Distal radius chondrosarcoma in a 35-year-old female patient: A case report.

Key Clinical Message: Chondrosarcoma, although rare in the distal radius, poses significant challenges. Early diagnosis through incisional biopsy is essential. Surgical resection with margin control and fibular grafting can be effective, but vigilant surveillance is crucial due to its aggressive nature. Metastasis demands consideration of additional interventions or palliative care. Abstract: Chondrosarcomas constitute a rarity in the upper limbs, and their occurrence in the distal radius is even rarer with only one case previously documented. We report a case of distal radius chondrosarcoma in a 35-year-old female patient who presented with pain and swelling in her left wrist. Following an initial examination, an incisional biopsy was performed, confirming the diagnosis of dedifferentiated chondrosarcoma. The patient underwent a marginal resection of the distal radius and first carpal with ipsilateral fibular and locking compression plate fixation. Unfortunately, despite the interventions, the patient experienced recurrent swelling and ultimately required below-elbow amputation, followed by above elbow amputation due to metastasis. Unfortunately, the patient passed away due to recurrence and metastasis.

Giant Cell Tumor of the Distal Fibula Managed by an Autologous Proximal Fibula Graft.

A giant cell tumor of the bone is among the most common bone tumors encountered by orthopedic surgeons. These benign and aggressive tumors are most commonly present around the knee joint; however, rare cases may involve the distal fibula. An 18-year-old man presented with a painless swelling of the lateral aspect of the left ankle. Clinical examination, radiologic evaluation, and biopsy confirmed the diagnosis of a giant cell tumor of the distal fibula. The patient was treated with resection of the distal fibula followed by reconstruction using an ipsilateral proximal fibula graft. The post-operative recovery was uneventful, and the patient was doing well on the last visit, one month after the intervention.

Outcomes Of Reconstruction With Vascularized Vs Non Vascularized Bone Graft After Resection Of Bone Tumours- A Systematic Review And Meta-Analysis.

BACKGROUND: Vascularized (VBG) and non-vascularized (NVBG) bone grafting are two crucial biological reconstructive techniques in the management of bone tumours. The objective of this study is to compare the outcomes of reconstruction with vascularized and non-vascularized bone grafts after resection of bone tumours. METHODS: A systematic evaluation of the literature from 2012-2021 was undertaken using the online databases PubMed/Medline, Google Scholar, and Cochrane Library considering only comparative articles with specific outcomes for the restoration of the defect with vascularized and non-vascularized bone graft following the resection of bone tumours. The quality of the research methodology was evaluated using Oxford Quality Scoring System and Newcastle Ottawa Scale for randomized trials and non-randomized comparison research respectively. The SPSS version 23 was used to examine the data that was collected. Musculoskeletal tumour society score (MSTS), bone union time, and complications were the outcomes of this review. RESULTS: Four clinical publications were considered, totalling 178 participants (92 men and 86 women) with 90 patients with VBG and 88 with NVBG. MSTS score and bone union time were the key outcomes that were measured. The overall MSTS (p>0.05) and rate of complications (p>0.05) results were comparable between the two groups, however, VBG had a better rate of bone union (p<0.001). CONCLUSIONS: As a result of the quicker bone union, our systematic evaluation demonstrated that VBG causes earlier recovery. Complication rates and functional results were the same in both groups. The link between the bone union time and functional score following VBG and NVBG must also be demonstrated.

The prevalence of deep Venous thrombosis of the lower extremity in hospitalised bedridden orthopaedic patients: a pilot study.

OBJECTIVE: To determine the prevalence of objectively confirmed deep vein thrombosis of lower extremities in bedridden hospitalised orthopaedic patients who received no thromboprophylaxis. METHODS: The prospective cross-sectional study was conducted at Dr Ruth Pfau Civil Hospital, Karachi, from April to June 2021, and included all patients aged ≥40 years admitted for intended major lower limb surgery and expected to be confined to the bed for at least 4 days. Duplex ultrasound scanning of both legs was used to confirm deep vein thrombosis. Data was analysed using SPSS 22. RESULTS: Of the 104 subjects, 60(57.6%) were males and 44(42.3%) were females. The overall mean age was 51.9±7.4 years. The most common type of fracture was the neck of femur 28(26.9%). The mean delay between the fracture and admission was 6.44±4.9 days. The mean length of hospital stay was 12.76±3.8 days. The overall prevalence of deep vein thrombosis was 16(15.3% and none of these patients had any symptom at all. CONCLUSIONS: There was 15.3% prevalence of deep vein thrombosis. Considering that the condition is potentially lethal, routine prophylaxis for all at-risk patients should be encouraged.

