Clinical outcome of locking plate fixation in distal tibia fractures.

A study was conducted to assess the outcome of close distal tibial fractures fixed with pre-contoured locking-plate using Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) technique in terms of union and infection, at the Department of Orthopaedic Surgery King Edward Medical University/Mayo Hospital, Lahore from August 2013 to May 2017. Fourty cases with close distal tibial fractures were enrolled. Fractures were managed with locking compression plate using MIPPO technique. Patients were followed for 12 months post-fracture stabilisation. Of the 40 patients 24 were males and 16 females, with male to female ratio of 1.5:1. The mean age of the patients was 44.70±13.67 years with minimum and maximum ages of 18 and 60 years, respectively. All fractures united with the mean union time of 16±4 weeks. The infection rate was 5%. Locking compression plate when used with MIPPO technique provides early bone union and low infection rate.

A novel way of quantifying bone defect in primary total knee replacements using plain radiographs.

Bone defect assessment in primary advanced knee arthritis can present a challenge for the surgeon and lead to unfavourable outcomes if not adequately determined during preoperative planning. The aim of this study was to introduce a new, simple and quick way to assess and quantify bone defect using short film radiographs and utilising it to choose the total knee prosthesis. This is a prospective case series of patients who underwent TKA (Total Knee Arthroplasty) using various types of prostheses. Three different angles - Tibiofemoral angle, MPTA (medial proximal tibial angle), and JLCA (joint line convergence angle) - were measured preoperatively to evaluate limb alignment, placement of the tibial, and femoral components of total knee prosthesis. Postoperatively roentgenographic index introduced by Lotke et al was used to assess our preoperative methodology. The American knee society score was used pre- and postoperatively up to one year. A total of eight knees of six patients were analysed (four males, two females). The mean age of the patients was 57.75±5.701 years. All the knees were in varying degrees of varus deformity preoperatively. The accuracy of the preoperatively used radiological angles was analysed by postoperative measurement of tibiofemoral angle (d), tibial anatomical axis (b) and femoral anatomical axis (a), and Roentgenographic index as suggested by Lotke et al. Postoperatively, all the knees were in valgus with tibiofemoral angle (d) 6.50±0.926, tibial component alignment (b) mean was 89±1.195, and femoral component alignment (a) mean was 5.13±0.991 valgus. Mean roentgenographic index was 89.38±3.292. American knee society score improved at one-year follow-up postoperatively and was statistically significant with p<0.001. In this study, a new classification for bone defects in primary arthritic knees by utilising simple plain radiograph short films and as a guide for implant selection is proposed.

Comparing the effects of muscle energy technique and mulligan mobilization with movements on pain, range of motion, and disability in adhesive capsulitis.

OBJECTIVES: To compare the effect of muscle energy technique and Mulligan mobilisation with movement on pain, range of motion and disability in patients of adhesive capsulitis. METHODS: The single-blind, randomised controlled study was conducted at the Physiotherapy Department of Mayo Hospital, Lahore, Pakistan, from July to December, 2018, and comprised patients of either gender aged 30-70 years with adhesive capsulitis stage 2. The subjects were randomised using the lottery method into Mulligan mobilisation with movement group A, and the muscle energy technique grouo B. Conventional treatment, including hot packs and exercises like pulley rope exercise, wall climbing, and shoulder wheel, were part of both the groups. Each technique was applied five times per set, 2 sets per session 3 days a week for three weeks. Baseline and post-intervention readings were recorded for pain, range of motion and disability Using numeric pain rating scale, goniometer, and shoulder pain and disability index. Data was analysed using SPSS 23. RESULTS: Of the 70 individuals assessed, 64(91.4%) were included; 32(50%) in each of the two groups. The mean age in group A was 49.93±6.69 years, while in group B it was 49.17±8.92 years. Group A showed significantly better results compared to group B (p<0.05). CONCLUSIONS: Muscle energy technique and Mulligan mobilisation with movement were both found to be effective, but the latter was significantly better compared to the former. CLINICAL TRIAL NUMBER: IRCT20200611047734N2 (https://www.irct.ir/trial/48851).

