Radial head resection versus prosthetic arthroplasty in terrible triad injury: a retrospective comparative cohort study: a retrospective comparative cohort study.

AIMS: The crucial role of the radial head in the stability of the elbow in terrible triad injury is acknowledged. This retrospective study aims to compare the results of resection of a severely comminuted radial head with or without prosthetic arthroplasty as part of the reconstruction for this injury. PATIENTS AND METHODS: The outcome of radial head resection was compared with prosthetic arthroplasty in 29 and 15 patients with terrible triad injuries, respectively. There were ten female patients (34.5%) in the resection group and six female patients (40%) in the prosthesis group. The mean age was 40.7 years (sd 13.6) in the resection group and 36 years (sd 9.4) in the prosthesis group. The mean follow-up of the patients was 24.4 months (sd 12) in the resection group and 45.8 months (sd 6.8) in the prosthesis group. Outcome measures included visual analogue scale (VAS) for pain, Mayo Elbow Performance Score (MEPS), Disabilities of Arm, Shoulder and Hand (DASH) Score, and range of movement. Postoperative radiological complications were also recorded. RESULTS: The mean ranges of extension, flexion, supination, and pronation were not significantly different between the two study groups (p = 0.75, p = 0.65, p = 0.82, and p = 0.68, respectively). The mean VAS score, DASH score, and MEPS of the two groups were also not statistically significantly different (p = 0.93, p = 0.19, and p = 0.32, respectively). At the final visit, the elbow was stable in all patients. No patient was found to have developed an Essex-Lopresti injury. Osteoarthritis grade I and II was observed in five and three patients of the resection group, respectively, and four and one patients of the arthroplasty group, respectively. CONCLUSION: The outcome of patients undergoing treatment for terrible triad injuries is similar whether the patient's radial head was excised or replaced. Cite this article: Bone Joint J 2018;100-B:1499-505.

Avulsions of Triceps Brachii : associated injuries and surgical treatment ; a case series.

This study reports the clinical presentations, intra -operative findings, type of the treatments, outcome of the treatment and specially associated injuries in patients with the avulsion of the distal end of the triceps brachii (TB) tendon. We studied 6 patients with rupture or avulsion of the distal end of the TB tendon. The medical records, imaging files, clinical outcomes at the final follow up visit were reviewed. The clinical outcomes were assessed by Mayo Elbow Score at the final follow-up visit. All patients were male, 4 of them having injury in the left hand as the non-dominant hand. Mean age of them was 34.5 years. All cases had small bony fleck in the posterior of elbow in lateral radiograph. Three patients had associated injuries -including intra-articular fractures and medial collateral ligament rupture. In one case V-Y plasty of the distal TB was done. In 4 patients the results of surgery were excellent, one was good and one was fair. Although TB tendon rupture is rare, it should be -considered in differential diagnosis of the upper -extremity trauma and its associated injuries should be addressed properly.

Congenital bilateral pseudarthrosis of the index metacarpal bones.

Congenital pseudarthrosis is very rare in upper extremity, and has only previously been reported in the forearm. A case of bilateral congenital pseudarthrosis of the index metacarpal bones is described.

Health status and renal function evaluation of kidney vendors: a report from Pakistan.

Unrelated kidney transplants have lead to commerce and kidney vending in Pakistan. This study on 104 vendors reports demographics, history, physical and systemic examination, ultrasound findings, renal and liver function and GFR by Cockcroft-Gault. Results were compared with 184 age, sex and nephrectomy duration matched living-related donors controls. Comparison of vendors versus controls showed mean age of 30.55 +/- 8.1 versus 30.65 +/- 7.85 (p = 0.91) years, M:F of 4.5:1 versus 4.2:1 and nephrectomy period of 33.89 +/- 30 versus 32.01 +/- 29.71 (p = 0.60) months respectively. Of the vendors 67% were bonded laborers earning <50 $/month as compared to controls where 68% were skilled laborers and self-employed earning >100 $/month. History of vendors revealed jaundice in 8%, stone disease in 2% and urinary tract symptoms in 4.8%. Postnephrectomy findings between vendors versus donors showed BMI of 21.02 +/- 2.8 versus 23.02 +/- 4.2 (p = 0.0001), hypertension in 17% versus 9.2% (p = 0.04), serum creatinine (mg/dL) of 1.17+/-0.21 versus 1.02 +/- 0.27 (p = 0.0001), GFR (mL/min) of 70.94 +/- 14.2 versus 95.4 +/- 20.44 (p = 0.0001), urine protein/creatinine of 0.150 +/- 0.109 versus 0.10 +/- 0.10 (p = 0.0001), hepatitis C positivity in 27% versus 1.0% (p = 0.0001) and hepatitis B positive 5.7% versus 0.5% (p = 0.04), respectively. In conclusion, vendors had compromised renal function suggesting inferior selection and high risk for developing chronic kidney disease in long term.

Oral zinc supplementation in pregnant women and its effect on birth weight: a randomised controlled trial.

Pakistan lies in a zinc deficient area where oral zinc supplementation has been advocated for various reasons. A double blind, randomised case-control study was carried out on pregnant women to evaluate the effects of oral zinc supplementation on the weights of newborns. No significant difference was found in the birth weights between the cases supplemented with 20 mg elemental zinc and controls receiving oral placebos (p=0.57).

Comparative studies on nicotinic acid derivatives as hypolipoproteinemic agents.

Nicotinic acid and its related compounds are well known lipid lowering agents but the use of nicotinic acid in clinical practice is limited because of its side effects. To reduce the unwanted effects, new derivatives of nicotinic acid have been synthesized and tested in control and pathological animals for their antilipoproteinemic effects. Two newly synthesized derivatives of nicotinic acid i.e. 3-methoxy phenacyl nicotinium bromide (T1) and 2-methoxy phenacyl nicotinium bromide (T2) have been screened for their hypolipoproteinemic effects in white male rabbits. The compounds were administered in the doses of 30 mg/day and the results were compared with aspirin taken as the reference drug. The present work revealed that both of these synthesize compounds exhibited marked effects on plasma lipoproteins assuming that these compounds exerted their action by inhibiting hepatic production of very low density lipoprotins (VLDL), ultimately leading to reduction in low density lipoprotein. Clofibrate and aspirin are taken as standards to evaluate the potentials of these agents for their effects on lipid.