Abstract:
Introduction:
CoVID-19 (Coronavirus disease) pandemic has involved the whole globe and exposed the limitation of health care system of different countries. Although , different countries have introduced various modalities to protect both general population and health care provider to counter this world health crises but still lacked immensely leading to higher probability of contracting disease .We followed standard protocols and sharing our experience of 2688 cases. Physiological stress compromise immunity of patient result in increasing complications .We also determined rate of mortality and infection in covid and non- covid patients.
Methods:
Clinical data of 2688 patients was assessed retrospectively who underwent orthopaedics surgeries during the period of COVID-19 wave in Pakistan at Ghurki Trust Teaching Hospital in Lahore, between march 19 to June 30, 2020.Hospital protocol for Covid screening was followed including questionnaire soughting respiratory symtoms,travel history, contact history and investigations like CBC, CRP and chest radiography. HRCT and nasopharyngeal PCR swabs are only performed in highly suspicious patients.
Results:
Out of 92 highly suspicious patients ,71 came out to Covid-19 positive. Group A patients were significantly younger compared to group B (32.1±18.9 vs. 40.6±26.9, p value 0.008). There was male preponderance in both groups. Lower limb trauma constituted more than half of workload. Majority of patients were given spinal anaesthesia. Operative time was significantly higher in group B (p value <0.0001). Post-operatively, proportion of patients requiring admission to ICU was significantly higher for patients who were COVID positive (p-value 0.002). In 30 day post-operative period 3 (4.2%) COVID positive and 59 (2.3%) COVID negative patients died (p-value 0.22).
Conclusion:
In this retrospective surgical audit , mortality and complications were equivocal when Covid positive patients were matched with non Covid patients. Therefore ,it is suggested we should continue treating patients .However, protocols and necessary preventive measures should be followed.
Objective: To find out outcome of retrograde nailing in the treatment of extra articular supracondylar femur fractures. Study Design: A prospective observational study. Place and Duration of the Study: The Department of Orthopedic Surgery, Ghurki Hospital, Lahore, Pakistan from January 2020 to August 2021. Methodology: A total of 92 patients of both genders aged 18 to 50 years with supracondylar femur fractures and supracondylar fractures with fracture line extending to distal third of femoral shaft were enrolled. Retrograde nailing was performed among all patients. Surgery time and functional outcome were noted. All surgeries were accomplished under spinal/epidural or general anaesthesia. Results: Out of a total of 92 patients, there were 59 (64.1%) were male and 33 (35.9%) female. Overall, the mean age of patients was 33.12±9.08 years. The mean surgery time was noted to be 85.29±7.48 minutes. A total of 85 patients completed the designated period of 12-weeks for the evaluation of functional outcome. Excellent outcomes were observed in 47 (55.3%) cases, good 25 (29.4%), fair 9 (10.6%) and poor in 4 (4.7%) cases. Excellent to good outcomes were observed in 72 (84.7%) cases. Conclusion: Retrograde nailing had good outcomes in the treatment of extra articular supracondylar femur fractures. Keywords: Femur fracture, nailing, surgery time, functional outcome.
Objective: To report the early experience, the relationship of surgical site infection after pelvi-acetabular fracture fixation with certain possible risk factors, and organizational protocol for emergency pelvic surgery currently being used during the COVID-19 pandemic by an integrated team of orthopedic surgeons. Study Design: Prospective study. Setting: Department of Orthopedic and Spine Surgery, “Ghurki Trust Teaching Hospital Lahore, Pakistan. Period: March 2020, to August 2020. Material & Methods: A total of 25 patients diagnosed with acetabular fractures were included. Fracture patterns were classified according to judet and letournel and young burgess classification systems. Factors studied included patient’s age, gender, body mass index, fracture pattern, type of surgery, comorbidities, smoking status, associated injuries, surgical site infections and mortality. Results: In a total of 25 patients, 21(84.0%) were male and 4(16.0%) female patients with overall mean age as 38.04±14.58 years. Overall, mean BMI was 23.20±2.60 kg/m2. There were 12(48.0%) patiens who had hypertension while 4 (16.0%) smokers. There were 21 (84.0%) patients who did not have any associated injuries while 3 (12.0%) had the associated extremities. The mean hospital stay of the patients was 5.08±0.76 days. The results revealed no significant association of Gender with these parameters (p > 0.001). Conclusion: There is no added risk of infection and mortality for the provision of emergency trauma services to pelvi-acetabular fractured patients even during panic and pandemic situations.
