Objective: To determine if below-elbow casts are as effective as above-elbow casts in the treatment of the distal third closed forearm fractures in children. Materials and Methods: This was a prospective comparative study and was conducted at orthopaedic department of Liaquat University of Medical and Health Sciences (LUMHS). Children 4 to 12 years of age who presented to, distal 1/3rd fractures of the forearm were randomized in order to manage with either an above-elbow or below-elbow cast after closed reduction under fluoroscopic guidance. Radiographic analysis was done for angulation and displacement at the injury time, following reduction, and at subsequent intervals of follow-up. At the fracture level, the cast index for evaluating the cast moulding quality was assessed from the post-reduction radiographs. Variations between post-reduction and final values for displacement and angulation, the range of motion of elbow, forearm and wrists and cast indices between the two groups were compared. Results: Of total 50 study subjects, 26 underwent above-elbow cast and 24 subjects underwent below-elbow cast techniques. Mean age of above-elbow cast group patients was 9.42 year and the mean age in of below-elbow cast group patients was 9.13 years. 15 male and 11 female patients were present in above-elbow cast group; 14 male and 10 female patients were present in below-elbow cast group. The mean cast index of above-elbow cast group was 0.71 and the mean cast index of below-elbow cast was 0.70. In terms of patient demographics, injury mechanism, characteristics of initial fracture, cast index or shift in displacement and angulation during treatment, no significant variances were observed between both groups. In above-elbow cast group, the mean elbow arc of motion on cast removal at six weeks was only 78° compared to 141.6° in below-elbow cast group. There was a significant decline in arc of motion of elbow joint in above-elbow cast group compared to below-elbow cast group in six weeks which became normal at final follow-up in three months. The complication rates in both the groups were similar. Conclusion: Below-elbow cast is the safe reliable and cost-effective method of cast immobilization in distal third forearm fractures in the children of 4 to 12 years of age.

Objective: To study the efficacy of platelet-rich plasma with Methylprednisolone in patients with tennis elbow. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Orthopedics, Jinnah Postgraduate Medical Centre, Karachi, Feb 2019 to Sep 2020. Methodology: All the patients with chronic lateral epicondylitis with the onset of symptoms of greater than three months were grouped into two groups. Seventy-six patients in each group were treated. Group-A received an injection of 5ml Platelet-rich plasma. Group-B was administered 1 ml of Methylprednisolone (dosage; 4-30 mg). The severity of pain using the visual analogue scale was evaluated at baseline. Results: In the PRP group, significant changes in pain perception were observed. The mean baseline VAS score in the PRP group was 6.9 ± 1.7, which decreased to 3.4 ± 2.9, 1.7 ± 0.3, and 1.2 ± 1.4 at four weeks, 12 weeks, and 52 weeks follow-up visit, respectively. Similarly, in group-B (Methylprednisolone), there was a significant change from baseline to 52 weeks postprocedure (p<0.001). It was found that the efficacy of Platelet free plasma was significantly higher than methylprednisolone (77.6% versus 48.7%, <0.005). Conclusions: The study concluded that Plasma rich platelet therapy was significantly more effective in relieving the pain and improving the functional outcomes in patients with elbow epicondylitis than Methylprednisolone.

Background: The management of open tibial diaphyseal fractures is the most challenging glitch faced by orthopedic surgeons. For open or comminuted fractures, external fixation remains the gold standard. This study aimed to assess the treatment response of fixators by comparing the results of open diaphyseal tibial fracture stabilization in adults by Plaster of Paris (POP) cast versus Naseer Awais External Fixator (NAEF). Methodology: A single-center, prospective study was conducted at the leading teaching institute and tertiary care hospital of Jamshoro and Hyderabad, Pakistan. A total of 30 patients having an open diaphyseal fracture of the tibia were randomly assigned to two groups (Group A-POP cast and Group B to NAEF; n=15 each). Duration of hospital stay and postoperative complications (like wound infection, union rate, and functional outcome) were compared between groups. Results: On average, group A patients stayed in the hospital for 3.65 weeks, while group B patients stayed for 2.49 weeks (p=0.004). Wound infections were observed in 26.7% and 53.3% of the patients in group A and B, respectively. No significant difference in the adequate callus formation (i.e. union) and good functional outcome was observed among patients of group A and B (p>0.05).   Conclusion: The use of NAEF for open diaphyseal fractures of the tibia has a significant advantage over POP cast in reducing the duration of hospital stay. However, no significant differences were observed in wound infection, union rate and time, and functional outcome.

Objective: To evaluate the outcome of intramedullary interlocking nailing in the management of Gustillo-I diaphyseal fracture of tibia. Study Design: This is an observational study. Setting: Study carried out at Orthopaedic Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form March 2018 to February 2021. Materials & Methods: 72 consecutive patients of Gustillo Type-I diaphyseal fracture of tibia. All patients age between 18-60 years with traumatic fracture like Gustillo Type-I diaphyseal fracture of tibia were included in this study. Patients reported chest, abdominal and head trauma with neurovascular deficit were excluded. Patients were prepared for surgery after relevant investigation and radiographs. Results: Out of 72 patients included in this study 11.11% were female (N=8) and 88.88% male (N=64); with mean age was 38.26±8.20 years (Range 18 to 60 years). Road traffic accident was common cause of tibia fracture (Gustillo Type-I). Postoperative mean union time of tibial fractures were 9.9±3. 2 week.Postoperatively started partial weight bearing associated with help of two axillary crutches. The patients walking with partial weight bearing allowed at 4.1±1.12 weeks. While patients walking with full weight bearing allowed at 10.8±2.4 weeks. Postoperatively 11(15.27%) patients were complaining of pain. Wound infection observed in 7(9.72%) cases. Clinically excellent results were found in 24(33.33%) patients, while good results remained in 30(41.66%) patients and fairs in 18(25%) patients.   Conclusion: We conclude that interlocking intra-medullary nailing may be considered as a suitable option for treatment of Gustilo-I diaphyseal fracture of tibia.

Objective: To determine the early outcome of mid-shaft radius and ulna fracture osteosynthesis through single posterior incision approach. Study Design and Setting: This is a retrospective study carried out at Orthopaedic Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, from September 2019 to December 2020. Material and Methods: In total 14 patients were operated out of which 9(64.29%) were male and 5 were females through posterior single incision approach (Thompson approach). Demographic data regarding the pattern of fracture and the complications after the surgery at 2,6 and 12 weeks was collected respectively. Results: The total number of cases operated from September 2019 to December 2020 were 14, out of 14 patients 9(64.29%) were males and 5(35.71%) were females. The average age of patients was 26.5 years ranging from 16-40 years .The average time of surgery was 61 minutes ranging from 50-70 minutes. The patients were discharged on 3rd post-operative perficial wound infection which was treated with antibiotics after culture and sensitivity There was no neurovascular deficit in all patients. All the fractures were united within 3 months time, and there was no radio ulnar synostosis observed within mean time. Conclusion: To conclude we can say that the single posterior incision approach for treatment of mid-shaft radius ulna fractures osteyosynthisis is effective and safe provided the surgical expertise and good anatomical knowledge for identification of the vital structures are there.