average of 16.5 weeks. Two patients developed superficial infection at the site of screws which were treated accordingly with drainage and antibiotics and removal of the distal screw. All the patients had full range of knee movement while 28 patients had full range of ankle movements. The remaining two patients had 15-20 degree loss of ankle dorsiflexion. Nail breakage was not observed in any patient while two had breakage of the proximal and two had breakage of distal screws. We concluded that closed intra medullary nailing for closed diaphyseal fracture of the tibia is a safe and rewarding technique which has high rate of union and relatively low complications rate, there is early return to activities

Intertrochanteric fracture of femur; outcome of dynamic HIP screw in elderly patients

Intertrochanteric [IT] fracture is common in elderly population. The dynamic hip screw is widely accepted in the treatment of IT fractures of the proximal femur. To determine the outcome of dynamic hip screw in intertrochanteric fracture of femur in elderly patients. A descriptive observational study Department of Orthopaedic Khyber Teaching Hospital, Peshawar. Period: From 7[th] Jan 2008 to 7[th] Jan 2009. 113 consecutive patients with intertrochanteric fracture of the femur treated with dynamic hip screw. All patients were investigated and optimized for surgery. An accurate close reduction was done under fluoroscopic control. A dynamic hip screw [DHS] was inserted by a standard technique. Patients were reviewed clinically and radiographically on 2nd, 6th, 12th and 24th weeks. We studied 113 Patients of intertrochanteric [IT] fracture, 13 patients were lost to follow up and the study was completed on 100 patients. Forty seven [47.0%] patients were male and 53 [53.0%] were female. Postoperatively seven patients [7%] suffered from infections, 3 [3.0%] patients suffered from restricted hip joint movements. There was shortening of lower limb in 3 [3.0%] patients, 2 [2.0%] patients developed non union of the fracture site, 1 [1.0%] patient develop varus deformity. Seven [7.0%] patients had implant failure, 3 of which have lag screw cut-out through superior cortex, 3 patients have broken leg screw at barrel shaft junction and 1 patient has broken leg screw at 3 sites. 77 [77.0%] healed without complications. It is concluded that the Dynamic Hip Screw is safe, suitable and reliable method of fixation for Boyd and Griffin type I and type II intertrochanteric fracture of femur

Challenges in access to and utilization of reproductive health care in Pakistan

Pakistan's maternal mortality rate is high, and adequate and timely emergency services could prevent most maternal deaths. A woman's right to life-saving services of skilled health care providers in childbirth is undeniable. This paper examines factors restricting women's access to emergency obstetric care services in Pakistan. This cross-sectional survey on emergency obstetric care services collected information at the health facility level using UN process indicators. The study enrolled 170 health facilities from nineteen randomly selected districts in Punjab and NWFP. Diverse factors limit women's access to Emergency Obstetric Care [EmOC] services. EmOC services were unavailable in most health facilities surveyed. Staff absenteeism, geographic remoteness, delayed access, and ambulance shortages jeopardize the transferral of seriously ill patients to higher level care facilities. Cultural norms dictate that women should be examined by women doctors, whose dearth makes these services inaccessible. Many maternal deaths would be avoidable if EmOC health services were accessible. The geographic obstacles to timely access, poor hospital infrastructure, and high staff absenteeism rates require immediate attention. Health facilities' working hours were inconsistent with the provision of around-the-clock essential services, depriving and endangering the lives of many in need. It is imperative to increase skilled female workers capable of managing EmOC problems through proper incentives. A focused approach at local levels through proper supervision, motivation, and management would unquestionably save women's lives

Intramedullary Kirchner wire fixation of unstable radius-ulna fractures in children

To evaluate the results and outcome of paediatric unstable fractures of radius and ulna treated by Kirchner wire fixation. Prospective quasi experimental study from July 2004 to May 2007. Department of Orthopaedics and Trauma, Khyber Teaching Hospital, Peshawar. Children with displaced fractures of both forearm bones, in whom closed manipulation had failed. The children were treated with open reduction and internal fixation of both forearm bones with Kirchner wires [K wires]. Under general anesthesia and tourniquet control the fractures were fixed by retrograde method. Patients were followed every month for clinical and radiological union of fracture and for any complications. The K wires were removed after healing of fractures. The patients were assessed for symptoms such as pain, ability to participate in physical activities or sports, and physical examination was done to see range of motion of wrist, elbow and forearm, Grading of the results was done according to modified Price criteria. The total number of patients was 22. Sixteen were males and six were females. The age range was 6-12 years with an average age of 9.5 years. In most cases the middle third was involved. The average time of surgery was 65 minutes [range 50-95 minutes]. The average time for clinical and radiological union was 9.2 weeks. The mean interval between the initial surgery and removal of the K wires was 3.2 months. At final assessment there were 18 excellent, two good and two fair results. In unstable fractures involving both forearm bones, open reduction and internal fixation [ORIF] with Kirchner wires have excellent results amongst children