Single-Centre Experience Regarding the Use of Fibular Graft for Reconstruction after Resection of Grade III GCT of Distal Radius.

Background: A giant cell tumour (GCT) is a locally invasive benign tumour of bone in young adults. Treatment includes surgical resection as first-line or denosumab pharmacotherapy in inoperable patients. However, surgical resection of distal radius GCT has produced debatable functional outcomes. Here we study the use of fibular grafts for reconstruction of surgically resected GCT of the distal radius. Methods: A total of 11 patients having Grade III GCT of the distal radius were recruited for a retrospective single-centred study. Five underwent arthrodesis with fibular shaft graft and six received arthroplasty with the proximal fibula. Functional outcomes at 6 weeks, 6 and 12 months were measured by Mayo wrist score (MWS) (>51% = good) and Revised Musculoskeletal tumor society (MSTS) score (>15 = good). Results: At 6 weeks, mean MSTS score and MWS were 23.64 and 58.64% respectively, and the length of the fibular graft was a predictor for both MSTS score (p = 0.014) and MWS (p = 0.006). At 6 months, the mean MSTS and MWS were 26.36 and 76.82%, respectively. At 6 months, the surgical procedure was a predictor in MSTS score (p = 0.02) while MWS was predicted by length of graft (p = 0.02). At 12 months, MSTS score was 28.73, and MWS remained 91.82%. Length of the fibular graft was an insignificant predictor, but a significant risk factor was surgical procedure for MWS (p = 0.04) at 12 months. No variable was found significant for MSTS score. Conclusions: Resection along with reconstruction of Grade III GCT of the radius with fibular graft was found an optimal treatment option. Also, use of the fibular head grafts and shorter length grafts are predictors for better outcomes after surgery. Level of Evidence: Level IV (Therapeutic).

Outcomes of Extended Curettage with and without Bone Allograft for Grade II Giant Cell Tumors around the Knee. A Retrospective Comparative Study.

Objective This is the first study to establish the utility of extended curettage with or without bone allograft for Grade II giant cell tumors GCTs around the knee joint with the aim of exploring postoperative functional outcomes. Methods We retrospectively reviewed 25 cases of Campanacci grade II GCTs undergoing extended curettage between January 2014 and December 2019. The participants were divided into two groups: one group of 12 patients underwent extended curettage with bone allograft and bone cement, while the other group of 13 patients underwent extended curettage with bone cement only. Quality of life was assessed by the Revised Musculoskeletal Tumor Society Score and by the Knee score of the Knee Society; recurrence and complications were assessed for each cohort at the last follow-up. The Fisher test and two-sample t-tests were used to compare the categorical and continuous outcomes, respectively. Results The mean age was 28.09 (7.44) years old, with 10 (40%) males and 15 females (60%). The distal femur and the proximal tibia were involved in 13 (52%) and in 12 (48%) patients, respectively. There was no significant difference in the musculoskeletal tumor society score (25.75 versus 27.41; p = 0.178), in the knee society score (78.67 versus 81.46; p = 0.33), recurrence (0 versus 0%; p = 1), and complications (25 versus 7.69%; p = 0.21). Conclusions Extended curettage with or without bone allograft have similar functional outcomes for the knee without any major difference in the incidence of recurrence and of complications for Grade II GCTs. However, surgical convenience and cost-effectiveness might favor the bone cement only, while long-term osteoarthritis prevention needs to be investigated to favor bone allograft.

Traumatic Bilateral Femoral Fracture And Concurrent Vascular Injury In A 2-Year-Old Child - A Rare Case Report.

Fractures are an ordinary consequence of trauma. Paediatric fractures are rather uncommon because the bony framework is still in its growth phase and therefore compliant to such traumas. The incidence of vascular injuries is also low lying (<1%) in this age group. Nevertheless, management and recovery continue to be a challenge. In this case report, we discuss a 2-year-old child with a traumatic bilateral femoral fracture, a tibial fracture with added vascular injury. Delayed management may give rise to a variety of complications in such a peculiar case. Fortunately, this child is healthy, leading a normal life with no complications.