Methylprednisolone acetate injection with casting versus casting alone for the treatment of De-Quervain's Tenosynovitis: a randomized controlled trial.

OBJECTIVE: To compare the success of treatment between thumb spica cast with "methylprednisolone acetate injection" versus thumb spica cast alone for the treatment of de Quervain's disease as functional outcomes, complications and patient compliance. METHODS: A single blinded randomized controlled trial using a probability sampling technique was conducted from January 2014 to h February 2017at the Orthopaedic Unit II, King Edward Medical University / Mayo Hospital, Lahore. A total of 134 patients of both genders, between 30-60 years of age presented with wrist pain and diagnosed de Quervain's disease, were included in the study. Patients were randomly divided into two group by the computer allocation method. Patients in Group-A received thumb spica cast with methylprednisolone acetate and xylocaine injection while patients in Group-B were treated with thumb spica cast alone. The outcome variable was frequency of successful treatment which was noted and compared among the groups. RESULTS: Amongst the total 134 patients, the age of the patients ranged from 30 to 60 years with a mean of 37.16±5.15 years. Most of the patients were aged between 30 40 years (78.8%) followed by 41-50 years (21.2%). There were 38 (28.4%) male and 96 (71.6%) female patients in the study group with a male to female ratio of 1:2.5. In group-A mean VAS and Quick DASH score before treatment and after the treatment was statistically significant (p-value <0.001). In group-B mean VAS and Quick DASH score before and after the treatment was also significant (p-value <0.001) ( Table-2). CONCLUSIONS: The effectiveness of treatment was significantly higher in patients treated with thumb spica cast with methylprednisolone acetate injection as compared to thumb spica cast alone.

Comparison of proximal femoral nail (PFN) and dynamic hip screw (DHS) for the treatment of AO type A2 and A3 pertrochanteric fractures of femur.

OBJECTIVE: To compare the dynamic hip screw with proximal femoral nail for the treatment of Arbeitsgemeinschaft für Osteosynthesefragen type A2 and A3 per trochanteric fractures of femur. METHODS: The randomised controlled single-blind study was conducted at the Mayo Hospital, Lahore, Pakistan, from September 2015 to September 2017, and comprised patients aged 40-75 years with Arbeitsgemeinschaft für Osteosynthesefragen type A2 and A3 per trochanteric fracture. The patients randomised into two equal groups. In Group A, patients were treated by closed reduction and internal fixation with dynamic hip screw, while those in Group B were treated by closed reduction and internal fixation by proximal femoral nail. Follow-up was done at 2nd, 6th and 12th weeks, and at 6th, 9th and 12th month post-operatively. Variables evaluated were frequency of union, surgical time, approximate amount of blood loss and complications. The functional assessment was done by using Harris hip score. SPSS 20 was used for data analysis. RESULTS: Of the 68 patients, there were 34(50%) in each group. The mean age of patients in Group A was 60.88±12.49 years and in Group B it was 59.32±2.39 years. The mean surgery time in Group A was 58.71±7.84 minutes and in Group B 35.35±5.48 minutes (p<0.05). Mean blood loss was 273.82±30.0ml and 149.79±21.3ml in Group A and B respectively (p<0.05). The mean Harris hip score after 12 months in Groups A and B were 81.83±23.01 and 87.62±17.28 respectively. Infection was seen in 2(5.9%) patients in Group A and 1(2.9%) in Group B. CONCLUSION: Proximal femoral nail provided equivalent functional outcome compared to dynamic hip screw with lesser blood loss and surgical time.

Radiological Outcome of Fracture of Neck-of-Femur Treated with Two versus Three Cannulated Screws Fixation in Adults.

