Aim: The aim of the study is to evaluate the results of treatment of a closed reamed interlocking in the treatment of closed fractures of the tibial shaft. Study design: A Descriptive observational study Venue and Duration: This study was conducted in the Orthopedic department of Ayub Teaching Hospital, Abbottabad for six months duration i.e from September 2020 to February 2021. Patients and methods: The study included 43 patients over 19 years of age. The patients were taken to the emergency and Orthopedic department for surgery of Ayub Teaching Hospital, Abbottabad for six months duration i.e from September 2020 to February 2021. Written approvals were granted from all selectees. Detailed history was asked and each patient was assessed clinically and radiographically. The reamed intramedullary nailing performed according to the protocol. Patients were followed for 1 year and assessed for infection, union, knee and ankle range of motion, and implant problems. 3 patients were excluded from follow-up, and the study was held in 40 patients. Results: All fractures were having complete union without the need for bone grafting. Simple fractures have union at mean of 14 weeks, comminuted and segmented fractures have union for longer than five weeks, and a mean duration of 18.5 weeks. Superficial infection at the screw site occurred in two patients, and the drainage was done, antibiotics were given and distal screw were removed, respectively. While all patients had a full range of knee motion, 37 patients had a full range of ankle movement. The other three patients had a 15-to-20-degree dorsiflexion loss at the ankle joint. No nail fracture, proximal screw end fracture in one patients and distal screw fracture in two patients were observed. Conclusion: We came to the conclusion that closed intramedullary nailing in the case of a closed shaft fracture of the tibia is a safe and satisfactory technique with a high rate of union and a relatively low complication rate and early return to activity. Keywords: Fracture, Internal, Fixation, Interlocking nail.
Objective: Analysis and assessment of anatomical refurbishment with the use of percutaneous cross pinning versus two lateral pinning and to determine the functional consequences of these procedures, to evaluate the hurdles faced in these treatment methodologies, and the comparison between the patient acceptances in both methods. Methods: This research was a comparative cross-sectional analysis which was conducted at Orthopedics department of Ayub Teaching Hospital Abbottabad for duration of six months i.e from March 2021 to August 2021. The sample size for the research was 50 patients who were admitted both at the (outpatient department) OPD and in the emergency ward. All the patients were clinically examined carefully and thoroughly, and all of their details were recorded. Base line investigations and X-rays were performed of every patient. Results: Percutaneous cross pinning or two lateral pinning methods were used to treat 50 patients suffering from supra-condylar fracture of humerus. Two groups were formed, each had 25 patients. Group A consisted of patients were treated from PCP, while group B patients were treated from TLP. Among the patients of Group, A, 20(80%) were male, 5(20%) were female, with a female: male ratio of 1:5, while in group B patients, 22(88%) were male, 3(8%) were female, with a female: male ratio of 1:8. The average age of both the groups was 7.30+3.30 years. The most prominent reason of fracture in the designed study was fall during playing (54%), 24% patients reported falling from bicycle, while only 22% patients had fallen from trees, the height of which was around 5-7 feet. Postero-medial displacement was observed in 66% patients, while Postero-lateral displacement was observed in 34% patients. Among the list of complications, in TLP, 8% patients suffered from superficial pin tract infection, 12% patients suffered from non-union, and 4% patients had K-wire migration and 4% had Cubitus varus. On the other hand, in PCP group patients, one patient developed superficial pin tract infection, 8% patients had nonunion, and 4% patients had K-wire migration. When the results were analyzed using the Flynn criteria, they were excellent (48% group A patients versus 36% patients of group B), 32% patients in group A had good results and 28% in group B, 20% patients of group B versus 12% patients of group A were regarded as fair, and 8% patients of group A versus 16% patients of group B were considered as poor. The patients who carried angle loss were 12% of group A versus 24% of group B, and who complained about loss of motion were 15% patients of group A versus 25% patients of group B were classified according to Flynn criteria Conclusion: Percutaneous cross pinning is concluded as the better, and more predictable treatment method in terms of management, as compared to two lateral pinning method to treat the Supra-condylar fractures. Key Words: Percutaneous cross pinning, two lateral pinning, supra-condylar fracture, humerus