Objective: To compare outcome of retrograde nailing versus locked compressive plating in the treatment of extra articular supracondylar femur fractures. Study Design: A randomized prospective trial. Place and Duration of the Study: Department of Orthopedic Surgery, Ghurki Hospital, Lahore, Pakistan from January 2020 to November 2021. Methodology: A total of 160 (80 in each group) patients aged between 18 to 50 years of both genders with extra articular supracondylar femur fractures were randomized into either retrograde nailing group (Group-A) or locked compressive plating (Group-B). Surgery time and functional outcome were compared in both groups. Demographic characteristics along with mean surgery time and functional outcomes were compared between both study groups. Results: In a total of 160 patients, mean age was 33.57±9.45 years. The mean age in Group-A was 33.24±8.61 years and in Group-B 33.90±10.26 years. In group-A, there were 49 (61.25%) male and 31 (38.75%) female cases while in group-B there were 56 (70%) male and 24 (30%) female cases. The mean surgery time in group-A was significantly less as compared to group-B (83.29±7.48 minutes vs. 106.62 ± 7.69 minutes, p<0.01). The frequency of excellent to good outcome was statistically higher in Group-A as compared to Group-B (p< 0.05). Conclusion: Retrograde nailing gave better results in the treatment of extra articular supracondylar femur fractures when compared with locked compressive plating. Retrograde nailing can be opted to reduce the surgery time and gain better functional outcome. Keywords: Femur fracture, nailing, plating, surgery time, functional outcome
Objective: The determine the functional outcome of custom-built fixed hinged prosthesis for tumors around the knee.
Methods: This descriptive study was conducted in Department of Orthopedics & Spine Surgery Ghurki Trust Teaching Hospital Lahore from 3rd January 2015 to 3rd January 2021.All adults patients of either gender and age with tumours of distal femur,proximal tibia or both fulfilling the inclusion criteria were operated for custom-built fixed hinged prosthesis.Post operative functional outcome was determined using Musculoskeletal Tumor Society(MSTS) system and results were graded as excellent(75-100%), moderate (70-74%), Good (60-69%), Fair(50-59%) and Poor (<50%) outcome.Functional outcome was compared for type of tumor,gender and site of tumour and P value calculated with simple Pearson Chi-Square test.P value<0.05 was considered significant.
Results: A total of 34 patients were included in our study.The mean age was 30.65±14.23 years.Male patients were 23(67.6%) and female 11(32.4%). Osteosarcoma was present in 25(73.5%) patients,Giant cell tumour in 5(14.7%) and Ewing Sarcoma in 4(11.8%). Tumor involvement of the distal femur was present in 25(73.5%), proximal tibia in 7(20.6%) and both femur and tibia in 2(5.9%) patients. The mean Musculoskeletal Tumor Society(MSTS) score at 2.5 years was 73%(range 34% to 95%).Excellent functional outcome was noted in 22(64.7%), moderate in 2(5.9%),good in 7(20.6%), fair in 1(2.9%) and poor in 1(2.5%). No significant difference was noted when functional outcome was compared for gender,type of tumour,stage of tumor,location of tumor, side of tumor and type of stem fixation (P>0.05).
Conclusion: Custom-built fixed hinge prosthesis for tumors around the knee yielded excellent functional results in majority of our patients. We found custom build fixed hinged endoprosthetic reconstruction safe and effective technique for limb salvage in cases of distal femur and proximal tibia tumors.
