Outcome of ilizarov fixator in complex non-union of long bones.

OBJECTIVE: To evaluate the efficacy of Ilizarov fixator in the management of complex non-union of long bones. METHODS: The retrospective study was conducted at Ayub Teaching Hospital, Abbottabad, and Khyber Teaching Hospital, Peshawar, Pakistan, and comprised data of patients aged 14- 60 years of either gender with complex non-union of long bones between January 2006 and December 2013. Data, including age, gender, mechanism of injury, type of long bone involved, complications of surgery and final outcome, was documented on a pre-designed proforma. Outcome was graded using Association for the Study and Application of Methods of Ilizarov scoring system. SPSS 20 was used for analysis. RESULTS: There were 45 patients of whom 30(66.7%) were males and 15(33.4%) were females. The overall mean age was 32.20±12.48 years (range: 14-60 years).Of the 45 non-unions, 39(86%) healed successfully, and the mean time to union was 30.69±8.6 weeks (range: 16-52weeks).In terms of outcome, 29(64.44%) patients had excellent bone results, 9(20%) had good results, 2(4.44%) had fair results and 5(11.1%) had poor bone results. There were 32(71.11%) patients with excellent functional result, 8(17.77%) good, 2(4.44%) fair and 3(6.66%) patients had poor results. CONCLUSIONS: Ilizarov fixator gave good and excellent results in complex non-union of long bones by eradicating the infection, filling the defect with bone transport, and correcting the deformity and limb length discrepancy.

Femoral Shaft Fractures in Children: Exploring Treatment Outcomes and Implications.

INTRODUCTION: Femoral shaft fractures significantly impact children and families, posing a significant challenge for pediatric patients. The prevalence of limb shortening in femur shaft fractures treated with hip spica casting in our group, however, has not been the subject of many recent investigations. AIMS: By comparing the prevalence of limb shortening to various age groups and common pediatric injury patterns, this research seeks to close this information gap. METHODS: This research, which lasted six months and was done at the Orthopedics Unit of Khyber Teaching Hospital Peshawar, Pakistan, included 129 children with closed femur shaft fractures who were between the ages of one and six. Clinical assessments, radiological examinations, and hip spica casting, all supervised by experienced orthopedic surgeons, were carried out. Senior postgraduate trainees oversaw the study's findings. RESULTS: The results unveiled key insights into the study population. Among the findings, 33% (n=43) of the children were aged one to three years, while 67% (n=86) fell within the three to six years age range. Gender distribution revealed that 72% (n= 93) were male. In terms of mechanism, 22% (n=28) of fractures were attributed to road traffic accidents, 69% (n=89) were the result of falls, and 5% (n=12) were due to other causes. Notably, 19% (n=29) of the children exhibited limb shortening. CONCLUSION: This study contributes significantly to the understanding of femur shaft fractures in children, shedding light on their complex dynamics. The study enhances our understanding of pediatric femur shaft fractures. We found that 19% of children exhibited limb shortening, underscoring the need for targeted treatment strategies. These insights can significantly improve patient care and treatment protocols for this challenging condition, benefiting both children and their families.

Results of type-III supracondylar fracture humerus with open reduction and internal fixation in children after failed closed reduction.

BACKGROUND: Supracondylar fracture of humerus is the second most common fracture in children which account for 60-75% of all fractures around the elbow. There are various treatment modalities for type-III fracture, i.e., closed reduction and casting, skeletal traction, close reduction and percutaneous pinning and open reduction and internal fixation. This study was conducted to see the outcome of open reduction and internal fixation after failed closed reduction. METHODS: This study was conducted in the Orthopaedics Departments of Khyber Teaching Hospital Peshawar and Ayub Teaching Hospital Abbottabad from February 2007 to Nov 2007 on 30 children. Patients included were of either gender with age range from 5-12 years with displaced supracondylar fracture (type-III) after failed closed reduction. All fractures were fixed with two cross K-wires by open reduction and internal fixation. The patients were assessed both clinically and radiologically and results were tabulated according to Flynn criteria. RESULTS: Twenty-eight patients had excellent results while two had good results according to Flynn criteria. None of the patients had either fair or poor result. CONCLUSION: Open reduction and internal fixation is a good and reliable method after failed closed reduction and gives stable fixation with anatomical alignment.

Scott wiring for direct repair of lumbar spondylolysis.

