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Full-Text Articles in Orthopedics

The Functional Outcome Of Direct Lateral Approach For Fixation Of Proximal Humeral Fractures: A Case Series From A Tertiary Care Hospital, Mujahid Jamil, Irfan Anwer, Muhammed Tabish Saleem, Ahmed Abdul Habib Khan, Mohammad Zohaib Nawaz Khan Dec 2019

The Functional Outcome Of Direct Lateral Approach For Fixation Of Proximal Humeral Fractures: A Case Series From A Tertiary Care Hospital, Mujahid Jamil, Irfan Anwer, Muhammed Tabish Saleem, Ahmed Abdul Habib Khan, Mohammad Zohaib Nawaz Khan

Section of Orthopaedic Surgery

Displaced proximal humeral fractures warrant surgical fixation for early rehabilitation and better functional outcome. These fractures are traditionally fixed by delto pectoral surgical approach. Direct lateral approach has recently gained interest as it involves less soft tissue dissection and is particularly helpful in certain fracture patterns. However, there have been concerns of axillary nerve damage with this approach. We report a case series of proximal humerus fractures fixed by direct lateral approach from our institution. All displaced Type 2 and 3 fractures were included in our study. Pathological and comminuted Type 4 fractures and fractures with ipsilateral clavicle or elbow …


Effects Of Accelerated Versus Standard Care Surgery On The Risk Of Acute Kidney Injury In Patients With A Hip Fracture: A Substudy Protocol Of The Hip Fracture Accelerated Surgical Treatment And Care Track (Hip Attack) International Randomised Controlled Trial, Flavia K. Borges, P J. Devereaux, Meaghan Cuerden, Mohit Bhandari, Ernesto Guerra-Farfán, Ameen Patel, Alben Sigamani, Masood Umer, John Neary, Maria Tiboni Sep 2019

Effects Of Accelerated Versus Standard Care Surgery On The Risk Of Acute Kidney Injury In Patients With A Hip Fracture: A Substudy Protocol Of The Hip Fracture Accelerated Surgical Treatment And Care Track (Hip Attack) International Randomised Controlled Trial, Flavia K. Borges, P J. Devereaux, Meaghan Cuerden, Mohit Bhandari, Ernesto Guerra-Farfán, Ameen Patel, Alben Sigamani, Masood Umer, John Neary, Maria Tiboni

Section of Orthopaedic Surgery

Introduction: Inflammation, dehydration, hypotension and bleeding may all contribute to the development of acute kidney injury (AKI). Accelerated surgery after a hip fracture can decrease the exposure time to such contributors and may reduce the risk of AKI.
Methods and analysis: Hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) is a multicentre, international, parallel-group randomised controlled trial (RCT). Patients who suffer a hip fracture are randomly allocated to either accelerated medical assessment and surgical repair with a goal of surgery within 6 hours of diagnosis or standard care where a repair typically occurs 24 to 48 hours after …


Leaving Against Medical Advice From In-Patients Departments Rate, Reasons And Predicting Risk Factors For Re-Visiting Hospital Retrospective Cohort From A Tertiary Care Hospital, Obada Hasan, Muhammad Adil Samad, Hamza Khan, Maryam Sarfraz, Shahryar Noordin, Tashfeen Ahmad, Gul Nowshad Aug 2019

Leaving Against Medical Advice From In-Patients Departments Rate, Reasons And Predicting Risk Factors For Re-Visiting Hospital Retrospective Cohort From A Tertiary Care Hospital, Obada Hasan, Muhammad Adil Samad, Hamza Khan, Maryam Sarfraz, Shahryar Noordin, Tashfeen Ahmad, Gul Nowshad

Section of Orthopaedic Surgery

Background: Approximately 1% to 2% of hospitalized patients get discharged or leave from the hospital against medical advice and up to 26% in some centers. They have higher readmission rate and risk of complications than patients who receive complete care. In this study we aimed to determine the rate of leave against medical advice (LAMA) and reasons for the same across different in-patient departments of a tertiary care hospital.
Methods: Retrospective cohort study on patients admitted in all departments at our institute over a 1-year period. All patients who were admitted to an in-patient ward at the hospital and who …


