Hemostasis in cases of post-partum bleeding caused by low-lying placenta/placenta previa can be achieved by using a large volume, fluid-filled tamponade balloon.

ABSTRACT… Objectives:The aim of our study is to study the radiological and functional outcome of proximal humerus fractures treated via open reduction and internal fixation using the proximal humerus internal locking system or PHILOS. Study Design: Case series study. Period 05 years duration from January 2011 to December 2015. Setting: Large tertiary care centre in Karachi, Pakistan. Materials and methods: The study population consisted of n=50 patients all of whom underwent open reduction and internal fixation utilizing the proximal humeral internal locking system or PHILOS for fractures of the proximal humerus. The inclusion criterion was all the patients with closed fractures of the proximal humerus and were belonging to 2,3 and 4 part of the Neer system of classification. Physiotherapy was started as soon as possible for the patients. Serial radiographic imaging in two views was done at 6, 12, 24 and 52 weeks postoperatively. For the functional outcome of the procedure Constant and Murley scoring system was used. Data was analyzed using IBM SPSS version 21. Results: The study population consisted of n= 50 patients of which n= 35 were males and n= 15 were females having a mean age of 38.50 years. The mean duration of follow up was 24 months. All the patients in the study had union of fracture both radiographically and clinically, the mean time duration for the radiographically evident union of the humerus bone was 12 weeks with a range of 8 to 20 weeks, the mean Constant Murley score for the functional outcome of the shoulder joint was 79 at the final follow up with a range of 50 to 100. Complications were found in n= 9 patients and varus malunion was the most common complication. In our case series we did not observe complications such as avascular necrosis, non union or implant failure. Conclusion: According to the results of our study the proximal humerus internal locking system or PHILOS is a good method for open reduction and internal fixation of the proximal humerus fractures and provides a stable fixation, and has lower incidence of complications such as avascular necrosis. Key words:Humerus fractures; Open reduction internal fixation; Proximal humerus internal locking system; PHILOS; Surgical outcome. Article Citation: Jabbar FA, Shah RA. Proximal humerus fractures; radiological and functional outcome as treated with the philos plating system, at a tertiary

ABSTRACT… Objectives: We aim to evaluate the level of satisfaction after total knee arthroplasty procedure in the patient population at a tertiary care hospital in Karachi, Pakistan, and to assess the relationship between patient satisfaction and the outcome based on traditional scores. Methods: Study Design: Case series for determination of patient satisfaction. Period: One year duration from April 2015 to May 2016. Setting: Tertiary care centre in Karachi, Pakistan. The inclusion criteria was all the patients with late stage osteoarthritis of the knee joint and underwent total knee arthroplasty at our institute. Data was analyzed using SPSS version 22. Results: A total of n= 102 patients were included in the study while n= 109 knee surgeries were done in total (n= 95 patients had unilateral surgery, while n= 7 patients had bilateral surgeries on both the knee joints) n= 58 patients were females while n= 44 patients were males, the median age was 60 years, patients had a mean body mass index (BMI) of 27kg/ m 2 . Of the total surgeries performed n= 100 were in the satisfaction group while n= 9 were in the dissatisfaction group. The majority of the patients reported that they would recommend the procedure. The co morbid conditions did not affect the patient's level of satisfaction having a p value of 0.678. In the dissatisfied group, there was no significant difference when it comes to gender, the mean age of patients in the dissatisfaction group was higher than the mean age of patients in the satisfaction. We found that WOMAC scores for functioning and the final WOMAC scores were correlated with patient satisfaction and that was statistically significant, similarly SF-36 form patients were satisfied about the improvement in the physical health while they did not improve the mental health aspect of their disease. Conclusion: According to our study total knee arthroplasty is an effective treatment for osteoarthritis of the knee, patient satisfaction is correlated with post-operative WOMAC function and overall scores, and SF-36 physical component. It is important to keep patients expectations in check through proper counseling. Key words:Osteoarthritis; patient satisfaction; total knee arthroplasty; TKA. Article Citation: Jabbar FA, Shah RA, Hashim M. Total knee arthroplasty; Evaluation of the patient satisfaction, its comparison with traditional physician based scores, at Karachi, Pakistan.

