Analysis of human ABO Blood Group as a risk factor with knee osteoarthritis at tertiary care hospital in Pakistan.

Objective: To investigate the association and risk estimation of ABO blood group distribution and clinical attributes in patients with Knee Osteoarthritis. Method: This was a hospital-based study conducted at, Liaquat University Hospital Hyderabad from December, 2019 to December, 2022 to investigate this least researched area of highly prevalent musculoskeletal disease in Pakistan. Non-Probability Convenience Sampling was used for selecting 190 cases of confirm Knee Osteoarthritis patients diagnosed by Orthopedic surgeon based on standard clinical and radiographic criteria. Data were analyzed using IBM-SPSS version 23.0. Percentages and frequencies were counted for categorical data. Pearson Chi Square test and fisher's exact test were used to check the association and Multinomial Logistic Regression was used to estimate the risk for moderate and severe kellgren grading Knee Osteoarthritis (KOA) cases with ABO blood grouping in comparison of mild Kellgren grading. Results: A total of 190 cases of Knee Osteoarthritis (KOA) were included in the study. Females (61.6%) and patients with age 50 and above were 40.5 % were found in greater proportion. Majority (41.6%) were classified radiologically as mild cases with O group (39.5%) and positive Rh antigen (95.8%). Strong association (p = <0.01) was found between gender, age group and ABO blood group with KOA radiological Kellgren and Lawrence score. Conclusion: There is strong relation in between radiological grading of knee osteoarthritis severity and A blood group, gender and age.

Ilizarov fixator pin site infection: A comparison between transverse wires and half pins.

OBJECTIVE: To evaluate the difference in the infection rates between Ilizarov wires and half-pins in routine practice. METHODS: This was an observational, prospective; single-centre study approved by the institutional ethics committee. Hundred cases were treated from June 2014 to May 2018 at Ilizarov Surgery Unit, Department of Orthopaedic Surgery & Traumatology Liaquat University of Medical & Health Sciences Jamshoro Sindh Pakistan. All patients were subjected to an evaluation of half-pins and Ilizarov wires. Patients with monolateral fixators were excluded from the study. The demographic data included patient's age and sex, surgical indication, application and removal of Ilizarov fixator, follow-up duration and type of pin (transverse wire or half pin) used. Non probability consecutive sampling technique was used and sample size was calculated randomly. RESULTS: Of the total 100 cases, 79(79%) were male and 21(21%) were female with a mean age of 42.8±8.2 years. A total of 890 pins were applied in 100 patients with 170(19.10%) Half pins and 720(80.89%) wires. The transverse wire's infection rate according to Paley's grading system of Pin tract infection was, 46(53.48%), 25(29.06%) and 15(17.44%) in Grade I, Grade II and Grade III respectively. In case of half pin's infection, the majority of the cases were categories in grade II 22(55.0%) followed by Grade I 12(30.0%) and Grade III 06(15.0%). CONCLUSIONS: The tensioned transverse wires had a significantly low infection rate as compared to half pins.

Ilizarov External Fixation: Percutaneous Gigli Saw Versus Multiple Drill-hole Osteotomy Techniques for Distraction Osteogenesis.

Introduction Many different methods and variations have been employed to perform osteotomy for deformity correction, bone lengthening, and segmental bone transport. Currently, multiple drill-hole (MDH) and Gigli saw osteotomies are the two most preferred ones, being favoured over other techniques. Our objective is to compare the modified healing index (mHI) of these two commonly used procedures. Methodology This retrospective study was conducted at the department of Orthopedics, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan. The study population consisted of all skeletally mature patients who underwent tibial bone osteotomy for bone lengthening or bone transport using Ilizarov circular fixator from June 2016 to September 2018. We excluded patients with metabolic bone disease and patients who underwent osteotomy for deformity correction. Preoperative and operative patients' demographics and clinical data were gathered through a review of medical record and mHI was calculated to compare the effectiveness of osteotomy techniques. Results A total of 50 patients, 74% males and 26% females 26% with a mean age of 33.14 ± 12 years were included in the study. Of the 50 patients, 23 (27 osteotomies) had undergone MDH osteotomy (group I), whereas 27 patients (37 osteotomies) had a Gigli saw osteotomy (group II). The overall mHI of both groups was 1.60 ± 0.34 month/cm (range 1.0-2.5 month/cm). When we compared the mHI of both techniques, the mean mHI was 1.72 ± 0.33 month/cm (range 1.2 - 2.5 months/cm) in MDH group and 1.54 ± 0.36 month/cm (range 1.0-2.5 month/cm) in the Gigli saw group. The healing index was significantly lower in the Gigli saw group. None of our patients showed nonunion at the osteotomy site. However, the problems of incomplete osteotomy in two cases and bone fractures in four cases were seen in MDH osteotomy. Conclusion According to our results, percutaneous Gigli saw osteotomy technique by two small incisions minimizes the local soft tissue trauma and periosteal disruption around the osteotomy more than the multiple drill holes osteotomy, resulting in better consolidation following distraction osteogenesis.

