Objectives: To determine the clinical and radiological outcome of proximal femur shaft fractures in school going children treated with locking compression plates (LCP). Methods: This descriptive study was conducted in Orthopaedic Division Lady Ready Reading Hospital Peshawar from 25th June 2018 to 25th September 2020. Children of either gender and age 6 to 12 years old with subtrochanteric and proximal one third femur factures fulfilling the inclusion criteria were enrolled in this study. Open reduction and internal fixation with 4.5 mm narrow locking compression plates (LCP) were done in all. Post operative clinical outcome was evaluated by using Flynn scoring system and graded as excellent, satisfactory and poo results. Radiological assessment of fracture union was done through anteroposterior (AP) and lateral X-ray radiographs. Results: A total of 60 children with mean age 9.01±1.61 SD (range 6 to 12 years) were included in our study. Oblique fractures were present in 23(38.3%) children, spiral in 20(33.3%), transverse in 11(18.3%) and comminuted in 6 (10%) children. The radiological union time was 13.3±1.2 weeks (range 9.4 to 18 weeks). Majority (88.3%, n=53) of children had excellent clinical outcome according to Flynn’s scoring system while satisfactory outcome was noted in 7(11.6%) children. No cases of delayed union, mal union, nonunion and implant failure was reported. Conclusion: The results of our study indicated that proximal femoral shaft fractures in school going children treated with locking compression plates had excellent clinical and radiological outcome. We therefore recommend locking compression plate as the implant of choice to fix proximal femoral shaft fractures in school going children. doi: https://doi.org/10.12669/pjms.37.5.3938 How to cite this:Shah FA, Ali MA, Naeemullah. Outcome of proximal femur shaft fractures in school going children treated with locking compression plates. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.3938 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Supracondylar fracture of the humerus is one of the most common fractures in children. The purpose of our study was to analyze the temporal variations and mechanisms of paediatric supracondylar fractures presented to our hospital during the COVID-19 pandemic lockdown period. As the schools and parks were closed and children were confined to their homes, they were thus more prone to injuries while playing inside. We claim that this would be the first study in Pakistan to provide unique information about these fractures. We conducted this descriptive study in the Accident and Emergency Department at Lady Reading Hospital in Peshawar, Pakistan from 18th March 2020 to 18th June 2020. In the enrolled children data regarding day and time of fracture occurrence, mechanism of fracture, height of furniture or play equipment from which the children fall and types of landing surfaces were all noted. Important variables were compared and a Chi-square test was applied to calculate P value (P<0.05 was considered significant). The total number of children in our study was 160 with a mean age of 5.3±1.3 years. The most common mechanism of fracture was fall from furniture (63.1%, n=101) and the landing surface was cemented or tiled floor in the majority (84.1%, n=101) of children. Maximum (40.6%, n=65) number of fractures were reported in the month of April and on a Monday (23.7%, n=38). Most (65.6%, n=105) children sustained fractures in PM time. The peak time of occurrence of fracture was 1700 h. We concluded that the majority of children sustained fractures due to a fall from furniture landing on hard cemented or tiled surfaces. Maximum number of fractures was reported in the month of April and on a Monday. Most of these injuries occurred in the evening and were operated on at night. The increased frequency of paediatric supracondylar fractures in the COVID-19 pandemic supports that preventative strategies should focus more on adult supervision, prevention of falls from furniture and provision of softer landing surfaces to lessen the impact of injury. Keywords: fracture, gartland, humerus, paediatric, supracondylar, surface resilience, temporal variations, weekday
ABSTRACT… Objectives:To determine the frequency of lag screw cut out in intertrochanteric fractures fixed with dynamic hip screw and to identify the possible contributing factors for screw cut out. Study Design: Descriptive case series. Place and Duration of the Study: Orthopaedic & Traumatology Unit"A" Lady. Reading Hospital Peshawar from January 2014 to January 2017. Material and Methods: Patients of either gender or age with intertrochanteric fractures fulfilling the inclusion and exclusion criteria were fixed with dynamic hip screw (DHS). Post operatively fracture reduction, position of screw in head of femur and tip apex distance were calculated on anterio posterior and lateral radiographs. All the patients were reviewed fortnightly for two month and then monthly for six months for lag screw cut out on radiographs. Results: Total 110 patients mean age 72(range 22 to 98 years) years were fixed with dynamic hip screw. Lag screw cut out was noted in 12(10.9%) patients with 4(33.3%) male and 8(66.6%) female patients. The mean age was 62 years. Right side was involved in two (16.6%) patients while left in ten (83.3%) patients. Radiographically fracture reduction was poor in most (50%, n=6)) patients. The mean tip apex distance (TAD) was 32mm (range 24 to 40 mm). Majority (75%, n=9) of cut out screw were in superior portion of the head of femur. Four (33.3%) patients had screw cut out at 8 th week postoperatively while eight (66.6%) patients had screw cut out at 12 th week. Conclusion: Lag screw cut out wasthe most common mechanical complication after fixation of intertrochanteric fractures and all of the cut out patients were elderly with inadequately reduced fracture, superiorly placed lag screw and longer tip apex distance. Key words:Intertrochanteric fracture, dynamic hip screw, tip apex distance.