OBJECTIVE: To compare the radiological outcome of two cannulated screws versus three cannulated screws in fixation of fractures of neck-of-femur in adults. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Department of Orthopedic Surgery and Traumatology, Mayo Hospital, Lahore from September 2013 to September 2015. METHODOLOGY: A total of one hundred and twenty adults, age ranging from 14-49 years, with all Garden's types fracture of neck-of-femur, were inducted through Accident and Emergency Department after a written informed consent. Patients were randomly divided into two treatment groups. Group A underwent two cannulated screws fixation, while Group B underwent three cannulated screws fixation. Radiological union was checked at the 12th postoperative week. RESULTS: The median age was 36 years with interquartile range of 1.5 (p=0.895). There were 54 (90%) males and 06 (10%) females in GroupA; while 55 (91.7%) males and 05 (8.3%) females in Group-B (p=0.752). In the 12th postoperative week, radiological union was evident in 107 (89.2%) patients. The frequency of radiological union at 12th postoperative week was 98.3% in Group A and 80.0% in Group B (p<0.001). CONCLUSION: Frequency of radiological union of two cannulated screws fixation was found to be significantly higher than three cannulated screws fixation in adults with fracture of neck-of-femur.

Comparative study of effectiveness of rush pin with long arm cast and dynamic compression plate in management of closed diaphyseal fracture of radius and ulna in adults.

OBJECTIVE: To compare the effectiveness of Rush pin with long arm cast and dynamic compression plate in the management of diaphyseal fracture of radius and ulna in adults. METHODS: The randomised control study was conducted at the Mayo Hospital, Lahore, Pakistan, from December 2012 to December 2015, and comprised diaphyseal fracture of radius and ulna cases aged 15-45 years of either gender. The patients were divided randomly into two groups. Group A was managed with open reduction and internal fixation with Dynamic Compression Plate, while group B was managed with closed reduction and internal fixation with Rush pin and long arm cast. Groups were compared for age, gender, Orthopaedic Trauma Association fracture type distribution, surgery time, amount of blood loss, union achieved, time to union and functional outcome in terms of Grace-Eversmann criteria and the Disabilities of the Arm, Shoulder and Hand score. The complications in the two groups were also noted. SPSS 20 was used for data analysis. RESULTS: Of the 60 patients, 30(50%) each were in groups A and B. In group A, there were 23(76.67%) males and 7(23.33%) females, while in group B, there were 26(86.67%) males and 4(13.33%) females. The mean age in group A was 30.33} 4.26 years (range 21-37 years), and in group B it was 28.60}7.69 years (range 15-45 years). There was significant short time to union in group B compared to group A (p<0.0001). Frequency of union and functional outcome were not significantly different between the groups (p>0.05). CONCLUSIONS: Functional outcome and frequency of union was not significantly different between the groups, but there was a statistically significant earlier union in cases managed with Rush pin and long arm cast than those managed with open reduction and internal fixation with Dynamic Compression Plate.

Axillary Artery Injury In Blunt Shoulder Trauma - An Uncommon Association With Proximal Humerus Fracture.

Axillary artery injury along with proximal humerus fracture as a result of blunt trauma is a rare incidence. We present a 65-year-old male with a pulseless cold hand, who had blunt trauma 3 days ago, leading to fracture of proximal end of humerus along with axillary artery injury. Surgical intervention revealed contusion of axillary artery with intravascular thrombosis causing complete occlusion. Internal fixation of fracture along with excision of contused axillary artery was done followed by interposition venous graft. The diagnostic modalities and treatment options for such a case are discussed.

Effectiveness of locking compression plate in wedge fracture of diaphysis of radius and ulna in adults: A descriptive case series.

The aim of the study was to see the effectiveness of locking compression plate (LCP) in wedge fracture of diaphysis of radius and ulna in adults. This prospective descriptive case series study inducted total 45 patients presenting with wedge fracture (AO Type, 22-B) of radius and/or ulna. The treatment outcome of these patients were monitored for 24 weeks in 8 visits. Presence or absence of radiological union was noted. The functional outcome was evaluated in terms of Disability of Arm, Shoulder and hand (DASH) score and Grace and Eversmann criteria. Mean age of the patients included in this study was 28.76±6.16 years (range 18-47 years). Among them 28 (62.2%) were male while 17 (37.8%) were females. Union was achieved in all the patients at mean time of 12.62±2.24 weeks (range 8-16 weeks). Mean DASH score was 12.20±4.3 (range 5-19).According to Grace and Eversmann criteria, 41 (91.1%) had excellent result, 3 (6.7%) had good result, 1 (2.2%) had satisfactory results while there was no patient with unsatisfactory result. High rate of union along with good functional outcome and minimal complication can be achieved in patients with diaphyseal wedge fracture of radius and/ or ulna when managed with locking compression plate.

