Objective: To determine if below-elbow casts are as effective as above-elbow casts in the treatment of the distal third closed forearm fractures in children. Materials and Methods: This was a prospective comparative study and was conducted at orthopaedic department of Liaquat University of Medical and Health Sciences (LUMHS). Children 4 to 12 years of age who presented to, distal 1/3rd fractures of the forearm were randomized in order to manage with either an above-elbow or below-elbow cast after closed reduction under fluoroscopic guidance. Radiographic analysis was done for angulation and displacement at the injury time, following reduction, and at subsequent intervals of follow-up. At the fracture level, the cast index for evaluating the cast moulding quality was assessed from the post-reduction radiographs. Variations between post-reduction and final values for displacement and angulation, the range of motion of elbow, forearm and wrists and cast indices between the two groups were compared. Results: Of total 50 study subjects, 26 underwent above-elbow cast and 24 subjects underwent below-elbow cast techniques. Mean age of above-elbow cast group patients was 9.42 year and the mean age in of below-elbow cast group patients was 9.13 years. 15 male and 11 female patients were present in above-elbow cast group; 14 male and 10 female patients were present in below-elbow cast group. The mean cast index of above-elbow cast group was 0.71 and the mean cast index of below-elbow cast was 0.70. In terms of patient demographics, injury mechanism, characteristics of initial fracture, cast index or shift in displacement and angulation during treatment, no significant variances were observed between both groups. In above-elbow cast group, the mean elbow arc of motion on cast removal at six weeks was only 78° compared to 141.6° in below-elbow cast group. There was a significant decline in arc of motion of elbow joint in above-elbow cast group compared to below-elbow cast group in six weeks which became normal at final follow-up in three months. The complication rates in both the groups were similar. Conclusion: Below-elbow cast is the safe reliable and cost-effective method of cast immobilization in distal third forearm fractures in the children of 4 to 12 years of age.
Period: Two year from 2009 to 2011. Total 40 cases of open tibia fracture had selected all the cases with fresh open diaphyseal fractures of tibia and patient arriving within one week injury. And Grade II, IIIA had included. All the cases associated with head injury or abdominal injury, diabetic mellitus and liver or kidney disease had excluded. Results: Total 40 cases of open diaphyseal fracture of tibia were selected in this study based on inclusion criteria. The mean age was 33.1 + 10.27 years. Out of 40 cases, 36(90.0%) were male. Majority of patients of RTA were injured due to motorcycle accidents 24(60.0%). Mean of union time was 18.1 + 3.72 weeks. Wound became infected in 5(12.5%) cases, 5.0%, n = 40) were seen with late union, screw sites infection found in 5.0% cases, Knee stiffness was found in 10.0% cases, six 15.0% patients developed pain during walking. Conclusion: AO fixation is very safe, insignificant intrusive, get short surgical time, following by hospital duration, low infection rate and can be utilized as unequivocal and effective administration of open tibial fractures.
Background: The management of open tibial diaphyseal fractures is the most challenging glitch faced by orthopedic surgeons. For open or comminuted fractures, external fixation remains the gold standard. This study aimed to assess the treatment response of fixators by comparing the results of open diaphyseal tibial fracture stabilization in adults by Plaster of Paris (POP) cast versus Naseer Awais External Fixator (NAEF). Methodology: A single-center, prospective study was conducted at the leading teaching institute and tertiary care hospital of Jamshoro and Hyderabad, Pakistan. A total of 30 patients having an open diaphyseal fracture of the tibia were randomly assigned to two groups (Group A-POP cast and Group B to NAEF; n=15 each). Duration of hospital stay and postoperative complications (like wound infection, union rate, and functional outcome) were compared between groups. Results: On average, group A patients stayed in the hospital for 3.65 weeks, while group B patients stayed for 2.49 weeks (p=0.004). Wound infections were observed in 26.7% and 53.3% of the patients in group A and B, respectively. No significant difference in the adequate callus formation (i.e. union) and good functional outcome was observed among patients of group A and B (p>0.05). Conclusion: The use of NAEF for open diaphyseal fractures of the tibia has a significant advantage over POP cast in reducing the duration of hospital stay. However, no significant differences were observed in wound infection, union rate and time, and functional outcome.
Objective: To determine the frequency of various causative bacterial organisms and their culture sensitivity pattern in patients with open tibial fracture. Subject and Methods: This is cross sectional study conducted at Orthopedic Surgery, Liaquat University of Medical and Health Sciences, Jamshoro and SMBBMU Larkana from 14th October 2015 to 13th April 2016. Total of 150 patients having open tibial fracture with signs and symptoms of infections presenting within one week of fracture were included in this study. All this information was recorded through Proforma (attached). Results: Out of 150 infected fractures, S. aureus was present in 40% cases, MRSA in 14%, Enterococcus in 4%, B-Staphylococcus in 4%, Pseudomonas aeruginosa in 8%, Acinetobacter in 4%, E.coli in 16% and Klebsiella in 10%. Regarding sensitivity analysis, Meronem, Pipericillin, Avelox, Linzulid were more than 80% sensitive to S. Aureus. MRSA Enterococcus Sp, B-Streptococcus. Ceftazidime, Gentamicin were more than 80% sensitive to S. Aureus and gentamicin also 83.3% sensitive to B-Streptococcus. Gentamicin was 83.3% sensitive to Enterococcus Sp as shown in table 2A. Meronem, Pipericillin were 80% to 96% sensitive to Pseudomonas aeruginosa, Acinetobacter, E. Coli and Klebsiella Species. Avelox was 83.3% sensitive to Pseudomonas aeruginosa. Ceftriaxone and Avelox were 87.5% and 100% sensitive to E. coli. Conclusion: It is noted that infection rate is higher in open fracture mostly fracture at extremity of bones. More severe and exposure, more is infection rate noted. Key Words: Open fracture, Bacterial organisms, Sensitivity pattern, Open tibial fracture
Objectives: To appraise effectiveness of AO external fixator, a treatment methodfor open diaphseal tibial fractures (type II, IIIA). Methods: Study Design: Cross sectional study.Setting: Department of Orthopedic Surgery and Traumatology (DOST) Liaquat University ofMedical & Health Sciences Jamshoro. Period: Two year from 2009 to 2011. Total 40 cases ofopen tibia fracture had selected all the cases with fresh open diaphyseal fractures of tibia andpatient arriving within one week injury. And Grade II, IIIA had included. All the cases associatedwith head injury or abdominal injury, diabetic mellitus and liver or kidney disease had excluded.Results: Total 40 cases of open diaphyseal fracture of tibia were selected in this study basedon inclusion criteria. The mean age was 33.1 + 10.27 years. Out of 40 cases, 36(90.0%) weremale. Majority of patients of RTA were injured due to motorcycle accidents 24(60.0%). Mean ofunion time was 18.1 + 3.72 weeks. Wound became infected in 5(12.5%) cases, 5.0%, n = 40)were seen with late union, screw sites infection found in 5.0% cases, Knee stiffness was foundin 10.0% cases, six 15.0% patients developed pain during walking. Conclusion: AO fixationis very safe, insignificant intrusive, get short surgical time, following by hospital duration, lowinfection rate and can be utilized as unequivocal and effective administration of open tibialfractures.
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