a b s t r a c tPurpose: Firearm injuries impose a continuous economic burden on society and hospital resources. The aim of this study was to assess the pattern of bony injuries among victims of gunshots. Methods: A retrospective study was conducted in the Department of Orthopedics, Dow University of Health Sciences and Civil Hospital Karachi from January 2011 to December 2012. Patients with isolated bony injuries were included while patients with other systemic injuries were excluded. Results: There were 90 cases and the majority of them were male (84.4%). Mean age was (32.52 ± 10.27) years. Most of the patients (72.2%) belong to the younger age group. A low velocity weapon was used in 61 (67.8%) cases and a high velocity weapon was used in 29 (32.2%) cases. Armed robbery (64.4%) was the cause of conflict in more than half of the cases. Lower limb was involved in 72.2%. Fifty eight (64.4%) patients remained hospitalized for 15e20 days and others for more than 20 days. Internal fixation with intramedullary nailing was done in 35 patients while K-wire was used in 5 patients. Fifty patients were managed with external fixation, either uniplanar or multiplanar ilizarov. Deep wound infection and nonunion were observed more often in high velocity injuries. Conclusion: Armed robbery was the leading cause of gunshot bony injuries in our hospital. Young males were victimized in a majority of cases. High velocity injuries were associated with more complications.

Osteoarthritis is the most common articular disease. The aim of this study was to observe the outcome after intra-articular platelet-rich plasma (PRP) injection in our patients presenting with knee osteoarthritis. Methods: This study was conducted in Dow University of Health Sciences, Karachi, Pakistan, from December 2014 to December 2015. All patients between 35 years and 60 years of age diagnosed with grade I and II arthritis were included in the study. Three PRP injections were injected in the knees at 4-week interval. Patients were followed up in outpatient department (OPD) and were assessed for pain and physical activity associated with arthritis using the Western Ontario and McMaster University Arthritis Index (WOMAC) score at the time of induction in the study and at 6 months interval. Results: Two hundred fourteen patients with the mean age of 55.15 (+6.93) years were studied. Female to male ratio was 3:1. One hundred fifty-five patients were classified as having Kellgren-Lawrence grade 1 osteoarthritis, while 59 were grade 2. One hundred eighty-nine patients had clinical symptoms for less than 2 years and 25 for more than 2 years. Mean WOMAC score before the start of treatment was 83.05, and after 6 months, it was reduced to 38.84 which was statistically significant (p ¼ 0.000). WOMAC score was improved more in the subgroup with patients having symptoms less than 2 years (p ¼ 0.005). Three patients developed minor hyperemia which was managed conservatively with activity limitation and ice application, but none of the patient developed gross infection. Conclusion: The sequential use of PRP injection for the treatment of early osteoarthritis proved to be effective in our study.

After the earthquake in Battagram, young persons, especially females, were prone to orthopedic injuries, mainly involving the extremities. A comprehensive disaster plan would have helped to manage these emergencies, and further experience is needed for on-site surgical interventions.

… Background: Ponseti technique for club foot treatment has become more popular during the last decade. But the most common problem following correction by Ponseti technique is the relapse of deformity. Setting: Dow University Hospital as well as other hospitals were included in the study. Period: April 2013 to April 2016. Methods: 335 children with idiopathic club foot presented in OPD with relapse, treated with Ponseti technique. Pirani scoring was used to assess the severity of relapse. Children with both unilateral and bilateral involvement, aged up to 5 years were included. 335 children with idiopathic club feet who underwent treatment with Ponseti technique, presented with relapse of deformity were enrolled in the study. Results: There were 207(59.7%) boys and 128(37%) girls. Mean age at presentation for casting (previous treatment age) was 5.98 months (SD ±6.07), and 153(44.2%) had Right sided involvement, 112 (32.4%) had left sided involvement and 69(19.9%) had bilateral involvement. Mean age at which relapse occurred was 24.7 months (SD ±7.35). The mean Pirani score was 4.78 (SD ±4.30). Percutaneous heel cord tenotomy was done in 286 (82.7%) children. Number of cast to maintain initial correction was 7.58 (SD ±1.19).Out of 335 patients 246(71.1) used brace and out of them 123 (50%) used brace up to one year, 70 (25.5%) used for1-2 years, 30 (15.5%) used for 2-3 years and 23 (9%) used for 3-4 years. Conclusion: Ponseti method is safe and effective method of treatment for club foot. Despite the proper use of Ponseti method, relapses and recurrences still occurs due to certain factors. The best treatment for recurrent club foot is prevention in the form of consistent primary treatment, constant use of braces and regular follow up