Journal of Pakistan Orthopaedic Association

Journal of Pakistan Orthopaedic Association

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  • Country of publisher: pakistan
  • Date added to EuroPub: 2020/Sep/30

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This journal has '13' articles

Telemedicine after COVID: An unanticipated benefit to a pandemic

Telemedicine after COVID: An unanticipated benefit to a pandemic

Authors: Benjamin J. Miller
Year: 2020, Volume: 32, Number: 02
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Abstract

Healthcare providers have been featured prominently throughout the global response to COVID-19. Images of first responders, nurses, and ICU doctors became the symbols of courage for the rest of us to follow. The roles and expectations of those on the front line are clear and their job is well defined. For others, like orthopaedic surgeons, finding our place in all of this has been more confusing. Trauma, infection, and cancer: these conditions do not stop because of a virus, but they account merely for a small subset of the whole of orthopaedic surgery. Orthopaedics by nature is a field designed to restore the health, temporarily lost, of the inherently well. Appropriately so, our patients were some of the first to have their procedures delayed, and our elective practices the least defendable to continue as the outbreak worsened.

Keywords: Telemedicine after COVID
A subjective comparative analysis of quality of Short Answer Questions(SAQ) Items between Orthopedics and Other specialties used in internal examinations in MBBS course in Medical College of Lahore

A subjective comparative analysis of quality of Short Answer Questions(SAQ) Items between Orthopedics and Other specialties used in internal examinations in MBBS course in Medical College of Lahore

Authors: Amina Husnain1, Asif Khan2, Tariq Aziz3, Faisal Nazeer Hussain4
Year: 2020, Volume: 32, Number: 02
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Abstract

ABSTRACT Objective: To compare the subjective quality of various items used in short answer questions (SAQ) papers between Orthopaedics and other specialties used in internal examinations in MBBS course in a Medical College of Lahore. Methods: This retrospective descriptive study was conducted over a period extending from 25th October 2019 to 25th February 2020 at Avicenna Medical College Lahore. Previously used short answer questions (SAQ) papers (in internal assessments) of MBBS examination were collected from various departments of medical college. They were segregated in two groups as those from Orthopedic Surgery and those from Non Orthopedics subjects like general surgery, medicine and other subjects in the Miscellaneous group. SAQ in both the groups were assessed for the level of cognitive domain like C1(Recall),C2(Identify) and C3(Analyze) level and for clinically focused and relevant scenarios. The statements were evaluated whether scientifically correct and leading to an appropriatediagnosis without providing a lead into the question that would follow. All items were checked for mistakes in language or spelling and grammar. A comparison was made and P value calculated with Chi-square test. P value of < 0.05 was considered significant. Results: A total of 12 Orthopaedic SAQ papers comprising of 84 items and 14 miscellaneous papers comprising of 101 items were evaluated and compared. The number of C1 questions in Orthopaedic SAQ papers were 24(13%),C2 questions were 32(17.4%) and C3 was 28(15.2%).In the miscellaneous group C1 questions were 33(17.4%),C2 questions were 31(16.8%) and C3 questions were 37(20.1%). The number of SAQ scenarios were focused in 74(40%) SAQ in Orthopaedics versus 48(25.9%) in miscellaneous group(P value 0.013).The quality of statement was clear in 56(30.3%) SAQ in Orthopaedics while only 14(7.6%) of the miscellaneous papers had clear statement. Spelling mistakes were detected in 12(21.1%) SAQ of Orthopaedics and 22(38.8%) in miscellaneous group. Grammatical mistakes were noted in 10(17.5%) Orthopaedics SAQ and 5(8.8%) in miscellaneous group. Conclusion: The number of Orthopaedic SAQ with cognitive levels(C3,C4) were less than other specialty SAQ. However, the quality of scenarios were better focused and statement much clear in Orthopaedic SAQ than in miscellaneous group.

Keywords: Cognition, Quality, Short Answer Questions.
The Future is Here!

The Future is Here!

