Management of early and late presenting tibial stress fracture with advanced osteoarthritis of the knee: A dilemma among arthroplasty surgeons in developing countries.

BACKGROUND: Single-stage total knee arthroplasty (TKA) with long-stem is a viable option to treat proximal tibial stress fracture in advance knee osteoarthritis. However, in patients with old mal-united or non-united tibial fractures, treatment becomes complicated. Therefore, our aim in this study was to monitor clinical and radiological outcome in patients presenting early or late managed by single-stage long-stem TKA. METHODS: This retrospective study included 24 consecutive patients; all were female. Patients with recent and mobile stress fracture (Group A) were treated with close reduction and long-stem tibial component. However, in patients with old, sclerotic or mal-united fractures (Group B), open reduction, partial fibulectomy and plating with bone grafting was also performed. Outcome was monitored by tibiofemoral angle, functional Knee Society score and time taken for union. RESULTS: The mean age of patients was 62.34 years. There were 13 patients in Group A and 11 in Group B. The mean follow up was 42.79 months (range, 18-72 months). Knee Society score improved from 29.83 ± 6.10 to 91.57 ± 4.89 in Group A and from 27.21 ± 3.32 to 89.87 ± 3.89 in Group B. Tibiofemoral angle improved from 20.57 ± 3.00° to 0.80 ± 0.46° in 21 varus knees, whereas it improved from 22.33 ± 4.61° to 0.83 ± 0.28° in three valgus knees. Iatrogenic perforation of tibial cortex occurred in one case. Union of stress fracture was achieved in all cases with a mean duration of 4.70 months. CONCLUSION: Excellent results were obtained in both groups but were slightly lower in patients presenting late, therefore all efforts must be made to treat such cases as early as possible.

Vitamin D deficiency and possible link with Bony pain and onset of Osteoporosis.

OBJECTIVE: To explore if vitamin D deficiency had a direct correlation with bone pain or if it contributes in any way to the onset of osteoporosis. METHODS: The cross sectional Study was conducted from February to May 2014, presented at Liaquat National Hospital, Karachi, and comprised Orthopaedic outpatients. Who were questioned, examined and counselled, before a questionnaire was filled that included questions about their complaint, and its severity. Several blood test reports were incorporated including serum Vitamin D, to evaluate kidney and liver functions. Dual energy X-ray absorptiometry scans of the lumber and hip regions were also included. Data was collected manually and analysed using SPSS version 16. RESULTS: The mean age of the 65 subjects, was 52.±16 SD years, and 54(83.1%) were overweight with body mass index of 29.7kg/m2. Besides, 61(93.8%) had a positive association of low vitamin D levels as a causative agent for bone pain with mean pain severity index 6±1 SD. On the other hand 25(38.5%) were diagnosed as cases of osteoporosis, and, of them, 21(84%) had low vitamin D levels. CONCLUSIONS: Deficiency of vitamin D was directly related to the intensity of bone pain. Some patients had vitamin D deficiency along with osteoporosis, which may have aggravating effect in this context.

Pseudomonas as trespassers in diabetic foot infections: More questions and fewer answers.

OBJECTIVE: To assess microbiological isolates from diabetic foot ulcers presented at a tertiary care teaching hospital. METHODS: The prospective observational study was conducted at department of Orthopaedics, Liaquat National Hospital Karachi, from January 2009 to October 2011, and comprised patients with diabetic foot ulcers (Wagner grading 1-4). Grade 0 and 5 were excluded. Wound swabs or tissue biopsies were taken before the induction of antibiotic prophylaxis according to the standard aseptic protocols. SPSS 16 was used for statistical analysis. RESULTS: Of the 250 patients in the study, 151(60.4%) were male with an overall mean age of the subjects of 46±8.1 years. Mean duration of diabetes was 14±6.7 years. Based on Wagner's grading, 90(36%) patients had grade 1, 58(23.2%) grade 2, 97(38.8%) grade 3, and 5(2%) grade 4. The most common isolates were polymicrobial in 90(36%) patients and pseudomonas aeruginosa in 87(34.8%). Resistance antibiogram for pseudomonas aeruginosa showed sensitivity against Imipenem, Aztreonam, Ceftazidime, Ciprofloxacin and Gentamicin. CONCLUSIONS: The isolation of pseudomonas aeruginosa gives an idea about the recent microbial spectra from our region and should prompt the need for multi-centre studies from South Asia to devise treatment guidelines for this part of the world.

Predictors of obesity among post graduate trainee doctors working in a tertiary care hospital of public sector in Karachi, Pakistan.

OBJECTIVES: To identify the predictors of obesity among post graduate trainee doctors working in a tertiary care hospital of public sector at Karachi, Pakistan. METHODS: A cross sectional analytical study was conducted at one of the tertiary care hospitals of public sector in Karachi. Information was collected from 117 post graduate trainee doctors via pre-tested self administered questionnaire and standard tools were used for height and weight measurement. Obesity was defined as body mass index (BMI) > or =23 by using South Asian cut-off points. SPSS version 16 was used for data analysis, and logistic regression technique was applied to come up with predictors of obesity. RESULTS: Frequency of overweight and obesity among doctors was 31.6% and 28.2% respectively. Nearly, 18% were using tobacco and family history of obesity was present in 44%. Approximately 64% doctors were taking lunch outside home, 76% were taking tea at least once a day, 59% were taking snacks between meals and 50% were physically inactive. Predictors of obesity among doctors include; taking lunch outside home OR = 7.11 (2.28-22.09), snacks between meals OR = 5.36 (1.51-19.03), tea OR = 7.85 (1.63-37.63), physical activity OR = 0.18 (0.05-0.57), increase duration of training OR = 1.7 (1.15-2.49), family history of obesity OR = 3.35 (1.11-10.08) and male gender OR = 3.83 (1.07-13.72). CONCLUSION: Frequency of overweight and obesity was high among post graduate trainee doctors. Taking lunch outside home, snacks and tea intake between meals, increase duration of training, family history of obesity, male gender and lack of physical activity were found to be predictors of obesity among doctors.