Predictors Of An Increased Length Of Stay Following Total Knee Arthroplasty: Survey Report, Azeem Tariq Malik, Syed Hamza Mufarrih, Arif Ali, Shahryar Noordin Aug 2019

Predictors Of An Increased Length Of Stay Following Total Knee Arthroplasty: Survey Report, Azeem Tariq Malik, Syed Hamza Mufarrih, Arif Ali, Shahryar Noordin

Section of Orthopaedic Surgery

Objective: To find various preoperative, intraoperative and postoperative factors that predict an increased length of stay in patients following total knee arthroplasty.
Methods: The retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised record of patients regardless of gender, co-morbids and age who had undergone a unilateral or bilateral total knee arthroplasty between January 2007 and December 2015. An increased length of stay was defined as ≥75th centile (≥11 days).
Results: Of the 577 patients, 448(77.6%) were women. Overall, 311(53.9%) patients were aged 56-70 years. Of the total, 100(17.3%) patients stayed for at least 11 …


Microbial Colonization Of Pneumatic Tourniquets In The Orthopedic Operating Room, Syed Hamza Mufarrih, Nada Qaisar Qureshi, Rizwan Haroon Rashid, Bilal Ahmed, Seema Irfan, Akbar Jaleel Zubair, Shahryar Noordin Aug 2019

Microbial Colonization Of Pneumatic Tourniquets In The Orthopedic Operating Room, Syed Hamza Mufarrih, Nada Qaisar Qureshi, Rizwan Haroon Rashid, Bilal Ahmed, Seema Irfan, Akbar Jaleel Zubair, Shahryar Noordin

Section of Orthopaedic Surgery

Background: The rate of surgical site infections following orthopedic procedures is approximately 2% globally. Potential sources of contamination in the operating room include pneumatic tourniquets, blood pressure cuffs, and stethoscopes, among others. Our study aims to investigate microbial colonization on reusable pneumatic tourniquets stored and used in the orthopedic department of our institution and evaluate the efficacy of the cleaning protocols employed. Methods: Over a course of two weeks, 26 samples were obtained. A total of 14 pneumatic tourniquets were sampled preoperatively on Monday morning following the weekly cleaning protocol of soaking the tourniquets in sodium hypochlorite for 30 minutes …


Malignant Distal Femur Tumors Management In Children, Low Cost Innovations With Affordable Care In A Tertiary Care Hospital, A Cross Sectional Study, Masood Umer, Javeria Saeed, Obada Hussein Hasan Jul 2019

Malignant Distal Femur Tumors Management In Children, Low Cost Innovations With Affordable Care In A Tertiary Care Hospital, A Cross Sectional Study, Masood Umer, Javeria Saeed, Obada Hussein Hasan

Section of Orthopaedic Surgery

Introduction: Malignant musculoskeletal tumors in children are mostly comprised of Osteosarcoma and Ewing's sarcoma and distal femur is the most common site for primary bone tumors. This study examined the surgical management outcomes of pediatric patients (<18 years) presented in our setup with malignant distal femur tumors.
Methodology: We retrospectively reviewed the medical records of patients diagnosed with malignant sarcomas of distal femur and younger than 18 years of age who underwent limb salvage surgery during June 2009-June2017.
Results: There were 31 pediatric patients who had distal femur malignant tumors and out of them 20 patients were selected who underwent limb salvage as a primary surgery. The mean age (range) …


Can Alternate-Day Statin Regimen Minimize Its Adverse Effects On Muscle And Tendon?: A Systematic Review, Zehra Abdul Muhammad, Tashfeen Ahmad, Naveed Baloch Jul 2019

Can Alternate-Day Statin Regimen Minimize Its Adverse Effects On Muscle And Tendon?: A Systematic Review, Zehra Abdul Muhammad, Tashfeen Ahmad, Naveed Baloch