Outcomes of Extended Curettage with and without Bone Allograft for Grade II Giant Cell Tumors around the Knee. A Retrospective Comparative Study / Resultados da curetagem estendida com e sem aloenxerto ósseo para tumores de células gigantes de grau II no joelho. Um estudo comparativo retrospectivo

Abstract Objective This is the first study to establish the utility of extended curettage with or without bone allograft for Grade II giant cell tumors GCTs around the knee joint with the aim of exploring postoperative functional outcomes. Methods We retrospectively reviewed 25 cases of Campanacci grade II GCTs undergoing extended curettage between January 2014 and December 2019. The participants were divided into two groups: one group of 12 patients underwent extended curettage with bone allograft and bone cement, while the other group of 13 patients underwent extended curettage with bone cement only. Quality of life was assessed by the Revised Musculoskeletal Tumor Society Score and by the Knee score of the Knee Society; recurrence and complications were assessed for each cohort at the last follow-up. The Fisher test and two-sample t-tests were used to compare the categorical and continuous outcomes, respectively. Results The mean age was 28.09 (7.44) years old, with 10 (40%) males and 15 females (60%). The distal femur and the proximal tibia were involved in 13 (52%) and in 12 (48%) patients, respectively. There was no significant difference in the musculoskeletal tumor society score (25.75 versus 27.41; p= 0.178), in the knee society score (78.67 versus 81.46; p= 0.33), recurrence (0 versus 0%; p= 1), and complications (25 versus 7.69%; p= 0.21). Conclusions Extended curettage with or without bone allograft have similar functional outcomes for the knee without any major difference in the incidence of recurrence and of complications for Grade II GCTs. However, surgical convenience and cost-effectiveness might favor the bone cement only, while long-term osteoarthritis prevention needs to be investigated to favor bone allograft.

Resumo Objetivo Este é o primeiro estudo a estabelecer a utilidade da curetagem estendida com ou sem enxerto ósseo em tumores de células gigantes (TCGs) de grau II na articulação do joelho com o objetivo de explorar os resultados funcionais pós-operatórios. Métodos Revisamos retrospectivamente 25 casos de TCGs de grau II de Campanacci submetidos a curetagem estendida entre janeiro de 2014 e dezembro de 2019. Os participantes foram divididos em 2 grupos: um grupo de 12 pacientes foi submetido a curetagem estendida com aloenxerto ósseo e cimento ósseo, enquanto o outro grupo, com 13 pacientes, foi submetido a curetagem estendida apenas com cimento ósseo. A qualidade de vida foi avaliada pela Pontuação Revista da Musculoskeletal Tumor Society (MTS, na sigla em inglês) e pela Pontuação da Knee Society (KS, na sigla em inglês), enquanto as taxas de recidiva e complicações foram avaliadas em cada coorte na última consulta de acompanhamento. O teste de Fisher e os testes t de duas amostras foram usados para comparação de resultados categóricos e contínuos, respectivamente Resultados A média de idade dos pacientes foi de 28,09 (7,44) anos; 10 (40%) pacientes eram do sexo masculino e 15 (60%) pacientes eram do sexo feminino. O fêmur distal e a tíbia proximal foram acometidos em 13 (52%) e 12 (48%) dos pacientes, respectivamente. Não houve diferença significativa na pontuação revista da MTS (25,75 versus 27,41; p= 0,178), na pontuação da KS (78,67 versus 81,46; p= 0,33) e nas taxas de recidiva (0 versus 0%; p= 1) e complicações (25 versus 7,69%; p= 0,21). Conclusões A curetagem estendida com ou sem aloenxerto ósseo tem resultados funcionais semelhantes em pacientes com TCGs de grau II no joelho, sem qualquer diferença importante na incidência de recidivas e complicações. No entanto, a conveniência cirúrgica e o custo-benefício podem favorecer a utilização apenas de cimento ósseo, enquanto a prevenção da osteoartrite em longo prazo precisa ser investigada para favorecer o enxerto ósseo.

Resection and reconstruction with and without neoadjuvant denosumab in campanacci grade III giant cell tumors of proximal humerus: a retrospective comparative study.

