Diagnostic value of sinus tract culture versus intraoperative bone culture in patients with chronic osteomyelitis.

To compare the organisms isolated from the sinus tract culture and intraoperative bone culture in patients with chronic osteomyelitis. This cross sectional prospective study was conducted from February 2015 to March 2016. Ninety consecutive patients were enrolled in study (n=90). Inclusion criteria were patients with either sex, any age, chronic osteomyelitis having discharging sinus. Sample from sinus tracts and bone were taken through standardized aseptic technique and organism were cultured. There were 62 males and 28 females, male to female ratio 3:1, mean age was 40 years. 23 patients had primary osteomyelitis and 67 had secondary osteomyelitis. 68 patients had orthopaedic implant infections. In 61/90 (67%) patients the same organism was isolated on both sinus tract and intraoperative cultures.In our scenario we found that within the limitations of this study, there was a high ratio of agreement between the sinus tract and intraoperative cultures. We conclude that if used judiciously, sinus tract cultures can yield accurate results in the majority of cases.

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.

Precontoured anatomical plates new era in the complex tibail plateau fractures fixation.

OBJECTIVE: Functional outcome of Intraarticular Tibial Plateau Fractures fixed with precontoured anatomical plates using Knee Society Score. METHODS: Observational study with retrospective review of collected data. Patient's demography, mechanism of injury, schatzker's classification includingtype IV, V and VI. All patients underwent screw and plate fixation using two incision technique with pre-contoured anatomical plates and intercondylar lag screws where indicated. Passive range of motion exercises started at 2 weeks. Postoperative knee pain, range of motion and stiffness were recorded at followup 3 and 4 months. Mean±SD were calculated for quantitative variables and qualitative variables were presented with frequency and percentages. The association of outcome (Knee Society Score) with gender, age and Schatzker's type was evaluated by applying Fisher's Exact test considering p-value <0.05 as significant. RESULTS: Twenty-five patients were included in study. 20 patients were available and 05 lost to follow up. 16 were males and 4 females out of 20 patients. Average age is 36.2±12.89 years. All patients sustained injuries after RTA. 5 patients had postoperative knee pain while remaining were pain free. Average flexion was 123.8 with (SD 8.88)range of 105 to 135 degree. Average extension was 3.15 with (SD 2.41) range of 0 to 8 degress. 4 patients developed stiffness of knee. 2 patients symptomatic implant. All fractures healed at follow up at 4 months. According to Knee Society score (SD 7.65) 14 cases scored as good, 4 cases scored fair and 2 cases scored poor. There was no association of knee score was found with gender (p=0.493) but significant association of knee score was found with age (p=0.007) and Schatzker's type (p=0.028). CONCLUSIONS: Tibial plateau fractures can be effectively treated by anatomical reduction and absolute fixation using pre-contoured anatomical plates. Functional outcome calculated by Knee Society score is better in young patients. With appropriate surgical techniques and early post-operative rehabilitation, good functional results can be achieved.

One Bone Forearm: A Valid Option For Treating Post Infection Bone Deficiencies.

Surgical fixation of radius to ulna has been described in the literature at various instances when deficiencies of either of the bones are encountered. The main concept of one bone forearm relies on an intact elbow and wrist articulations so a stable functioning limb can be achieved after union of radius to the ulna. This case report elaborates post infection loss of proximal ulna treated with fixation to radius.

Fucntional and Radiological Outcome of Surgical Management of Acetabular Fractures in Tertiary Care Hospital.

PURPOSE: Acetabular fractures are mainly caused by trauma and the incidence is rising in developing countries. Initially these fractures were managed conservatively, due to lack of specialized and dedicated acetabulum surgery centres. Our aim is to study the radiological and functional outcomes of surgical management of acetabular fractures in tertiary care hospital. MATERIALS AND METHODS: Total 50 patients were enrolled. The patients with acetabular fractures were enrolled between the years 2012 to 2014. Patients were evaluated clinically with Harris hip score (HHS) and radiologically with Matta outcome grading. The factors examined include age, gender, fracture pattern, time between injury and surgery, initial displacement and quality of reduction on the final outcome. RESULTS: There were 34 males and 16 females. Mean age was 44.20±11.65 years while mean duration of stay was 9.28±2.36 days. Duration of follow-up was 24 months. Most common mechanism of injury was motor vehicle accident (n=37, 74.0%). Open reduction and internal fixation of fractures were performed using reconstruction plates. Mean HHS at 24 months was 82.36±8.55. The clinical outcome was acceptable (excellent or good) in 35 (70.0%) cases and not acceptable (fair or poor) in 15 (30.0%) cases. The radiological outcome was anatomical in 39 (78.0%) cases, congruent in 5 (10.0%) cases, incongruent in 6 (12.0%) cases. CONCLUSION: Study results indicated that mechanism of injury, time between injury and surgery, initial degree of displacement and quality of reduction had significant effect on functional as well as radiological outcome.