Section of Orthopaedic Surgery

Objective: To review evidence-based data with respect to safety and efficacy of alternate-day statin therapy in dyslipidaemia compared to the standard daily dose.
Methods: The literature review was conducted at Aga Khan University Hospital, Karachi from July, 2016 to August, 2017. Electronic database search was carried out to compile available literature using PubMed, Excerpta Medica database and Google Scholar. The most relevant evidence-based research articles published over 10 years were selected. The latest search was dated August 03, 2017.
Results: A total of 2,074 articles were initially located. Alternate day statin regimen was reported in 53% of articles. Adverse effects …


Rationale And Design Of The Hip Fracture Accelerated Surgical Treatment And Care Track (Hip Attack) Trial: A Protocol For An International Randomised Controlled Trial Evaluating Early Surgery For Hip Fracture Patients, Flavia K. Borges, Mohit Bhandari, Ameen Patel, Victoria Avram, Ernesto Guerra-Farfán, Alben Sigaman, Masood Umer, Maria Tiboni, Anthony Adili, John Neary May 2019

Rationale And Design Of The Hip Fracture Accelerated Surgical Treatment And Care Track (Hip Attack) Trial: A Protocol For An International Randomised Controlled Trial Evaluating Early Surgery For Hip Fracture Patients, Flavia K. Borges, Mohit Bhandari, Ameen Patel, Victoria Avram, Ernesto Guerra-Farfán, Alben Sigaman, Masood Umer, Maria Tiboni, Anthony Adili, John Neary

Section of Orthopaedic Surgery

Introduction: Annually, millions of adults suffer hip fractures. The mortality rate post a hip fracture is 7%-10% at 30 days and 10%-20% at 90 days. Observational data suggest that early surgery can improve these outcomes in hip fracture patients. We designed a clinical trial-HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) to determine the effect of accelerated surgery compared with standard care on the 90-day risk of all-cause mortality and major perioperative complications.
Methods and Analysis: HIP ATTACK
is a multicentre, international, parallel group randomised controlled trial (RCT) that will include patients ≥45 years of age and diagnosed …


Infected Non-Union Of Tibia Treated With Ilizarov External Fixator: Our Experience, Shah Fahad, Aysha Habib, Muhammad Awais, Masood Umer, Haroon Rashid Mar 2019

Infected Non-Union Of Tibia Treated With Ilizarov External Fixator: Our Experience, Shah Fahad, Aysha Habib, Muhammad Awais, Masood Umer, Haroon Rashid

Section of Orthopaedic Surgery

Introduction: Tibia is the most common long bone fractured due its vulnerable subcutaneous location and most often associated with acquired complications of delayed union or non-union due to infection. Amongst the various treatment options to treat them, the Ilizarov external fixator application is considered superior due to its multiple advantages. The objective of this study was to analyse the role of Ilizarov fixation in infected tibial non-union, as well as to assess bony union and associated functional outcomes.
Materials and Methods: A retrospective review was conducted for the duration between 1st January 2005 to 31st December 2016. Total of fifty-one …


Does Surgeon Experience Influence The Amount Of Radiation Exposure During Orthopedic Procedures?: A Systematic Review, Azeem Tariq Malik, Hamid Hussain Rai, Riaz Hussain Lakdawala Mar 2019

Does Surgeon Experience Influence The Amount Of Radiation Exposure During Orthopedic Procedures?: A Systematic Review, Azeem Tariq Malik, Hamid Hussain Rai, Riaz Hussain Lakdawala

Section of Orthopaedic Surgery

With an increasing use of intraoperative fluoroscopy in operating rooms worldwide, the topic of radiation exposure has become a major concern among hospital staff, doctors and patients alike. Since fluoroscopy has become an integral part in orthopedic intraoperative management, we sought to identify whether surgeon grade or experience plays a role in the amount of radiation used and consequently exposed. We performed a systematic review examining the association between surgeon experience and radiation exposure using primary outcome measures (radiation dose and total screening time/fluoroscopy time). To be included in the review, the study population had to compare varying surgeon experience …


