Background: Hip bone fractures are the main cause of concern on a worldwide level. The main two operative techniques involve dynamic hip screw and proximal femoral nail technique. Aim: To compare the dynamic hip screw with proximal femoral nail technique in intertrochanteric femur fracture patients. Study design: Retrospective study Place and duration of study: Department of Orthopaedics, Khyber Teaching Hospital, Peshawar from 1-7-2019 to 30-12- 2021. Methodology: Seventy patients were enrolled and they were divided in two groups; Group 1 patients were operated with dynamic hip screw (DHS) while group 2 patients were operated by proximal femoral nail (PFN) technique. The detailed pre and post-operative clinical information including blood loss, incision size, Harris hip score and rate of complication was documented. Results: The mean age of patients was 58.62±6.71 year with more male patients than females. The Harris hip score of proximal femoral nail technique was better than distal hip screw. The incision length of distal hip screw cases was 7.61±0.89 in comparison to 4.72±0.73 in proximal femoral nail technique cases with a longer duration of surgery and inter-operative blood loss in case of distal hip screw cases. Conclusion: Proximal femoral nail technique is comparatively better than the distal hip screw procedure. Keywords: Proximal femoral nail technique, distal hip screw, Hip fracture
Background: Orthopaedic surgeries require sensitive protocol for prevention of infection pre and post-surgery. Antibiotic-prophylaxis has been reported for reducing risk of infection in orthopaedic surgeries such as removal of implants. Aim: To assess the effect of prophylactic antibiotics in orthopaedic surgery. Study design: Retrospective study Place and duration of study: Dept. of Orthopaedics, Khyber Teaching Hospital, Peshawar from 1-1-2020 to 31-12- 2020. Methodology: One hundred and ten patients within 18-75 years were divided into two groups. Each group had 55 patients. Group 1 were given prophylactic antibiotics pre-operative as a single dose while group 2 were given only saline. All patients were admitted for removal of orthopaedic implants in foot, ankle or leg. Patients 30 days record was observed for any surgical-site infection. Results: The mean age of patient was 42.95±10.8 years. Group 1 and Group 2 had more males than females. There were 10.9% and 9.09% diabetic patients within group 1 and group 2. The 30 days assessment of post implant removal orthopaedic surgery showed a decrease of surgical-site infection in group 1. Surgical-site infection decreased by a rate of 5.4% among patients who were given cefazolin antibiotic. Conclusion: The effect of prophylactic antibiotic reduces chance of surgical-site infection in orthopaedic surgery. Keywords: Antibiotic-prophylaxis, Orthopaedic surgery, Implant-removal, Surgical-site infection
Pediatric patients with unstable radius-ulna fracture can be treated with intramedullary Kirschner wire fixation. Objective: To determine the functional outcome of Intramedullary Kirschner Wire fixation in unstable radius-ulna fractures in children. Methods: All pediatric age patients were enrolled into the study with unstable radius and ulna fracture. Informed consent was taken before study. Proper history, examination and X-rays of the forearm was taken after taking consent from the guardian of the patient. Under general anesthesia and tourniquet, control radius was first fixed through a small volar incision by drilling a k wire at fracture site in radius so that the wire exits on the dorsolateral side of the radius. The fracture was than reduced and the wire tapped with hammer to the radial head. Similarly, ulna was fixed by first drilling the wire up to the olecranon process and after reduction of the fracture down to the styloid process. After checking stability both bones, both wounds were washed with normal saline and closed in reverse order and above elbow cast was applied for three to four weeks. Results: In this study, as per functional outcomes, 5(4.0%) patients had good outcome, 80(64%) patients had excellent outcomes whereas 40(32%) patients had poor outcomes. Conclusions: This study demonstrates excellent functional outcome of Intramedullary Kirschner Wire fixation in unstable both bone forearm fractures in children.
Aim BOAST guidelines on fracture clinics suggest a standard of care that all patients with significant injury should expect to receive in a Trauma & Orthopaedics outpatient setting in the United Kingdom. Method A prospective analysis of 358 patients presenting to fracture clinic at Gloucestershire Hospitals NHS Foundation Trust from September to November 2020. Patients completed an anonymous questionnaire based on BOAST guidelines. Results Most patients received a written management plan (82%), but only some received a leaflet (36%) and definite information about their procedure (47%). Most patients felt a leaflet (72%) and information about procedures (87%) would be useful. Patients were generally seen early or within 30 minutes of their appointment time (77%), but some waited more than 30 minutes (23%). Most patients found X-rays easily (91%) and rated staff (97%) and fracture clinic experience (93%) as very good or good. Comments included noting an efficient and friendly service, with suggestions on providing more information on waiting times and procedures to be performed. Conclusions Our study showed high patient satisfaction with fracture clinic and particularly positive feedback about staff. Areas of improvement include providing more leaflets and information about practical procedures. Following this audit, we will produce leaflets on common conditions and record videos on common procedures such as application of casts, splints and removal of k-wires or sutures, which can be accessed by patients prior to their appointment. The audit could be repeated at a regional or national level to help centres assess the level of care provided.
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