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The femur fractures usually happen with oomph forces like motor vehicleaccidents. Objectives: To assess the mode of injury and complications of the management, indiaphyseal femoral fractures, in comparison of close versus open intramedullary interlockingnail (IMN). Study Design: Experimental and comparative study. Period: April 2013 to March2014. Setting: Department of Orthopaedic Surgery, Peoples University of Medical & Healthsciences, Nawabshah. Methods: The cases were divided into two groups A and B. Group Awas treated by open nailing (n = 20) and group B by close nailing (n = 20), all the cases wereoperated within 48 hours of admission. All the data were recorded on well structured proforma.Serial radiographies were performed at 3, 6, 12 weeks, and 6 months; additional radiographieswere performed as needed postoperatively. Knee, ankle, and hip motions were begun andprotected weight bearing was started on the second day postoperatively and increasedgradually to full WB depending on x-ray findings of callus formation. The patients were followedfor two years. Results of open and closed I.M.N were assessed and the complications if anywere observed over a mean follow-up period of two years. Results: The mean age in groupA was 29.40 years and the mean age in group B was 30.45 years. Out of 40 cases, 32(80.0%)were males with male to female ratio 1:4. Mean ± SD hospital stay was 19.80 ± 14.60 days ingroup A, and 17.90 ± 5.95 days in group B (p value 0.55). Average time between injury andadmission was 1.53 days (n = 40), in the group A it was 1.05 days, and in the group B it was2.0 days (p value 0.03). The average of time between injury and operation in the group A was8.75 days, and in the group B, it was 8.20 days, (p value 0.71). The average of time betweenadmission and discharge in the group A was 11.0 days, and in the group B was 9.15 days,(p value 0.55). Mean ± SD union time was 11.70 ± 6.45 weeks, in group A and 11.90 ± 5.77weeks, in group B. (p value 0.91). All the patients had full ranged of hip motion and 2 (10.0%)patients of group A had mild limitation of knee motion with a flexion ranges between 80 and110 degrees. Final functional results based on Thoresen BO criteria16. Excellent results wereobserved in 19 (47.5%) cases, out of them 5(25.0%) were in group A and 14(70.0%) were ingroup B. Good results were found in 13(32.5%) patients, out of these 7(35.0%) were in group Aand 6(30.0%) were in group. Fair and poor results were detected in 4(10.0%) cases of group A.Conclusions: Road traffic accidents by motorcycle was found the commonest (47.5%) causeof femur fracture, a few complications were observed in open interlocking nailing as comparedto closed interlocking nails.

Objectives: To determine the outcome and various complications in the management of comminuted intra articular fractures of distal radius in adults treated with closed reduction associated with Percutaneous Pinning. Study Design: Observational study. Setting: Department of Orthopaedic PUMHS, Nawabshah. Period: January 2017 to December 2018. Material and Methods: 45 consecutive cases of closed comminuted intra articular fractures of distal radius matching the inclusion criteria, all patients were adult aged between 23 – 38 years having Gartland and Werly type II and III fractures of 6 to 7 days duration. After initial resuscitation, thorough clinical examination done and all base line laboratory investigations and x-rays were obtained. The demographic and clinical data was recorded on a proforma. The patients were informed about the study and surgery and a written consent was taken and all of the patients were gone for closed reduction with percutaneous K – wiring. Functional outcome like union, healing and any complication were assessed. Patients were also checked for the range of movements. After 6 weeks, the K – wires and cast were removed and the procedure of physiotherapy started. After six weeks all the patients were advised for follow up at an interval of 3 months and 6 months. The data collected was statistically analysed and the results were tabulated. Results: 45 cases of closed intra articular fractures of distal radius were assessed, out of these 20 cases have Gartland type II and 25 cases have Gartland type III fractures. The age of patient was ranged between 23 – 38 years (mean 34+ 4.63), majority (55.6%) of patients were male. The left side of fractures were present in 66.3% of cases. All the patients checked for complications and that were seen in only 07 cases consisting of pin tract infection, reduced grip strength and finger stiffness. At the end of study period the range of movements in different directed were checked and evaluation was done according to modified Demerit scoring system. Conclusion: Closed reduction of distal radius with percutaneous pinning in comminuted intra articular fractures gives promising excellent results, it is a simple and minimal procedure providing anatomic reduction, fixation of fracture and maintenance of reduction with an suitable technique of immobilization.