ABSTRACT… Objectives:The aim of our study is to determine the outcome of cervical pedicle screw fixation for fractures/dislocations of the cervical spine at our set up in Karachi, Pakistan. Study Design: A prospective case series. Period: 04 years duration from January 2013 to December 2016. Setting: Tertiary Care Centre in Karachi, Pakistan. Method: All the patients who were included in the study signed a full informed consent. The inclusion criterion was all the patients who cervical spine fracture/dislocation, presented to us within 24 hours of injury and were operated at our set up. Data was collected in a predesigned proforma which included a complete history and physical examination, age, gender, cause of injury, co morbidities, preoperative radiological findings, past medical and surgical history. Serial X rays, MRI and CT scans were taken at 3, 6, 12 and 24 months post operatively for evaluation of stability, fusion and any complication such as deformity. The American Spinal Cord Injury Association impairment scale was utilized in all the patients at follow ups to determine the sensory and motor function improvement post operatively. Data was analyzed using IBM SPSS for windows version 21. Results:The study population consisted of n= 40 patients of which n= 28 were male and n= 12 were female with a mean age of 45.2 years. The various types of injuries sustained by the patients were as follows, n= 6 (15%) cases of cases had compression fractures (vertical), n=15 (37.5%) had flexion rotation injury and n=19 (47.5%) had flexion compression fractures respectively. While the division of bony injuries in the patient was as follows, n=5 (12.5%) had cervical spinal burst fracture with dislocation, n= 15 (37.5%) patients had joint facet fracture with dislocation bilaterally along with compression fracture of the vertebral body, n= 14 (35%) patients had facet joint fracture with dislocation bilaterally and n= 6 (15%) had unilateral fracture dislocation of joint facet. Complications such as injury to the vertebral artery, spinal cord, nerve root were not observed in any of the patients in this series, all the patients achieved full bony fusion at the 6 month follow up as observed on radiographic images. We also did not find any incidence of screw penetration into the pedicle, similarly no incidence of screw breakage or loosening was observed. N=24 patients with incomplete injury of the spinal cord showed improvements in their ASIA impairment scale, the patients n= 15 who had a complete spinal cord injury failed to show any improvement post operatively, but reported some decrease in pain and numbness post operatively. Conclusion: For fractures/dislocations of the cervical spine the cervical pedicle screw is a reliable and effective method and provides good stability and bony fusion. However the technique is dependent on surgeons experience and the extensive use of pre-operative imaging to select the best insertion site of the screws as individualized for every patient accordingly. Key words:Cervical Spine; Dislocati...

Objectives: In this study we analyze and study the effectiveness of pediclescrew and rod fixation for the management of unstable fractures of the thoracolumbar spine.The type of study is a Study Design: Case series. Period: 1.5 year duration from April 2014 toSeptember 2015. Setting: Tertiary Care Centre in Karachi, Pakistan. Materials and methods:N= 35 patients were operated at our institute and included in the study. The inclusion criteriawas all those patients who presented to us with unstable fractures of the thoracolumbar spinevia the accident and emergency department of the hospital, and were operated upon and gavefull informed consent to partake in the research were included in this study. All the patientswere operated under general anesthesia. The short segment fixation with pedicle screw rodfixation using the posterior approach was the technique utilized for treatment. Rehabilitationwas started immediately after the surgical procedure. Data was analyzed using SPSS version23. Results: The study population consisted of n= 35 patients of which n= 25 (71.42%) weremales and n= 10 (28.57%) were females, the mean age of the study population was 33.5years. A history of fall from height was the most common cause of injury in n= 26 (74.28%)of the patients, next was automobile accidents in n= 9 patients (25.71%). Burst fracture wasthe most common type of injury. The sagittal angle was 23.5O pre operatively and 10.75 O postoperatively, and at follow up the loss of angle was found to be 4.80 respectively. The sagittalindex values were as follows, pre-operative 0.53, post-operative 0.75 and 0.72 at follow up (finalfollow up). N= 30 (85.71%) patients showed improvement in their ASIA status, n= 19 (54.28%)showed single grade improvement, n= 10 (28.57%) showed double grade improvement, n=1 (2.85%) showed triple grade improvement, while n= 5 (14.28%) cases did not show anyimprovement. The mean duration between injury and surgical intervention was 5.5 days witha range of 1 to 23 days, the major cause of this delay was delay in reaching the hospital. Themost common complication observed was pressure sores in n= 4 (11.42%) and urinary tractinfections (UTI) seen in n= 5 (14.28%) of patients, followed by implant failure in n=3 (8.57%)patients. Conclusion: According to the results of our study unstable burst fractures was themost prevalent type of fracture observed, there was a marked improvement in the radiologicalparameters post operatively, while the neurological improvement was decent. The technique ofpedicle screw rod and fixation using the posterior approach provides good surgical outcomeand better stabilization, with a fair amount of neurological improvement for these patients.

