Perspective on Clinical and Functional Outcomes of Arthroscopic All-Inside Meniscal Repair: Insights From a Lower Middle-Income Country.

Background Meniscal tears are a common injury in the adult population. With the advent of newer devices, the adoption of the all-inside repair technique has been expanding substantially because of its feasibility and reduced risk to surrounding neurovascular structures. This study was conducted in a lower middle-income country to assess the functional outcome of the arthroscopic all-inside technique and to identify the potential factors that may affect the functional outcome that will eventually influence the future management of these patients. Method This study is a retrospective case series conducted at the Department of Orthopedic Surgery, Aga Khan University Hospital, Karachi, Pakistan. Patients presenting to the outpatient clinics with meniscal tears who underwent arthroscopic all-inside repair from January 2015 to December 2021 were included in this study. The exclusion criteria included patients who had associated fractures and patients with meniscal tears greater than six months ago. Results A total of 29 patients underwent all-inside meniscal repair for meniscus tears. The mean age of our patients was 26.31 years (SD = 7.11 years), ranging from 17 years to 48 years. Of these patients, 26 were males and three were females, accounting for 89.7% and 10.3%, respectively. The most frequent mechanism of injury was twisting while playing sports, accounting for 51.7%, followed by falling while playing sports and road traffic accidents (RTAs), accounting for 13.8% and 20.7%, respectively. Of the 29 patients, 16 (55.2%) had lateral meniscal injuries, 10 (34.5%) were diagnosed with medial meniscus injuries, and three (10.3%) had injuries to both menisci. The most common type of tear that was observed in our sample size was bucket handle tears, which were found in 14 patients, accounting for a total of 48.3%, followed by complex tears in seven patients (24.1%). The majority of the patients, i.e., 19 out of 29 patients (65.5%), had an acute course of injury, i.e., less than six weeks. For the functional outcome, the Lysholm score was calculated at 12 months and was found to be excellent in 17 patients, good in six patients, and fair in six patients, accounting for 58.6%, 20.7%, and 20.7%, respectively. The mean Lysholm score was 90.03 ± 8.85 points. Of the 29 patients, 27 (93.2%) had no complaints at the regular 12-month follow-up, whereas one patient (3.4%) experienced rotatory instability and one patient (3.4%) experienced stiffness at the knee joint. None of the patients had to undergo a reoperation. The mean Lysholm score in the 25 patients who had an associated anterior cruciate ligament tear was 89.64 ± 9.442 points, whereas the four patients who had an isolated meniscal tear had a mean score of 92.50 ± 2.887 points, which was not significantly different (p-value = 0.831). Conclusion All-inside meniscal repair for treating meniscal tears has become the new treatment paradigm as it not only renders excellent functional outcomes with minimal complications but also prevents damage to the surrounding neurovasculature and the soft tissue envelope as it is a minimally invasive technique.

Frequency of Urinary Tract Infection Among Patients Undergoing Implant Fixation for Acute Trauma.

OBJECTIVE: This study aims to determine the frequency of urinary tract infection (UTI), identify the isolated bacteria, and assess antibiotic sensitivity in patients undergoing orthopedic implant fixation for hip fractures. METHODOLOGY: After ethical approval from the institutional review board, this retrospective cross-sectional study was conducted at the Orthopedic Surgery Department of Dow University Hospital Karachi from June 2022 to June 2023. Through non-probability consecutive sampling, 186 patients above 16 years of age, of either gender, presenting with hip fractures such as intracapsular or extracapsular fractures, who underwent surgical fixation, were included in the study. A urine sample for urinalysis of these patients was sent on admission. Patients who presented with open fractures or those treated with conservative management were excluded from the study. The fracture diagnosis was confirmed on radiographs. All other relevant baseline investigations were also performed before surgery, per protocol, and urine-detailed and cultured reports were followed. In addition, each patient was asked about common symptoms of UTI before surgery and then diagnosed with UTI on positive urine culture and sensitivity (CS). RESULTS: Out of 186 hip fracture patients, 98 (52.7%) were males and 88 (47.3%) were females, with a mean age of 61.03 ± 16.43 (16-96) years. Pre-operative UTI symptoms were reported by 79 patients, including dysuria (16; 20.3%), polyuria (19; 24.0%), and burning (44; 55.7%). UTI was diagnosed on culture and sensitivity report in 65 (34.9%) patients with Escherichia coli as commonly diagnosed bacteria 35 (53.8%), followed by Enterococcus 8 (12.4%), Klebsiella 7 (10.9%), Pseudomonas aeruginosa 3 (4.7%), and Acinetobacter 2 (3.1%) patients. E. coli was sensitive to amikacin, amoxicillin/clavulanic acid, ampicillin, cefixime, ceftriaxone, cefuroxime, ciprofloxacin, colistin, cotrimoxazole, fosfomycin, gentamycin, levofloxacin, meropenem, nitrofurantoin, polymyxin B, and piperacillin-tazobactam. CONCLUSION: Urinary tract infection is common in patients undergoing orthopedic implant fixation for hip fractures, which can lead to potentially serious outcomes. Overall, hygiene, prompt treatment, and standard protocol should be utilized to treat those infected and minimize the spread.

Outcome of management of tibial plateau fracture by posterior Lobenhoffer approach: case series.

Displaced Tibiai plateau fractures are complex periarticular injuries. Restoration of the anatomy and internal fixation are key elements for early return to function and better functional outcome. Newer modalities like CT scans has enabled better understanding of these fractures. Posterior approaches were not very common as compared to anteromedial and anterolateral surgical approach. Posterior approach has the advantage of avoiding anterior skin and soft tissues that has been compromised as a result of the fracture; it is also particularly helpful in direct and accurate reduction in certain fracture patterns. This case series highlights the importance of posterior approach to restore the articular surface of complex periarticular proximal Tibial fractures. All displaced tibial plateau fractures with posteromedial fragment were included in the study. Pathological fractures and all open fractures were excluded from this study. Oxford Knee score was done at regular intervals for functional outcome assessment. No wound complications or iatrogenic neurovascular damage were observed with this approach in this series. Anatomical reduction and radiological union was obtained in all patients with excellent functional outcome. We recommend posterior Lobenhoffer approach for fixation in select group of patients with Tibial plateau fractures.

Outcome of Total Hip Replacement with Ceramic on Ceramic Bearings, Case series from Aga Khan University Hospital, Karachi, Pakistan.

Total Hip replacement offers complete resolution of symptoms and restoration of the hip function. The long-term success of hip replacement primarily depends on wear and osteolysis resulting from the bearing surfaces used in hip replacement surgery. Different bearing surfaces have been used in hip replacements, with variable success rates. Traditional combinations include metal on polyethylene, ceramic on polyethylene, and metal on metal articulations. Ceramic on ceramic Bearing couple is a relatively newer combination recommended for younger patients, requiring Total hip Arthroplasty. Ceramics have the lowest wear rate and are showing promising long-term results in international literature. We report the use of this bearing surface for the first time in Pakistan.