Background: To determine the frequency of tibial diaphyseal fractures among patients presenting with motorcycle accidents. It was a cross-Sectional Study, conducted at Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi between May to December, 2020. Methods: All patients irrespective of gender, between ages 18–60 years who suffered from a motorcycle injury with a single bone involvement were eligible for the study. All patients who refused to take part in the study, had head injury, or had multiple fractures were excluded from the study. The data included patient's age, sex, associated bones involved and types of injury. The fractures were classified according to whether it was open or closed. Results: A total of 174 patients were included in the study with a mean±SD age of 43.7±12.4. Tibial diaphyseal fracture was found to be in 111 (63.8%) patients as shown. Duration of fracture, gender, side of fracture, type of fracture was done with respect to Tibial diaphyseal fracture among patients. Insignificant difference was noted in age group (p=0.346), duration of fracture (p=0.087), gender (p=0.672), and type of fracture (p=0.063) whereas significant difference was found in side of fracture (p=0.0001). Conclusion: We highlighted the importance of tibial diaphyseal fractures in middle aged men who use motorcycles as a means of transport in Karachi, Sindh which is a frequent finding among these patients. Efforts should be made at both the community and government levels to increase awareness regarding traffic rules and consequences of reckless driving.
Objective: To determine the efficacy of dynamization in delayed union of tibia diaphyseal fractures Methodology: A descriptive cross sectional study was done at the Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from July 2020 to April 2021. A total of 97 consenting patients who suffered from delayed union following intramedullary interlocking nailing were included in the study. Dynamization involved removal of proximal or distal locking screws in statically locked intramedullary nail. Patients were followed up for six months to check for delayed bone union. All the collected data were entered into a pro forma and used electronically for research purpose. Results: Over all union was achieved in 72 (74.2%) cases after dynamization. The mean age of our study population was 39.42+13.79 years. Advanced age, smoking, fresh or old fracture, the time of initial intramedullary nailing, and diabetes were associated with decreased efficacy of dynamization, with p-value <0.001, 0.033, 0.007, and <0.001 respectively. While no significant association was found between gender, BMI, hypertension, and union (p-value >0.05). Conclusion: The findings of this study support the idea that dynamization can be an effective method to promote healing in tibia diaphyseal fractures for delayed union. More randomized comparative clinical trials are necessary to evaluate the effectiveness of dynamization.
Objective: To compare the outcome of intramedullary nailing versus external fixator fracture repair in patients presenting with Gustilo Type IIIA tibiofibular fracture. Study Design: Cross-sectional study. Place and Duration of Study: Department of Orthopaedics, Jinnah Postgraduate Medical Center, Karachi Pakistan, from Feb to Nov 2020. Methodology: A total of 200 patients were included. Patients were divided into two Groups. In Group-1, intramedullary nailing was done. In Group-2, uniplanar external fixation was done. Both Groups were followed up for six months for assessment of bone union. Results: The mean age in the Intramedullary Nailing (IMN) Group was 39.21+6.24 years and in the External Fixator (EF) Group mean age was 37.48+8.41 years. In our study, it was found that 81(81%) patients in the EF-Group showed bone union, while 92 patients in the IMN-Group showed bone union. Malunion occurred in 10 in the EF-Group, while only six in the IMN Group. Non-union of bone was unfavourable in the 18 patients of EF- Group and 7 in the IMN-Group. The infection rate was also higher (16%) in patients treated with EF. We noted a significant association between union, non-union, infection and mode of treatment with the p-value of 0.023, 0.019 and 0.046, respectively. Conclusion: Bone union outcome of Gustilo IIIA open tibial shaft fractures appear superior when treated by Intramedullary Nailing technique compared to External Fixation.
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