Clinical outcome of locking plate fixation in distal tibia fractures.

A study was conducted to assess the outcome of close distal tibial fractures fixed with pre-contoured locking-plate using Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) technique in terms of union and infection, at the Department of Orthopaedic Surgery King Edward Medical University/Mayo Hospital, Lahore from August 2013 to May 2017. Fourty cases with close distal tibial fractures were enrolled. Fractures were managed with locking compression plate using MIPPO technique. Patients were followed for 12 months post-fracture stabilisation. Of the 40 patients 24 were males and 16 females, with male to female ratio of 1.5:1. The mean age of the patients was 44.70±13.67 years with minimum and maximum ages of 18 and 60 years, respectively. All fractures united with the mean union time of 16±4 weeks. The infection rate was 5%. Locking compression plate when used with MIPPO technique provides early bone union and low infection rate.

Comparison of proximal femoral nail (PFN) and dynamic hip screw (DHS) for the treatment of AO type A2 and A3 pertrochanteric fractures of femur.

OBJECTIVE: To compare the dynamic hip screw with proximal femoral nail for the treatment of Arbeitsgemeinschaft für Osteosynthesefragen type A2 and A3 per trochanteric fractures of femur. METHODS: The randomised controlled single-blind study was conducted at the Mayo Hospital, Lahore, Pakistan, from September 2015 to September 2017, and comprised patients aged 40-75 years with Arbeitsgemeinschaft für Osteosynthesefragen type A2 and A3 per trochanteric fracture. The patients randomised into two equal groups. In Group A, patients were treated by closed reduction and internal fixation with dynamic hip screw, while those in Group B were treated by closed reduction and internal fixation by proximal femoral nail. Follow-up was done at 2nd, 6th and 12th weeks, and at 6th, 9th and 12th month post-operatively. Variables evaluated were frequency of union, surgical time, approximate amount of blood loss and complications. The functional assessment was done by using Harris hip score. SPSS 20 was used for data analysis. RESULTS: Of the 68 patients, there were 34(50%) in each group. The mean age of patients in Group A was 60.88±12.49 years and in Group B it was 59.32±2.39 years. The mean surgery time in Group A was 58.71±7.84 minutes and in Group B 35.35±5.48 minutes (p<0.05). Mean blood loss was 273.82±30.0ml and 149.79±21.3ml in Group A and B respectively (p<0.05). The mean Harris hip score after 12 months in Groups A and B were 81.83±23.01 and 87.62±17.28 respectively. Infection was seen in 2(5.9%) patients in Group A and 1(2.9%) in Group B. CONCLUSION: Proximal femoral nail provided equivalent functional outcome compared to dynamic hip screw with lesser blood loss and surgical time.

Comparative study of effectiveness of rush pin with long arm cast and dynamic compression plate in management of closed diaphyseal fracture of radius and ulna in adults.

OBJECTIVE: To compare the effectiveness of Rush pin with long arm cast and dynamic compression plate in the management of diaphyseal fracture of radius and ulna in adults. METHODS: The randomised control study was conducted at the Mayo Hospital, Lahore, Pakistan, from December 2012 to December 2015, and comprised diaphyseal fracture of radius and ulna cases aged 15-45 years of either gender. The patients were divided randomly into two groups. Group A was managed with open reduction and internal fixation with Dynamic Compression Plate, while group B was managed with closed reduction and internal fixation with Rush pin and long arm cast. Groups were compared for age, gender, Orthopaedic Trauma Association fracture type distribution, surgery time, amount of blood loss, union achieved, time to union and functional outcome in terms of Grace-Eversmann criteria and the Disabilities of the Arm, Shoulder and Hand score. The complications in the two groups were also noted. SPSS 20 was used for data analysis. RESULTS: Of the 60 patients, 30(50%) each were in groups A and B. In group A, there were 23(76.67%) males and 7(23.33%) females, while in group B, there were 26(86.67%) males and 4(13.33%) females. The mean age in group A was 30.33} 4.26 years (range 21-37 years), and in group B it was 28.60}7.69 years (range 15-45 years). There was significant short time to union in group B compared to group A (p<0.0001). Frequency of union and functional outcome were not significantly different between the groups (p>0.05). CONCLUSIONS: Functional outcome and frequency of union was not significantly different between the groups, but there was a statistically significant earlier union in cases managed with Rush pin and long arm cast than those managed with open reduction and internal fixation with Dynamic Compression Plate.

Effectiveness of locking compression plate in wedge fracture of diaphysis of radius and ulna in adults: A descriptive case series.