STUDY DESIGN: This is a retrospective study of consecutive patients who underwent Scott wiring for symptomatic lumbar spondylolysis using the MacNab criteria. OBJECTIVE: The aim of the study was to assess the clinical outcome of the procedure after a mean follow-up period of more than 10 years. SUMMARY OF THE BACKGROUND DATA: Previous studies have shown this technique to be effective in the management of patients up to the age of 25 years who have symptomatic lumbar spondylolysis with or without a Grade 1 slip. No study has been published with regard to the long-term outcome of Scott wiring. METHODS: Between 1986 and 1993, Scott wiring was performed for 15 patients younger than 25 years of age who had symptomatic lumbar spondylolysis. MacNab criteria were used to assess their pre- and postoperative status. A postal questionnaire was used to assess their clinical outcome. Their notes also were studied to find subsequent episodes of low back pain. RESULTS: The postoperative questionnaires were returned by 14 patients. The mean follow-up period was 10.9 years. Of the 14 patients, 12 had a "good" or "excellent" result according to MacNab criteria. The two patients classified as "poor" required further procedures for continued low back pain. CONCLUSIONS: The Scott wiring technique is recommended for the treatment of symptomatic lumbar spondylolysis in patients younger than 25 years because it gave "good" or "excellent" results in approximately 86% of the patients with a mean follow-up period of 10.9 years.

A ligamentum flavum-preserving approach to the lumbar spinal canal.

STUDY DESIGN: This is a retrospective study of a consecutive series of patients undergoing spinal decompression or disc enucleation with preservation of the ligamentum flavum. MacNab criteria and Prolo scoring was used to assess them pre- and after surgery. OBJECTIVES: The aim of the study was to assess the incidence of perioperative complications and long-term clinical outcome of the procedure. SUMMARY OF THE BACKGROUND DATA: One previous study has shown this technique to be effective in reducing the rate of perioperative complications and recurrences in patients undergoing microscopic disc enucleation. However, this study does not comment on the long-term clinical results or the use of the technique in a wider range of spinal procedures. METHODS: Between 1991 and 1999, we operated on 214 patients for peripheral lumbar radiculopathy. MacNab criteria and Prolo scoring was used for their pre- and postoperative assessment. Postoperative assessment was with the help of a postal questionnaire. In addition, clinical notes were studied to look for any further procedures or operative complications. RESULTS: All 214 patients returned the postoperative questionnaires. There were 104 males and 110 females. The mean follow-up was 5.97 years. Thirty-eight patients had an associated fusion or Graf ligament stabilization. Two hundred ninety-six levels were operated in all. There were four instances of dural tear and one of nerve root injury. Five patients underwent revision. There was a statistically significant improvement in the MacNab criteria (P < 0.001) and Prolo score (P < 0.001) after surgery. CONCLUSIONS: We recommend a ligamentum flavum preserving approach because it decreases the rate of perioperative complications while giving comparable long-term results.

Correlation between inter-vertebral disc morphology and the results in patients undergoing Graf ligament stabilisation.

BACKGROUND: Previous studies have shown Graf ligament stabilisation procedure to give mixed results in the short to medium term. The aim of this study was to correlate the pre-operative state of the disc, multifidus muscles, age of the patient, levels operated and the clinical outcome after a mean follow-up of 47 months. METHODS: Graf ligament stabilisation procedure was carried out in 38 patients between 1996 and 1999. Their post-operative status was assessed using MacNab criteria. The post-operative follow-up was by postal questionnaires and review of the clinical notes. Disc morphology and multifidus muscle wasting was graded blindly and independently. The intra- and interobserver reliability was measured with kappa score and classified using the kappa classification of Landis and Koch. Correlation was measured with the help of Spearman correlation coefficient. RESULTS: Thirty-eight patients (100%) returned the questionnaires. Mean follow-up time was 47.55 months. Fifty-nine levels were operated on. Mean age was 39.68 years. The overall re-operation rate was 15.8%. The intra- and interobserver reliability was graded as good to substantial. Twenty-two patients (57.89%) were satisfied with the procedure. There was no statistically significant correlation between disc morphology, multifidus muscle wasting, sex, age, number of levels operated, the levels operated, and the satisfaction rate. CONCLUSIONS: The indications of Graf ligament stabilisation procedure are not clear. Further work is necessary to clearly identify the indication for the procedure.