Objectives: To determine the pattern and frequency of various bone tumors at a tertiary care centre in rural area. Study Design: Retrospective study. Setting: Orthopaedic Peoples University of Medical and Health Sciences (PUMHS), Nawabshah. Period: June to December 2018. Material and Methods:  The 5 years record from July 2015 to June 2018, of all the patients who were admitted and operated for any bone tumor was retrieved. A total of 68 cases were included in the study having complete file record, regardless of their age and sex, the histopathological report of their bone biopsy was mandatory for inclusion in the study. The patients of incomplete file record, without histopathological report and the cases of other bone non-neoplastic conditions were not included in the study. All the collected data was recorded on a proforma, analysed statistically and results were tabulated. Results: In present study 68 cases of bone tumors were evaluated. The patients were aged between 7.5 to 73 years with a mean of 26.4 + 12.7 years. Among these 68 cases 41 (60.3%) were male. The malignant tumors were diagnosed in 25 (36.8%) cases among these 14 (20.6%) cases in male patients and 11 (16.2%) cases in female. The overall benign tumors were observed in 43 (63.2%) cases, and among these 27 (39.7%) cases were male and 16 (23.5%) cases were female. Osteosarcoma was the most common malignant tumor diagnosed in 14/25 (56%) cases followed by chondrosarcoa in 4/25 (16%) cases. In benign tumors the osteochondroma was the commonest tumor detected in 11/43 (25.6%) cases followed by benign giant cell tumor which was diagnosed in 9/43 (21%) cases. Most of the malignant tumors (24%) were diagnosed in 11 - 20 years age group, and most of benign tumors were detected in 21-30 and 31- 40 age groups each comprising of 23.3% cases. Three cases of metastatic tumors were also diagnosed and all were present in older 61 – 70 years age group. Conclusion: The bone tumors are more common in males, occurred predominantly in the second decade of life. osteochondroma and osteosarcoma was the most common benign and malignant bone tumors. Metastatic lesions were observed in older age group.

Objective: To determine the outcome and consequences of close intramedullaryinterlocking nailing in diaphyseal tibial fractures and to observe the hospital stay & complicationsin this method of treatment. Place & Duration: The study was conducted in department oforthopaedic unit-I at Liaquat University Hospital Jamshoro/Hyderabad during Jan 2011 to June2012. Patients & Method: The present study constituted on 43 patients, 3 cases were droppedduring follow up and the rest 40 cases completed 1 year post operative follow up. After havingroutine laboratory investigations and necessary x – rays, the stable patients were operated forintramedullary interlocking nailing on routine operating days. The patients were assessedaccording to the criteria mentioned in follow up proforma from date and time of arrival to final visitin review clinic and results were tabulated. Results: Among 40 patients, 38 (95%) were males and02 (5%) females. The age ranges from 17 to 50 years with mean age of 32.23 years. There were 25close fractures (62.5%) 15 open fractures (37.5%), among these 13 (32.5%) were Gustilo type Iand 2 (5%) were of type II. The mode of injury in majority (75%) of cases was road traffic accident.Good union achieved in 39 cases (97.5%) in 17.53 weeks. But only 1 (2.5%) case unfortunatelywent in infected non union and was converted into Illizarove external Fixation. The maincomplication observed after surgery was loosening of screw in 3 (7.5%) cases. Deep infectionwas observed in the medullary cavity in 3(7.5%) cases (table-V). It has been observed inanalyzing the functional outcome of these patients that majority (80%) of cases was able to sit onbed in 12-24 hours and was able to stand in 24-48 hours. In next 24 hours after surgery 75% ofpatients were pain free. The mean hospital stay in these cases was 8.53 days and by the 48thweek all of cases were able to join their job except one case in which non union observed due toinfection. Conclusions: The data from the current study reveals that intramedullary interlockingnailing of closed and open grade I and II fractures is a safe technique. It combines a high rate ofunion with a low complication rate, less hospitalization and early return to job.