Objective: The aim of this study is compare the outcomes among three different approaches (lateral approach, medial approach and posterior approach) for supracondylar humerus fractures in children. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Orthopedics department of Ayub Teaching Hospital, Abbottabad for duration of one year from January 2020 to December 2020. Methods: There were one hundred and thirty five children had supracondylar humerus fracture were presented. Patients were aged between 3-12 years. Informed written consent was taken from authorities for detailed demographics age, sex, cause of fracture and side of fracture. Patients were categorized into three equal groups, group A had 45 patients and received lateral approach, group B had 45 patients and received medial approach and group C received posterior approach with 45 cases. Shaft Condylar Angle (SCA) and Baumann angle were used to analyze the radiological result. All children were assessed using Flynn's criteria for functional outcomes, and the results were divided into Excellent, Good, Fair and Poor. Post-operative outcomes among all the three groups were calculated and compared. SPSS 23.0 version was used to analyze complete data. Results: There were 90 (66.7%) males (30 in each group and 45 (33.3%) females (15 in each group). In group A mean age was 6.88±5.45 years, mean age in group B was 7.11±5.33 years and in group C mean age was 7.17±5.66 years. Sports 85 (62.9%) was the most common cause of fracture followed by traffic accidents 30 (22.2%) and the rest were 20 (14.8%) fall from the height. According to radiological outcomes, Mean shaft condylar Angle in group A was 41.5±6.3, in group B was 41.8±1.9 and in group C was 40.1±3.8 respectively (P>0.05). Mean Bauman angle in group A was 18.8±6.11, group B was 19.4±7.5 and in group C 20.4±5.3 with (P>0.05). According to Flynn’s criteria, excellent outcomes were observed in 33 (73.3%) in LA group, 24 (53.3%) in MA group and 22 (48.9%) in PA group, good results were observed in 11(24.4%), 19 (42.2%) and 21 (46.7%), fair outcomes in 1 (2.2%), 2 (4.4%) and 2 (4.4%). Conclusion: As a result of this research, we have concluded that the lateral technique for supracondylar fractures is superior to the medial or posterior approaches in terms of radiological and functional results. However, there was no statistically significant difference between the three groups. Keywords: Supracondylar fractures, Flynn’s criteria, Functional outcome, Open reduction
Objective: The aim of this study is to determine the outcomes of using two ring hybrid ilizarov fixator for the management of proximal tibial fractures in adult patients. Study Design: Descriptive Study Place and Duration: Methods: There were 60 patients of both genders were presented in this study. Patients were aged between 25-65 years. Informed written consent was taken from all the patients for detailed demographics age, sex, body mass index and cause of fracture. All the patients had proximal tibial fractures were included, type of fractures were assessed by schatzker technique. Outcomes were assessed by using Rasmussen score in terms of excellent, good and fair. Radiological outcome was measured by fracture healing on radiography. Student t-test and chi square test was used. SPSS 24.0 was used to analyze all of the data. Results: There were 45 (75%) patients were males and 15 (25%) were female patients. Mean age of the patients was 42.3±7.43 years with mean BMI 25.07±6.29 kg/m2. Falling was the most common cause of fracture found in 33 (55%), followed by road traffic accidents in 17 (28.3%) and 10 (16.7%) fractures by assault. Majority of the patients were schatzker type VI fractures 34 (56.7%) followed by schatzker type V fractures in 11 (18.3%), metaphyseal fractures found in 8 (13.3%) cases and proximalone third shaft fractures in 7 (11.7%) cases. Mean surgery time was 4.2±6.17 hours and mean union time of fractures was 19.8±6.61 weeks. According to Rasmussen score 39 (65%) cases showed excellent results with knee flexion more than 90 degree, good results found in 17 (28.3%) patients and fair results in 4 (6.7%) cases. Pin tract infection was the most common complication found in 12 (20%) cases, followed by compartment syndrome in 4 (6.7%) and delayed union in 3 (5%). No any poor outcome was assessed in this study. Conclusion: We concluded in this study that the use of two ring hybrid ilizarov fixator in the management of proximal tibial fractures were effective and useful in terms of excellent and good outcomes of knee flexion. The ilizarov approach allowed for early definitive treatment with a low rate of complications and a favourable clinical outcome. Keywords: Proximal Tibial fracture, Ilizarov Fixator, Shatzker, Rasmussen score, Outcomes
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