Prevalence of inadequate vitamin D level and its predictors in children presenting with torus fractures.

BACKGROUND: Review of the published articles does not show any study done to see if children with torus fracture are with Vitamin D deficiency. The aim of this study was to determine association of inadequacy of Vitamin D level with torus fracture and its predictors in children in Karachi Pakistan. METHODS: Patient underage of 13 years came with torus fracture were included in study, and managed non-operatively with below elbow cast. Proforma was made which includes demographic data (age, gender, nutritional status) and exposure to sunlight, dietary habits, kind to apparel and type of accommodation they were living at. All participants underwent measurement of serum vitamin D level. RESULTS: Out of 558 children presented with limb fractures in emergency department, 190 (34.05%) had torus fracture, with mean age of 6.0 ± 4.2 years. 93 (48.94%) in pre-school group, 59 (31.05%) in school and 38 (20%) were breast-fed. On nutritional status, malnourished were 72 (37.89%), out of which 32 (44.44%) had first-degree malnutrition. On vitamin D level status only 52 (27.36%) participants had Vitamin D within normal range while 86 (45.26%) were found Vitamin D deficient. We found that vitamin D level is directly related to nutritional status, duration of sun exposure maternal vitamin d levels and not significantly related to age, gender, type of accommodation and different fabric types. CONCLUSION: In this study torus fracture in children is significantly associated with Vitamin D deficiency, with common predictors including nutritional status, maternal Vitamin D level for lactating mothers and duration of exposure of sunlight. Vitamin D supplementation in children can prevent a significant number of fractures via national programs for food fortification and increase the awareness of general population on the importance of sunlight exposure and intake of food rich in Vitamin D.

Does malnutrition in clubfoot patients affect Ponseti technique and its outcome?

OBJECTIVES: Malnutrition is a crucial health problem predominantly in the developing countries. Malnutrition in children is one of the main risk factors for diseases and mortality. Club foot or congenital talipes equinovarus (CTEV) is the most common form of congenital orthopaedic abnormality. Over the past 20 years, the Ponseti method is considered the gold standard for the treatment of clubfoot. Our objective is to determine the prevalence of malnutrition in clubfoot patients, and its effects on the outcome of Ponseti technique in patients presenting to the Orthopaedic Clinic of tertiary care Hospital in Karachi, Pakistan. METHOD: The cross-sectional study was conducted from January to December 2018. Total 153 clubfoot patients were treated and the World Health Organization (WHO) classification of weight-for-age index was used to assess the nutritional status of patients, and its impact on outcome of Ponseti technique was recorded and analysed with a P value ≤ .05 as significant. RESULTS: Of the 153 patients, 112 (79.7%) were found in good nutritional status and 42 (20.6%) were malnourished. The average number of casts per patient and patients requiring 6+ casts in the undernutrition group was higher compared with good nutrition group (45.5% vs 21.42%, respectively). The number of Achilles tenotomy performed in the undernutrition group was also higher (76.4% vs 51.8%). CONCLUSION: A significant correlation between patients' nutritional status and outcome of the Ponseti technique is found as it influences the number of casts, possible relapse and failure of treatment.

Hydatid Cyst of Skeletal Muscle Presenting as Soft Tissue Tumour.

Hydatid disease is helminthic infection caused by tape worm echinococcus granulosis. It commonly involves liver (65-75%) and the lungs (25 to 30%). Involvement of bones and skeletal muscle is very rare, i.e. 3 to 5%. This is the report of a 21-year girl, city resident, presented with mass involving left proximal thigh. The mass was painless and had gradually increased in size over three years. MRI revealed solid cum cystic lesion in vastus medialis muscle. Tru-Cut needle biopsy of the lesion revealed necrotic material. Intraoperative findings were of different sized cystic lesions, typical of hydatid cyst. The cysts were removed intact. No recurrence was seen in 11-month follow-up. Hydatid cyst involving skeletal muscle is very rare entity, but should be considered while making differential diagnosis of soft tissue mass.

Qing-Qi Rickshaw : A Boon Or Bane For Public Transportation? A Study Of Road Traffic Injury Patterns Involving Qing-Qi Rickshaws In Karachi Pakistan.

BACKGROUND: The three-wheeler Qing-qi and Compressed Natural Gas (CNG) auto-rickshaws were introduced in Karachi to meet the transportation demand of the growing population. These vehicles have directly or indirectly been implicated in a number of road traffic violations as well as road accidents. This study aims to describe the crash characteristics and injury patterns for Qing-qi rickshaw occupants and other road users hit by Qing-qi rickshaw in Karachi, Pakistan. METHODS: An Observational/ Descriptive study was conducted at Accident & Emergency and Orthopaedic Surgery Department, Jinnah Post Graduate Medical Centre, Karachi Pakistan from July 2014 to June 2015.All patients who came with Qing-qi rickshaw accident in Accident & Emergency (A&E) of JPMC were included. Crash characteristics, details of injuries, injury severity parameters and outcome were documented in detailed interviews. RESULTS: Four hundred and eighty-six rickshaw related injuries were noted in road traffic accidents by Qing-gi rickshaw. Age range was 2-85 (43.5±58.68). 350 injured victims were males and 136 were females. By occupation most victims were laborers and daily wage workers (45%) and students (21%). Overloading of vehicle with more than two passengers was found in (28.5%). The most common cause of injury was collision with a moving vehicle (56%), followed by fall from rickshaw. The most common contributing factor was the overloading of rickshaw and roll over on turning (61%). Injury severity on arrival were mild (49%), moderate were (32%), and severe were (19%). Injuries related to head and neck (26%), face (14%), thorax and abdomen (5%), lower extremity and pelvic girdle (31%) and upper extremity (23%) were observed. CONCLUSIONS: Qing-qi rickshaw injuries are common and these vehicles are vulnerable to road traffic accidents. Occupants and road users are both at risk of injuries.

Dupatta (Long Scarf) related injuries in female pillion riders in Karachi Pakistan.

OBJECTIVE: To assess the frequency, type of injuries and reason behind avoidable injuries due to dupatta entrapment in motorcycle wheels among female pillion riders. METHODS: This observational / descriptive study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, from July 2013 to December 2014, and comprised female patients with dupatta-related motorbike injuries. The patients had injuries around head and neck, face, chest, abdomen, etc. SPSS 11 was used for data analysis. RESULTS: Of the 450 dupatta-related injuries, 49(10.89%) patients were admitted, whereas the remainder with minor injuries on neck and other parts of body were primarily managed in the accident and emergency department, detained for observation and discharged after first aid. The mean age was 31.5±19.09 years (range: 18 to 45 years). Besides, 37(75.51%) patients were admitted to the orthopaedic department, 5(10.2%) to the ear, nose and throat department, 4(8.16%) to the neurosurgery department and 2(4.08%) to the general surgery department. The number of injuries related to head and neck was 11(23%), face 8(17%), chest, abdomen and pelvic contents 1(2%) each, extremity and pelvic girdle 14(29%) and external injuries 13(28%). CONCLUSIONS: Dupatta entrapment was found to be a common cause of motorcycle accidents.