Authors: Munawar Shah1, Danial Shah2
Year: 2020, Volume: 32, Number: 04
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Abstract

We live in an amazing world at amazing times as we are in the evolutionary stages of Orthobiologics. Now we are increasingly looking for biological solutions of biological problems and the best news is that it has gone from science fiction to a very real entity. Similarly access to investigations for previously impossible tasks have become a reality. Imagine a scenario when one is playing sports and hurts his shoulder and we would like to investigate him after a thorough clinical assessment. We would like to order a Magnetic Resonance Imaging (MRI) to exclude soft tissue injuries and we run into a well as the patient is claustrophobic, has a pacemaker or is overweight or has metal inside his body.1,2 Although clinical examination and MRI play a key role in diagnosis, sometimes interpretation can be unclear or even wrong.3,4 Nothing is more accurate than direct visualization, particularly when we have to determine if the patient need surgery.5,6With forward thinking and innovation technology there is now a real solution Office -Based Needle Arthroscopy.7 It is a small Gadget that will make a Big Difference to the clinical practice.8 (Fig IA, IB, IC, ID) Clinic or office based arthroscopy is by no means a new idea but it has previously failed to become widely used. This is probably due the difficulties in transferring the type of required equipments (which closely mirrored that used in operating theatres) to the clinic environment.

Keywords: Arthroscopy, keen Arthrex
Clubfoot – Today

Clubfoot – Today

Authors: Deven Taneja
Year: 2021, Volume: 33, Number: 01
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Abstract

The incidence of club foot is 4 to 6 per 1000 births and majority of the babies with club foot are born in the developing countries. 1Multiple factors are responsible for this deformity. The vascularity and the accessory muscles of the feet also have an important role to play.2,3 We also know that there is an abundance of collagen in the ligaments which are stretchable but the collagen in Tendoachillis is not stretchable therefore, Tenotomy has to be done.4 Out of many classifications of club foot, Pirani classification and the Dimeglio classification are accepted all over the world today.5 The radiography in club foot has many pitfalls6,7 whereas, the ultrasonography shows significant correlation as the non ossified Talar bones can also seen.8 The computerized pedobarography although popular in some centers also does not correlate with the clinical outcome.9 Even today the treatment of this deformity although looks simple is still challenging as it has high rate of recurrence in some countries.

Keywords: Clubfoot
Frequency of Musculoskeletal Pain Among Hospital Cleaning Workers in Tertiary Care Hospitals in Lahore.

Frequency of Musculoskeletal Pain Among Hospital Cleaning Workers in Tertiary Care Hospitals in Lahore.

Authors: Ayesha Sarfraz, Faisal Masood, Syed Faraz Ul Hassan Shah Gillani, Naima Siraj, Zamir Hussain Tunio , Ahmed Ali
Year: 33, Volume: 33, Number: 01
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Abstract

Objective: To determine the frequency of musculoskeletal pain among hospital cleaning workers in tertiary care hospitals of Lahore. Methods: This cross-sectional study was conducted in University of Lahore Teaching Hospital and Services Hospital Lahore from 3rd Septemberer 2019 to 22nd February 2020. Hospital cleaning workers of either gender and all ages fulfilling the inclusion criteria were interviewed face to fac for musculoskeletal pain complaints. The data were collected using Nordic Questionnaire and analyzed through descriptive and analytical statistics. Frequency of musculoskeletal pain in workers with normal body mass index (BMI) and those with increased BMI was compared and P value was calculated with Chi-square test (P value <0.05 was considered significant). Results: We interviewed 130 hospital cleaning workers. There were 73 (56.2%) females and 57 (43.8%) males. The mean age was 38±11.7 years. Majority (80.8%, n=105) of the hospital cleaning workers had musculoskeletal pain while only 25 (19.2%) had no pain. The pain was moderate in intensity 59 (45.3%) and sever in 46 (35.4%) workers. Low backach was reported in 31 (23.8%) workers, knee pain in 15 (11.5%) and neck and shoulder pain in 14 (10.7%) workers. Majority (53.8%, n=70) of cleaning workers did not missed their duty during the previous week inspite of musculoskeletal pain. The frequency of musculoskeletal pain was more in overweight and obese workers than normal weight workers. (P value 0.001) Conclusion: The frequency of musculoskeletal pain among hospital cleaning workers was very high. Overweight and obese workers were more prone to had musculoskeletal pain.