The aim of the study was to see the effectiveness of locking compression plate (LCP) in wedge fracture of diaphysis of radius and ulna in adults. This prospective descriptive case series study inducted total 45 patients presenting with wedge fracture (AO Type, 22-B) of radius and/or ulna. The treatment outcome of these patients were monitored for 24 weeks in 8 visits. Presence or absence of radiological union was noted. The functional outcome was evaluated in terms of Disability of Arm, Shoulder and hand (DASH) score and Grace and Eversmann criteria. Mean age of the patients included in this study was 28.76±6.16 years (range 18-47 years). Among them 28 (62.2%) were male while 17 (37.8%) were females. Union was achieved in all the patients at mean time of 12.62±2.24 weeks (range 8-16 weeks). Mean DASH score was 12.20±4.3 (range 5-19).According to Grace and Eversmann criteria, 41 (91.1%) had excellent result, 3 (6.7%) had good result, 1 (2.2%) had satisfactory results while there was no patient with unsatisfactory result. High rate of union along with good functional outcome and minimal complication can be achieved in patients with diaphyseal wedge fracture of radius and/ or ulna when managed with locking compression plate.

Improvement in Harris Hip Score after cementless total hip arthroplasty in young active adults with secondary hip arthritis- A short-term follow-up result.

OBJECTIVE: To determine the improvement in Harris Hip Score after non-cemented total hip replacement in younger patients with secondary hip joint arthritis. METHODS: The quasi-experimental study was conducted at Unit I, Department of Orthopaedic Surgery and Traumatology, Mayo Hospital, Lahore, and comprised patients diagnosed clinically and radiologically as secondary hip joint arthritis from September 2009 to December 2014. Harris Hip Score was calculated pre-operatively. All patients were operated by the same surgical team. One dose of second-generation intravenous cephalosporin after test dose was given at induction of anaesthesia followed by 3 times daily postoperatively along with aminoglycosides twice daily for three days followed by oral quinolones for 2 weeks. Patients were followed up for 6 months. The improvement in hip score was classified as poor, fair, good and excellent. Data entry and analysis was done using SPSS 11.5. RESULTS: Of the 65 patients in the study, 43(66%) were male and 22(34%) were females. Right hip was involved in 40(62%) patients and 25(38%) had pathology in the left hip. Overall mean age of male and female patients was 35.69±5.55 years and 35.72±5.95 years respectively. Harris Hip score improved over 6 months from poor to fair. CONCLUSIONS: The use of non-cemented total hip arthroplasty conferred a significant improvement in function in young patients with arthritis of the hip joint.

In Vitro Antioxidant and Antimicrobial Potency of Mimosa pudica of Nepalese Terai Region: Insight into L-Mimosine as an Antibacterial Agent.

Aim: The study aimed to evaluate the in vitro antioxidant and antimicrobial potency of Mimosa pudica found wildly in the Terai region of Nepal and assess its physicochemical properties, such as total phenolic content (TPC) and total flavonoid content (TFC). Materials and Methods: The physicochemical properties of ethyl acetate extract of Mimosa pudica (EAMP), such as extractive value, total ash content, loss on drying, and phytochemical screening, were calculated using standard protocols. The TPC was determined by using the Folin-Ciocalteu method taking gallic acid as standard, and TFC was conducted by using the AlCl3 colorimetric method, using a 96-well plate reader. The in vitro antibacterial activity of different concentrations of the extract against four bacterial ATCC strains was determined by the agar well diffusion method in the Mueller Hinton agar (MHA) medium. The in silico molecular docking model was used to ascertain the antibacterial potency of L-mimosine against the selected strains of bacteria used for the in vitro study by calculating the binding affinity towards the protein of bacteria. Results: The preliminary screening of the extract showed the presence of several phytochemicals. The total ash content (7.67%), loss on drying (2.30%), and extractive value (8.966%) were determined by analyzing the crude sample. The total phenolic and flavonoid contents were 418.640 ± 0.018 mg GAE/g (dried extract) and 14.126 ± 0.021 mg QE/g (dried extract), respectively. The extract showed a potent free radical scavenging activity with an IC50 value of 158.95 ± 1.12 µg/mL. The plant extract also demonstrated the antibacterial activity against both Gram-positive bacteria Staphylococcus aureus (15 mm) and Bacillus cereus (22 mm) and Gram-negative bacteria Escherichia coli (17 mm) and Klebsiella pneumoniae (16 mm) at 200 mg/mL concentration of extract. There was a noteworthy binding affinity of antibiotics with almost all selected bacterial proteins with binding energy against Escherichia coli DNA gyrase subunit B (-5.7 kcal/mol), Staphylococcus aureus DNA gyrase subunit B (-6.1 kcal/mol), Bacillus cereus metallothiol transferase (-5.2 kcal/mol), and Klebsiella pneumoniaebeta-lactamase (-6.1 kcal/mole), respectively, with the L-mimosine. Conclusion: The findings of the current study suggest that Mimosa pudica from the Terai region of Nepal is rich in phenolic and flavonoid compounds, has a significant impact on bacterial growth inhibition, and has a notable potential to scavenge free radicals (DPPH). According to the in silico analysis, L-mimosine is a potent antibacterial compound that might be utilised to discover novel antibacterial drugs to combat antibiotic resistance.