Outcome of Subtrochanteric Femur Fractures Treated by Proximal Femoral Nail in a Tertiary Care Hospital

Background: Subtrochanteric femoral fractures are challenging for surgeons, as it has strong collapsing forces at fracture site.The management of sub-trochanteric fractures, especially nonunion is challenging.Proximal Femoral Nail can be helpful in achieving high success rate. But there was a lack of local evidence. Objective: To determine the Outcome of Subtrochanteric Femur Fractures Treated by Proximal Femoral Nail in a Tertiary Care Hospital. Material and methods: This prospective study was conducted from 1stJuly 2017 to 30th June 2019. The inclusion criteria were all the patients of both genders above 16 years of age presented to emergency department with subtrochanteric fractures of the femur. Exclusion criteria included pathological fractures, fractures in children, old neglected fractures and multiple fractures. Radiographs were taken and all the patients were classified according to Seinshemers classification. All the patients underwent internal fixation with Proximal Femoral Nail. The outcome of all patients were assessed by using Modified Harris Hip Score. Results: A total of 110 patients were included in the study. Mean age of patients was 30.05±8.59 years. 81 (73.63 %) patients were males and 29 (26.36%) were females. According to Seinshemers classification, we had 54 patients with Type II fracture, 35 patients with Type III fracture, 19 patients with Type IV fracture and 02 patients with Type V fracture. Mean duration of hospital stay was 06 days and mean time of full weight bearing was 12 weeks. In our study, excellent results were found in 71 patients (64.5%), good results in 28 patients (25.4%), fair results in 06 patients (5.4%) and poor results in 03 patients (2.7%).02 patients were lost in follow up. The mean Harris Hip score was 93.5± 5.42. 14 patients (12.7%) had minor complications including 06 patients with Superficial wound infections, 03 patients with Deep infection, 01 patient with Deep vein thrombosis and 04 patients had Fracture from distal tip of nail. All the fractures unite within 6 months period and no implant failure was observed. Conclusion: Proximal Femoral Nail is a good choice implant for the fixation of subtrochanteric femur fractures leading to high rate of union, fewer implant related complications and excellent functional outcome. Key words: Subtrochanteric, Femur fracture, Proximal Femoral Nail, Modified Harris Hip Score, Seinshemers classification, Complication

Mathematical Model for Image Restoration Based on Fractional Order Total Variation

This paper addresses mathematical model for signal restoration based on fractional order total variation (FOTV) for multiplicative noise. In alternating minimization algorithm the Newton method is coupled with time-marching scheme for the solutions of the corresponding PDEs related to the minimization of the denoising model. Results obtained from experiments show that our model can not only reduce the staircase effect of the restored images but also better improve the PSNR as compare to other existed methods

Risk Factors of Infection in Total Knee Arthroplasty

Background: To determine risk factors of infection in total knee arthroplastyMethods: In this descriptive study all patients undergoing primary total knee arthroplasty were included. Patients were followed post-operatively at 2,4,8,12 and 24 weeks. Signs of inflammation and inflammatory markers such as total leukocyte count (TLC), C-reactive protein (CRP) and ESR were measured. Risk factors like age, body mass index (BMI), ASA, co-morbid conditions were also noted.Results: Out of the 78 patients osteoarthritis (94.87%) was the pre-dominant cause of total knee replacement (TKR). 6.41% cases got infected. In majority of the infected cases (60%), Staphylococcus aureus was the infective organism. Diabetes Mellitus (p=0.01) and Obesity (p=0.02) had a significant relation to post-operative infection.Conclusion: Pre-operative risk evaluation and prevention strategies along with early recognition of infection and control can greatly reduce the risk of joint infection post-TKR which will not only improve the mobility of patient but also its morbidity and mortality as wel

Impact of COVID Pandemic on the Mental Well-Being of Orthopaedic Patients – A Single Centre Study