Keywords: Backach, Body mass index, Hospital Cleaning worker, Musculoskeletal, Pain.
Is Free Hand Technique for Pedicle Screw Insertion Safe in Setup Lacking Advance Navigation System?

Is Free Hand Technique for Pedicle Screw Insertion Safe in Setup Lacking Advance Navigation System?

Authors: Waqar Hassan1, Shams Ur Rahman 2, Mehmood Ul Hassan 3, Naeemullah4, Wali Mohammad Khan5, Syed Imran Bukhari6
Year: 2021, Volume: 33, Number: 01
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Abstract

Objective: To determine the safety of pedicle screw fixation of the spine by free hand technique in terms of screw malposition and screw related post operative complications. Methods: This descriptive study was conducted in Orthopedic department Lady Reading Hospital Peshawar Pakistan from 23rd April 2017 to 23rd March 2020. Patients of either gender and age operated with pedicle screw fixation of the spine by free hand technique using universal entry point were included. Post operative radiographs of the spine were utilized for screw position. Patients with malposition radiographic screws and those with screw related post operative complications were screened with CT scan of the spine. CT based position of the pedicle screw was classified as per Zhang classification as type 0 (good), type 1 (Acceptable), type 2 (Unacceptable) and type 3 (Grievous). Revision surgery was performed for symptomatic pedicle screws and type 2 and type 3 malposition screws. Results: The total number of patients enrolled in our study were 96. Mean age was 34.20±9 years (range 10 to 70 years). Male patients were 45 (46.9%) and female 51 (53.1%). Total number of screws were 717 with maximum number of screws (n=425, 59.27%) in lumbar spine followed by thoracic spine (n=250, 34.87%) and sacral spine (n=42, 5.86%). Radiologically 684 (95.40%) screws were within the pedicles and patients were without any symptoms while 33 (4.6%) screws were malposition. CT scan classified 29 (4.0%) malposition screws as type 1 but the patients were asymptomatic. Only 3 (0.4%) screws in two patients were symptomatic type 2 and revision was done. No screw related vascular or visceral complication was reported. Conclusion: Free hand technique of pedicle screw fixation using universal entry point is a safe and reliable method in the absence of advance navigation system. Thorough knowledge of the spine, anatomy of the vertebrae and surgeon’s experience are however mandatory for safe placement of pedicle screw with free hand technique.

Keywords: Accuracy, Free hand technique, Fluroscopy, Navigation system, Pedicle Screw, Safety, Spine.
The Efficacy and Safety of Prakash Method of Closed Reduction of Anterior Shoulder Dislocation.

The Efficacy and Safety of Prakash Method of Closed Reduction of Anterior Shoulder Dislocation.

Authors: Hassan Amir us Saqlain1, Syed Sajid Hussain2, Niaz Hussain Keerio3, Nuresh Kumar Valecha4, Masood Ahmed Qureshi5, Syed Shahid Noor6
Year: 2021, Volume: 33, Number: 01
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Abstract

Objective: To determine the effectiveness and safety of Prakash method of shoulder reduction in patients of anterior shoulder dislocation presenting to the emergency department. Methods: This cross-sectional study was conducted in the emergency department of Al Qassimi Hospital Sharjah, United Arab Emirates, from 3rd July 2018 to 3rd July 2020. All patients with anterior shoulder dislocation meeting the inclusion criteria were managed using Prakash technique. Outcome was determined in terms of successful reduction and documentation of any technique related complications. Results: A total of 100 patients with mean age 32.5 ± 8.3 years were included in this study. Males were 72 (72%) and female 28 (28%). Majority (96%, n=96) of the shoulders were successfully reduced with Prakash method. No complication related to the technique was noted. Conclusion: Prakash method of shoulder reduction had a high success rate and without any complication. We recommend this procedure as a technique of choice to reduce anterior shoulder dislocations presenting to the emergency department.