BACKGROUND: Giant cell tumors (GCT) of the proximal humerus are rarely reported case that requires complex surgeries due to involvement of the shoulder joint. Therefore, we report the first retrospective comparative study where the postoperative functional outcomes, recurrence rate and complications in patients who underwent arthrodesis of shoulder after resection of grade III GCT with and without neoadjuvant denosumab are compared. METHODS: A retrospective review of eight cases of grade III GCT of proximal humerus receiving resection and fibular strut graft and arthrodesis between January 2014 and December 2019 is performed. They were stratified into two groups: one group of four patients received once-weekly denosumab 120 mg for 4-weeks before resection and reconstruction, while the other group of four patients did not receive denosumab before surgery. Primary outcomes included the functional outcomes assessed by revised Musculoskeletal tumor society (MSTS) score and shoulder pain and disability index (SPDI) at 6-weeks and 12-months postoperatively while secondary outcomes included complications and recurrences. RESULTS: There was no significant difference in terms of SPDI at 6 weeks and 12 months, MSTS at 12 months, complications, recurrence among denosumab and non-denosumab groups. At 6-weeks follow-up, a significantly better pain score in SPDI and MSTS was acquired in the denosumab group. CONCLUSIONS: Resection and reconstruction with or without neoadjuvant denosumab for Grade III GCT of proximal humerus had similar functional outcomes and with no major differences in recurrence and complications. Hence, postoperative pain relief while long-term benefits were not discovered with the use of neoadjuvant denosumab.

A Comparison of Outcomes of 'Extensor Carpi Ulnaris Tenodesis' versus 'No Tenodesis' after Resection of the Distal Ulna in Patients with Giant Cell Tumor.

Background: One of the methods of stabilizing the stump of the ulna following resection of the distal ulna is tenodesis of the extensor carpi ulnaris (ECU). Some studies have recommended stabilization, whereas others have not found it useful. Most of these studies have a mix of different pathologies and often do not have a control group. The aim of this study is to compare the outcomes of ECU tenodesis versus no tenodesis after resection of the distal ulna in patients with grade III giant cell tumor (GCT) of the distal ulna. Methods: The retrospective study included 10 patients with Campanacci grade III GCT of the distal ulna treated by resection of the distal ulna between 2014 and 2019. Patients were stratified into two groups based on whether they underwent ECU tenodesis (n = 5) or no tenodesis (n = 5). The patients were assessed at 6 weeks, 6 months, and 12 months for complications and outcomes using the Mayo wrist score (MWS) and the revised musculoskeletal tumor society score (MSTS). Results: The MWS and the MSTS were significantly better in the ECU tenodesis group at 6 weeks. At 6 months, MWS was similar in both groups, but MSTS continued to be significantly better in ECU tenodesis group. At 12 months, both groups reported similar MWS and MSTS. There were no recurrences in either groups. One patient in the ECU tenodesis group developed ECU tendonitis that resolved with conservative treatment. Conclusions: The outcomes of ECU tenodesis were better in the short term (6 months), although both groups reported similar outcomes at 12 months. Level of Evidence: Level III (Therapeutic).

Allograft bone banking experience in Pakistan.

To share our experience of establishing a bone bank in Pakistan, and the clinical use of these indigenously produced bone grafts. We retrospectively reviewed our experience of the procurement, processing, and storage of bone grafts at a bone bank in Karachi, Pakistan, the first bone bank to be established in a public sector hospital in Pakistan. The bone bank was established at Sindh Institute of Urology and Transplantation (SIUT), Karachi, in collaboration with Department of Orthopaedic Surgery, Dow University of Health Sciences/Civil Hospital, Karachi (CHK) in May, 2015. Since then, a large number of bone grafts from the tissue bank have been used for various orthopedic procedures. This paper describes the problems and challenges faced in establishing and running a tissue bank in a Muslim and a developing country and the progress of the bone bank over the first 4 years. A total of 93 bone grafts were retrieved and preserved in the bone bank over the 4-year period. Among these, 56 (60.2%) bones were retrieved from male donors and 37 (39.8%) from females. The mean age of all donors was 55.9 ± 15.34 years (range: 16-90 years). All bone donors were living patients. No c bones were obtained from deceased donors. Types of bone grafts included: femoral heads, 68; head with neck of femur, 19; radius and ulna, 1; lower femur, knee joint, lower leg and foot bones, 4; and skull bone, 1. All grafts were subjected to aerobic and anaerobic bacterial cultures, as well as fungal cultures. Microbiological contamination was observed in 18/93 (19.35%). All culture positive bones were discarded. Bone grafts issued from the bank and transplanted were 51/93 (54.8%) in all. Bone grafts were used in a variety of tumor and non-tumor orthopaedic procedures in CHK. Nine bone grafts were donated to the other hospitals to be used for revision total hip replacement and tumor surgeries. There were no service charges. Two patients (3.92%) developed infections postoperatively, one superficial and one deep. No other complications were noted. This is the preliminary report on the establishment and functioning of a bone bank in a public sector hospital in Pakistan. The favorable outcome has inculcated confidence in orthopedic surgeons for greater use of bone allografts for a variety of indications in this country.

