Objectives: To evaluate the outcome of retrograde flexible intramedullary nailsin treatment of paedriatic diaphyseal fractures in comparison with the traditional treatment ofimmediate hip spica cast. Hypothesis: We hypothesised that in children with femur fracturewho are managed with flexible intramedullary nails have better outcome in comparison tothose managed with immediate hip spica cast. Study Design: Randomized control trail. Place& Duration of Study: Lady Reading Hospital, Peshawar from June 2016 to October 2017.Methods: A group of forty-eight children aged 6-12 were randomly allocated either elasticintramedullary nail or immediate hip spica casting and were followed up to six months. Fracturealignment (coronal and sagittal angulation, leg length discrepancy), time for fracture union,recovery mile stones (time to start weight bearing with aids, independent walking, knee rangeof movement) and the presence of complications including surgical site infection were recordedand compared between two groups. Results: Children treated with elastic intramedullary nailsin comparison with those treated with immediate hip spica had early union (p<0.001), shortertime to start weight bearing with support or independently (p<0.001). Leg Length discrepancy(p<0.001), coronal and sagittal angulation (p<0.001 and p=0.02) was significantly higher in hipspica group. Difference observed between the two groups regarding knee range of movement(p=0.085) and surgical site infection (p=0.076) was not significant. Conclusion: Children aged6-12 years treated with elastic intramedullary nail for femoral diaphyseal fracture had earlierunion, reduced rate of shortening, malunion and allowed earlier rehabilitation.
Objectives: To compare the frequency of surgical site wound complicationrate between the skin closure with staples and polypropylene suture after elective hip surgery.Study Design: Prospective Randomized trial. Place and Duration of the Study: Orthopaedic& Traumatology Department Lady Reading Hospital from 13/03/2016 to 25/12/2017. Materialand Methods: All patients of either gender or age with intertrochanteric fractures fulfilling theinclusion criteria and fixed with dynamic hip screw (DHS) were randomly divided into two groups.Group A surgical site skin wounds were closed with metallic skin staples while Group B woundswere closed with polypropylene sutures. Wounds were examined for inflammation, necrosis,dehiscence, discharge and abscess on 3rd day, 2nd week, 4th, and 8th weeks in both groups andcompared. P value was considered significant if < 0.05. Results: Surgical site skin closure of100 patients were done with staples (group A, 50 patients) and interrupted polypropylene suture(group B, 50 patients). Baseline parameters of both groups had no significant differences. Meanage of group A and B patients were 61.6±SD 17.1 and 61.02±SD 19.2 respectively. Surgicalsite wound complications were reported in 9(18%) patients with staples closure and 8(16%)patients with suture closure (p > 0.05). Conclusion: We found no significance difference insurgical site complication rates of staples and suture closure in elective hip surgery patients.The operating surgeon can use closure material of his own choice.
Purpose: Lumbar epidural is an established procedure, which is commonly used to control pain in cases of disc herniation secondary to lumbar disc disease. We conducted the present study to evaluate the clinical effectiveness of lumbar epidural injection using image intensifier comparing to injection using loss of resistance technique with no fluoroscopy. We also evaluated the outcome of these patients with patients treated conservatively with opioid or other analgesia as a control group. Setting: Epsom General Hospital, an elective part of Epsom & St Helier’s University Hospital spine services. Study Design: Prospective randomized controlled trial. Period: April 2013 and October 2013. Material and Methods: Single center, after seeking appropriate ethical approval in our institution. Group allocation for loss of resistance and II was done by list schedulers independent to the knowledge of trial, operating list become available to research team on the day of procedure. Fifty-five patients were included in each group. A single clinician performed all procedures and the same combination of local anaesthetic and steroid were injected in all patients. Preoperative and postoperative visual analogue score (VAS) and Oswestry Disability Index (ODI) were obtained for each patient. Conclusions: There is a better outcome demonstrated in both injection groups when compared with control. The post-operative scores did not statistically differ significantly between fluoroscopic and loss of resistance groups. The final results of this trial question the efficacy and cost effectiveness of epidural injections using image intensifier and may be used as a reference to change the current practice within several hospitals as cost saving measure. Level of Evidence: 1.
To evaluate the outcome of retrograde flexible intramedullary nails in treatment of paedriatic diaphyseal fractures in comparison with the traditional treatment of immediate hip spica cast. Hypothesis: We hypothesised that in children with femur fracture who are managed with flexible intramedullary nails have better outcome in comparison to those managed with immediate hip spica cast. Study Design: Randomized control trail. Place & Duration of Study: Lady Reading Hospital, Peshawar from June 2016 to October 2017. Methods: A group of forty-eight children aged 6-12 were randomly allocated either elastic intramedullary nail or immediate hip spica casting and were followed up to six months. Fracture alignment (coronal and sagittal angulation, leg length discrepancy), time for fracture union, recovery mile stones (time to start weight bearing with aids, independent walking, knee range of movement) and the presence of complications including surgical site infection were recorded and compared between two groups. Results: Children treated with elastic intramedullary nails in comparison with those treated with immediate hip spica had early union (p<0.001), shorter time to start weight bearing with support or independently (p<0.001). Leg Length discrepancy (p<0.001), coronal and sagittal angulation (p<0.001 and p=0.02) was significantly higher in hip spica group. Difference observed between the two groups regarding knee range of movement (p=0.085) and surgical site infection (p=0.076) was not significant. Conclusion: Children aged 6-12 years treated with elastic intramedullary nail for femoral diaphyseal fracture had earlier union, reduced rate of shortening, malunion and allowed earlier rehabilitation.
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