Aim: To find out if there was a negative impact or consequence of performing surgeries related to sports injuries during COVID-19 period when most of the hospital services were suspended all over the globe. Study design: Prospective study Place and duration of study: Department Orthopaedic and Spine, Ghurki Trust Teaching Hospital, Lahore from 19thMarch 2020 to 6thAugust 2020. Methodology: Seventy patients with sports injuries were enrolled. The history and thorough clinical examination, X-rays and CBC along with other relevant investigations were recorded. The patients were discharged in 24 to 74 hours period intervals and all the necessary SOPs regarding COVID-19 were strictly followed. Results: None of the patients who underwent procedure developed infection or acquired coronavirus illness after discharge from the hospital or during follow-ups in OPD. Conclusion: The surgeries performed during COVID-19 did not result in wound infection or patient-related mortality. Keywords: Anterior cruciate ligament (ACL), Arthroscopy, COVID-19, Pandemic, Posterior cruciate ligament (PCL), Sports injuries, Infection, World Health Organization (WHO)
Objective: To report the outcome in terms of union in cases treated with interfragmentary screw fixation of displaced extra-articular metacarpal fractures. Study Design: Retrospective study. Place and Duration: The Department of Orthopedic surgery, Ghurki Trust Teaching Hospital Lahore, Pakistan from January 2021 to December 2021. Methodology: During the study period, a total of 79 cases of both genders aged 18-60 years with unilateral displaced metacarpal fractures within 2 weeks and undergoing interfragmentary screw fixation were analyzed. A special format was designed to record all study data. Information like gender, age (years), side involvement (left or right) and occupational details were noted. Patients were followed up till 16th week to label the union at the last follow up. Results: In a total of 79 cases undergoing interfragmentary screw fixation for displaced extra-articular metacarpal fractures, 49 (62.0%) were male and 30 (38.0%) female representing a male to femal ratio of 1.6:1. The mean age was noted to be 37.64±11.81 years while 51 (64.6%) cases were aged between 18-40 years. Residential status of 54 (68.4%) cases was rural. Socio-economic status of 43 (54.4%) cases was low. Right side was involved in 50 (63.3%) cases. Thirty two patients (40.5%) were manual workers. Table-1 is showing socio-demographic characteristics of all cases undergoing interfragmentary screw fixation for displace extra-articular metacarpal fractures. At the final follow up (16th week), union was reported in 75 (94.9%) cases while remaining 4 (5.1%) cases were having non-union. Practical Implications: Comparative studies are necessary to further establish the efficiency of contemporary approaches regarding treatment of extra-articular metacarpal fractures. Conclusion: Outcomes in terms of union in cases treated with interfragmentary screw fixation of displaced extra-articular metacarpal fractures were very good. Keywords: Interfragmentary screw fixation, metacarpal fracture, outcome, union.
Objective: To compare the frequency of union in cases treated with percutaneous intramedullary kirschner wire versus interfragmentary screw fixation of displaced extra-articular metacarpal fractures. Study Design: Randomized controlled trial. Place and Duration: The Department of Othropedic surgery, Ghurki Trust Teaching Hospital Lahore, Pakistan from May 2021 to November 2021. Methodology: A total of 70 cases (35 in each group) of both genders aged 18-60 years with displaced extra-articular metacarpal fracture were included. Surgery was performed with the patient under peripheral anesthesia adopting pneumatic tourniquet and image intensification. Patients were randomly divided into 2 groups, undergoing either percutaneous intramedullary K-wire fixation or interfragmentary Screw Fixation. Patients were followed up till 16th week to see the union. Results: The mean age of patients in K-wire group was 37.89±9.34 years and in screw fixation group was 40.17±12.82 years. In K-wire group, there were 24 (68.57%) male and 11(31.4%) female cases while in Screw fixation group there were 17 (48.6%) male and 18 (51.4%) female cases. In K-wire group, 20 (57.1%) cases reported union while in Screw fixation group, 33 (94.3%) cases reported union at the final follow up (p<0.001). Practical Implications: Interfragmentary screw fixation in displace extra-articular metacarpal fractures yielded better outcomes. Conclusion: Significantly more cases treated with interfragmentary screw fixation of displaced extra-articular metacarpal fractures reported union in comparison to percutaneous intramedullary kirschner wire. Keywords: Metacarpal fractures, internal fixation, intramedullary K-wire, screw fixation, union.
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