OBJECTIVE: To evaluate the Ponseti treatment in neglected club foot patients. Result of this study shall help us to manage untreated or neglected patients with club foot in better way and this study shall provide platform for bigger studies on clubfoot in Pakistan. METHODOLOGY: This multicentre observational cross sectional study was conducted on retrospective data of patients registered to Ponseti Club foot Clinic between July 2013 to Dec 2016 at Dr Ruth Pfau Civil Hospital Karachi and Jinnah postgraduate Medical Center, Karachi. In this study 41 feet in 28 patients with Neglected club foot between 3 to 11 years were treated by Ponseti guidelines for older child (already walking child). Deformity was assessed with pirani scoring. Average follow up time was 3 years. RESULTS: Painless plantigrate foot was obtained in all patients. In 3 patients equinus deformity recurred. Two were managed with recasting while in the third one along with recasting and retenotomy was undertaken. In 2 patients mild varus was recurred, which was managed with recasting. One patient was lost to follow-up after 2 years. CONCLUSION: This study conclude that treatment of neglected idiopathic club foot patients presenting to us after walking age with Ponseti method according to Ponseti guidelines for older children is safe, effective and low cost method. It also reduces the risk of excessive surgical procedures.
Objectives: Our experience by dynamic condylar screw in the treatment ofsupracondylar femur fracture, which is quite a long time, has stayed challengeable issue inorthopedic surgery, at LUH. Study Design: An observational cross sectional study. Setting:Orthopedic Surgery Department, Liaquat University. Methodology: Cases along both sexeswith additional articular fractures, conceded inside of 2-3 days were incorporate and caseshaving open epiphysis, open fracture, pathological and intra articular fractures were not a pieceof this study. Hospital stay average was 18 days. Follow up was done of every one of thePatients after each third week for two only visits, then every 6th week for about 6 months. Allthe data were recorded on particularly outlined proforma. Results: In this study 19(63.3%) maleand 11 female (36.6%) patients. Mean age was found 35yrs. Commonest cause of injury wasRTA in 80% patients. 65% patients got injury to left lower limb while 35% to right lower limb. Therewere only two infections i.e. the infection rate was 6.66%. Union rate was 93.3% and nonunionrate was 3.3% and there was only one mal union i.e. mal union rate was 3.3% .Bone grafting wasdone in 21 patients. The overall good to excellent results were in 84% cases and fair to poor in16% cases. Conclusions: DCS gives solid fractures fixation after decrease and makes postoperativerecovery simple, so in light of patient’s financial state in Pakistan. DCS is perfect insertfor distal femoral exceptionally for these fractures.
Objectives: To analyze the comparative results of dynamic DHS fixation in stableand the unstable intertrochanteric fractures at LUH. Study Design: Comparative study. Setting:Orthopedic unit I of LUH Jamshoro. Period: 26th May 2010 – 25th August 2011. Methodology:All 40 patients with femur intertrochanteric fracture were enlisted. All cases isolated in 2 groupsevery having 20 patients, group A stable fracture and group B unstable fractures. After completephysical examination, examinations and fracture arrangement evaluation, patients were readiedfor operation. Fracture table was used in each operation. Fracture reduction was initiallyattempted by close manipulation and was successful in 30 (75%) cases. Lateral approach forproximal femur was used in every case. All fractures, whether stable or unstable, were reducedanatomically without any type of osteotomy and then fixed with 135o dynamic hip screw.Results: Mean age was 62.8.2 years of the cases. Gender ratio was 3:1. According to modeof injury were found RTA in 21 (70%) patients. Postoperative complications were recorded as;superficial infection noted in 2 (5%) patients and there was no case of deep infection. Averagestay of hospital found 16.5 days in 17 (42.5%) patients belongs to stable group and 06 (15%)patients belong to unstable group. All (n=40) patients were pain free on their discharge fromhospital. In all (n=40) patients we achieved union and there was no case of delayed unionor non-union. We assessed functional outcome of our patients on the base of Stinchfield HipAssessment system. According to SHAS 28 (70%) patients were excellent, 05 (12.5%) patientswere good, 04 (10%) were fair and 03 (7.5) were poor. We had not found mortality in our patients.Conclusions: According to our conclusion DHS is the best implant for intertrochanteric fracturefixation. No matter; whether fracture is stable, unstable and fresh or old.
All 40 patients with femur intertrochanteric fracture were enlisted. All cases isolated in 2 groups every having 20 patients, group A stable fracture and group B unstable fractures. After complete physical examination, examinations and fracture arrangement evaluation, patients were readied for operation. Fracture table was used in each operation. Fracture reduction was initially attempted by close manipulation and was successful in 30 (75%) cases. Lateral approach for proximal femur was used in every case. All fractures, whether stable or unstable, were reduced anatomically without any type of osteotomy and then fixed with 135 o dynamic hip screw. Results: Mean age was 62.8.2 years of the cases. Gender ratio was 3:1. According to mode of injury were found RTA in 21 (70%) patients. Postoperative complications were recorded as; superficial infection noted in 2 (5%) patients and there was no case of deep infection. Average stay of hospital found 16.5 days in 17 (42.5%) patients belongs to stable group and 06 (15%) patients belong to unstable group. All (n=40) patients were pain free on their discharge from hospital. In all (n=40) patients we achieved union and there was no case of delayed union or non-union. We assessed functional outcome of our patients on the base of Stinchfield Hip Assessment system. According to SHAS 28 (70%) patients were excellent, 05 (12.5%) patients were good, 04 (10%) were fair and 03 (7.5) were poor. We had not found mortality in our patients. Conclusions: According to our conclusion DHS is the best implant for intertrochanteric fracture fixation. No matter; whether fracture is stable, unstable and fresh or old.
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