Motor-Vehicle Crash Patient Injury Patterns From A Level One Trauma Center In A Metropolitan City: A Cross-Sectional Study, Obada Hasan, Sadaf Sheikh, Asad Abbas, Nida Zahid, Naveed Baloch Feb 2019

Motor-Vehicle Crash Patient Injury Patterns From A Level One Trauma Center In A Metropolitan City: A Cross-Sectional Study, Obada Hasan, Sadaf Sheikh, Asad Abbas, Nida Zahid, Naveed Baloch

Section of Orthopaedic Surgery

Introduction: Motorcycles are an inexpensive and popular mode of transportation in Karachi, Pakistan, despite the increasing number of motor vehicle injuries. Although motorcycle-related injuries have been studied previously, to our knowledge, there are no published reports on the orthopedic injuries associated with motorcycles crashes.
Methods: We conducted a cross-sectional study of medical records of patients with motorcycle-related injuries in 2015, at the Aga Khan University in Karachi, Pakistan. We reviewed the patient demographic and medical data, helmet use, the Glasgow coma score, the spectrum of injuries, length of stay, specific injury diagnosis, and final disposition of patients. Data were analyzed …


Analysing Outcomes Through Orthopaedic Trauma Registry: A Prospective Cohort Study, Tashfeen Ahmad, Zehra Abdul Muhammad, Shahryar Noordin, Ammar Humayun Feb 2019

Analysing Outcomes Through Orthopaedic Trauma Registry: A Prospective Cohort Study, Tashfeen Ahmad, Zehra Abdul Muhammad, Shahryar Noordin, Ammar Humayun

Section of Orthopaedic Surgery

Objective: To develop a registry for recording injury-specific data to identify gaps and improve care.
Methods: The prospective cohort study was conducted at Aga Khan University Hospital, Karachi, from June 2015 to July 2018 though enrollment of patients with limb trauma is continuing to date. Data on injuries and management related to Tibia shaft fractures was collected from medical records, and outcomes were assessed on follow-up visits. Internationally validated injury-specific scores were utilised for assessing functional, clinical and radiological outcomes. SPSS version 19 was used for data analysis.
Results: There were 763 patients with 825 limb injuries. Of the injuries, …


Low Cost Reconstructive Options After Musculoskeletal Tumour Resection In Developing Countries: Affordable, Effective And Durable Alternatives, Arif Ali, Obada Hasan, Ahmed Habib, Masood Umer Feb 2019

Low Cost Reconstructive Options After Musculoskeletal Tumour Resection In Developing Countries: Affordable, Effective And Durable Alternatives, Arif Ali, Obada Hasan, Ahmed Habib, Masood Umer

Section of Orthopaedic Surgery

Over the last two, three decades, the overall survival rates for non-metastatic malignant tumours of the bone have dramatically improved. This has become possible due to the recent advances and multidisciplinary approach towards these diseases, specifically the advent of multi-agent chemotherapy and radiotherapy. Limb salvage has now become the norm in the treatment of musculoskeletal tumours without compromising on the overall survival and recurrence of the disease. In the era of metal, prosthetic reconstruction has become the standard procedure specifically in the large tumours which involve the joints as this method of reconstruction helps in joint mobility and early weight-bearing. …


Inflammatory Arthritis And Mycobacterium Tuberculosis Infection: A Diagnostic And Management Challenge For Knee Arthroplasty In Endemic Areas, Obada Hasan, Riaz Hussain Lakhdawala, Vickash Kumar, Syed Faisal Mahmood, Shahryar Noordin Feb 2019

Inflammatory Arthritis And Mycobacterium Tuberculosis Infection: A Diagnostic And Management Challenge For Knee Arthroplasty In Endemic Areas, Obada Hasan, Riaz Hussain Lakhdawala, Vickash Kumar, Syed Faisal Mahmood, Shahryar Noordin