Objectives: To assess the frequency of psychiatric diseases in orthopaedic patients during the COVID-19 pandemic.   Material and methods: This study was conducted from 20th April 2020 to 20th September 2020 at the Department of Orthopaedics, Benazir Bhutto Hospital, Rawalpindi, Pakistan. Patients aged 18 years and above and belonging to either gender with Orthopaedic injuries were included. Gender, age, injury mechanism, associated trauma, site of fracture, use of tobacco and mental health disorder was recorded. Data was analyzed using SPSS version 23.   Results: The study included 210 patients with Orthopaedic injuries. Mean age of patients in the study was 40.45±12.54 years. Falls were the most common mechanism of injury (50.4%) followed by motorcycle accidents (22.8%) and motor vehicle accidents (16.7%). 70.47% patients with Orthopaedic injuries were diagnosed with a mental health problem. There were notably higher rates of depression (33.1%) and anxiety (24.3%).   Conclusion: There was a high frequency of psychiatric illnesses in Orthopaedic patients during the COVID-19 pandemic.   Keywords: COVID-19, mental well-being, orthopaedic injuries, psychiatric illness

Outcome of Minimally Invasive Percutaneous Plate Osteosynthesis Technique for Management of Extra Articular Distal Tibial Fractures

Objective: To assess the outcome of the minimally invasive percutaneous plate osteosynthesis (MIPPO) method applied for the management of extra-articular distal tibial fractures.Materials and Methods: This quasi-experimental study was conducted at the Department of Orthopaedic Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan. Total 57 patients have included extra-articular type A distal tibial fracture, duration of injury <1 week, and competent neurological and vascular status of the fractured site. All the patients were treated with MIPPO Technique by using the distal tibial medial locking plate and the outcome of all patients was assessed radiologically in terms of union and functionally by using the Ovadia-Beals clinical scoring system. Data were analysed by using SPSS v. 21. Results: As per sample size calculation, 57 patients were included with a mean age of 37.19 ± 9.22 years. There were 45 (78.94%) male patients and 12 (21.05%) female patients. According to AO classification; the most common type was 43A1 with 31 patients (54.38%) whereas 18 (31.57%) were in Type 43A2 and 8 (14.03%) in Type 43A3. In our study, fracture union was achieved in a mean duration of 19.6 ± 3.45 weeks. When the functional outcome was analyzed, 41 (71.92%) patients had excellent outcome, 8 (14.03%) had good results, 5 (8.77%) had fair and 3 (5.26%) had poor outcome based on the subjective result and 44 (77.19%) patients had excellent, 7 (12.28%) had good, 3 (5.26%) had fair and 3 (5.26%) had poor result based on an objective result of Ovadia-Beals clinical scoring system. Conclusion: Thus MIPPO can be highly successful in achieving good to excellent outcomes in the maximum number of patients presented with a distal tibia fracture. So in the future, we can rely on this technique for such types of fractures. &nbsp

Effect of Delay in Operative Treatment on the Range of Motion in Supracondylar Humerus Fracture

To determine the relationship ofdelay in management of supracondylar fracture ofhumerus with reduced mobility of the joint.Methods: In this descriptive study patients withisolated fracture of supracondylar of humeruswithout any associated trauma, were included. Theywere classified into groups according to Gartlands’classification based on antero-posterior and lateralview Xrays of the affected elbow joint. Patients werecalled for follow up 4,8 and 12 weeks after removalof backslab and Kirschner wires.Results: Mean age of presentation for fractures ofsupracondylar of humerus was 5.67±2.064 years withfracture occurring predominantly in males. Out ofthe 32 patients who sustained Gartland type IIIfractures, only 8(25%) patients were managed byclosed reduction and internal fixation. In 28(75%)patients, open reduction and internal fixation had tobe done. Mean delay time for treatment in type-I andtype-II fractures was 2.86±2.25 and 2.56±1.42 daysrespectively. Gartland type-III injuries had a delaybetween injury and surgery of 4.88±2.95 days. Rangeof motion was more reduced in flexion angle ascompared to extension, supination and pronation.Conclusion: An inverse relation was foundbetween delay in presentation and range of motion.Increase in delay to seek optimal treatment isassociated with a reduction in range of movement atthe supracondyle of humerus. In Gartland type IIIfractures, open reduction had to be done to achievesatisfactory results in most of the patients whopresented after a delay of more than 3 days. Followup of the patients showed an improvement inmobility of the joint in the postoperative period butrole of physiotherapy in achieving maximummobility has not been determined ye