Role of denosumab before resection and reconstruction in giant cell tumors of bone: a single-centered retrospective cohort study.

BACKGROUND: Denosumab has been approved by Food and Drug Authority in 2013 for use in surgically unresectable Giant cell tumor (GCT) to achieve resectable tumor margins. The aim of this study is to investigate the functional outcome and surgical convenience with the use of neoadjuvant denosumab before resection and reconstruction in Campanacci grade III GCT. METHODS: We retrospectively reviewed 70 cases of Campanacci grade III GCT receiving resection and reconstruction between January 2014 and December 2019. They were stratified into two groups: one group of 29 patients received once-weekly denosumab 120 mg for 4-weeks before resection and reconstruction, while the other group of 41 patients did not receive denosumab before resection and reconstruction. Quality of life by musculoskeletal tumor society score where 0-7 means poor, 8-14 means fair, 15-22 means good; above 22 means excellent, incidence of tumor recurrence, intraoperative duration in minutes and postoperative positive margins were assessed for each cohort after 12 months follow-up. RESULTS: There was no significant difference in musculoskeletal tumor society score (25.75 vs. 27.41; P  = 0.178), incidence of recurrence (3.45% vs. 4.88%; P  < 0.001), and postoperative positive margins (10.34% vs. 4.88%; P  = 0.38) for both groups. However, the intraoperative duration (133.38 vs. 194.49; P  < 0.001) was significantly higher in the non-denosumab group compared with denosumab group. CONCLUSIONS: Neoadjuvant denosumab is equally effective considering postoperative functional outcomes and surgical convenience except intraoperative duration where it is highly helpful in saving the operating time duration. Easier identification, resection and lesser reconstruction are the key surgical convenience offered by neoadjuvant denosumab.

Clinical Outcomes Of Intra-Articular High Molecular Weight Hyaluronic Acid Injection For Hip Osteoarthritis- A Systematic Review And Meta-Analysis.

BACKGROUND: Osteoarthritis is the most common degenerative disease of the synovial joints in the elderly population with hip osteoarthritis as the second most commonly affected joint. A multitude of conservative treatments is used for pain relief and functional improvement including acetaminophen, NSAID, intra-articular corticosteroid, and viscosupplementation (VS). Different preparations of VS based on different molecular weights are commercially available. No systematic review or meta-analysis regarding the use of intra-articular high molecular weight hyaluronic acid (HMWHA) injection for the hip joint was published before. This review analyzes the efficacy of intra-articular HMWHA for hip osteoarthritis. METHODS: PubMed, Google Scholar, Cochrane Library for randomized trials describing the efficacy of HMWHA for hip osteoarthritis was searched. The search terms were osteoarthritis, hip joint, outcomes, viscosupplementation, and high molecular weight hyaluronic acid in different combinations. Standardized mean difference (SMD) in VAS for pain relief and Lequesne index for functional outcomes while risk ratio (RR) for complications was used for data pooling. RESULTS: Four studies comprising 185 and 189 patients in HMWHA and control groups were included, respectively. SMD for VAS and Lequesne index was -0.056 and -0.114, respectively while RR for complication was 0.879. CONCLUSIONS: Intra-articular HMWHA injection provided pain relief, functional improvement, and no severe complications on immediate short term basis. However, the results do not favor treatment with HMWHA over other treatment methods. Randomized trials are further necessary to provide data regarding comparisons between HMWHA for hip osteoarthritis concerning clinicians' convenience, compliance, duration of relief, and cost-effectiveness.

Bilateral asymmetrical hip dislocations with acetabulum fractures; a case report.