Objectives: We aim to evaluate the level of satisfaction after total knee arthroplastyprocedure in the patient population at a tertiary care hospital in Karachi, Pakistan, and to assessthe relationship between patient satisfaction and the outcome based on traditional scores.Methods: Study Design: Case series for determination of patient satisfaction. Period: Oneyear duration from April 2015 to May 2016. Setting: Tertiary care centre in Karachi, Pakistan.The inclusion criteria was all the patients with late stage osteoarthritis of the knee joint andunderwent total knee arthroplasty at our institute. Data was analyzed using SPSS version 22.Results: A total of n= 102 patients were included in the study while n= 109 knee surgerieswere done in total (n= 95 patients had unilateral surgery, while n= 7 patients had bilateralsurgeries on both the knee joints) n= 58 patients were females while n= 44 patients weremales, the median age was 60 years, patients had a mean body mass index (BMI) of 27kg/m2. Of the total surgeries performed n= 100 were in the satisfaction group while n= 9 were inthe dissatisfaction group. The majority of the patients reported that they would recommend theprocedure. The co morbid conditions did not affect the patient’s level of satisfaction having ap value of 0.678. In the dissatisfied group, there was no significant difference when it comes togender, the mean age of patients in the dissatisfaction group was higher than the mean age ofpatients in the satisfaction. We found that WOMAC scores for functioning and the final WOMACscores were correlated with patient satisfaction and that was statistically significant, similarlySF-36 form patients were satisfied about the improvement in the physical health while they didnot improve the mental health aspect of their disease. Conclusion: According to our studytotal knee arthroplasty is an effective treatment for osteoarthritis of the knee, patient satisfactionis correlated with post-operative WOMAC function and overall scores, and SF-36 physicalcomponent. It is important to keep patients expectations in check through proper counseling.

Objectives: The aim of our study is to determine the surgical outcome andrates of complication in patients undergoing surgical treatment for osteoarthritis of the hip jointwith total hip arthroplasty and compare it with hip resurfacing procedures. Study Design: Aprospective cohort study. Period: Five years duration from January 2011 to December 2016.Setting: Tertiary Care Centre in Karachi, Pakistan. Materials and methods: The study populationconsisted of n= 170 patients (n= 110 patients undergoing cementless THA and n=60 patientsundergoing hip resurfacing procedures). The inclusion criteria was all the patients who came toour outpatient clinic, with unilateral or bilateral osteoarthritis (grade 3,4) of the hip joint requiringsurgical treatment, were fit for surgery and gave informed consent to participate in the study.All the procedures were done by the same team of surgeons at the same institute in seriesunder general anesthesia. Data was collected in a pre-designed proforma. Postoperatively thepatients were restricted to a reduction of weight bearing by half for the first six weeks, andwere involved in physiotherapy till discharge from the hospital. The patients from both groupsreceived the same thromboembolic and infection prophylaxis. Data was analyzed using IBMSPSS version 22. Results: In our study we found that the rates of reoperation had statisticallysignificant differences, being n= 5 in THA group and n=9 in resurfacing group having a pvalue of 0.019. In the resurfacing group n= 4 patients had fractures of the femoral neck. All therevision surgeries were undertaken utilizing the posterolateral approach, n= 2 patients wererevised utilizing cementless femoral stems while n=2 were revised utilizing cemented femoralstem, n= 5 patients were revised to total hip arthroplasty procedure on account of asepticloosening. No dislocations were observed after the revision surgical procedures. There wasno statistically significant difference in the total rates of complications among the two groups,having a p value of 0.44. The pre-operative Harris hip scores were similar in the two groupshaving a p value of 0.2. Conclusion: According to the results of our study the outcome in theboth the cementless total hip arthroplasty and hip resurfacing procedure are similar in termsof implant survival and clinical results however rate of complication is higher in the patientsundergoing hip resurfacing technique and needed revision surgeries. The patients undergoinghip resurfacing had better mobility post operatively, and hence this consideration is to be madeduring patient selection, as hip resurfacing is preferred by younger patients due to its higherfunctional outcomes.

Objectives: The aim of our study is to study the radiological and functionaloutcome of proximal humerus fractures treated via open reduction and internal fixation usingthe proximal humerus internal locking system or PHILOS. Study Design: Case series study.Period 05 years duration from January 2011 to December 2015. Setting: Large tertiary carecentre in Karachi, Pakistan. Materials and methods: The study population consisted of n=50patients all of whom underwent open reduction and internal fixation utilizing the proximalhumeral internal locking system or PHILOS for fractures of the proximal humerus. The inclusioncriterion was all the patients with closed fractures of the proximal humerus and were belongingto 2,3 and 4 part of the Neer system of classification. Physiotherapy was started as soon aspossible for the patients. Serial radiographic imaging in two views was done at 6, 12, 24 and52 weeks postoperatively. For the functional outcome of the procedure Constant and Murleyscoring system was used. Data was analyzed using IBM SPSS version 21. Results: The studypopulation consisted of n= 50 patients of which n= 35 were males and n= 15 were femaleshaving a mean age of 38.50 years. The mean duration of follow up was 24 months. All thepatients in the study had union of fracture both radiographically and clinically, the mean timeduration for the radiographically evident union of the humerus bone was 12 weeks with a rangeof 8 to 20 weeks, the mean Constant Murley score for the functional outcome of the shoulderjoint was 79 at the final follow up with a range of 50 to 100. Complications were found in n= 9patients and varus malunion was the most common complication. In our case series we did notobserve complications such as avascular necrosis, non union or implant failure. Conclusion:According to the results of our study the proximal humerus internal locking system or PHILOSis a good method for open reduction and internal fixation of the proximal humerus fractures andprovides a stable fixation, and has lower incidence of complications such as avascular necrosis.