Comparing the Techniques for Management of Closed Tibial Fractures

Objective: The objective is to compare the radiological outcome of closed interlock intramedullary nailing versus dynamic compression plating in closed tibial fracture. Methodology: The study took place in Department of orthopedics Nishtar Hospital Multan from 9th July 2016 to March 2017. Study design is randomized controlled trials. There were 302 patients divided in two equal groups of 151. Permission was taken from the ethical committee of Nishtar Hospital. The 302 patients in age group 20-50 years of both genders meeting the inclusion and exclusion criteria attending the outpatient clinic or admitted to the orthopedics department through emergency were included in the study. All the data entered and analyzed using computer software SPSS version 10. For quantitative variables like age and duration of fracture mean and standard deviation was calculated. For categorical variables like gender, malunion and infection frequency and percentage were calculated. Chi-square test was applied to compare the malunion and infection in both groups. A p value 0.05 was considered statistically significant. Results: The 100% (n=302) patients were divided into 2 groups equally, 151 in each, i.e. intramedullary nail (group 1) and dynamic compression plating (group 2). The main outcome variables of this study were the malunion and infection. It was observed that malunion presented as 57% (n=86) and 70.9% (n=107) in group 1 and group 2 respectively. It was also observed that infection presented as 23.2% (n=35) and 37.1% (n=56) in group 1 and group 2 respectively. After applying chi-square test, it was noted that malunion associated with groups having p-value 0.012. But it was not associated with gender, stratified age and duration of fracture having p-values 0.497, 0.800 and 0.218 respectively. Similarly, after applying chi-square test, it was noted that infection associated with gender and groups having p-values 0.007 and 0.008 respectively. But it was not associated with stratified age and duration of fracture having p-values 0.565 and 0.344 respectively. Conclusion: Closed interlock intramedullary nailing has malunion and infection rates less than dynamic compression plating. So closed interlock intramedullary nailing is preferred method of closed tibia diaphyseal fracture treatment. Keywords: Intramedullary nailing, closed tibia diaphyseal fracture, dynamic compression plating

Efficacy of the Epidural Blood Patch for the Treatment of Post Epidural Puncture Headache

Objective: To evaluate the efficacy of the epidural blood patch for the treatment of post-Dural puncture headache (PDPH). Patients and Methods: This cross sectional study was conducted in the Department of Anesthesia and Intensive care, Nishtar Hospital Multan. Out of total 326 patients, 186 were male 140 were female. Patients having age 16 years and above, presented with PDPH started from previous 24 hours up to last six days were included in the study. Efficacy of treatment was measured on patients comment about relief from pain after PDPH. Chi-Square along with Fisher exact test was used to see effect modification. Results: Overall, there were 326 (100%) patients in this study, among them 57% (n=186) were males and 43% (n=140) were females. ASA-1 and ASA-2 noted as 73.3% and 26.7% respectively. The main outcome of this study was efficacy of treatment. It was observed that after 1st patch, efficacy was noted as good in 75.8% (n=247) patients, while after 2nd patch it was good in 97.5% (n=318) patients. There was significant difference between the efficacy of 1st and 2nd patch. (P value=0.000), according to Fisher exact test. Conclusion"Results of our study concluded that epidural blood patch (EDBP) is the better choice for treatment of epidural puncture headache (EDPH). If one time it is incompletely effective its 2nd patch can be considered