Objective: The aim of this study is to determine the effectiveness of reamed interlocking nail in the management of closed tibal shaft fractures. Study Design: Descriptive/ Observational study Place and Duration: Study was conducted in Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and DHQ Teaching Hospital Gomal Medical College Dera Ismail Khan for nine months duration from January 2019 to September 2019. Methods: Total 80 patients of both genders were presented in this study. Age ranges of enrolled cases were 20-70 years. Demographically details of enrolled cases were recorded after taking written consent. Patients who had tibial shaft fractures were admitted in emergency ward and underwent for reamed interlocking nail. Postoperatively union time and rate of complications were assessed. Complete follow up of the patients were take place in duration of 14-months. Data was analyzed by SPSS 20.0 version. Results: Mean age of the patients was 28.65±8.77 years with mean BMI 24.16±6.23 kg/m2. Out of 80 patients, 47 (58.6%) were males and 33 (41.4%) were females. Traffic accident was the most common cause of fracture found in 60 (75%) cases, followed by fall from the height 15 (18.75%) and the rest were others 5 (6.25%). Mean united time of simple fractures were 13.14±4.14 weeks while among segmental fractures union time observed 18.13±6.17 weeks. Frequency of union fractures was 62 (77.5%), delayed unions were 13 (16.25%) and non-unions were 5 (6.25%). Satisfaction rate was 72 (90%) among all cases. Conclusion: We concluded in this study that reamed interlocking nail was an effective and safest method for the management of closed tibal shaft fractures. Overall union rate in this study was 93.75% and showed less morbidity among cases. Keywords: Interlocking nail, Tibial shaft fractures, Union

Objective: To determine the effectiveness of intraarticular injection of methylprednisolone acetate in subacromial impingement syndrome. Study Design: Descriptive Case Series Place and Duration: Study was conducted in Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and MTI, Hayatabad Medical Complex Peshawar for one year duration from February 2020 to February 2021. Methods: Total 100 patients of newly diagnosed subacromial impingement syndrome were enrolled in this study. Patients were aged between 20-60 years. Patients details demographics age, sex and body mass index were recorded after taking informed written consent. Patients did not receive any treatment before were included. Effectiveness of intraarticular injection of methyl prednisolone acetate was measured by using visual analogue scale (VAS) for pain intensity from 0 to 10 by VAS score after 4 weeks.Completedata was analyzed by SPSS 22.0 version. Results: Mean age of the patients was 38.14±7.44 years with mean BMI 25.64±18.9kg/m2. Among 100 cases, 75 (75%) patients were males and 25 (25%) were females. Diabetic patients were 25 (25%) and 14 (14%) patients were gout among all cases. Mean VAS score before treatment was 6.14±4.84 and after treatment VAS score was reduced to 4.41± 3.64. After follow up of 4 weeks VAS score was decreased to 1.11±3.65. Satisfaction among patients were 90 (90%). Conclusion: We concluded in this study that for the treatment of subacromial impingement syndrome, intraarticularinjection of methylprednisolone acetate was effective and useful. It was also observed that VAS score among patients were reduced significantly with should pain. Keywords: Intra articular methylprednisolone injection, Subacromial impingement syndrome, Effectiveness, Visual analogue scale

Objective: The aim of this study is to determine the outcome of distal femoral fracture treated with locking plate. Study Design:Prospective study Place and Duration: Conducted at Orthopaedic Unit Ayub Medical Teaching Institute, Abbottabad for one year duration from 1stJanuary 2020 to 31st December 2020. Methods: Total 90 patients of both genders were presented in this study.Patients were aged between 18-80 years of age. Patients’ detailed demographics including age, sex and body mass index were recorded after taking informed written consent. All the patients had distal femoral fracture treated with locking plate. Radiological assessment was done. Mean union time and complications associated to procedure were examined.Functional outcomes were analyzed according to the Flyn’s criteria. Follow-up was taken at 6 months postoperatively. Complete data was analyzed by SPSS 24.0 version. Results:There were 58 (64.4%) patients were males and 32 (35.6%) were females. Mean age of the patients were 42.61±12.88 years with mean BMI 27.65±9.56 kg/m2. According AO/OTA classification 55 (61.1%) had A1, A2 fracture was among 18 (20%) cases and the rest were 17 (18.9%) had A3. 62 (68.9%) fractures were caused due road traffic accidents, falling from height were among 17 (18.9%) cases and 11 (12.2%) cases were due to sports. Right side fracture was the most common side of fracture among 54 (60%). Mean union time among patients was 5.16±1.27 months.According to Flyn’s criteria, 38 (42.2%) cases had excellent results, 32 (35.6%) patients had good, fair results were among 16 (17.8%) cases and poor results were among 4 (4.4%) cases. Complications were delayed union, stiffness, varus deformityand non union observed among all cases. Conclusion: We concluded in this study that the locking plate for the treatment of distal femoral fractures was effective in terms of good results with fewer complications. Keywords:Distal femoral fracture, Locking plate, RTA, Complications