Objectives: To evaluate the outcome of retrograde flexible intramedullary nailsin treatment of paedriatic diaphyseal fractures in comparison with the traditional treatment ofimmediate hip spica cast. Hypothesis: We hypothesised that in children with femur fracturewho are managed with flexible intramedullary nails have better outcome in comparison tothose managed with immediate hip spica cast. Study Design: Randomized control trail. Place& Duration of Study: Lady Reading Hospital, Peshawar from June 2016 to October 2017.Methods: A group of forty-eight children aged 6-12 were randomly allocated either elasticintramedullary nail or immediate hip spica casting and were followed up to six months. Fracturealignment (coronal and sagittal angulation, leg length discrepancy), time for fracture union,recovery mile stones (time to start weight bearing with aids, independent walking, knee rangeof movement) and the presence of complications including surgical site infection were recordedand compared between two groups. Results: Children treated with elastic intramedullary nailsin comparison with those treated with immediate hip spica had early union (p<0.001), shortertime to start weight bearing with support or independently (p<0.001). Leg Length discrepancy(p<0.001), coronal and sagittal angulation (p<0.001 and p=0.02) was significantly higher in hipspica group. Difference observed between the two groups regarding knee range of movement(p=0.085) and surgical site infection (p=0.076) was not significant. Conclusion: Children aged6-12 years treated with elastic intramedullary nail for femoral diaphyseal fracture had earlierunion, reduced rate of shortening, malunion and allowed earlier rehabilitation.
Objectives: To compare the frequency of surgical site wound complicationrate between the skin closure with staples and polypropylene suture after elective hip surgery.Study Design: Prospective Randomized trial. Place and Duration of the Study: Orthopaedic& Traumatology Department Lady Reading Hospital from 13/03/2016 to 25/12/2017. Materialand Methods: All patients of either gender or age with intertrochanteric fractures fulfilling theinclusion criteria and fixed with dynamic hip screw (DHS) were randomly divided into two groups.Group A surgical site skin wounds were closed with metallic skin staples while Group B woundswere closed with polypropylene sutures. Wounds were examined for inflammation, necrosis,dehiscence, discharge and abscess on 3rd day, 2nd week, 4th, and 8th weeks in both groups andcompared. P value was considered significant if < 0.05. Results: Surgical site skin closure of100 patients were done with staples (group A, 50 patients) and interrupted polypropylene suture(group B, 50 patients). Baseline parameters of both groups had no significant differences. Meanage of group A and B patients were 61.6±SD 17.1 and 61.02±SD 19.2 respectively. Surgicalsite wound complications were reported in 9(18%) patients with staples closure and 8(16%)patients with suture closure (p > 0.05). Conclusion: We found no significance difference insurgical site complication rates of staples and suture closure in elective hip surgery patients.The operating surgeon can use closure material of his own choice.
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