Distraction osteogenesis in segmental bone defects in tibia by monoaxial external fixator

To evaluate the results of segmental bone transport using monoaxial external fixator in patients with non union of the tibia with segmental bone loss. This descriptive study was carried out at orthopedic unit of Hayatabad Medical complex Peshawar from July 2004 to January 2007 with 32 patients of tibial non union with segmental bone loss. Locally made "Naseer-Awais" uniplanner external fixator was applied and osteotomy performed. Distraction started at tenth post operative day. Patients were followed fortnightly. Check radiographs were taken on every visit. At the end of consolidation phase fixtor was removed. Results were assessed using Association for the Study and Application of the Method of ILIZAROV [ASAMI] scoring system. Out of 32 patients 29 were male and 3 were female. Eighteen patients had road traffic accidents, 10 fire arm injuries and 4 bomb blast injuries. Average length of bone transport was 7cm. Average duration of fixator was 8 months and average follow up was 25 months. Eight[25%] patients had some additional procedure in form of fibular osteotomy, fasciocutaneous flap and bone grafting. Twentyeight[87.5%] patients had pin tract infection. Repositioning of pins was done in 18[56.25%] patients. External fixator was changed in 10[31.25%] patients. Four patients developed mal-alignment which required fixator resetting. Four[12.5%] patients had re-osteotomy. Five[15.62%] patients developed persistent equinus deformity. Nine[28.12%] patients had to modify their profession. Distraction osteogenesis can be achieved with locally made Naseer Awais fixator in non union of tibia with segmental bone loss

Adverse events after local anesthesia in a day care orthopedic surgery

Each type of anesthesia has its own complication but the day care surgery under local anesthesia has minimized most of them. Different types of local anesthesia can be used in day care surgery. This study was conducted to determine the frequency of adverse events after local anesthesia. This descriptive study was conducted on 48 consecutive patients who underwent day care surgery under local anesthesia in Orthopedic Department of Hayatabad Medical Complex Peshawar from 2006 to 2008. Bupivacaine Hydrochloride was used as a local anesthetic. After two hours of surgery, patients were assessed by surgeon and subsequently discharged home [score of 9 or more] using post anesthetic discharge scoring system [PADSS] after taking notes on postoperative nausea and vomiting, post operative pain, difficulty in movements and resumption of normal diet. Out of 48 patients 20 were female and 28 were male. Average age was 23 years. The procedure performed were 7[14.58%] knee arthroscopy, 10[20.83%] excisional release of trigger finger, 9[18.75%] release of carpal tunnel, 19[39.58%] removal of foreign body and 3[6.25%] excision biopsies. Postoperative nausea and vomiting was noted in 3[6.25%] patients, post operative pain requiring parenteral analgesics in 12[25%], difficulty in movements in 7[14.58%] and not resuming normal diet in 2[4.16%] patients. Although local anesthesia was associated with minor adverse events, however the patients could resume normal diet and daily activities quickly

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

Bilateral simultaneous fractures neck of femur: a case report and review of literature

We report a case in an elderly lady who had an epileptic convulsion and sustained bilateral simultaneous fracture neck of femur. This lady was deaf and dumb and the diagnosis was therefore delayed. The patient was initially diagnosed as flaccid paralysis and was kept under observation. After 36 hours, x-rays of hip and dorsolumber spine was done that showed bilateral simultaneous fractures of hip. Both fractures were treated with bilateral modular hip hemiarthroplasties within 24 hours of diagnosis. She made uneventful recovery

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

Frequency of osteopenia and osteoporosis in different parts of north west frontier province

To find out the frequency of osteopenia and osteoporosis in different parts of North West Frontier Province based on calcaneal bone mineral density [BMD]. 1868 persons were scanned in 8 localities of NWFP by SAHARA Clinical Bone sonometer [Quantitative Ultrasound] to measure the calcaneal bone mineral density as stiffness index. People with hyperthyroidism, hyperparathyroidism, malignancy and osteomalasia were excluded from the study. Two main variables in the study were the age and sex. On T score- bone mineral density up to -1 was taken as normal, up to -2.5 as osteopenla and -2.5 and below as osteoporosis. Out of the total I868 persons in all the selected areas, 554 [29.65%] were normal, 904[48.39%] were osteopenic and 410[21.95%] were osteoporotic. Out of 1372 females, 378[27.55%] were normal, 655 [47.74%] were osteopenic and 339 [24.70%] were osteoporotic. Out of 496 males, 176 [35.48%] were normal, 249[50.20%] were osteopenic and 14.31% were osteoporotic. Calcaneal Ultrasound is a cheap and radiation free method which provides information on BMD and perhaps on bone quality as well. Osteoporosis and osteopenia detected by calcaneal ultrasound is more frequent in our society than most parts of the world. To study it further much larger studies and expensive equipments like dual-energy x-ray absorptiometry [DEXA] is needed