Outcome Of Open Interlocking Nailing In Closed Fracture Shaft Of Femur.

BACKGROUND: Various treatment modalities have been used in treating femoral shaft fractures, i.e., open intramedullary nailing, plating and external fixators but these does not always produce stable fixation and there is increased risk of infection, closed locked intramedullary nailing technique has being the gold standard and is a routine procedure but it requires proper orthopedic operation table with traction apparatus and the use of image intensifier. The use of open interlocking nailing technique doesn't require any special orthopaedic table nor it requires use of Image intensifier. The objective of this study is to find out and determine the frequency of fracture union and wound infection in open reamed interlocking nailing of close fractures of shaft of femur. METHODS: This study included fifty-eight patients from either gender, above 14 years of age with closed femoral shaft fracture presenting within 2 weeks. Data was collected on Performa about gender, age, address, date of fracture, date of operation and discharge, type of fracture and follow-up visits. RESULTS: Mean age of the patients were 31.24±8.662. According to Winquist & Hansen, femur shaft fractures were divided into four types. Type I were found in the 16(27.6%), Type II in 21 (36.2%), Type III in 12 (20.7%) and Type IV in 9 (15.5%). Total number of fracture union with regard to Winquist & Hensen Classification of fracture shaft femur were, Type I, 14 (24.1%), Type II, 21 (36.2%), Type III, 12 (20.7%), Type IV, 8 (13.8%) respectively while the rest 3 (5.2%) were found in non-union. Total number of fracture union with regard to gender of the patients were, 41 (70.7%) males and 14 (24.1%) were females while the rest 3 (5.2%) patients fracture union has not occurred. Fracture union was found in 55 (94.8%) out of 58 patients; while fracture union had not occurred in 3 (5.2%) out of 58 patients. The total number of patients who developed wound infection following surgery were 5 (8.6%) out of 58 patients; while the non-infected patients were 53 (91.4%) out of 58 patients. CONCLUSIONS: The open interlocking nailing technique for close fractures shaft of femur without the use of image intensifier achieved excellent results in terms of fracture union. Results obtained are mostly similar to the results of close interlocking nailing and it also requires less expertise, recourses and without the use of image intensifier.

Prevalence of hepatitis 'B' and 'C' in orthopaedics patients at Ayub Teaching Hospital Abbottabad.

BACKGROUND: Hepatitis B and C is a common global health problem and is spreading rapidly in developing countries due to lack of health education, poverty and illiteracy. Both of these infections can be transmitted through blood or body fluids, tattooing, through infected instruments, unsafe shave by barbers and sexual contact. Medical personnel are most exposed to these infections. There should be proper preventive measures to prevent its spread in the community. METHODS: This is a descriptive study carried out from July 2003 to July 2004 on 1630 patients admitted in the department of Orthopaedics Ayub Teaching Hospital Abbottabad. Patients of either sex, of all ages undergoing surgery were included in the study. All patients underwent screening for Hepatitis-B and Hepatitis-C and confirmed by Elisa method in positive patients. RESULTS: Out of 1630 patients 1205 (73.92%) were male and 425 (26.07%) were female. Hepatitis B and C was present in 84 (5.15%) patients. Out of 84 infected patients 51 (3.12%) were suffering from hepatitis C and 33 (2.02%) were suffering from hepatitis B. In 2 (0.12%) patients both hepatitis B and C infections were present. Out of 51 hepatitis C patients, 33 (64.71%) were male and 18 (35.29%) were female. Out of 33 hepatitis B patients, 28 (84.85%) were male and 5 (15.15%) were female patients. Among the predisposing factors previous history of surgery was positive in 18 (21.43%) patients, history of blood transfusion in 13 (15.47%) patients, dental procedure was in 7 (8.33%) patients, and abroad visit in 4 (4.76%) patients. CONCLUSION: The prevalence of hepatitis B and C in orthopaedic patients is quite high with the common risk factors: previous history of surgery or blood transfusion. Therefore, all patients which need surgery should be routinely screened for hepatitis B & C to prevent transmission to other patients, medical staff. There should be separate operation theatres facilities for these patients. There should be policy by the Government for protection of medical personnel who are exposed to these patients and there should be compensation for those who get infected with these infections during their service otherwise the medical personnel especially surgeons will hesitate doing surgeries on hepatitis B and C infected patients.