Introduction Intertrochanteric fractures are the most frequently operated fracture type and have the highest postoperative fatality rate. The most commonly used devices are the dynamic hip screw (DHS) with side plate assemblies and proximal femoral nail (PFN). The aim of this study was to determine the functional and radiological outcome of unstable intertrochanteric fracture post DHS fixation at a tertiary care hospital in Karachi, Pakistan. Methods A study was carried out in the department of orthopedics at the Jinnah Postgraduate Medical Center (JPMC), from 12th June 2016 to 8th September 2017. A total of 106 patients between 18 and 75 years of age with unstable intertrochanteric fracture were included. Those patients who had multiple injuries and open fractures, subtrochanteric fractures, intracapsular fractures neck of femur, pathological fractures and patients who were non-ambulatory prior to their injury were excluded. Functional outcomes were measured both during pain using the visual analog scale and range of motion on goniometer between 80 and 100 degrees. Satisfactory outcomes were measured after three months. Results A total of 106 patients with the radiological diagnosis of the unstable intertrochanteric fracture having post DHS fixation were included in this study. Out of which, 69.8% (74) were males and the mean age was 66.61 ± 7.79 years over the range of 50 to 80 years. Patients with type II diabetes were 22.6% (24) with a mean duration of 4.3 ± 8.37 years. At the end of three months, no pain was reported in 82.1% (87) patients and 85.8% (91) patients had normal function. The satisfactory radiological outcome was observed in 86.8% (92) patients. Overall, acceptable outcomes were observed in 81.1% (86) patients at the end of three months. Conclusion The treatment of unstable intertrochanteric fracture with dynamic hip screw (DHS) fixation results in better outcomes. In our study, we observed acceptable outcomes in a vast majority, 81.1%, of patients after three months of DHS fixation of the unstable intertrochanteric fracture.

BackgroundCrescent fracture-dislocation of sacroiliac joint is a type of lateral compression pelvic injury associated with instability. These fractures comprise 12% of lateral compression fractures.ObjectiveThe objective of this study is to share the experience and to assess the functional outcome of fixation in crescent fracture-dislocation.MethodsWe analyzed a descriptive case series with clinical data of 15 patients at the Department of Orthopedics Surgery at the Dr. Ruth K.M. Pfau Civil Hospital at Dow University of Health Sciences in Karachi, Pakistan, from January 2016 to August 2018. The patients were treated by closed and open fracture reduction and fixed with percutaneous screws and reconstruction plates.ResultsA total of 15 patients were included in this study with age ranging from 20 to 60 years (11 men [73%]; four women [27%]). According to the mechanism of injury, five (33%) had motorcycle accidents; four (27%) had collision while sitting in a car; three (20%) were pedestrians hit by a vehicle; four (27%) were injured while sitting in van; two (13%) had bus-related injury, and one (6.5%) presented with a history of wall collapse.Five (33%) patients had type I fractures, seven (47%) had type II fractures, and three (20%) had type III fractures Associated injuries were midshaft femur fracture in two patients, contralateral superior and inferior rami fracture in three patients, and open tibia fracture in one patient. All fractures were fixed with reconstruction plates and screws. Patients were kept as non-weight-bearing on the injured joint for three weeks, mobilized non-weight-bearing on the contralateral leg after three weeks, and partial weight-bearing was started at eight weeks; full weight-bearing was started after three months. Nine patients (60%) had excellent outcomes, three (20%) had a good outcome, and three (20%) had a poor outcome.ConclusionCrescent fracture-dislocations are unstable injuries. These fractures should have proper reduction and fixation that will reduce pain, malunion, and shortening.

