Efficacy of preoperative Tranexamic Acid in patients undergoing intertrochanteric hip fracture surgery: A randomized placebo controlled trial.

Objective: To determine the efficacy of preoperative Tranexamic Acid (TXA) in reducing perioperative allogenic blood transfusion frequency in patients with intertrochanteric fractures treated with Dynamic Hip Screw (DHS). Methods: We conducted this placebo controlled double-blinded randomized trial in Orthopaedics & Traumatolgy Division Lady Reading Hospital, Peshawar from 1st January 2020 to 25th December 2022. All patients with intertrochanteric hip fractures fulfilling the inclusion criteria were treated with Dynamic Hip Screw (DHS) and were randomly divided into two equal groups. One group was administered single dose IV Tranexamic Acid (TXA) in a dose of 15mg/kg body weight in 100ml of saline while the other group (Placebo) was given 100 ml normal saline preoperatively. Post-operative Hemoglobin was measured on first, second and third day. The frequency of allogenic blood transfusions in the perioperative period was determined in both groups based upon the transfusion trigger (Hemoglobin 9g/dl). Categorical variables were compared with Chi-square test and mean with Independent sample t-test. P value of <0.05 was considered significant. Results: The total number of patients in our trial were 200 which were equally but randomly allocated into TXA group and Placebo group each containing 100 patients. The mean age of the patients in TXA group was 48.16±1.75 years and the age of patients in the Placebo group was 48.35±1.60. The baseline demographic and clinical variables of both groups were identical (p< 0.05). The average preoperative hemoglobin was 11.5±4.2 g/dl in TXA group and 11.3±2.4g/dl in the Placebo group (p>0.05). The frequency of allogenic blood transfusion was significantly lower (p<0.05) in TXA group (13%, n=13) than in the Placebo group (41%, n=41). Conclusion: Tranexamic acid (TXA) significantly reduces the frequency of peri operative allogenic blood transfusion in patients undergoing Dynamic Hip Screw (DHS) for intertrochanteric fractures.

A comparison of distal femoral locking plates for distal femur fractures: Long working length versus short working length.

OBJECTIVE: To compare long working length distal femoral locking plates with short working length for treating extra-articular distal femur fractures in terms of union and implant failure. METHODS: The randomised controlled trial was conducted at the Lady Reading Hospital, Peshawar, Pakistan, from April 28, 2018, to March 10, 2021, and comprised all adult patients of either gender with extra-articular distal femur fractures who were randomised into two groups. Group A was exposed to long working length, while group B had short working length. Patients in both the groups were followed up regularly for one year for the assessment of fracture union and implant failure. Data was analysed using SPSS 22. RESULTS: In the group of the 61 patients, 30(49.2%) were in group A; 24(80%) males and 6(20%) females with overall mean age of 37.9±9.6 years. The remaining 31(50.8%) were in group B; 26(83.8%) males and 5(16.1%) females with overall mean age of 37.2±1 years. The mean working length in group A was 75±5mm and in group B it was 35±9mm. In group A 28(93.3%) fractures healed, while in group B 19(61.2%) fractures achieved union (p=0.01). Non-union was noted in 2(6.6%) patients in group A and 7(22.5%) in group B (p=0.08). Plate breakage was noted in 3(9.6%) patients and screw breakage in 2(6.4%) patients in group B and none in group A (p=0.0001). CONCLUSIONS: Long working length titanium locking plates were found to be better than short working length in achieving fracture union and avoiding implant failure.

Outcome of proximal femur shaft fractures in school going children treated with locking compression plates.

OBJECTIVES: To determine the clinical and radiological outcome of proximal femur shaft fractures in school going children treated with locking compression plates (LCP). METHODS: This descriptive study was conducted in Orthopaedic Division Lady Ready Reading Hospital Peshawar from 25th June 2018 to 25th September 2020. Children of either gender and age 6 to 12 years old with subtrochanteric and proximal one third femur factures fulfilling the inclusion criteria were enrolled in this study. Open reduction and internal fixation with 4.5 mm narrow locking compression plates (LCP) were done in all. Post operative clinical outcome was evaluated by using Flynn scoring system and graded as excellent, satisfactory and poo results. Radiological assessment of fracture union was done through anteroposterior (AP) and lateral X-ray radiographs. RESULTS: A total of 60 children with mean age 9.01±1.61 SD (range 6 to 12 years) were included in our study. Oblique fractures were present in 23(38.3%) children, spiral in 20(33.3%), transverse in 11(18.3%) and comminuted in 6 (10%) children. The radiological union time was 13.3±1.2 weeks (range 9.4 to 18 weeks). Majority (88.3%, n=53) of children had excellent clinical outcome according to Flynn's scoring system while satisfactory outcome was noted in 7(11.6%) children. No cases of delayed union, mal union, nonunion and implant failure was reported. CONCLUSION: The results of our study indicated that proximal femoral shaft fractures in school going children treated with locking compression plates had excellent clinical and radiological outcome. We therefore recommend locking compression plate as the implant of choice to fix proximal femoral shaft fractures in school going children.

Pattern of peer review proforma of medical journals of Pakistan.

OBJECTIVE: To analyze the contents and format of peer review proforma of Medical journals of Pakistan. METHODS: This descriptive study was conducted in the Department of Orthopaedics and Traumatology Lady reading Hospital Peshawar Pakistan from 3rd August 2018 to 9th February 2019.An email was sent to the chief editors of all the medical journals listed on the official website (www.pmdc.org.pk) of Pakistan Medical and Dental Council (PM&DC).They were requested to send peer review proformas of their journals. The received proformas were analyzed for major contents and format or style. The proforma had a structured format when each portion of the manuscript i.e, title, abstract, key words, methodology, results, discussion, conclusion and references were individually sectioned for evaluation. Whereas in the unstructured proformas the reviewer was asked to assess the manuscript as a whole. RESULTS: We received 41 proformas via emails. Majority (82.9%) of the proformas were structured while 17% were unstructured. A scoring or rating system for the manuscript was present in 31.7% of the proformas while 43.9% of the proformas were without any scoring system. Guidelines for the peer reviewers were given in 58.5% of the proformas. The peer review policy (closed or open) was mentioned in only 7.3%.About 9.7% of the proformas asked the reviewers to disclose conflict of interests. CONCLUSION: A spectrum of contents and format of peer review proformas of medical journals were observed. We found structured peer review proforma with a scoring scale comprehensive and more appropriate for peer review.

Does pin tract infection after external fixator limits its advantage as a cost-effective solution for open fractures in low-middle income countries, a prospective cohort study.

OBJECTIVE: To determine the frequency of pin tract infection in external fixator tibia and its effects on the definite fracture fixation and bone healing. Methods: The prospective study was conducted at Lady Reading Hospital, Peshawar, Pakistan, from August 2017 to July 2018, and comprised patients regardless of age and gender with open fracture tibia Gustillo-Anderson type II and type IIIA. Pin tract infection was assessed following the application of locally made external fixation of tibia open fractures. Follow-up was done fortnightly till soft tissue healing, removal of external fixator and definite fracture healing. Pin tract infection was classifiedand treated according to the Checketts-Otterburn classification system. SPSS 20 was used for data analysis. Results: Of the 117 patients, 95(81%) were males and 22(19%) were females with an overall mean age of 24.7±9.35 years. Pin tract infection was documented in 28(23.9%) patients. Minor and major pin tract infections were reported in 27(96.4%) and 1(3.5%) patient respectively. Soft tissues healed in 27(96.4%) cases. Conclusion: External fixator for initial stabilisation of open tibial fractures in all patients is recommended..