Objectives: To determine the failure of DHS (dynamic hip screw) in terms of lag screw cutout. Study Design: Hospital Based Cross Sectional study. Setting: BVH and Civil Hospital Bahawalpur. Period: From 2013 to 2018. Material & Methods: 273 patients of both genders with age more than 50 years having stable intertrochanteric fractures were included in this study. With the help of C arm, the best possible anatomical reduction and rigid internal fixation was done with 135 degree DHS. Lag screw position and TAD determined on first postoperative day on radiographs (Anteroposterior & Lateral). Failure of fixation was determined on the radiographs during follow up. Lag screw cut-out was the projection of the screw from the femoral head by more than 1mm. Results: The mean age of the patients was 68.6 years (50-88). There were 132 (51.1 %) males and 126 (48.8%) females. Overall lag screw cutout rate was 11.2%. 21(30.8%) had screw cutout while 47 (69.1%) healed successfully among 68 patients with TAD ≥ 25mm. On the other hand 8(4.2%) had screw cutout while 182 (95.7%) healed successfully among 190 patients with TAD < 25mm. Middle middle and inferior middle position had highest success rate (˃ 92%) while inferior posterior position had highest cutout rate (36.2%). Among different age categories high failure rate (17.8%) seen in patients more than 70 years. Conclusion: The incidence of lag screw cutout is 11.2 % and risk of cutout can be minimized by placing lag screw in middle middle or inferior middle position and keeping the TAD < 25mm. More attention during follow up should be paid to patients with age ˃ 70 years.
Objectives: To compare the outcome in terms of carrying angle with medial versus lateral approach in the treatment of these fractures among children. Study Design: Randomized Clinical trial. Setting: Department of Orthopaedic Surgery Civil Hospital Bahawalpur and Nishtar Hospital Multan. Period: From June 2018 to September 2019. Material & Methods: A total of 154 children of both genders, aged 2-14 years having supracondylar humeral fracture of type II and III, with duration of fracture within 7 days, were enrolled. Patients were divided in two groups (77 in each group), group A and group B. Group A was managed by open reduction internal fixation (ORIF) with cross K-wire through medial approach and group B underwent lateral approach. Results: Out of 154 cases, 102 (66.2%) were boys and 52 (33.8%) were girls. Overall, mean age was noted to be 7.98 ± 2.23 years. Obesity was present in 16 (10.4%) cases. Mean duration of fracture was noted to be 4.21 ± 1.34 days while 106 (68.8%) had duration less than 5 days. There were 119 (77.3%) cases with history of fall and 35 (22.7%) had history of road traffic accidents (RTA). Sixty one (39.6 %) cases were classified as Gartland type II fractures while remaining 93 (60.4 %) were type III fractures. Excellent outcome with carrying angle 0–5o in group A was noted to be 67 (87 %) while that of group B was 54 (70.1%) (p = 0.011). Conclusion: Medial approach for the treatment of pediatric SHF was noted to be superior in terms of postoperative carrying angle having satisfactory outcome in comparison with the lateral approach.
Background: Femoral fractures are common fractures in orthopedics. Aim: To study the outcomes in patients with fracture shaft of femur, managed by close reduction and Inter Locking nail by traction table versus modified Naseer Awais fixator. Study design: Non randomized clinical study. Methodology: One hundred patients (50 in each group) were included in present study. Inter Lock femoral nailing was done in group A by TM distractor. Traction table was used in group B for the same procedure. Number of fluoroscope images per procedure, operation duration/time, contact between fracture fragments after reduction, limb rotation, limb length discrepancy, union time (radiological) and frequency of infection occurrence was noted and compared between the above said two groups. Results: Number of images per-operatively were 38.55±19.087, in group A 43.08±23.67, in group B 34.02±11.56 (P=0.017). The operative time in group A was 81.40±25.95 mins. The limb length discrepancy after surgery was 0.17±0.49 cm. The time of radiological union was 5.62±2.29 months in group A, versus 5.44±3.32 months in group B (P=0.753). Conclusion: We concluded that TM distractor group has comparable outcome with traction table group because there was no statistically significant difference in terms of operation duration/time, contact of major fracture fragments after reduction, limb length discrepancy (LLD), union (radiological), non-union and frequency of infection. However numbers of images in a procedure were less in traction table group in our study. Keywords: TM Distractor, Femoral Nail, Traction Table, Modified NA Fixator and Inter Lock Nail.
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