Bone mineral density level by dual energy X-ray absorptiometry in rheumatoid arthritis.

OBJECTIVE: To observe the level of bone mineral density by Dual Energy X-ray Absorptiometry in rheumatoid arthritis patients. METHODS: The observational study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan, from January 2011 to December 2014. Bone mineral density was measured from the femoral neck, ward's triangle and lumbar spine, in patients 25-55 years of age, who were diagnosed with rheumatoid arthritis. All the cases were assessed for bone mineral density from appendicular as well as axial skeleton. Data was collected through a designed proforma and analysis was performed using SPSS 21. RESULTS: Of the 229 rheumatoid arthritis patients, 33(14.4%) were males. Five (15.1%) males had normal bone density, 14(42.4%) had osteopenia and 14(42.4%) had osteoporosis. Of the 196(85.5%) females, 45(29.9%) had normal bone density, 72 (37.7%) had osteopenia and 79(40.30%) had osteoporosis. Of the 123(53.7%) patients aged 30-50 years, 38(30.9%) had normal bone density, 59(48.0%) had osteopenia, and 26(21.1%) had osteoporosis. Of the 106(46.3%) patients over 50 years, 12(11.3%) had normal bone density, 27 (25.5%) had osteopenia and 67(63.2%) had osteoporosis. CONCLUSIONS: Osteoporosis and osteopenia were most common among rheumatoid arthritis patients. Assessment of bone mineral density by Dual Energy X-ray Absorptiometry can lead to quick relief in the clinical symptoms with timely therapy.

Open proximal & distal fractures of tibia treated with Naseer Awais External Fixator with T-clamp.

OBJECTIVE: To compare the outcome of the open proximal and distal fractures of tibia treated by Nasser Awais External Fixtator with T-clamp. METHODS: The descriptive case series was conducted from August 2009 to July 2012 at Department of Orthopaedic Surgery & Traumatology, Liaquat University of Medical & Health Sciences, Jamshoro, and comprised in-patients of open proximal and distal fractures of tibia who were divided into two equal groups: group A had distal and group B had proximal patients. All patients had extra-articular open fractures Gustilo I, II, IIIA and IIIB of proximal and distal end of tibia between 15 and 60 years of age who had arrived within 8 hours of the injury. Below-knee plaster cast was applied for 02 to 03 weeks after the removal of Nasser Awais External Fixtator and all patients were followed up for 12 months. SPSS 17 was used for statistical analysis. RESULTS: Overall, there were 30 patients; 15(50%) in each of the two groups. The mean age in group A was 28.9±9.43 years and 34.3±14.60 years in group B. There were 11(73.3%) males and 4(26.7%) females in group A, and 15(100%) males in-group B. Mean fracture union time in group A was 17.20±2.93 weeks (range: 11-23 weeks) and in group B it was 23.53±2.44 weeks (range: 19-28 weeks). Ankle joint stiffness occurred in 2(6.7%) cases that were in group A, and knee joint stiffness was seen in 2(6.7%) cases and they were in group B. CONCLUSIONS: Nasser Awais External Fixator with T-Clamp was a safe technique and promoted the union with a low complication rate with less union time in distal tibial fracture compared to proximal fracture.

Adverse fetomaternal outcome among pregnant overweight women.