Bilateral hip dislocation is a rare injury and asymmetrical hip dislocations are even very rare entities. We are reporting two cases of bilateral asymmetrical hip dislocations with associated acetabulum fractures. Mechanism of injury in first case was fall from height and in other case road traffic accident. Associated injuries were midshaft femur fracture and sciatic nerve (Peroneal part). Anterior hip dislocation in both cases is reduced closely but posterior hip dislocation in both cases relocated openly due to ipsilateral femur fracture in first case and unstable hip in second case. Acetabulum fractures fixed with reconstruction plate. Postoperative recovery of patient was uneventful except sciatic nerve injury (Peroneal part) lead to foot drop that is supported with ankle foot arthrosis.

Understanding The Rare Bone Tumor "ADAMANTINOMA".

Adamantinoma is a rare neoplastic bone tumor that has the potential to metastasize. The classic presentation is in the tibial region however; cases involving other bones of the body have been noticed. The tumour is very likely to be mistaken for other bone diseases and therefore it is important to investigate and study about its nature and thus differentiate it from other differentials. Nevertheless, literature on the presentation, findings, investigations and treatment options of adamantinomas are limited. In this case series, we report four cases from a local hospital in Karachi who were diagnosed, treated and followed up for adamantinoma. Studies regarding the disease will help us understand more about its features.

A Case Report of Metallosis With a Failed Distal Femur Plate.

Metallosis is a very rare condition that poses a diagnostic challenge. Its precise incidence is not known and the condition should be suspected in patients who present with the clinical signs and symptoms discussed below. In particular, physicians and surgeons should pay special attention to whether metal prosthesis has been used for fracture repair or joint function. Here we report the case of a 40-year-old male who presented at an orthopedic surgery outpatient department in a tertiary care hospital with pain in the right distal thigh that had been ongoing for three months and swelling that had been ongoing for two months. According to the patient, he had received an operation for a right-sided distal femur fracture that was fixed with plate at a different hospital one year prior. Despite receiving all the appropriate physical exams and labs, and getting a radiologic workup, the diagnosis was unclear, and ultimately surgical exploration was conducted, which led to the diagnosis of metallosis. Although metallosis is a well-known complication, due to its rarity, physicians and surgeons often forget to keep metallosis as a differential that leads to diagnostic difficulties.

Predictive Factors Associated With Fear Faced by Healthcare Workers During COVID-19 Pandemic: A Questionnaire-Based Study.

Background The coronavirus disease 2019 (COVID-19) since the beginning has been a reason of fear among healthcare workers (HCWs) due to the increased mortality, especially in the HCWs themselves. In this survey study, we aimed to explore the predictive factors associated with fear faced by HCWs during the COVID-19 pandemic and to identify the areas which need to be addressed to reduce it. Methods On May 14, 2020, we conducted an observational, cross-sectional survey using a self-administered questionnaire, consisting of the following two parts: (1) focused on factors associated with HCWs' fear of getting an infection and being a source of carrying the infection to whom they care, and (2) focused on factors associated with HCWs' fear of uncertainty and lack of support from concerned health authorities. Results The mean age of the participants was 40.04 ± 12.92 years with 79.3% being males. More than half (51.1%) of the participants were consultants. The most important factors associated with fear included getting infected (84.8%), quarantined (69.6%), not getting medical treatment (62%), losing a life (56.8%), and infecting family members (94.2%). Another major factor associated with HCWs' fear was lack of support from concerned health authorities, 80.2% thought of solatium, and 71.7% believed that the job should be given to eligible family members of the deceased. More than 82.2% were concerned about health expenses and around 97.6% felt an additional health risk allowance should be given. Conclusion Our results indicate that the risk of getting infection to themselves and their families, along with a lack of support from concerned health authorities, was strongly associated with fear among HCWs. We hope through these findings that the concerned health authorities will take notice and do something in this regard by developing appropriate policies and measures to make sure that HCWs and their families are cared for if they get infected.

Knowledge, Attitude, and Practices of Healthcare Workers Regarding the Use of Face Mask to Limit the Spread of the New Coronavirus Disease (COVID-19).

