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.

Outcome of plating, bone grafting and shortening of non-union humeral diaphyseal fracture.

BACKGROUND: Humeral diaphyseal fracture usually heals with closed methods but when non union develops then it needs surgical intervention in the form of plating and bone grafting, intramedulary nailing (open or closed simple or interlocking nails) and external fixators (circular or one plane fixator). In our unit we treated non union humeral diaphyseal fracture with plating and bone grafting and shortening of fracture ends up to 4 to 5 cm when needed. METHODS: This study was conducted at Orthopaedic Department of Ayub Teaching Hospital Abbottabad from January 2002 till December 2003. We included 15 cases with atrophic non-union in 9 (60%) and hypertrophic non-union in 6 (40%) patients. All atrophic non-union were treated with plating, bone shortening by transverse osteotomy and bone grafting, while hypertrophic non-union were treated with decortications of non-union ends and fixation with compression plates, with bone grafting in old age. Follow up measures were based on clinical (range of joints motion) and radiological (healing) findings. Follow up was done for up to 6 months. RESULTS: Out of 15 patients the age range was 20-80 years, 12 (80%) were male and 03 (20%) female. Right humerus involved in 5 (33.33%) while left humerus in 10 (66.66%) patients. In 9 (60%) patients with atrophic non union bone shortening by transverse cut osteotomy was done while in remaining patients with hypertrophic non-union plating was done in 2 (13.33%) cases and plating with bone grafting in 4 (26.66%) patients. Union was achieved in all patients after 16 to 20 weeks of surgery. In one patient (6.66%) of 75 years age with hypertrophic non-union implant was loosened after 03 months of surgery. At that time healing (Union) was evident on X-rays and humeral brace was applied for further 03 months. Two patients (13.33%) got neuropraxia of radial nerve which resolved with in 3 months time. 02 patients (13.33%) developed shoulder stiffness which resolved after exercise. CONCLUSION: In Non Union of Humerus shortening by transverse osteotomy & rigid fixation with plates give excellent results in selected cases.