OBJECTIVE: To compare the adverse fetometernal out come in overweight and normal weight pregnant women. METHODS: This comparative cohort study was conducted from 1(st) October 2010 to 30 September 2012. Total 200 gravid women 100 were overweight and 100 normal weight pregnant women with gestational age for 08-40 weeks were included. Women having BMI (25 - 29.9 Kg/m(2)) were measured overweight and included in group A and 100 women having normal BMI of 18.5 to 24.9 as controls were in-group B. Chi-square test was applied to compare the proportion of maternal and fetal outcomes. Significant P - value of < 0.05 was considered. RESULTS: The age range was between 30 to 45 years with mean age of 30±4.1 years in both groups. Overweight pregnant women had significantly high frequency of pre-eclampsia (27% versus 9% in controls), PIH (24% versus 8% in controls), gestational diabetes mellitus (22% versus 5% in controls), prolonged labour (4% versus 6% in controls), Caesarean section (44% versus 16% in controls), Wound infection (3% versus 2% in controls) and Postpartum Hemorrhage (5% versus 2% in controls). P-value < 0.001 was considered significance. Fetal complications in overweight pregnant women compared to controls i.e. Still birth (13% versus 2%), Early neonatal death (11% versus 1%), shoulder dystocia (5% versus 1%) and NICU admission (47% versus 10%). Results were statistically significant except shoulder dystocia. CONCLUSION: We conclude that the result of present study indicates obesity exerts deleterious effect, both on fetal and maternal outcome.

Aerial firing and stray bullet injuries: a rising tide.

BACKGROUND: Aerial firing is shooting, using fire arm, into the air usually during a celebration. OBJECTIVES: This observational study aimed to quantify magnitude and impact of stray bullet injuries by aerial firing at surgical emergencies of the Liaquat University Hospital (a university hospital), Hyderabad, Sindh, Pakistan from January 2009 to December 2010 (2 years). PATIENTS AND METHODS: During the study period, 144 firearm injuries due to stray bullet reported to the A and E departments of the university hospital. All patients referred to surgical unit providing emergency cover on that day irrespective of the severity of the injury for medico-legal reasons. For this study, the cases were divided into those having trivial injury and do not require any active surgical intervention and those having serious injury mandating surgical intervention. One hundred and two cases of stray bullet injury sustained trivial injury and followed as outpatients after an overnight period of indoor hospitalization; however, 42 patients with stray bullet injuries requiring surgical intervention were hospitalized. RESULTS: The most common events leading to aerial firing and stray bullet injuries were marriage ceremonies, followed by a political rallies and New Year celebrations. Stray bullet injury also reported after aerial firing on cricket/hockey team victories, Pakistan Independence Day (14th August), cultural day in Sindh and Basant (Kite) festival in Punjab. The most frequent sites with serious stray bullet injury were chest (15), head and neck (10), abdomen (9) and limbs (8), respectively. Surgical interventions performed included chest intubation, exploration of wound tract to retrieve bullet if lodged superficially and was palpable, laparotomy to managed intra-abdominal injury, reduction of fracture site followed by reconstruction, flap reconstruction and graft for nonhealing wound. The mean duration of hospital stay was 19 days. No mortality was observed in this series of patients. CONCLUSIONS: We conclude that the prevalence of aerial firing resulting in stray bullet injuries is alarmingly on rise in our country. Above all, those doing aerial firing do not considered it as crime, instead taken it as they are privileged to do anything when celebrating. Awareness of the consequences must be propagated by every means to condemn this social crime.

Ossification and hypertrophy of ligamentum flavum at thoracic spine.

