Background and Objectives: Elbow is the most common site of fractures in children. It accounts for approximately 60% of all injuries in children. These fractures are caused by direct or indirect low energy trauma. Immediate & late complications are common in fracture of this region. The objective of this study was to compare the outcome of two different modes of treatment i.e. crossed K-wires versus lateral wires for displaced type-III supracondylar fracture of Humerus in children. Methods: A total of 80 patients having age between 2-13 years with type-III supracondylar fracture of Humerus type III those fulfilling the inclusion criteria were admitted through emergency department of this hospital. All these patients underwent x-rays of the elbow joint both AP & Lat views before the surgery. Patients were randomly divided into 2 equal groups. In group A, all fractures were fixed with crossed K-wires after reduction of these fractures, one wire from the medial condyle and one from the lateral condyle while in group B all fractures were fixed from the lateral condyle with 2 parallel K-wires of 2mm size in a divergent way after reduction of these fractures. In both of these groups, all these fractures were reduced closely under G/A with the help of image intensifier. Results: In group A 62.5% patients presented with type-III A while 37.5% presented with type-III B fractures. In group B 70.0% patients had type-III A fractures while 30.0% patients type-III B fractures. Functional & radiological assessment was done with Baumann's angles & modified Flynn's criteria. At the final follow up the Baumann's angle was equal in both of these groups (78.15 + 3.32 in Group A) & (79.1 + 4.21 in Group B p>0.45). Conclusion: This study concluded that there is no statistical significant difference in both modes of treatment regarding the stability of fixation and in terms of functional outcomes. However there are more chances of ulnar nerve injury with crossed k-wires fixation.
Background and Objectives: In total Hip arthroplasty, thromboembolism prophylaxis is a standard practice with minimal recommended duration of ten days. Thromboembolism prevention leads to reduction in symptomatic venous thromboembolic complications without risk of major bleeding.To assess and compare the efficacy of oral rivaroxaban with subcutaneous enoxaparin for prevention of thromboembolism after total hip and total knee replacement. Methods: It was a Randomized Control Trial conducted at Department of Orthopedic Surgery, Services Hospital Lahore. After permission from the Institutional review board, a total number of 200 patients who underwent either total hip replacement (THR) were enrolled in the study. These patients were divided into 2 equal groups A and B, each group having 100 patients. In Group A, all the patients were given Rivaroxaban 10 mg daily while in Group B Enoxaparin 40mg s/c was given. In all the patients’ anticoagulant prophylaxis was started 3-5 days before the surgery and 7-10 days after the surgery during Hospital stay. Results: In group A where all patients were given Tab Rivaroxaban 10mg daily, did not show any signs of DVT in the final follow up. In Group B DVT occurred in 2 patients (2%) during the 1st week post operatively. This shows that Rivaroxaban causes lower incidence of thromboembolism when compared to enoxaparin (relative risk of 0.70 & 95% of confidence interval). Conclusion: Rivaroxaban showed better anticoagulant effects than enoxaparin. It has slight higher risk of bleeding than enoxaparin. Direct factor Xa inhibitors are effective to prevent thromboembolism after total hip and total knee replacement. The anticoagulant effects are not necessarily compromised with risk of high bleeding.
