Local recurrence of giant cell tumour of bone after intralesional treatment with and without adjuvant therapy, a single institution case series.

BACKGROUND: Giant cell tumour (GCT) of bone is generally a benign tumour composed of mononuclear stromal cells and characteristic multinucleated giant cells that exhibit osteoclastic activity. It usually develops in long bones but can occur in unusual locations. The typical appearance is a lytic lesion with a well-defined but non-sclerotic margin that is eccentric in location, extends near the articular surface, and occurs in patients with closed physes. OBJECTIVE: The current study was planned to summarise our experiences with GCTB, and to evaluate individual effect of bone cement, high-speed burring and hydrogen per oxide (H2O2) on local recurrence. GCT can mimic or be mimicked by other benign or malignant lesions at both radiological evaluation and histological analysis. In the past, the mainstay of treatment was surgical, primarily consisting of curettage with cement placement, with recurrence rates of 15%-25%. Recurrence is suggested by development of progressive lucency at the cement-bone interface. RESULTS: Of the 21 patients who started the study, 4(19%) were lost to follow-up, and 17(81%) represented the final study sample. Of them, 16(94.11%) patients underwent the curettage procedure with adjuvant therapy and reconstruction with bone grafts taken from iliac crest. In 3(26.3%) patients, no adjuvant was used. Total of 6 (42.1%) patients had local recurrence and 3(50%) of them were those who were treated without any adjuvant; 2(33.3%) with phenol and 1(16.6%) with PMMA. CONCLUSIONS: The results of the present study suggest that an "aggressive curettage" with the use of adjuvant reduces the recurrence rate in a disease whose aggressiveness is not easy to predict.

Clinical outcome of patients with isolated tibial shaft fractures treated with S.I.G.N interlock nails in terms of surgical site infection and radiological bone healing on follow up.

OBJECTIVE: To determine the clinical outcome of patients with isolated tibial shaft fractures treated with Surgical Implant Generation Network interlock nails. METHODS: The observational study was conducted from January 2010 to October 2014 at Allied Hospital, Faisalabad, Pakistan, and comprised in-patient charts. The Surgical Implant Generation Network Fracture Care Online Database was also screened for patients' data to be included in the study. The dependent variables were surgical-site infection and radiographic callus formation (bone healing). Data was analysed using SPSS 17. RESULTS: Out of the 80 patients in the study, 56(70%) were male and 24(30%) were female; the male-to-female ratio being 2.3:1. Overall, 64(80%) patients showed radiographic union and 3(3.75%) patients had surgical-site infection on follow-up after 12 weeks. CONCLUSIONS: The treatment of isolated tibial shaft fractures with Surgical Implant Generation Network interlock nails showed good results in terms of infection and radiographic bone healing.

Outcome of open reduction internal fixation with cross K-wires for supracondylar fracture of humerus in terms of Flynn's criteria in children.

OBJECTIVE: To determine the outcome of open reduction and internal fixation of supracondylar fracture of humerus in children using Flynn\'s criteria. METHODS: The quasi-experimentalstudy was conducted at Punjab Medical College/Allied Hospital, Faisalabad, Pakistan from July 2012 to June 2014and comprised children aged between 5 and 12 years with supracondylar fracture of humerus presenting within one week of the fracture. Post-surgery follow-up included clinical assessment and measurement of carrying angle on radiographs. Outcome was assessed using Flynn\'s criteria. SPSS 17 was used for statistical analysis.. RESULTS: Out of 79 cases, 50(63.3 %) were boys and 29(36.7%) girls. Overall mean age was 7.36±1.68 years. Excellent results were obtained in 58(73.4%), good in 14(17.7%), fair in 5(6.4%) and poor in 2(2.5%) patients in terms of functional and cosmetic outcome. CONCLUSIONS: Open reduction and internal fixation of supracondylar fracture was found to be a better choice of treatment with good functional results.

Short term evaluation of total hip arthroplasty; our experience at tertiary care center.

BACKGROUND: Total hip arthroplasty is a common and successful treatment for osteoarthritis of the hip. Demographic trends in Pakistan suggest a significant increase in the demand for total hip replacement surgery. OBJECTIVES: The current study was planned to assess the outcome of THA at our centre in terms of pain relief and functional improvement by using pre and postoperative HHS. It was observed in this study that the functional outcomes were highly encouraging. Patients were handicapped because of pain, loss of movements and inability to carry out day-to-day activities due to arthritis of the hip joint. The same functional improvements were noted from examination of the patients according to Harris Hip Score. PATIENTS AND METHODS: The descriptive case series was conducted at Punjab Medical College and affiliated hospitals from July 2013 to July 2014, and comprised patients of either gender 25 years or more of age with primary or secondary OA of hip. Severe complications in total hip replacement comprise dislocation, aseptic loosening, infection, peri-prosthetic fracture and limping. Time period of this study was short so a longer period of follow-up is suggested for better evaluation. RESULTS: Mean pre-operative HHS was 31.88+7.43 and post-operatively it was 81.23+9.56 which meant good results with marked improvement. CONCLUSIONS: The study concluded that total hip arthroplasty is a secure procedure with tremendous benefits.

Factors affecting functional outcome after lower extremity amputation.

BACKGROUND: More than 100,000 major lower extremity amputations -- amputations at the metatarsal, below-knee or above-knee level -- are performed yearly in the United States. Despite improvements in long-term outcome, operative mortality following such amputations has remained stable at 9% to 10% over the last 20 years. Several predictors for functional outcome of amputee patients are mentioned in the literature. OBJECTIVES: The current study was planned to assess the impact of comorbidities on functional status after lower extremity amputations. MATERIALS AND METHODS: It was a prospective comparative study held at the Department of Orthopaedics and Traumatology, Punjab Medical College, Faisalabad, and affiliated hospitals. The study included 104 patients regardless of age and gender. Patients were allocated into trans-metatarsal (TM) group, below-knee (BK) amputation group and above-knee (AK) amputation group. Comorbidities before amputation included diabetes mellitus (70.7%), coronary heart disease (57.1%), chronic kidney disease (53.6%), and/or congestive heart failure (52.1%). RESULTS: Mortality within 30 days of hospital discharge was 9%, and hospital readmission was 27.7%. Stroke, end-stage renal disease (ESRD) and poor baseline cognitive function were associated with the poorest functional outcome after amputation. Patients undergoing BK or AK amputation failed to return to their functional baseline within 6 months. CONCLUSIONS: Higher amputation level, history of stroke, ESRD, poor baseline cognitive scores, and female gender are factors associated with inferior functional status after amputation.

Glomus tumours: Outcome based on tumour location in hand.

OBJECTIVE: To determine the clinical outcome of patients with glomus tumour in nail matrix and nail bed that were excised with transungual approach. METHODS: The case series was conducted at the Allied and District Headquarter Hospital, Faisalabad, Pakistan,from January 2012 to June 2014, and comprised patients with glomus tumour at finger tipswhose diagnosis was confirmed with biopsy results. Variables noted were the location of the tumour in the nail i.e. either nail matrix or the nail bed. RESULTS: Of the 8 patients in the study, 5(62.5%) had tumours located in the nail matrix and 3(37.5%) in the nail bed. Three (60%) patients with nail matrix tumour had prolonged pain sensation, whereas none (with nail bed lesion had prolonged pain sensation. CONCLUSIONS: There was no recurrence but anatomic location of the subungual glomus tumour at initial presentation can predict postoperative prolonged pain.