Functional Outcome Analysis of Fracture distal end femur treated with distal femur LCP - A Prospective Study

Supra-condylar and inter-condylar fractures of the distal femur historically have been difficult to treat. They account for 7% of all femoral fractures. If hip fractures are excluded, 31% of femoral fractures involve distal portion. Because of the proximity of these fractures to the knee joint, regaining full knee motion and function may be difficult. Many of these fractures are the result of high energy trauma which generates severe soft tissue damage and articular and metaphyseal comminution, the management of which still remains complex and challenging to the orthopedic surgeons. The incidences of mal-union, non-union and infection are relatively high. Methods: A total of 25 patients were enrolled for this prospective study and all were treated with locking compression plate. Physical examination and radiographs were performed at regular follow-ups. Functional outcomes were analyzed using Modified Hospital for Special Surgery scoring system. Results: Patients were followed up every 2 weeks in the first month, then monthly for 3 months and then once every 3 months. The average range of knee flexion achieved was about 101°. The average knee score was 88.88 rated using Modified Hospital for Special Surgery functional score.The difference in knee range of motion was statistically significant for closed and open fractures but knee score and age was not statistically significant. Intra-articular fractures tend to have poorer results with respect to pain and function, more so because of the nature of the injury rather than the implant used, which limits the movement and causes loss of strength more than instability. Conclusion: The outcome seems to correlate with fracture severity, anatomic reduction, etiology, bone quality, length of time elapsed from injury to surgery, concomitant injuries and the exact positioning and fixation of the implant. Furthermore, the initial severe concomitant cartilage damage may predispose to early osteoarthritis although there is no evidence of that. Closed fractures have a higher range of motion as well as a better knee score as compared to open fractures thereby showing that soft tissue compromise also affects range of motion and further rehabilitation of the limb.

Prevalence of metabolic risk factors in non-alcoholic fatty liver disease

Objective: To determine the frequency of factors leading to metabolic syndrome among non-alcoholic fatty liver disease [NAFLD] patients at a tertiary care hospital

Study Design: Descriptive cross sectional study

Place and Duration of Study: Department of Medicine, Combined Military Hospital, Kharian. Study was carried out over a period of six months from Jan 2015 to Jun 2015

Material and Methods: A total of 110 patients were included in this study. Past history was taken to rule out alcohol intake, viral and drug induced etiology, to determine the presence of co-morbidities like obesity, type 2 diabetes mellitus, arterial hypertension and dyslipidemia. Physical examination was carried to determine the arterial blood pressure and to determine anthropometric data that is weight, height, body mass index [BMI] and abdominal obesity by measuring waist circumference

Results: Mean age of the patients was 49.95 +/- 8.86 years. There were 72 male patients [65.5%] while 38 [34.5%] patients were female. Different metabolic factors were central obesity in 82 patients [74.5%], raised high density lipoprotein [HDL] in 19 patients [17.3%], raised cholesterol in 87 patients [79.1%], raised blood pressure in 65 patients [59.1%] and raised fasting plasma glucose in 82 patients [74.5%]. Mean BMI was 26.31 kg/m2 +/- 2.68, mean waist circumference was 109.82 cm +/- 18.41, mean cholesterol was 237.50 +/- 48.47mg/dl, mean systolic blood pressure was 148.88mmHg +/- 22.10, mean diastolic blood pressure was 90.41mmHg +/- 12.25 and mean fasting plasma glucose was 113.28mg/dl +/- 22.80. Stratification with regard to age was carried out

Conclusion: A considerable number of patients with NAFLD had metabolic syndrome. There was a close correlation between NAFLD and metabolic syndrome

Early onset neonatal sepsis in preterm premature rupture of membranes

To determine the frequency of early onset neonatal sepsis in newborn with various duration of preterm premature rupture of membranes [PPROM]. Cross sectional study. Neonatal Intensive Care Unit Combined Military Hospital, Lahore from November 2009 to November 2010. Neonates of singleton pregnancies complicanted by pretern premature rupture of the membranes [PPROM] with delivery between 30 and 36 weeks gestation were included in the study. The overall frequency of neonatal sepsis was calculated on clinical and serological basis. Comparison of the frequency of sepsis among groups with varying duration of rupture of membranes was done. Out of 164 babies, 84 [51.2%] were female and 80 [48.8%] were male. Mean maternal age was 23 year [range: 18-36 years] .Mean gestational age was 33 weeks [range: 30-36 weeks]. Sepsis was suspected in 41 [25%] babies on clinical grounds. C-reactive protein was raised in 36 [22%] neonates. There was statistically insignificant difference between clinical versus serological diagnosis [p=0.515]. Frequency of neonatal sepsis was significantly higher in mothers with longer duration of rupture of membrane [p< 0.001]. Frequency of neonatal sepsis was observed to be 22%. PPROM is an important risk factor for early onset neonatal sepsis