Rating players in test match cricket

In general, the evaluation of player performance in test cricket is based on measures such as batting and bowling averages. These measures have a number of limitations, among which is that they fail to take into account the context in which runs are made or conceded and wickets are taken or given away. Furthermore, batting and bowling averages do not allow the comparison of performances in these two disciplines; this is because batting and bowling performances are measured using different metrics. With these issues in mind, we develop a new player rating system for test cricket. We use multinomial logistic regression to model match outcome probabilities session by session. We then use these probabilities to measure the overall contribution of players to the match outcome based upon their individual batting, bowling and fielding contributions during each session. Our measure of contribution has the potential for rating players through over time and for determining the “best” player in a match, a series, or a calendar year. We use results from 104 matches (in 2010, 2011 and 2012) to illustrate the method

Comparison of intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation in terms of mean pain reduction using vas score

INTRODUCTION: The most common dislocation presenting to emergency department is anterior shoulder dislocation. Posterior dislocations and inferior dislocations are rare. Dislocations of the anterior shoulder mostly occur with the position of the arm is abducted and externally rotated. This results in injury of the humeral head, labrum, capsuloligamentous structures and glenoid. Such patients experience severe pain, therefore prompt reduction is necessary to ameliorate the pain. Intravenous analgesia combined with sedation or intra-articular lidocaine injection can be used for closed reduction of anterior shoulder dislocation. Due to its side effects, Intra-articular lidocaine (IAL) is recommended for use as a probable alternative to intravenous sedation-analgesia especially for patients with contraindication to intravenous sedation-analgesia. OBJECTIVE: To compare intra-articular lidocaine versus intravenous sedative and analgesic for management of anterior shoulder dislocation in terms of mean pain using VAS during reduction of shoulder joint. STUDT DESIGN:   Randomized controlled trial (RCT). SETTING: Removed for blind review DURATION: 6 months (November 22nd, 2017 to May 21st, 2018) SAMPLE SIZE: 60 patients (30 in each group) RESULTS: We included sixty patients in my study. 19 (31.7%) were females and 41 (68.3%) were male patients. Out of all the patients 38 (63.3%) had right sided shoulder dislocation, while the rest 22 (36.7%) patients had left sided shoulder dislocation. Patients mean age was 33.27±10.535 years and mean pain score of all the patients was 4.966±1.930. The mean pain score in Group A was 4.200±1.648, while the mean pain score in Group B was 5.733±1.910 (p value = 0.002. Stratification was done according to gender and age group of the patients, and post-stratification t-test was applied. CONCLUSION:   Intra-articular lidocaine is better option in pain control during reduction of anterior shoulder dislocation. KEY WORDS: Intra venous analgesia, Intra-articular lidocaine, shoulder dislocation

Short Communication Clinico-Therapeutic Observations on an Outbreak of Infectious Coryza

ABSTRACT A disease in commercial flock in Arifwala, Punjab (Pakistan) was reported. The birds were showing respiratory signs and their production was dropped from 85 to 60% in three days. Samples from the sick and dead birds were examined. The bacterial growth was only isolated from nasal swab on blood agar, chocolate agar and tryptose agar. The colonies appeared as small (1 mm) dew drops. History, clinical sign, symptoms, and isolation and identification of the causative agent revealed that the bacterium was Haemophilus paragallinarum