Keywords: Dislocation, Reduction, Relocation, Shoulder, Glenohumeral.
Treatment of Paediatric Supracondylar Fractures of the Humerus: Closed or Open?

Treatment of Paediatric Supracondylar Fractures of the Humerus: Closed or Open?

Authors: Arsalan Khalil Ayub1, Abdul Rehman Khan2, Syed Muhammad Khalid Karim3, Shaikh Naeem ul Haq4, Badaruddin Sahito5, Syed Abdur Rub Abidi6
Year: 2021, Volume: 33, Number: 01
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Abstract

Objective: To compare the functional outcome of paediatric supracondylar fractures of the humerus treated with closed reduction and percutaneous (CRP) K wire fixation versus open reduction (OR) and K wire fixation. Methods: The design of our study was retrospective Cohort and was conducted in Department of Orthopaedics Civil Hospital Karachi. The medical record of all the children who were operated in the time period of 8th March 2019 to 07th September 2020 for type III distal humerus fractures were reviewed. All the children fulfilling the inclusion criteria were called for follow up. Patients were divided into group A (CRP crossed K wire fixation) and group B (OR crossed K wire fixation through posterior midline incision with triceps sparing approach). Functional outcome in both groups was evaluated with Flynn’s criteria and graded as Excellent, Good, Fair (satisfactory) and Poor (unsatisfactory). The results of both group A and B were compared and statistical significance documented by calculating P value with Chi-Square test (P <0.05 significant). Results: The total number of children were 60 and divided equally into Group A (n=30) and Group B (n=30). The mean age of group A was 6±1.1 years and group B 6.9 ± 3.83 years. Male children were 21 (70%) in Group A and 18 (60%) in group B while female children were 9 (30%) and 12 (40%) in Group A and Group B respectively. in Group A children results were excellent in 21 (70%) and good in 9 (30%) children. In group B excellent results were noted in 9 (30%), good in 08 (26.6%), fair in 6 (20%) and poor in 7 (23.3%) children. The difference among the excellent, fair and poor outcome of the two groups was found significant (P Value < 0.05) Conclusion: CRP K wire fixation of supracondylar fractures of the humerus was better than OR K wire fixation because it yielded excellent and good outcome in most patients

Keywords: Fracture, Humerus, Closed reduction, K wire.
Severity and Pattern of Bony Injuries among the Victims of Motorbike Accidents presented to the Accident and Emergency Department of a Tertiary Care Hospital in Karachi.

Severity and Pattern of Bony Injuries among the Victims of Motorbike Accidents presented to the Accident and Emergency Department of a Tertiary Care Hospital in Karachi.

Authors: Malik Wasim Ahmed1, Muhammad Jamil2, Jagdesh Kumar3, Adeel Ahmed Siddiqui4, Irfan Muhammad Rajput5, Ghulam Mustafa Kaim Khani6
Year: 2021, Volume: 33, Number: 01
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Abstract

Objective: To determine the severity and pattern of bony injuries among the victims of motor bike motorbike accidents presented to the Accident and Emergency Department of Dr. Ruth K.M Pfau Civil Hospital Karachi. Methods: This descriptive study was conducted in Dr. Ruth K. M Pfau Civil Hospital Karachi from 12th January 2019 to 12th January 2020. All adult patients of motorbike accidents with extremity fractures fulfilling the inclusion criteria were included in this study. In the included subjects the locations of fracture or dislocation and whether closed or open were noted. Results: The total number of patients were 380 with mean age of 28.67 ± 12.07 years. Lower extremity fractures were noted in 273 (71.8%) patients and upper extremity in 107 (28.1%) patients. Tibia fibula was the commonest lower limb fracture documented in 157 (41.3%) patients while radius was the commonly fractured upper limb bone in 46 (12.1%) patients. Majority (75.2%, n=286) of the fractures were closed while open fractures were seen in 94 (24.7%) patients. Conclusion: Victims of motorbike accidents sustained variable bony injuries. Majority of these fractures were closed. Tibia fibula was the commonest bone fractured.