Introduction Many countries including Pakistan are currently using face masks in their pandemic control plans. Being highly prevalent, the correct use of these masks is particularly important, as an incorrect use and disposal may actually increase the rate of transmission. The purpose of this study was to investigate the knowledge, attitude, and practices of healthcare workers (HCWs) in wearing a surgical face mask to limit the spread of the new coronavirus disease 2019 (COVID-19). Materials and Methods This survey was conducted by interviewing HCWs using a questionnaire consisting of the basic demographic characteristics, and the knowledge, attitude, and practices regarding the use of surgical face mask to limit the new COVID-19 exposure. Each correct answer was scored 1 and each incorrect answer scored 0. The total number of questions was 16, and the final score was calculated and then labeled according to the percentage (out of 16) of correct responses as good (>80%), moderate (60-80%), and poor (<60%). Results A total of 392 participants with a mean age of 42.37 ± 13.34 years (341 males and 51 females) were included in the study. The overall final results were good in 138 (35.2%), moderate in 178 (45.4%), and poor in 76 (19.3%). Around 43.6% of participants knew about the correct method of wearing the masks, 68.9% knew that there are three layers, 53% stated that the middle layer act as a filter media barrier, and 75.5% knew the recommended maximum duration of wearing it. The majority (88.2%) of participants knew that a cloth face mask is not much effective, around 79.8% knew that used face mask cannot be re-used, and 44.8% knew about the yellow-coded bag for disposal. Conclusions Knowledge, attitude, and practice of HCWs regarding the use of face masks were found to be inadequate. Studied HCWs had a positive attitude but moderate-to-poor level of knowledge and practice regarding the use of face mask. HCWs and general public awareness campaigns regarding the proper use of face mask by utilizing all social media available resources would be helpful during this pandemic.

Fixation of Crescent Pelvic Fracture in a Tertiary Care Hospital: A Steep Learning Curve.

Background Crescent fracture-dislocation of sacroiliac joint is a type of lateral compression pelvic injury associated with instability. These fractures comprise 12% of lateral compression fractures. Objective The objective of this study is to share the experience and to assess the functional outcome of fixation in crescent fracture-dislocation. Methods We analyzed a descriptive case series with clinical data of 15 patients at the Department of Orthopedics Surgery at the Dr. Ruth K.M. Pfau Civil Hospital at Dow University of Health Sciences in Karachi, Pakistan, from January 2016 to August 2018. The patients were treated by closed and open fracture reduction and fixed with percutaneous screws and reconstruction plates. Results A total of 15 patients were included in this study with age ranging from 20 to 60 years (11 men [73%]; four women [27%]). According to the mechanism of injury, five (33%) had motorcycle accidents; four (27%) had collision while sitting in a car; three (20%) were pedestrians hit by a vehicle; four (27%) were injured while sitting in van; two (13%) had bus-related injury, and one (6.5%) presented with a history of wall collapse. Five (33%) patients had type I fractures, seven (47%) had type II fractures, and three (20%) had type III fractures Associated injuries were midshaft femur fracture in two patients, contralateral superior and inferior rami fracture in three patients, and open tibia fracture in one patient. All fractures were fixed with reconstruction plates and screws. Patients were kept as non-weight-bearing on the injured joint for three weeks, mobilized non-weight-bearing on the contralateral leg after three weeks, and partial weight-bearing was started at eight weeks; full weight-bearing was started after three months. Nine patients (60%) had excellent outcomes, three (20%) had a good outcome, and three (20%) had a poor outcome. Conclusion Crescent fracture-dislocations are unstable injuries. These fractures should have proper reduction and fixation that will reduce pain, malunion, and shortening.

Experience of treating the Talipes equinovarus deformity with Ponsetti technique at district level.

OBJECTIVE: To assess the Ponsetti technique's effectiveness in the treatment of talipes equinovarus. Methods: The cross-sectional study was conducted from January 2013 to March 2018in Naushehero Feroze disctrict of the province of Sindh, Pakistan, and data was assessed at the Department of Orthopaedic Surgery, Dow University of Health Sciences / Civil Hospital, Karachi. Children with talipes equinovarus were treated with Ponsetti casting. Results: Of the 86 patients, 53(68%) were boys and 33(32%) were girls. There were a total of 111 feet in the study. Once the foot reached neutral, percutaneous tenotomy of tendo achilles was done in 86)85%) of 111 feet. Seven (8%) patients had recurrence because of non-compliance in the maintenance phase. Overall, 17(19.7%) patients were lost to follow-up. Conclusion: Ponsetti casting was found to be a simple, effective and acceptable method of treatment for talipes equinovarus.