Comparison of outcome in reamed versus unreamed nailing in the treatment of tibial diaphysial fracture

Background: Tibial diaphysial fractures are among the notorious fractures as far as management is concerned

Objective: To compare the outcome [union] between reamed and unreamed nailing in transverse tibial diaphysial fractures

Patients and Methods: Study Design: Experimental study. Setting: Department of Orthopaedic Surgery, Bahawal Victoria Hospital Bahawalpur. Study Duration: 8 months from 1[st] January 2009 to 31[st] August 2009. Study subjects: 210 patients were divided into two groups A and B. Group A patients were managed by reamed interlocking nail tibia and group B patients by unreamed interlocking nail tibia. Follow up was done up to 3 months and outcome in terms of union was compared between two groups. 15 patients in each group were lost to followup so data analysis was done on 180 patients. Union was achieved in 80% of patients in group A while 70% in group B. Our study suggests that reamed interlocking nail tibia is better treatment option than unreamed interlocking nail tibia

Evaluation of union of neglected femoral neck fractures treated with free fibular graft

To evaluate the frequency of union of neglected femoral neck fractures treated with free fibular graft. Descriptive case series. Department of Orthopedics Bahawal Victoria Hospital Bahawalpur, from April 2009 to January 2010. Patients of neglected femoral neck fracture [one month postinjury] were included in the study. They were operated and internal fixation was done with concellous screws and free fibular graft placed. They were followed till the evidence of radiological union. Out of 55 patients there were 40 males and 15 females. Ages ranged from 20 year to 50 year. The duration of injury was from 4 weeks to 6 months. Fifty patients achieved complete union while five patients developed non-union with complaint of pain. There was no wound infection and hardware failure. Fracture reduction and internal fixation with use of free fibular graft and concellous screws for neglected femoral neck fractures is the treatment of choice

Assessment of elbow function after stable fixation of AO type C fractures of the distal humerus in adults

Thirty five patients AO Type C fractures of the distal humerus reporting to Orthopedic Department were studied over a period of three years from January 2000 to March 2003. Close fractures and Gustilo Grade I and II fractures were included in the study. Age ranged from fifteen years to sixty years. all the patients were operated under general anaesthesia. A comparison b/w transolecranon approach [1] and Shahane and Stanley approach [2] was done. At a follow-up of six months the results using the Jupiter's modification of Cassebaum's rating system[3]. According to it thirteen results were rated excellent, eleven good, six fair and five poor. Complications included tourniquet palsy, infection, stiff elbow and prominent hardware

Skin coverage of the lower leg by fasciocutaneous island flaps

Fourteen cases presenting to our unit with skin loss over the lower 1/3rd of leg including the ankle and heel are presented. The skin loss was the result of roadside accident or was due to diabetic ulcers. Coverage of the wounds was done with fasciocutaneous island flaps based on the perforators of anterior tibial artery, posterior tibial artery peroneal artery and medial plantar artery. These patients would have ended up either in amputation or referral to other specialized units increasing financial cost and mental trauma. There was male predominance [71%] and most of the injuries were the result of roadside accidents [92%]. All the wounds except those resulting from diabetes mellitus were labelled as Open Grade IIIB according to the Gustilo classification of open fractures. The wounds were debrided within twelve hours of injury [10 patients]. The fractures were stabilized with either external fixator or were internally fixed [one case]. Three wounds [21%] were covered with flaps based on the perforators of anterior tibial A., eight wounds [57%] posterior tibial artery perforators and one each on rural A., peroneal A perforators and medial plantar artery. There was superficial necrosis in two patients and deep necrosis occurred in one patient for whom split thickness grafting was done. The results have been encouraging and we are now using fasciocutaneous island flaps for coverage in the area of lower leg, ankle and heel regularly due to the excellent results and easy technique