Keywords: Accident, Bone, Fracture, Injury, Motorbike, Pattern.
Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft and Endo button with Supervised Physical Therapy Rehabilitation.

Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft and Endo button with Supervised Physical Therapy Rehabilitation.

Authors: Javed Iqbal1, Zainab Aqeel Khan2, Faizan Hassan3, Behram Sidhwa4, Zeeshan Khan5, Umer Butt6
Year: 2021, Volume: 33, Number: 01
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Abstract

Objective: To determine the functional outcome of arthroscopic anterior cruciate ligament reconstruction (ACLR) using hamstring tendon as autograft and endobutton followed by supervised physiotherapy. Methods: This descriptive study was conducted in AO hospital Karachi from 2nd April 2017 to 2nd December 2020. All patients with Anterior Cruciate Ligament (ACL) tear meeting the inclusion criteria were operated arthroscopically for anterior cruciate ligament reconstruction (ACLR) using hamstring tendon as autograft and endobutton followed by 6 weeks supervised physiotherapy. The functional outcome was assessed with knee range of motion, Tegner-Lysholm score and International Knee Documentation Committee (IKDC) at 3rd, 6th and 12th months follow up and compared with pre operative values. P value was calculated with Chi-square test for statistical significance. P value < 0.05 was considered significant. Results: The total number of patients in our study were 79. The mean age was 25 ± 3 years (range 18 to 40 years). Full range of knee motion (118±60) was achieved in 75(95%) patients. The mean pre-operative IKDC score of 38.95±5 improved to 67.92 ± 2 at 6th months and to 90.73 ± 7 at 12th months follow up. The mean pre operative Tegner-Lysholm score of 51 (poor) improved to 87 (good) at 6th months and 97 (excellent) at 12th months. The Lachman’s test and pivot shift test was negative in all patients postoperatively and 56 (70.8%) patients could performed single legged hopping test without any difficulty at 6th months post operatively. Conclusion: Anterior Cruciate Ligament Reconstruction (ACLR) using hamstring tendon autograft with endobutton fixation and supervised rehabilitation yielded excellent functional outcomes in majority of our patients. We therefore recommend this protocol as treatment of choice for all patients with ACL tear.

Keywords: Anterior cruciate ligament, Arthroscopy, Endobutton, Hamstring tendon, Ligament injury, Rehabilitation
Comparison of Clinical and Radiological Outcomes of Freehand Patellar Resection Technique Versus Cutting Guide Technique in Total Knee Arthroplasty.

Comparison of Clinical and Radiological Outcomes of Freehand Patellar Resection Technique Versus Cutting Guide Technique in Total Knee Arthroplasty.

Authors: Ahmad Jamal1, M. Umar2, Imam ud Din3, Azhar Rashid4, Asad ullah Mehmood5, Muhammad Umair6
Year: 2021, Volume: 33, Number: 01
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Abstract

Objective: To compare the clinical and radiological outcomes of freehand patellar resection technique versus cutting guide technique in primary total knee arthroplasty. Methods: This randomized controlled trial was conducted in the Institute of Orthopaedics and Surgery Karachi from 1st February 2019 to 1st July 2020. All patients with primary total knee arthroplasty (TKA) fulfilling the inclusion criteria were divided randomly into patellar resection with freehand technique (group A) and cutting guide technique (group B). The post operative clinical and radiological parameters were compared in both groups and P value was calculated with Chi-square test for statistical significance. P value< 0.05 was considered significant. Results: The total number of patients in our study were 114 divided equally into group A and group B with 57 patients each. In group A male patients were 24 (42, 1%) and female 33 (57.8%). In group B male patients were 21 (36.8%) and female 36 (63.1%). The mean age of group A patients was 57.00 ± 5.60 and group B 57.65 ± 5.55 years. Post operatively slightly lesser frequency of patients had positive patellar glide test, patellar grind test, patellar edge tenderness and anterior knee pain in group A than in group B (P>0.05). No statistically significant difference in the mean values of lateral patellar tilt (LPT), lateral patellar displacement (LPD), Insall-Salvati (IS) index and hip knee ankle (HKA) angle and their outliers in both the groups were noted. (P>0.05). Conclusion: Identical clinical and radiological results were achieved by both free hand patellar resection technique and cutting guide technique. Freehand patellar resection technique however had slightly lower but not significant positive patellofemoral tests and anterior knee pain than cutting guide technique.