Section of Orthopaedic Surgery

Tuberculosis continues to be one of the most challenging health problems more prevalent in developing countries. Pakistan ranks 5th in tuberculosis prevalence among the high-burden countries. Prosthetic joint infection of the knee by acid fast bacilli is a rare and distressing complication, occurring in nearly 1% of primary joint arthroplasties requiring prolonged medical treatment and multiple surgeries. A recent publication extensively reviewed English literature from 1952 to 2016, and repor ted only 64 prosthetic joint infec tion with tuberculosis, of which 27 cases involved the knee. Tuberculosis is a global health problem adding to the challenges that arthroplasty surgeons face …


Arthroscopic Removal Of Loose Bodies In Synovial Chondromatosis Of Shoulder Joint, Unusual Location Of Rare Disease: A Case Report And Literature Review, Hussain Wahab, Obada Hasan, Ahmed Habib, Naveed Baloch Jan 2019

Arthroscopic Removal Of Loose Bodies In Synovial Chondromatosis Of Shoulder Joint, Unusual Location Of Rare Disease: A Case Report And Literature Review, Hussain Wahab, Obada Hasan, Ahmed Habib, Naveed Baloch

Section of Orthopaedic Surgery

Introduction: Synovial chondromatosis is a benign mono-articular arthropathy affecting synovial joints. It mostly affects knee joint, followed by hip, elbow and wrist and is rarely reported for shoulder joint. The exact pathogenesis is not known. Usual symptoms are pain, difficulty in movement due to mechanical obstruction. The classic treatment is arthrotomy, removal of chondromatoid loose bodies and synovectomy. With recent advances arthroscopic removal of the chondromatoid loose bodies is a good option with relatively better post op rehabilitation and faster recovery.
Case presentation: 20 years old gentleman presented to clinic with history of pain in right shoulder for 2 years …


Use Of Intraarticular Injections Of Platelet-Rich Plasma In The Treatment Of Knee Osteoarthritis: A Review Article, Naveed Baloch, Obada Hasan, Zain Baig, Umme-E-Hani Abdullah, Mohammad Atif, Hiroshi Ohuchi Jan 2019

Use Of Intraarticular Injections Of Platelet-Rich Plasma In The Treatment Of Knee Osteoarthritis: A Review Article, Naveed Baloch, Obada Hasan, Zain Baig, Umme-E-Hani Abdullah, Mohammad Atif, Hiroshi Ohuchi

Section of Orthopaedic Surgery

Osteoarthritis is one of the most common degenerative conditions affecting knee joint. As our understanding in the disease pathogenesis is evolving, so do the treatment modalities. One of the postulated mechanisms suggests the production of inflammatory cytokines secondary to repeated micro trauma than in turn lead to cartilage damage overtime. Cartilage being avascular structure has limited potential for repair. Based on this, recent studies have been focusing on stimulating cartilage-healing process by growth factors. This is where platelet-rich plasma comes in to light. Literature is showing promising results of platelet-rich plasma in treating knee osteoarthritis. In this review we have …


Does Surgical Approach Affect Outcome After Fixation Of Intra-Articular Fractures Of Distal Humerus?: Retrospective Cohort Study From A Level-1 Trauma Centre In A Metropolitan City, Muhammad Atif, Obada Hasan, Yasir Mohib, Rizwan Haroon Rashid, Pervaiz Hashmi Jan 2019

Does Surgical Approach Affect Outcome After Fixation Of Intra-Articular Fractures Of Distal Humerus?: Retrospective Cohort Study From A Level-1 Trauma Centre In A Metropolitan City, Muhammad Atif, Obada Hasan, Yasir Mohib, Rizwan Haroon Rashid, Pervaiz Hashmi

Section of Orthopaedic Surgery

Introduction: Fractures around the distal humerus fractures make up to 2% of all fractures. Complex intra-articular distal humerus fractures present as challenge to restore of painless, stable and mobile elbow joint. Surgical exposure to all critical structures is of paramount importance to achieve anatomic reduction. Conflict still persists regarding the choice of ideal approach. In this study we compare the effect of surgical approach triceps lifting vs olecranon osteotomy on the functional outcome after fixation of distal humerus fractures.
Methods: Non-funded, non-commercial, retrospective cohort study was conducted on patients with closed distal humerus intra-articular fractures between 2010 and 2015 at …