Functional Outcome Of Delayed Presenting Fracture Neck Of Femur Managed By Cannulated Screw And Fibular Graft.

BACKGROUND: Delayed presenting Fracture neck of femur is one of the complex and challenging fracture to treat. Multiple treatment options are available with varying results. This study was conducted to assess the functional outcome of fracture neck of femur seeking medical attention several days after injury that are managed by cannulated screw and fibular. METHODS: A total of 35 patients were included in the cross-sectional study performed at orthopaedic surgery department of United Medical & dental college Karachi. Adults aged 18 years and over both male and female with fracture neck of femur presenting 14 days after the injury for medical treatment were included in the study. Ethical approval was obtained from the ethical review committee and patients who provided written informed consent were included in study. Data analysis was performed through SPSS version 20. RESULTS: Thirty-five patients with fracture neck of femur of both sexes 25 (71.4%) male and 10 (28.6%) females were included in study. out of which 14 (40%) of the patients had sub-capital fracture and 21 (60%) patients had trans-cervical fracture neck of femur. Mean age of patients was 32.14±10.20 years. Twenty-eight (80%) patients out of 35 had excellent and good outcome, 4 (11.4%) cases had fair and 3 (8.5%) had poor outcome. CONCLUSIONS: Cannulated screw fixation along with non-vascularized fibular graft is effective technique to management of delayed presenting fracture neck of femur as it is easy, inexpensive and does not require any special instrumentation or expertise.

Assessment of Vitamin D Levels in Patients Presenting With Chronic Low Back Pain at a Tertiary Care Hospital.

Objective To evaluate the association of chronic low back pain with levels of vitamin D in the affected population. Methodology This observational study was carried out from August 2016 to August 2019 at Khairpur Medical College and Shaheed Mohatarma Benazir Bhutto Medical College, Karachi, Pakistan. Patients aged 18 years and above suffering from chronic low back pain with pain persisting for more than 12 weeks were the study participants after written consent and prior approval from the ethical review committee was obtained for conducting the study. Data was recorded on predesigned performa and analyzed on SPSS Version 20 (IBM Corp.). Results There were 1,152 cases with chronic lower back pain, of whom 632 (54.9%) were females and 520 (45.1%) were males. The mean age of the patients was 41.76 ± 11.18 years. The mean visual analog scale (VAS) level was 5.36 ± 1.65; 707 cases (61.4%) had moderate pain according to VAS, 292 (25.3%) had severe pain, and 153 (13.3%) had mild pain. Concerning vitamin D levels, the mean levels were 22.74 ± 13.80, with 599 (52%) of the patients having deficient levels of vitamin D, 347 (30.1%) having insufficient levels, and only 204 (17.7%) of the cases having normal vitamin D levels. Conclusions Lower back pain is one of the common presenting problems in orthopedic clinics. We found no relationship between chronic lower back pain and vitamin D levels in our study.

Functional Outcome of Intraarticular Fracture of Distal Radius Managed by Volar Locking Plate.

Objective This study's main purpose is to determine the functional outcome of volar locking plates in the management of intraarticular fracture of the distal radius. Methodology This cross-sectional study was conducted from August 2016 to August 2019. Forty-nine patients with the intraarticular distal radius fractures managed by the volar locking plate were included in the study. Patients with open fractures, ipsilateral other limb injuries, polytrauma patients, pathological fractures, and patients having neurovascular injuries were excluded from the study. AO Classification was used to classify fractures. The fracture was approached through the volar approach and fixed by the volar locking plate. A modified mayo wrist score evaluated the functional outcome. All the data were recorded on predesigned performa, and Statistical Package for the Social Sciences (SPSS), version 20 (IBM Corp., Armonk, NY) was used to analyze the data. Results A total of 49 patients with intraarticular fractures of the distal radius were included in the study. The mean age of the patient was 37.20 ± 10.05 years. Out of 49 patients, 29 (59.2%) were males, and 20 (40.8%) were females. Union was achieved in almost all fractures except one case, which went into non-union despite the adequate initial reduction, and the mean time of union was 11.98 ± 1.64 weeks. With respect to the stratification of functional outcome very good and good functional outcome was achieved in 46 patients (93.8%) in both the groups, the satisfactory outcome was achieved in two (4.1%) cases and one patient had a bad outcome in which union was not achieved and went into non-union. Conclusion Open reduction and internal fixation of intraarticular fracture of the distal radius using a volar locking plate is a good option for managing these fractures as it provides stable fixation, and good to excellent outcomes can be achieved by using these plates.