Objective: The aim of this study is to determine the outcomes between percutaneous cross pinning vs two lateral pinning in treatment of closed reduction supracondylar fracture of humerus in children. Study Design: Prospective study Place and Duration: Study was conducted in Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and DHQ Teaching Hospital Gomal Medical College Dera Ismail Khan during from October 2019 to May 2020 (09 months duration). Methods: Total 60 patients of both genders were presented in this study. Baseline demographically details of patients age, sex and body mass index were recorded after taking consent. Patients were aged between 2-14 years were included. Children who had supracondylar humerus fractures were enrolled and divided equally into 2-groups. Group I had 30 patients and received percutaneous cross pinning technique and group II had 35 patients underwent for lateral pinning. Radiological and functional results were assessed by Flynn’s criteria among both groups, frequency of complications was also observed. Complete date was analyzed by SPSS 22.0 version. Results: Total 36 (60%) were males (18 in each group) and 24 (40%) were females (12 in each group. Mean age of the patients in group I was 6.14±3.12 years and in group II mean age was 5.66±5.28 years. Sports 45 (75%) was the most common cause of fracture followed by traffic accidents 10 (16.67%) and the rest were 5 (8.33%) fall from the height. Mean surgical time in group I was 31.24±2.16 minutes while in group II mean time was 33.42±1.61 minutes. Mean radiation time in group I was 2.01±1.1 sec and in group II radiation time was 1.34±1.1 sec. According flynn’s criteria excellent results were found in 20 (66.7%) cases, good results in 8 (26.7%) and fair results found in 2 (6.7%) while in group II excellent results were found in 19 (63.33%), good results in 9 (30%) and fair results in 2 (6.7%). Significantly no any difference in outcomes was observed among both groups. Conclusion: We concluded in this study that the both techniques are safe and effective for the treatment of closed reduction supracondylar fracture of humerus in children but less operative and high radiation time was observed in percutaneous cross pinning as compared to two lateral pinning. Keywords: Percutaneous cross pinning, Two lateral pinning, Supracondylar humerus fracture, Children

Objective: The aim of this study is to determine the functional outcomes and mean duration of union in femoral shaft fracture in children treated with elastic intra-medullary nailing. Study Design:Retrospective Place and Duration: Conducted at Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and District Headquarter Teaching Hospital Gomal Medical College Dera Ismail Khan for duration from May 2020 to January 2021 (09 months). Methods: Total sixty eight patients with age ranges between 5-12 years were presented in this study. Patients detailed demographics age, sex and BMI were calculated after taking informed written consent. Complete patients were treated with elastic intramedullary nailing. Radiological assessment was done. Mean union time and complications associated to procedure were examined. Functional outcomes were analyzed according to the Flyn’s criteria. Follow-up was taken at 8 months postoperatively. Complete data was analyzed by SPSS 22.0 version. Results: Out of 68 patients, there were 48 (68.6%) males and 20 (31.4%) females. Most of the patients 41 (60.35) were aged between 8-12 years and the rest 27 (39.65%) were between 5-8 years.34 (50%) fractures were caused because of road accidents, falling from height were 20 (29.41%), due to sports were 10 (14.70%) and 4 (5.9%) were due to simple fall. 32 (47.06%) patients had left side fracture and 36 (52.94%) had right side fracture. Mean union time among patients was 4.14±2.72 months and there was no any case of non union. According to Flyn’s criteria, 50 (73.53%) cases had excellent results, 14 (20.6%) patients had good and fair results were among 4 (5.9%) cases. Complications were observed bone stiffness, delayed union and varus deformity among all cases. Conclusion: We concluded in this study thatElastic intramedullary nailing for femoral shaft fractures in children is safe and effective treatment modality. Union of bone achieved all the patients and majority of patients had excellent functional outcomes. Keywords: Femoral shaft fractures, Children, Elastic intra-medullary nail