Keywords: Osteoarthritis, Resection, Resurfacing, Patella, Total Knee Arthroplasty.
Does Nailing Distal Tibia Metaphyseal Fracture with Modified Interlocking Nail Produce Acceptable Outcome?

Does Nailing Distal Tibia Metaphyseal Fracture with Modified Interlocking Nail Produce Acceptable Outcome?

Authors: Syed Danish Ali1, Akram Aliuddin2, Ahmed Ali3, Syed Zohaib Gulzar Naqvi4, Imran Javed5, Kamran Qureshi6, Aslam Siddiqui7
Year: 2021, Volume: 33, Number: 01
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Abstract

Objective: To determine the functional results of distal tibia metaphyseal fractures treated with modified (shortened) interlocking nail and K wire fixation of the fibula. Methods: This descriptive study was conducted in Trimax Hospital Karachi from 20th June 2017 to 20th June 2020. All adults patients with distal tibia (5cm) and fibula (≤10cm) meeting the inclusion criteria were operated with modified (distal one centimeter of the standard nail was cut) interlocking nail in the tibia and K wire in the fibula. Functional results were assessed at 6th month with the American Orthopaedic Foot & Ankle Society (AOFAS) questionnaire score and graded as excellent, good, fair and poor. Comparison of AOFAS scores in both gender, sides and fracture types was done and P value was calculated for statistical significance. P < 0.05 was considered significant. Results: The total number of patients in our study were 60. The mean age of our patients was 33 ± 11.5 years. Male patients were 51 (85%) and female 9 (15%). Right tibia fibula was fractured in 49 (81.6%) and left in 11 (18.3%). The average union time was 15 ± 4 weeks (range 13 to 18 weeks) As per AOFAS questionnaire score 36 (60%) patients had excellent outcome, 13 (21.6%) good and 11 (18.3%) had fair outcome. No significant difference was found in AOFAS scores with regard to gender, sides and type of fractures (P>0.05). Conclusion: Majority of the patients treated with modified (shortened) interlocking nail tibia and K wire fixation fibula achieved excellent and good functional outcome. We therefore recommend this treatment protocol for all patients with distal tibia and fibula fractures.

Keywords: AOFAS, Tibia, Fibula, Interlocking nail.
Limb Salvage Surgery in Paediatric Distal Femur Osteosarcoma with Partial Cortical Resection and Coraline Silicon Bone Substitute-Case Report.

Limb Salvage Surgery in Paediatric Distal Femur Osteosarcoma with Partial Cortical Resection and Coraline Silicon Bone Substitute-Case Report.

Authors: Muhammad Bilal1, Ilyas Rafi2
Year: 2021, Volume: 33, Number: 01
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Abstract

Osteosarcoma is the most common malignant bone tumor of Paediatric and adolescent age. Historically radical treatments were opted but with advances in diagnosis and neoadjuvant chemotherapy limb salvage has now become possible in most of the cases. In this case report we presented an 8 year old girl who was diagnosed with osteosarcoma of the distal femur. She was treated successfully with neoadjvant chemotherapy followed by limb salvage surgery using partial resection of medial femoral cortex with lateral cortex remains in continuity and poraline silicon bone substitute for filling the defect. She is disease free after 3.5 year and walking pain free on her limb.

Keywords: Bone substitute, Limb salvage, Neoadjvuant, Osteosarcoma

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