Women's Rights Equal Women's Lives: The Case of Pakistan / 国際保健医療

<b><big>Objectives</big></b><br>The Constitution of Pakistan offer guarantees regarding women s rights, but unfortunately some laws and also customs violate the above commitments seriously affecting the health of women and even endangering their lives. The purpose of the study is to describe various aspects of women s health in Pakistan vis- -vis human rights.<br><b><big>Methods</big></b><br>Review of available literature was undertaken. The scientific electronic database (such as PubMed, Science-Direct & Pakistani database) was searched for women health issues in Pakistan, covering a period from 1980s to present. Published government reports have also been included as sources of information for this paper.<br><b><big>Results</big></b><br>In Asia, Pakistan s, maternal mortality ratio is among the highest; more than half of the women are anemic. Access to health services is deprived whether be it economic, geographical or social. Majority of women are illiterate. Pakistan is among the countries with low gender indices and where female life span is less then men, and men outnumber women. Government spending on health and particularly women health is low compared to other countries.<br><b><big>Conclusion</big></b><br>Women s disproportionate poverty, low social status, gender imbalances, and inadequate maternal services at the community level play a significant role in contributing to maternal deaths. In view of the fact that given accessible, quality health services, many maternal deaths can be avoided, demonstrates maternal mortality is clearly an issue of human rights.<br>There is a strong need that health sector spending is increased, role of women health care providers in rural areas be expanded (such as LHW) and involvement of private and NGO sector to fill gaps in service delivery, be ensured. In order to meet the targets of MDGs, the gender dimensions of demographic and social change need to be stressed further in all policies and development plans, which may result in narrowing of gender disparities and improving women lives.

Emergency obstetric care availability, accessibility and utilization in eight districts in Pakistan's north west frontier province

Reducing maternal mortality is a critical issue in Pakistan. Do public health care centers in Pakistan's North West Frontier Province [NWFP] comply with minimum UN recommendations for availability, use, and quality of basic and comprehensive Emergency Obstetric Care [EmOC] as measured by UN process indicators? All public health facilities providing EmOC [n=50] in 30% of districts in NWFP province [n=8 districts] sampled randomly in September 2003 were included in a cross-sectional study. Data came from health facility records. Almost all indicators were below minimum recommended UN levels. The number of facilities providing basic EmOC services was much too low to be called providing comprehensive coverage. A low percentage of births took place in hospital and few women with complications reached EmOC facilities. Caesarean section was either underutilized or unavailable. The case fatality rate was low, perhaps due to poor record-keeping. The findings of this first needs assessment in NWFP province can serve as a benchmark for monitoring future progress. In resource-poor countries like Pakistan, it is important to upgrade existing facilities, giving special emphasis to facilities that provide basic EmOC services, since many problems can be resolved at the most basic level. Health policy makers and planners need to take immediate, appropriate rectifying measures to, inter alia, improve staffing in rural areas, enhance staff skills through training, upgrade management and supervision, ensure medical supply availability, mandate proper record-keeping, and observe progress by monitoring process indicators regularly

Total abdominal paracentesis in cirrhotic patients with ascites with I/V albumin of polygeline

Ascites is a frequently encountered problem in Cirrhotics and Total Abdominal Paracentesis is an easy and quick way of relieving these patients. To observe the Total Abdominal Paracentesis with IV Albumin or Hemaccel and observe systemic hemodynamics, electrolytes and renal function. Material and 30 patients who were admitted in A.S.H. were included in study. Patients with hepatocellular carcinoma, child Grade, increased Prothrombin time etc. were excluded. Out of 30 patients enrolled, one expired as he was erroneously included in study. In rest of patients all were hemodynamically stable after one day. Total Abdominal Paracentesis is a safe procedure and can be used to relieve patients with tenso ascites in fast and safe way

Studies on phytochemical properties, medicinal uses and economic value of jatropha curcas linn.

Jatropha curcas Linn. is an economically important plant, its seeds oil is used as fuel. The plant is recommended as a remedy for various ailments used by the tribal people and the villagers for thousands of years. Many researchers have focused on the scientific facts, behind the usage in traditional and modern medicine system and economic importance of its seed oil used as commercial sources of the fuel. The present study is a comprehensive review of its utility in the light of contemporary research and information collected from the local people