Comparison of mean anterior knee pain between medial parapatellar tendon approach versus transpatellar tendon approach in tibial medullary nailing for treatment of tibial shaft fracture

Background: Tibial medullary nails are largely inserted by a transpatellar tendon approach or medial parapatellar tendon approach in fracture of shaft of tibia. One of the common complication of the tibial nailing is anterior knee pain

Objective: To compare the mean knee pain between Medical Parapatellar Tendon approach and Trans Patellar Tendon approach in Tibial medullary nailing for tibial shaft fracture. Methodology: Study Design: Randomized controlled trial. Study Duration: From 16th November 2015 to 15th May 2017. Settings: Department of Orthopedics, Bahawal Victoria Hospital, Bahawalpur. A total of 60 patients of closed or type I open fractures of tibial shaft, in 20-60 years of age, of either gender were included. Patients were placed randomly into two groups. In groups A patients, tibial medullary nailing was done by the Medical Parapatellar Tendon approach [MPT] while in group B, Tibial medullary nailing [TMN] was done by Trans patellar tendon approach [TPT]. Follow up was regular post-operatively and final knee pain was measured at the end of 2nd week. Data was analyzed by using SPSS version 16

Results: The mean age of patients in group A was 38+/-11years and in group B was 38+/- 9years. Out of these, 60 patients, 45 [75%] were male and 15 [25%] were females with ratio of 3:1. Mean knee pain in Group A [MPT approach] was 4.47 +/- 1.53 while in Group B approach] was 6.30 +/- 1.57 [p-value = 0.000]

Conclusion: Mean knee pain was less after Medical Parapatellar Tendon approach as compared to approach in Tibial Medullary Nailing for treatment of Tibial shaft fracture

Frequency of osteoarthritis among patients of knee joint pain

Background: Osteoarthritis knee causes disablity among middle aged people

Objective: To find out the frequency of osteoarthritis among patients of knee and its association with gender and obesity

Methodology: This cross sectional study was conducted at Department of Orthopedics, Bahawal Victoria Hospital, Bahawalpur from 1[st] January to 31[st] May 2014. Patients of both sexes with knee pain, age from 40 to 70 years were included in this study. Physical examination of all the patients was done and x-ray of knee joint were also taken from every patients to assess the knee osteoarthritis. The data was entered and analysed by using SPSS version 15

Results: Total 100 patients were included in this study. Mean age of the patients was 52.64 +/- 8.8 years. Osteoarthritis was found in 72 [72%] patients. 20 [55.6%] among male and 52 [81.25%] among female were having osteoarthritis. Out of 60 [60%] obese patients osteoarthritis was found in 56 [93.33%] patients

Conclusion: Obesity is found to be significant important risk factor for Osteoarthritis Knee [KOA]. KOA is also found more in females and obese

Vaginal delivery in a patient with pheochromocytoma, medullary thyroid cancer, and primary hyperparathyroidism [multiple endocrine neoplasia type 2A, Sipple's syndrome]

Multiple endocrine neoplasia 2A [MEN 2A], or Sipple's syndrome is a rare inherited dominant syndrome, characterised by medullary thyroid carcinoma, adrenal pheochromocytoma and hyperparathyroidism, due to specific RET proto-oncogene mutations. The women with MEN 2A syndrome are at risk of complicated pregnancy because of unrecognised pheochromocytoma and transmission of RET mutation to the progeny. We report a case of a woman with MEN 2A diagnosed in early pregnancy. Alpha-blockade medical therapy was used effectively and time was given for fetal maturation. Uncomplicated vaginal delivery performed under epidural analgesia. Six weeks postpartum adrenalectomy, thyroidectomy and parathyroidectomy were performed uneventfully