Functional Outcomes of Close Reduction With K-wires Vs Open Reduction and Internal Fixation in Distal Radius Fractures

Background: Radius and/or ulna fractures are frequent which encounter higher emergency room visits. Despite high incidence, proper management between closed reduction and internal fixation (CRIF) with K-wires and open reduction and internal fixation (ORIF) with anatomical Volar locking plate, remains debatable. This study aimed to compare the functional outcomes between the two management protocols. Methods: A total of 118 patients with distal radius fractures were treated operatively, at Dr. Ziauddin University Hospital Karachi, from January 2017 to October 2020. Out of these, 29 patients (24.6%) were treated with CRIF and 89 patients (75.4%) with ORIF. The functional outcomes of both groups were assessed through disabilities of arm, shoulder and hand (DASH) scores at 3 and 6 months. functional outcomes were assessed through a t-test, p-value <0.05 was considered significant. Results: The male to female ratio was 2.5:1, with an average age of 40.9 years. The Arbeitsgemeinschaft für Osteosynthesefragen (AO) 23-B type injury was observed in 29 (24.6%) patients. The mean DASH score among the ORIF group and CRIF group at 3 months was 43.03 and 46.19 (p <0.007) respectively. Whereas the DASH score of the ORIF and CRIF group at 6 months was 41.35 and 44.70 (p <0.007) respectively. Both groups at 6 months of management reported 33 (28%) patients with complete satisfaction, however, the return to work in the ORIF group was found highly significant (p=0.00). Conclusion: Open reduction and internal fixation with the distal radius locking compression plate produce functionally improved outcomes compared to K-wires for displaced distal radius fractures. Keywords: Radius, Bone Wires; Open Fracture Reduction; Fracture Fixation

Lumbar Disc Prolapse: Microdiscectomy and its Clinical Outcomes

Background: Prolapse lumbar intervertebral disc (PLID) is a localized disc displacement outside its margins is the most common source of sciatica pain, involving 1%-5% of the population annually. Standard management includes conservative management initially for a period of around 6 weeks. In general, microdiscectomy (MD) is considered a standard procedure for symptomatic cases, with approximately 60%-80% of satisfactory results. In this study, we aimed in describing experience of MD in patients diagnosed with PLID. Methods: This retrospective study has been conducted at Dr. Ziauddin University hospital, Karachi; Pakistan. The medical records from 2018 to 2020, of microdiscectomy for prolapsed intervertebral lumbar disc were studied. All patients of 18 years or more admitted with symptomatic PLID, and proceeded to single level MD have been included. The regular pre-operative work-up, surgical technique and post-operative management was followed. Data collection was performed using a standard proforma. Utilizing SPSS version 23.0, all statistical analyses were carried out a p <0.05 was considered statistically significant. Results: Mean age of patients was 43 to 42 years and Male: Female ratio was 1.6:1 and pre-operative neurological deficit was observed in 28 (42.4%) patients. Most common affected disc spaces were L4-L5 35(53%) and L5-S1 26 (39.4%). Left side disc Prolapse was found more affected as 39(59.1%) cases reported among the total. Visual analog scale (VAS) score dropped from more than 5 to no pain after surgery. Conclusion: Microdiscectomy is a safe treatment in prolapsed intervertebral lumbar disc for patients with failed conservative therapy and reported excellent outcomes with earlier surgical intervention. Keywords: Discectomy; Intervertebral Disc Displacement; Radiculopathy