Objective: The objective of the current study was evaluation of outcome of tendon transfers in high radial nerve palsy for restoration of power and function of wrist and hand in Karachi, Pakistan. Methodology: A descriptive case series with clinical data of 17 patients was analyzed at the Department of Orthopedics Surgery at the Dr. Ruth K.M. Pfau Civil Hospital at Dow University of Health Sciences in Karachi, Pakistan, from January 2018 to December 2021. Patients who were diagnosed with high and low RNP were registered. Those with multiple injuries which might have caused considerable disability (polytrauma patients) or those suffering from brachial plexus lesions were excluded. Results: Out of seventeen patients, 14 (85%) were male while 03 (15%) were femalewith mean age of 29.5 years. There were 65% right-sided injured patients. Mean of the Disabilities of the Arm, Shoulder and Hand (DASH) scores was 11.44 ± 3.35 with 94.1% patients in minimal disability category whereas 5.88% patients moderately disable.Motor power of wrist and finger extension was significantly improved between the preoperative period and three months post-operatively, between the pre-operative period and six months. Conclusion: Tendon transfers treating radial nerve palsy have positive functional outcomes in terms of wrist extension, finger extension, and handgrip strength, as well as positive patient satisfaction as measured by Quick DASH ratings. Tendon transfers help restoring nonfunctional dangling wrist and hand into functional powerful wrist and hand. Keywords: Radial nerve palsy, tendon transfers outcome, DASH scores
Objectives: To assess the functional outcome of dynamic condylar screws to treat subtrochanteric fractures in adult patients. Methods: The prospective descriptive study was conducted at the department of orthopedic surgery, Dr. Ruth KM Pfau civil hospital Karachi, Pakistan, from March 2016 to October 2019. A total of 47 patients of 18 to 60 years of either gender with subtrochanteric fractures treated with dynamic condylar screw were included in the study. After consent and counseling, patients were operated on by a consultant orthopedic surgeon and fixed with a dynamic condylar screw. Postoperatively patients were regularly followed at 2nd, 6th, 12th, 16th, 20th weeks, and onwards monthly for at least one year. Functional outcomes such as infection, union, failure of fixation were observed in all patients. SPSS software version 23 was used to analyze data. Mean and SD was reported for numeric variables, whereas frequency and percentage were reported for categorical variables. A Chi-square test was used to assess the association between variables. Results: The mean age was estimated as 37.53±12.31 years. Most of the patients were male (74.5%), and 25.5% were females. About 27 patients had a fracture on the right side (57.4%) and 20 on the left side (42.6%). Out 47 cases, 3 were lost to follow, 33 patients showed excellent outcomes, 6 cases had a good outcome, 3 cases had fair outcomes, and 2 cases had poor functional outcomes. During the follow-up, 42 cases showed union, 3 lost to follow-up, 1 died, and 1 patient had implant break. About 2 patients had infections in post- operative duration because of fracture. Conclusion: Subtrochanteric femur fractures are challenging to operate, especially in our society where extensive trauma becomes more frequent. Dynamic condylar screws showed overall acceptable results. It is simple, locally made, readily available, and cheap, with almost the same result as other implants around proximal femur fractures.
Objective: To determine the functional outcome of posterior lip acetabular fracture and hip dislocation fixed with reconstruction plate. Study Design: Descriptive Case Series study. Setting: Department of Orthopaedic, Dr Ruth K. M. Pfau Civil Hospital Karachi. Period: August 2014 to December 2020. Material & Methods: 36 patients were included in the study. Age between18 years to 60 years. All patients fixed with reconstruction plate. Harris hip score assessed at follow up till 12 months. Harris hip score above 90 was considered as excellent, between 70–89 as good and below 70 as poor. Results: The mean age of the patients was 43.67 ±11.56 years. Majority of the patients were males (n=29, 80.6%). Good functional outcome was found in (n=15, 41.7%) of the patients, excellent in 8 (22.2%) and poor in 13 (36.1%) patients. Satisfactory outcome was found in 23 (63.9%) patients. A significant association of satisfactory outcome was found with age (p-value <0.001). Avascular necrosis 7, infection 5 and arthritis in 6 patients noted. One patient had associated sciatic nerve palsy, three had head of femur fracture and 1 with ipsilateral midshaft femur fracture. Conclusion: For posterior hip dislocation with lip fracture we suggest emergency reduction and timely fixation of posterior lip fracture can improve the clinical outcome of patient and even complications happen in future it preserve the bone stock for the future arthroplasty procedure.
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