Background: Supracondylar fractures of humerus are one of the largest sources of serious problems and treatment controversy in childhood fractures. The advantages and disadvantages of different methods of treating supracondylar fractures of humerus in children are still evolving and need to be investigated. Objective: To compare the effectiveness of two techniques of treating Gartland type III supracondylar fractures of humerus in children Materials and Methods: This quasi-experimental study was carried out at Orthopedic Unit, Jinnah Hospital, Lahore from 22nd August 2007 to 31st May 2008. Sixty patients selected by non-probability sampling with Gartland type III supracondylar fracture of humerus were divided in Group A and B with 30 patient in each group. After stabilizing patients, group A was managed with closed reduction and percutaneous pinning and group B with open reduction and internal fixation. Patients were discharged when stable and followed clinically and radiologically for effectiveness of reduction and union of fracture at 2, 4, 8 and 12 weeks. Results: There were 78.3% males and 21.7% were females. Majority of patients (36.7%) were between 5-7 years of age. Right humerus was fractured in 63.3% of patients. Most common mode of injury (40%) was fall during play. Eighty percent of children were presented in 1st 24 hour of injury. Sixty percent of children in group A had a hospital stay of 2 days and in group B, 60% had hospital stay of 4-5 days. In group A, 16.6% patients developed postoperation complication and in group B, 46.7% developed complications. Functional outcome was excellent in 73.7% in group A and 60% in group B. Radiologically, callus formation was relatively poor to start in group B. Conclusion: Closed reduction & pining under image intensifier is as good as open reduction and internal fixation for these fractures in children with early callus formation.
Background: Trimalleolar fracture is very hamstring if it not maintained accurately. It is one of the pitiful condition. Trimalleolar ankle injuries have become more common in the last decade, with up to 40 per 100,000 people affected each year. Study design: It is a prospective study conducted for the duration of six months from February 2022 to July 2022 at Islam teaching hospital, Sialkot. Material and Methods: The study was carried out on 52 patients who were admitted in tertiary care unit during a period of one year. All the patients were following inclusion criteria, those who were unable to fulfill were excluded from the study. There were 36 males and 16 females taken for study. 30 patients had injury in the right side and 18 reported left side injury. The hospital review board committee give the approval to the study. The data was collected and statistically analyzed by using the renowned software SPSS. The result were presented in the form of table. Results: The injury pattern that was frequently observed in patients was supination external rotation reported in 40 patients. While 8 had pronation external rotation and 4 had to face supination adduction pattern. There were 4 cases that complaint about superficial infection and deep infection was observed in case of 2 patients. Conclusion: It is concluded that for the fixation of Trimalleolar fractures, there is a need for proper planning and reduction of lateral malleolus fractures by a lateral plating method. Keywords: ankle fracture, operative planning and Posterior malleolus fracture.
Objective: To determine forensic implications of carpel tunnel syndrome in relation to neurological, radiological and orthopedic assessments. Study Design: Prospective Place and Duration of Study: Department of Forensic Medicine in collaboration with Radiology and Orthopaedic Departments, Govt. Khawaja Muhamamd Safdar Medical College Sialkot from 1st March 2020 to 28th February 2021. Methodology: One hundred and fifty patients of both genders were enrolled and age between 15-70 years. Details demographics age, sex and body mass index of all patients were recorded after taking written consent. Patients were divided into 2 groups. Group I had 75 patients with carpal tunnel syndrome and group II had 75 patients without carpal tunnel syndrome. Patients were undergone for ultrasonography and ultradiagnostic test used to diagnose the carpal tunnel syndrome. The carpal tunnel and proximal levels of the median nerve's CSA were measured, delta cross-sectional area (CSA) was determined for each wrist based on the differences between CSAc and CSAp. Sensitivity and specificity in wrists among both groups were identified. Results: There were 15 (20%) males and 60 (80%) females in group I with 90 wrists while in group II 17 (22.7%) males and 58 (77.3%) females in group II with 100 wrists. Mean age in group I was 49.68±9.66 years with mean BMI 26.47±9.54 kg/m2 and in group II mean age was 51.68±9.66 years with mean BMI 25.47±9.54 kg/m2. Mean CSAc in affected wrists group I was 17.11±6.44 greater than group II 08.17±6.58 mm2. Mean delta CSA in healthier wrists was lower 1.01±2.11 than group I 8.44±9.55 mm2. It was shown that the delta-CSA threshold of 2 mm2 had the maximum sensitivity (98.7%) and specificity (100%) in group I than control group. Conclusion: As compared to CSAc, the CSA is more accurate in diagnosing carpal tunnel syndrome. Keywords: Carpel tunnel syndrome (CTS), CSA, Wrists, Specificity, Sensitivity, Ultrasonography
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