BACKGROUND: Hypertrophy of the ligamentum flavum is a pathological condition that causes neurological symptom (radiculopathy and / or myelopathy) and usually occurs in the thoracic,2 less frequently in the cervical spine that commonly involves thoracic spine. This study was conducted to analyse the clinical presentation and outcome of surgery of ossified ligamentum flavum at thoracic spine. METHODS: This case series was conducted at Department of Neurosurgery, Liaquat University of Medical and Health Sciences Jamshoro, from January 2010 to December 2012. Patients who presented with thoracic myelopathy due to ossified ligamentum flavum were included. All the patients, after detailed history, clinical examination and radiological investigation under went decompressive laminectomy at the appropriate level. Pre-operative, post-operative and neurolog'ifti', 06 months follow up was recorded. The patients having thoracic myelopathy due to other causes were excluded from the study. SPSS-10 was used to analyse the data. RESULTS: A total of 15 patients were admitted and operated (9 males, 6 females. (M:F ratio of 1.5:1). The majority of patients were in 6th decade. Backache and lower limb weakness was the presenting feature. Overall improvement in preoperative neurological status was seen in 9 (60%) patients. Neurology remained unchanged in 4 (26.6%) patients and worsened in 2 (13.3%) patients. CONCLUSION: The disease is common in 5th and 6th decade. Preoperative duration of symptoms significantly correlates with recovery.

Early Detection of Osteoporosis by Dual Energy X-ray Absorptiometry.

BACKGROUND AND OBJECTIVE: An early detection of osteoporosis through DEXA procedure will not only improve the disease management practices but also would help in impeding national productivity losses by mass screening and awareness. Our objective was to measure efficacy of DEXA procedure in early detection of osteoporosis and prevention of its complications. METHODS: This case series observational study was designed to confirm the bone mineral density by dual energy x-ray absorptiometery (DEXA). The duration of study was three years from November 2010 to October 2013. Subjects aged between 30 (when the risk of osteoporosis is low) to 60 (when osteoporosis is almost sure to be found). RESULTS: Three hundred thirty patients were evaluated. There were 23 (6.96%) male and 307 (93.03%) female. Normal male were 09 (39.10%), osteopenia 11 (47.80%) and osteoporosis 3 (13%). Normal females were 72 (23.50%), osteopenia 140 (45.60%) and osteoporosis 95 (30.90%). P-value was more then 0.005 and not significant. Mean age was 48.73, minimum 30, maximum 60 and SD 7.247. Population category distribution was 243(76.6%) from urban and 87(26.4%) rural. In urban areas normal were 56(23%), osteopenia 113(46.50%) and osteoporosis 74(30.50%). In rural areas normal 25(28.70%), osteopenia 38(43.70%) and osteoporosis 24(27.60%). P-value was 0.567. Out of 330 there were 81(24.54%) normal, 98 ((29.69%) osteoporosis and 151 (45.75%) osteopenia. CONCLUSION: Osteopenia was the most common diagnosis mostly in younger age group and early diagnosis of this problem can help prevent osteoporosis.

Bone mineral density in patients with chronic backache.

OBJECTIVE: To evaluate the association of bone mass density with chronic backache. METHODS: The case-control observational study was conducted at Bone Mass Density Assessment Unit, Liaquat University of Medical & Health Sciences Jamshoro from January 2011 to December 2013. Adult patients of either gender having chronic backache were studied alongside subjects without backache who served as the control group. Bone mass density of all patients was measured at the lumbar spine (L1-L4) and hip using a dual-energy X-ray absorptiometry scan. Association of chronic backache with age, gender, body mass index and bone mass density was assessed by performing multiple regression analysis. RESULTS: Of the 482 subjects in the study, 162(33.6%) were cases and 320(66.3%) were the controls. Overall age range was 20-78 years with a mean of 48.5±12.36. The mean age of the controls was 38.87±13.55, while for the cases it was 36.26±9.41. Bone mass density in the cases was significantly low compared to the controls (p-0.028). CONCLUSIONS: Severity of chronic backache could be predicted by low bone mass density.

Resistant clubfoot deformities managed by Ilizarov distraction histogenesis.