Proximal Fibular Osteotomy in the Management of Osteoarthritis of Medial Compartment of Knee Joint.

INTRODUCTION: This study was conducted to evaluate the efficacy of proximal fibular osteotomy (PFO) in terms of pain relief, and improvement in function in medial compartment osteoarthritis (OA) of the knee joint. MATERIALS AND METHODS: This case series study was conducted at the Shaheed Mohtarma Benazir Bhutto Medical College Lyari and United Medical and Dental College of Karachi. Patients with medial compartment knee joint OA were included in the study and patients with bicompartmental or tricompartmental OA, inflammatory joint disease, valgus knee deformity, morbid obesity, or any infectious pathology involving the knee joint were excluded from the study. The medial and lateral joint spaces were measured and recorded preoperatively and postoperatively. Pre- and postoperative values of visual analog scale (VAS) results and the Oxford knee score were recorded. A PFO was performed after getting informed written consent. RESULTS:  A total of 60 patients were enrolled in the study; 16 (26.7%) were men, and 44 (73.3%) were women. The mean age of patients was 51.8 ± 4.1 years. The mean preoperative medial joint space measurement on standard anteroposterior radiograph was 1.45 ± 0.28 mm. The mean preoperative lateral joint space was 8.86 ± 1.27 mm. The recorded mean preoperative Oxford knee score was 20.82 ± 1.97 mm. Recorded levels of mean postoperative medial joint space improved to 4.63 ± 0.668 mm, and mean postoperative lateral joint space was 4.72 ± 0.79 mm. Mean recorded levels of VAS for pain postoperatively were 2.32 ± 0.792, which improved significantly from 7.90 ± 0.79. CONCLUSIONS:  PFO is a good surgical technique for pain relief and functional improvement in patients suffering from medial compartment OA.

Use of fibular bone graft and cancellous screw fixation in the management of neglected femur neck fractures in young patients.

OBJECTIVE: To present the clinical outcome of patients with neglected femur neck fracture treated with fibular bone graft. METHODS: During May 2010-February 2013, 15 patients younger than 35 years of age with neglected fracture neck of femur were managed with non-vascularized fibular graft and cannulated screws. Fractures were classified according to Sandhu Classification. Hip function was assessed using Harris hip score. RESULTS: Fifteen patients with mean age of 28.67 years were managed. Mean period of delay from injury to presentation was 3.07 months. Mean follow-up was 18.5 months. Union was achieved in 13 cases. 2 patients developed nonunion with progression of avascular necrosis (AVN). Patients with healed fracture did not show radiological signs of AVN till the past follow-up. Functional status was evaluated at 6 months according to Harris hip score and was poor in 2 patients, fair in 2 patients, good in 6 patients, and excellent in 5 patients. CONCLUSION: Fibular graft along with two cancellous screws proved to be an effective technique in our cases with neglected femur neck fractures.

Is smartphone a necessity or luxury among orthopedic specialty?

OBJECTIVE: To assess the utilisation pattern of smart phones by residents and consultants with respect to their clinical work and academics. METHODS: The cross-sectional study was carried out in orthopaedic departments of various hospitals in Karachi in July 2014. Orthopaedic residents and consultants were asked to fill a questionnaire containing various questions, including utilisation of their smart phones for professional applications, books, internet and emails; and sharing of clinical data. RESULTS: A total of 98residents and consultants were approached and 83(84.7%) of them filled up the questionnaire. Of them, 70(84.3%) owned a smart phone and represented the study sample. Of them, 60(85.7%) were using applications on their mobile phone; and 27(38.6%) were using them for sharing clinical data with colleagues. The use of smart phone applications was more among residents than consultants (p=0.010) and the same applied to data sharing (p=0.028). AO Surgery reference was the most utilised application in 43(61.4%). Besides, 46(65.7%) respondents were using smart phones to read text books; 60(85.7%) were using internet on their smart phones for browsing web pages and to check emails; and 62(88.6%) wanted to have more applications available related to orthopaedic practice. Only 1(1.4%) respondent was willing to pay for these applications. CONCLUSIONS: Majority of orthopaedic caregivers owned a smart phone, but their clinical use was limited which may be enhanced to improve patient care.