One-stage Hip Reconstruction for Developmental Hip Dysplasia in Children over 8 Years of Age / 대한고관절학회지

PURPOSE: This study was performed to assess the clinical and radiological outcomes following one-stage hip reconstruction, consisting of open reduction femoral shortening and pelvic osteotomy, for neglected developmental dislocation of the hip (DDH). MATERIALS AND METHODS: This is a retrospective analysis of 77 hips in 65 patients (46 females and 19 males; 12 had bilateral dislocations), operated at a Ghurki Trust Teaching Hospital in Pakistan between 2013 and 2015. The average age at surgery was 11.02±3.43 years. According to the Tönnis classification, there were 10, 14, 22, and 31 patients in grades 1, 2, 3, and 4, respectively. The pelvic procedure utilized in this study was triple osteotomy (47 hips) followed by double and Salter osteotomy (18 and 12 hips, respectively). Postoperative evaluations were conducted using the modified MacKay's scoring system (functional outcomes) and Severin's scoring method (radiological assessment). RESULTS: Postoperatively, there were 38 (49.4%), 19 (24.7%), 14 (18.2%), and 6 (7.8%) hips in Severin grade I, II, III and IV, respectively. According to the modified McKay criteria, there were 22 hips (28.6%) in excellent condition, 44 (57.1%) in good condition, 9 (11.7%) in fair condition and 2 (2.6%) in poor condition. Both patients with poor outcomes had an unstable, painful hip with evidence of avascular necrosis of the femoral head. CONCLUSION: Based on the results presented here, we recommend the single stage procedure of open reduction, femoral shortening and pelvic osteotomy for treatment of DDH in older children with good to excellent functional and radiological outcomes.

Pattern of combat casualties in war against terror among soldiers wearing body armor at CMH Peshawar

To determine the pattern of gun shot and explosive injuries in soldiers equipped with body armor and helmet. Descriptive study Combined Military Hospital Peshawar, from 1st June 2008 to 30th May 2010. All combat casualties received in 'Emergency reception' of Combined Military Hospital, Peshawar were included. Data was taken from the patient's medical charts and by personal evaluation and entered in a proforma. The variables used were age, use of helmet, cause of the injury, site of injury, Haemo-dynamic Status, conscious level, intensive care treatment duration, total hospital stay, return to work and mortality. A total of 516 combat casualties were received in 'Emergency reception' of Combined Military Hospital, Peshawar, Pakistan. All patients were males with a mean age of 31.22 +/- 7.858 years. Sixty nine percent [356] cases had injury due to splinters from Improvised Explosive Devices [IED] and 31% [160] had gunshot wounds. Seventy five percent [391] patients were haemodynamically stable while 24.2% [125] were unstable. Penetrating Extremity Injury [PEI] was the commonest injury [71.9%] followed by Penetrating Injury of Face or Neck [PNFI] in 12.0% [62], Penetrating Torso Injury [PTI] in 8.9% [46] and Penetrating Injury of Cranial Vault [PCI] in 7.2% [37]. Overall mortality was 64 [12.4%] IEDs have become the weapon of choice in gorilla warfare by the terrorists in addition to guns, bombs, and anti-personnel mines. The use of body armor has decreased the mortality but the morbidity in terms of limb injuries has increased

Re-do orchidopexy in a general surgical unit-reliability of clinical diagnosis and the outcome of surgery

Re-do Orchidopexy is not very common, expertise is limited and the results of clinical examination and ultrasonography are not always reliable. This cross-sectional study was based on medical records of patients under-going re-exploration of inguinal region for a missing testicle after previous groin surgery, and no mention of orchidectomy. All patients were thoroughly examined, investigated with ultrasonography and offered re-exploration. Results were graded as Good, Fair and Poor. Out of 11 boys included in the study, 7 [63.63%] had failed orchidopexy. Another 3 [27.27%] were opened for 2nd stage orchidopexy and 1 [9.09%] had iatrogenic ascent of testis after herniotomy. On clinical examination 4 [36.36%] had a palpable testicle at the superficial ring, 2 [18.18%] were in inguinal canal [1 doubtfull], and no testicle could be palpated in 5 [45.45%]. Ultrasonography picked up 2 testicles [18.18%] at the superficial Inguinal ring, 1 [9.09%] in Inguinal canal and 1 [9.09%] testicle in the abdominal cavity. On reexploration, 10 [90.9%] testicles were found and brought down, 7 [63.63%] being considered of reasonable consistency and size. Another 3 [27.27%] were considered soft or small in size, and in 1 [9.09%]], no testicle was found. In 5 patients [45.45%], the testicle was at superficial ring, in 3 [27.27%] in the inguinal canal, and in 2 [18.18%] in the abdominal cavity. Results were considered good in 6 [54.54%], fair in 3 [27.27%]] and poor in 2 [18.18%]. Groin examination after previous inguinal surgery is tricky. Ultrasonography is also not very reliable. Re-exploration via the inguinal approach is adequate and recommended. Thorough exploration is essential before declaring the testicle absent

Congenital megalourethra complicated by circumcision

Congenital megalourethra [CMU] is a rare anomaly of the male urethra in which there is a non-obstructive dilatation of the penile urethra. Children usually present with an abnormal appearance of penis and ballooning of the penis during voiding. Diagnosis is easy by typical external appearance of the floppy penis. We report a case of CMU with an abnormal looking penile urethra resulted due to circumcision, carried out by the inexperienced traditional circumcision practitioner, [Nai]. A six years old child was referred with an abnormal appearance of the penis. At the age of two months, a traditional circumcision practitioner [Nai] carried out his circumcision, which led to an abnormal looking penile urethra. During this period, the child had two episodes of urinary tract infection. His urinary stream was good and he had no other urinary symptoms. Examination revealed a good sized penis with floppy large opening of the distal penile urethra. There was a wide urethral plate on the ventral surface of glans penis and the most distal part of corpora cavernosa were not palpable. Child, however, had normal erection. Diagnosis of congenital megalourethra complicated by circumcision was made because of the typical external appearance. Ultrasonography revealed bilateral hydroureter with hydronephrosis. Micturating cystourethrogram showed grade 4 vesicoureteric reflux on right side and grade 3 on left side. Isotope renal scans showed bilateral renal scarring, good renal function on both sides and differential functions of 35% and 65% on right and left side respectively. The child was operated and bilateral ureteric reimplantation performed. Six months follow-up visits showed stable renal functions, no evidence of vesicoureteric reflux. He is awaiting for repair of megalourethra, which shall be performed by Nesbit technique.2