Objective: The objective of the current study was evaluation of outcome of tendon transfers in high radial nerve palsy for restoration of power and function of wrist and hand in Karachi, Pakistan. Methodology: A descriptive case series with clinical data of 17 patients was analyzed at the Department of Orthopedics Surgery at the Dr. Ruth K.M. Pfau Civil Hospital at Dow University of Health Sciences in Karachi, Pakistan, from January 2018 to December 2021. Patients who were diagnosed with high and low RNP were registered. Those with multiple injuries which might have caused considerable disability (polytrauma patients) or those suffering from brachial plexus lesions were excluded. Results: Out of seventeen patients, 14 (85%) were male while 03 (15%) were femalewith mean age of 29.5 years. There were 65% right-sided injured patients. Mean of the Disabilities of the Arm, Shoulder and Hand (DASH) scores was 11.44 ± 3.35 with 94.1% patients in minimal disability category whereas 5.88% patients moderately disable.Motor power of wrist and finger extension was significantly improved between the preoperative period and three months post-operatively, between the pre-operative period and six months. Conclusion: Tendon transfers treating radial nerve palsy have positive functional outcomes in terms of wrist extension, finger extension, and handgrip strength, as well as positive patient satisfaction as measured by Quick DASH ratings. Tendon transfers help restoring nonfunctional dangling wrist and hand into functional powerful wrist and hand. Keywords: Radial nerve palsy, tendon transfers outcome, DASH scores

Objective: We aimed to evaluate the results of using a First and Second Inter-Compartmental Supraretinacular Artery (1,2-ICSRA) based vascularized bone graft (VBG) when performing Herbert screw fixation in scaphoid nonunion. Methodology: This is a retrospective study from January 2017 to August 2020 with a total of 16 patients. All those aged<50 years, fracture <2 yrs old, no previous surgical intervention on the fracture, and stage 1 or 2 degenerative changes at the fracture site were included. Patients with avascular necrosis of the scaphoid were excluded. All patients were radiologically examined. Herbert screw fixation was done under general anesthesia and a wedge-shaped VBG from the radius was placed at the nonunion site. Results: There were 12 males and 4 females with a mean age of 30.25±8.88 years. Chronic wrist pain at rest was completely relieved in all patients while the pain with motion was markedly diminished in 10 and eliminated in two. The average range of motion, pinch, and grip strength of the wrist improved after surgery. Power assessment showed that the mean power before surgery was significantly raised from 67.50±5.83 to 95.06±4.45 Kgs (p=0.001). The mean intensity of pain before surgery i.e. 5.54±1.36 reduced to 2.25±0.78 (p<0.001). Conclusion: We found excellent results when used Herbert screws along with a 1,2-ICSRA based VBG in patients with scaphoid nonunion, where the union was achieved in all and significant improvement was seen when power and pain were assessed.

Resumo Objetivo Este é o primeiro estudo a estabelecer a utilidade da curetagem estendida com ou sem enxerto ósseo em tumores de células gigantes (TCGs) de grau II na articulação do joelho com o objetivo de explorar os resultados funcionais pós-operatórios. Métodos Revisamos retrospectivamente 25 casos de TCGs de grau II de Campanacci submetidos a curetagem estendida entre janeiro de 2014 e dezembro de 2019. Os participantes foram divididos em 2 grupos: um grupo de 12 pacientes foi submetido a curetagem estendida com aloenxerto ósseo e cimento ósseo, enquanto o outro grupo, com 13 pacientes, foi submetido a curetagem estendida apenas com cimento ósseo. A qualidade de vida foi avaliada pela Pontuação Revista da Musculoskeletal Tumor Society (MTS, na sigla em inglês) e pela Pontuação da Knee Society (KS, na sigla em inglês), enquanto as taxas de recidiva e complicações foram avaliadas em cada coorte na última consulta de acompanhamento. O teste de Fisher e os testes t de duas amostras foram usados para comparação de resultados categóricos e contínuos, respectivamente Resultados A média de idade dos pacientes foi de 28,09 (7,44) anos; 10 (40%) pacientes eram do sexo masculino e 15 (60%) pacientes eram do sexo feminino. O fêmur distal e a tíbia proximal foram acometidos em 13 (52%) e 12 (48%) dos pacientes, respectivamente. Não houve diferença significativa na pontuação revista da MTS (25,75 versus 27,41; p = 0,178), na pontuação da KS (78,67 versus 81,46; p = 0,33) e nas taxas de recidiva (0 versus 0%; p = 1) e complicações (25 versus 7,69%; p = 0,21). Conclusões A curetagem estendida com ou sem aloenxerto ósseo tem resultados funcionais semelhantes em pacientes com TCGs de grau II no joelho, sem qualquer diferença importante na incidência de recidivas e complicações. No entanto, a conveniência cirúrgica e o custo-benefício podem favorecer a utilização apenas de cimento ósseo, enquanto a prevenção da osteoartrite em longo prazo precisa ser investigada para favorecer o enxerto ósseo.