Background: A host of different methodologies have been implemented in the management of distal humerus fractures, including conservative measures and surgical fixation with a variety of plates. This study was conducted to evaluate the functional outcome of open reduction and internal fixation of extra articular distal humerus fractures with distal humerus locking compression plate. Methods: This is a retrospective cohort study of patients with close extra articular distal humerus fractures who underwent open reduction and internal fixation with a distal humerus locking compression plate at Ghurki Trust Teaching Hospital from July 2017 to December 2019. Various demographic indicators were used for data analysis and radiological union was assessed in serial follow-ups. Functional outcome was evaluated using the Mayo Performance Elbow Score at the final follow-up. Results: Thirty-one patients presented with extra-articular fracture of humerus (N=31) with average age 33.5±9.90 years. The average follow-up period was 13.8 months. Radiological union was achieved in 14.8 weeks (range 12–20 weeks). Out of 31 patients, 28 had excellent results with mean Mayo Elbow Performance Score of 94.8. Two patients (6.5%) had radial nerve palsy post-operatively. Conclusion: This study shows that open reduction and internal fixation of extra-articular distal humerus fractures with distal humerus locking compression plates allows for stable fixation, good functional outcome, and low complication rates.

Background: Falling from a Java Plum (Jamun) tree is one of the primary causes of Spine and other extremity fractures during the Monsoon season (when it is harvested) in Pakistan. Objective: To assess the distribution of patients with different facture types presented with the history of fall from Jamun tree during Monsoon season. Study Design: Retrospective study Place and Duration of Study: Department of Orthopaedics & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore 1st May 2020 to 31st August 2020, Methodology: Forty two male patients age ranged from 12-55 years of age were enrolled. Information was obtained from the hospital’s trauma registry, and medical records were retrospectively reviewed for data about the type of fractures, occupational status, pre-hospital immobilization, time of presentation, and the time between fall and management and length of hospital stay were reviewed. Results: The average age of the patient was 34.6 years. Twenty four (57.14%) had spine fractures and 18 (42.8%) suffered other axial and skeletal fractures. Nearly three-fourths needed surgical intervention. In contrast, 26.1 % were managed conservatively. Conclusion: During monsoon season, we received 4.6% of extra patients with different injuries following fall from Jamun tree. In most cases, young men from lower socio-economic status suffer from varying degrees of disability and experience financial problems. Keywords: Fall, Java Plum, Mass awareness, Occupational-seasonal injury, Spine fractures

Background: Degenerative lumbar spinal stenosis (DLSS) is a condition where degenerative and arthritic state of the disc and facet joints respectively results in the displacement of the vertebra resulting in lower back pain in association with radiculopathy. In patients with degenerative lumbar spine, the rate of fixation has increased. Aim: To identify the difference in outcome of decompression alone versus decompression with spinal fixation in DLSS. Place and duration of study: Department of Orthopaedic & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore from 1st January 2017 to 31st December 2019. Methodology: All the discharged patients with primary diagnosis of DLSS were identified. Two subgroups were studied i.e. Decompression only and Decompression with TranspedicularScrew Fixation .Primary outcome among patients was assessed using Swiss Spinal Stenosis Score (SSS). All the data were entered and analyzed using SPSS software and p-value≤0.05 considered to be significant. Results: Total number of patients included in study was 87.out of the total,34(39%) patients had underwent decompression alone, whereas in 53(60.9%) patients decompression with transpedicular fixation were done. Significant difference was not observed among cases with respect to mean score on SSS based on two different types of surgical interventions. In decompression with fixation group, the average length of stay of patients in hospital was 6.4 days as compared to decompression only group as 4.4 days. Conclusion: Both surgical procedures decompression plus transpedicular fixation and decompression alone produce similar outcome at 2 years follow-up. Keywords: Decompression, Swiss Spinal Stenosis Score, Degenerative spine, Transpedicular screw fixation

Objective: To look into the relationship of Ramadan with peptic ulcer perforation. This will include assessing the effect of fasting as well as other Ramadan related factors like changes in eating and smoking habits. Study Design: Retrospective Analysis. Setting: Three Tertiary care hospitals of Peshawar i-e Hayatabad Medical Complex, Khyber Teaching Hospital and Lady Reading Hospital. Period: 6th May 2019 to 26th May 2020. Material & Methods: Patients presenting with the aforementioned complication of peptic ulcer during the research period were divided into two groups. Patients presenting during the two Ramadan months were designated as cases (Group 1). While those presenting during the rest of the period i-e 11 months, were the controls (Group 2). So comparison of these groups was done on basis of various predisposing factors of the disease. Inferences were drawn by applying Student’s t, Chi-square and Fischer’s exact chi-square tests. Results: A total of 129 patients were considered. Among these, 36 were cases (Group 1) and 93 were controls (Group 2) as per our study design. Number of perforations per month were statistically higher in Group 1 in comparison to Group 2 (i-e 18 patients per month vs 8.4 patients per month, p<0.05). Patients with dyspepsia and preference for fried food were significantly higher in Group 1 (p<0.001 and p=0.022 respectively). Whereas smoker were significantly lower in Group 1 (p=0.048). Conclusion: Analysis concluded that the incidence of perforation is higher during the Ramadan. Since Ramadan is not only about fasting, and it affects eating and smoking habits, this rise in rate of perforations can be considered to be an interplay of such changes and the complication of peptic ulcer.

Aim: To evaluate the efficacy of ankle arthrodesis by using Retrograde SIGN Nail. Study Design: Retrospective study. Place and Duration of the Study: Department of Orthopaedic & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore from 1st January 2018 to 30th June 2020. Methodology: Thirty patients were enrolled for arthrodesis by using retrograde nails. Clinical and radiological examination confirmed the severe arthritis of the subtalar joints in all cases. Surgical procedure was initiated by using lateral incision fibula segment of 1.5 cm was excised 6-8 cm proximal to the fibula tip. After adequate exposure, from proximal lateral to distal medial, approximately 5-6 cm transaction of the fibula was made obliquely. Soft tissue was the initiating point of dissection and the portion was placed on the back table for further use as an autogenous bone graft. To expose the medial gutter, approximately 2-3 cm incision was carefully made at medial to the tibialis anterior tendon without indulging saphenous nerve and vein. Results: A weak positive Pearson correlation was found between BMI and FAAM score but a significant (P=0.00001). Conclusion: Retrograde nailing techniques help to achieve the goals of the union. It also assists in the preservation of hind foot alignment. Keywords: Ankle deformity, Ankle arthrodesis, Ankle arthritis, Retrograde nailing