BACKGROUND: Resistant clubfoot deformities of the foot and ankle remain a difficult problem even for the most experienced surgeon. We report a series of neglected resistant clubfoot deformities treated by limited surgery and Ilizarov distraction histogenesis. MATERIALS AND METHODS: Twenty one patients with 27 feet having resistant clubfoot deformities were managed by Ilizarov distraction histogenesis from April 2005 to May 2008. The mean age was 12 years (range 8-20 years). A limited soft tissue dissection like percutaneous Achilles sheath tenotomy and plantar fasciotomy were done. Progressive correction of the deformities was achieved through the standard and simple Ilizarov frame construct setting. After removal of Ilizarov frame, a short leg walking cast was used for an additional 6 weeks, followed by an ankle foot orthrosis for 3 months. RESULTS: The mean followup period was 18.7 months (range 20-36 months). The mean duration of fixator application was 3.6 months (range 3-5 months). At the time of removal of the fixator, a plantigrade foot was achieved in 25 feet and gait was improved in all patients. There was residual varus hind foot deformity in two patients. Out of 27 feet, 3 (11.11%) were rated as excellent, 17 (62.96%) as good, 5 (18.51%) as fair, and 2 (7.40%) as poor according to Reinkerand Carpenter scale. Excellent and good results (74.07%) were considered satisfactory, while fair and poor results (25.92%) were considered unsatisfactory. CONCLUSION: The short term clinical and functional results of resistant clubfoot deformities with Ilizarov's external fixator is promising and apparently a good option.

Management of diabetic foot by natural honey.

BACKGROUND: Many studies have demonstrated that honey has antibacterial activity in vitro, and a small number of clinical case studies have shown that application of honey to severely infected cutaneous wounds is capable of clearing infection from the wound and improving tissue healing. Research has also indicated that honey may possess anti-inflammatory activity and stimulate immune responses within a wound. The overall effect is to reduce infection and to enhance wound healing in burns, ulcers, and other cutaneous wounds. The objective of the study was to find out the results of topical wound dressings in diabetic wounds with natural honey. METHODS: The study was conducted at department of Orthopaedics, Unit-1, Liaquat University of Medical and Health Sciences, Jamshoro from July 2006 to June 2007. Study design was experimental. The inclusion criteria were patients of either gender with any age group having diabetic foot Wagner type I, II, III and II. The exclusion criteria were patients not willing for studies and who needed urgent amputation due to deteriorating illness. Initially all wounds were washed thoroughly and necrotic tissues removed and dressings with honey were applied and continued up to healing of wounds. RESULTS: Total number of patients was 12 (14 feet). There were 8 males (66.67%) and 4 females (33.33%), 2 cases (16.67%) were presented with bilateral diabetic feet. The age range was 35 to 65 years (46 +/- 9.07 years). Amputations of big toe in 3 patients (25%), second and third toe ray in 2 patients (16.67%) and of fourth and fifth toes at the level of metatarsophalengeal joints were done in 3 patients (25%). One patient (8.33%) had below knee amputation. CONCLUSION: In our study we observed excellent results in treating diabetic wounds with dressings soaked with natural honey. The disability of diabetic foot patients was minimized by decreasing the rate of leg or foot amputations and thus enhancing the quality and productivity of individual life.

Anterior decompression, fusion and plating in cervical spine injury: our early experience.

OBJECTIVE: To evaluate the efficacy of anterior cervical decompression, fusion and titanium plate fixation in sub axial cervical spine injuries in respect of neurological outcome, postoperative stability and early rehabilitation. The Descriptive case series study was conducted at Department of Neurosurgery, Liaquat University Hospital, Jamshoro, Sindh Pakistan during year 2005 to 2007. METHODS: Patients with cervical spine injuries were admitted during study period were included in this study. All cases were evaluated for their clinical features. During initial phase, level and degree of neurological injury was assessed using ASIA impairment scale. Cervical traction was applied to all patients. Operative and post operative record with x-rays and MRI were maintained. Patients with Injury to C3-6 underwent decompression, fusion and local titanium plate implant fixation by anterior approach. The follow-up ranged from 6 to 12 months with clinical and radiological assessment. RESULTS: 37 cases of sub axial cervical spine injuries included in this study during year 2005 to 2007. Out of these, 28 (75.67%) were males and 9 (24.32%) females. Age range was 8-60 years mean (32-40%). Common mode of injury was fall. Post operative follow up showed good clinical and radiological outcome, bony fusion and favour early rehabilitation. No immediate complication found except temporary dysphagia. CONCLUSION: Anterior decompression, fusion and titanium plate fixation is an effective method with good neurological and radiological outcome.