Focal dome osteotomy for correction of varus deformity at elbow in children.

BACKGROUND: Cubitus varus is the most common complication of un-treated or mal-treated supracondylar fracture of humerus at elbow. Various osteotomies have been described to correct this deformity but each is associated with its own complications. In this study, focal dome osteotomy for correction of cubitus varus was performed to determine its functional and radiological outcome. MATERIALS AND METHOD: In this study, 35 children with cubitus varus deformity were admitted from Jan 2009- Jan 2013. Clinical assessment was done before the procedure by measuring the carrying angle at elbow joint. Radiographic assessment of deformity was done by anteroposterior (AP) radiographs of the elbow by measuring the humeral-ulnar angle (HUA) and metaphyseal-diaphyseal angle (MDA). Through anterolateral approach, supracondylar region of humerus was exposed and focal dome osteotomy was done at the center of rotation of angulation (CORA). Final assessment was done clinically for carrying angle and radiologically for HUA and MDA at 8 weeks to evaluate the functional and radiological outcome as good or poor. RESULTS: The mean age of 35 children at the time of surgery was (mean ± SD 8.03 ± 2.35) with range from 5 - 12 years, Male to female ratio was 1.50:1. The mean duration of injury was (170.26 ± 41.78) days. The functional outcome for carrying angle improved from 1.49 ± 5.95 to 14.46 ±1.44 with p value <0.05. Radiological outcome for humeral-ulnar and metaphyseal-diaphyseal angle improved from 27.71 ± 4.31 to 17.77 ± 1.23 and 103.66 ± 4.76 to 90.49 ± 1.96 with p value <0.05 respectively. The final Functional and Radiological outcome was good in 32 patients (91%) and poor in 3 patients (9%). CONCLUSIONS: Focal dome osteotomy is safe and stable method of correction of cubitus varus which avoids prominence of lateral condyle and is cosmetically acceptable.

Antibiotic prophylaxis in hip surgery: A comparision of two vs. three doses of cefuroxime.

OBJECTIVE: To compare the efficacy of two-dose regime with a three-dose regime of cefuroxime in the prevention of post-operative wound infection in hip surgery patients and to determine the most effective regime of antibiotic prophylaxis for such patients. METHODS: The prospective, comparative, multi-centre cohort study was conducted from January 1998 to June 1998 at Dundee Royal Infirmary and attached district hospitals (Stirling Royal Infirmary and Falkirk Royal Infirmary). It comprised patients who had hip surgery i.e. fracture fixation, hemiarthroplasty or total hip replacement. Patients were assigned to two groups. Group A patients received cefuroxime 750mg at induction of anaesthesia and 750mg at the end of the procedure, while Group B patients received 1.5gm of cefuroxime at the induction of anaesthesia, followed by 750mg 8 and 16 hours after the operation. Patients were assessed post-operatively daily according to the ASEPSIS wound scoring system during the hospital stay. RESULTS: There were 280 patients in the study, with 140(50%) in each of the two groups. In Group A 60(43%) patients required fracture fixation, the rate of wound infection was 2(3.3%), 40(28.5%) required hemiarthroplasty and the rate of wound infection was 1(2.5%) and 40(28.5%) required total hip replacement and the rate of wound infection was zero. In Group B, the corresponding numbers were 1/60 (1.6%), 1/40 (2.5%) and zero. No evidence of minor, moderate or severe wound infection was observed in 272(97%) patients regardless of the group. The most frequent pathogens were Staphylococcus aureus in 3(1%) patients and Staphylococcus epidermidis in 2(0.7%). CONCLUSIONS: There was no significant difference in the prevalence of wound infection between the patients who had received two or three doses of cefuroxime.