Introduction: The increasing use of minimally invasive orthopedic procedures has led to a greater reliance on fluoroscopy, resulting in elevated radiation exposure for surgeons. This study aimed to evaluate the knowledge, awareness, and daily practices of orthopedic surgeons regarding radiation safety in an academic hospital. Understanding radiation safety is crucial to minimize patient exposure and prevent adverse effects on surgeons. Methods: This cross-sectional study was conducted at the Department of Orthopedics of different tertiary care hospitals in Rawalpindi, Pakistan. Data were collected prospectively for two years, and a total of 505 participants, including residents, consultants, and operation theatre assistants, completed a questionnaire. The questionnaire was validated by experts and covered information on fluoroscopy usage, frequency of surgeries, awareness of radiation safety, and protective measures. Ethical approval was obtained, and data were analyzed using SPSS version 26.0. Results: The majority of participants were male (74.1%), and the sample included various ranks of orthopedic surgeons. Only 56.2% of participants were aware of the usage of fluoroscopy, and 40.2% had read some research on the topic. While 44.6% used lead aprons for radiation protection, the usage of other protective measures and dosimeters was limited. The mediation analysis showed an insignificant indirect association between the rank of orthopedic surgeons, number of surgeries performed, and fluoroscopy usage as a mediator. Awareness and reading research on fluoroscopy were significantly associated with radiation protection. Conclusion: The knowledge, awareness, and daily practices of orthopedic surgeons regarding radiation safety in fluoroscopy use need improvement. The findings emphasize the importance of implementing training programs, providing radiation protection devices, and ensuring compliance with safety guidelines.

No abstract

Introduction: Pseudomonas aeruginosa is a worldwide nosocomial infection that disrupts hospitalized patient's recovery. Use of the proper antipseudomonas antibiotic therapy is an expected challenge among health care providers. Methods: This is a cross-sectional in-vitro study which was conducted in Isfahan in 2016-2017. After selection of the patients with P. aeroginusa infection and isolation of bacteria, the presence of AME coding genes such as aac(6')-II and ant(2'')-I was surveyed by PCR method. Result: From 350 patients with P.aeruginosa infection, 100 samples were obtained. About half of the strains were taken from urine samples and respiratory tract swap. 93% of Pseudomonas aeruginosa strains were resistant to at least one antibiotic. The highest antibiotic resistance was dedicated to Tobramycin and Meropenem. However, all strains were sensitive to Colistin. In regard to AME genome, 13 specimens had ant(2'')-I and 4 strains had aac(6')-II genes. aac(6')-II gene caused 75% resistance to Amikacin, Tobramycin, and Gentamycin while ant(2'')-I gene posed Tobramycin and Gentamycin resistance. Conclusion: Overall, there was a high resistance ratio to various aminoglycosides, B-lactams, and fluoroquinolones isolated from infected patients. Less than 20% of strains demonstrated AME genes of aac(6')-II and ant(2'')-I.

Objective:The aim of this study is to determine the aetiology of TKA failure and to measure the functional outcome of patients underwent revision TKA. Study Design:Prospective study Place and Duration:In the department of Orthopedic, Mardan Medical Complex, Mardan, Fauji Foundation Hospital, Rawalpindi and Muhammad Medical Hospital, Mirpurkhas for duration of one year August 2020 to July 2021. Methods:Total sixty patients of both genders were presented in this study. Age of the patients was between 25-75 years.This research included all patients who had previously had a primary total knee replacement and had subsequently had a revision total knee arthroplasty. Revision arthroplasty was warranted based on the evidence. WOMAC questionnaire was used to evaluate the functional outcomes of revision total knee arthroplasty after 8 months of follow-up treatment. Pre and post-operative WoMAC scores were compared using the Student-t test and a P value was determined. Statistical significance was defined as a p-value of 0.05 or less. We used SPSS 20.0 to analyze all data. Results:There were majority females 48 (80%) and 12 (20%) patients were males.Mean of the patients was age 61.5±4.45 years and had mean Body mass indexwas 26.31±7.42 kg/m2. Majority of the cases 42 (70%) had left knee revision arthroplasty. Bilateral revision was performed in 9 (15%) cases and unilateral revision was done in 51 (85%) cases. Before revision arthroplasty function score, stiffness score and WOMAC pain score was significantly higher 70.8±6.12, 10.1±3.17 and 20.5±6.14 as compared to post revision 11.7±6.19, 4.1±6.3 and 3.0±5.11 with p value <0.05.We found infection was the most common aetiology of revision found in 27 (45%) cases followed by stiffness in 15 (25%), loosening in 13 (21.7%) cases and periprosthetic fracture found in 5 (8.3%) cases. Conclusion: The results of our investigation led us to the conclusion that infection was the most prevalent reason for revision arthroplasty in our study population. When we performed revision arthroplasty, the majority of our patients had satisfactory functional outcomes. Keywords: Revision TKA, Aetiology, Outcomes

Objective: The purpose of this study is to determine the functional and radiological outcomes of modified stoppa approach for fixation of acetabular fractures. Study Design: Descriptive Study Place and Duration: Study was conducted at Orthopaedic department of Ayub Teaching Hospital Abbottabad, Fauji Foundation Hospital, Rawalpindi and Islamabad International Hospital E-11/4, Islamabad for duration of two years form July 2019 to June 2021. Methods: There were thirty patients of both genders who had acetabular fractures were presented. Included patients were aged between 18-55 years. Patients' age, sex, body mass index and cause of fractures were recorded after taking informed written consent. Types of acetabular fractures were also recorded. Modified stoppa approach was used to operate acetabular fractures. Outcomes were operative time, radiological and functional outcomes were assessed in terms of excellent, good, fair and poor results. Post-operative complications and patients' satisfaction was also calculated. We used SPSS 24.0 version to analyze complete data. Results: Among 30 cases, majority of the patients 20 (66.67%) were males and 10 (33.33%) were females with mean age 29.4±10.37 years. Mean body mass index of the presented patients was 23.7±7.25 kg/m2. RTA was the most common cause found in 17 (56.67%), followed by fall from height in 8 (26.67%) and 5 (16.67%) fractures had other causes. Anterior wall fracture was the most common type found in 14 (46.67%) cases. Mean operative time was 3.87±13.18 hours. As per radiological outcomes, frequency of anatomical reduction found in 21 (73.3%) cases, not perfect found in 5 (16.67%) cases and poor results found in 4 (13.3%) patients. Majority of the cases 18 (60%) had good results in functional outcomes, excellent results in 7 (23.3%), fairs results in 3 (10%) cases and poor in 2 (6.67%) cases. Post-operative complications found in 2 (6.67%) cases. Satisfaction rate among patients was 86.67%. Conclusion: We found in this study that the use of stoppa approach for fixation of acetabular fractures was effective and safe method in terms of good radiological and functional outcomes. Except this less operative time and less number of complications were calculated with high number of customer’s satisfaction. Keywords: Acetabular Fractures, MSA, Complications, RTA