This unique postal survey was setup to assess the agreement on treatment options in displaced distal radius fractures and whether or not there existed a consensus amongst the surgeons contacted. With this in view we contacted 244 surgeons and 166 completed answers were received.We chose two common examples of displaced distal radius fractures. Case one was a 38 year old teacher with a closed, displaced extra-articular fracture (Frykman type II) of her left non-dominant hand and case two was a 42 year old carer, with a closed, displaced intra-articular fracture (Frykman type VII) of her right dominant wrist. There was a questionnaire included with these radiographs.In the first case, 82 (49%) surgeons favoured MUA + K-wiring, 47 (28%) favoured volar plating and 14 (8%) an external fixator. In the second case, 28 (17%) surgeons favoured MUA + K-wiring, 53 (32%) advocated volar plating and 33 (20%) an external fixator. Furthermore surgeons with specialist Upper limb interest were more likely to apply a volar plate (63% in either case) whilst the surgeons with general or other areas of expertise (18% in first case and 23% for second case).In conclusion there is no consensus among the Orthopaedic surgeons in treating displaced distal radial fractures. A multicentered randomized clinical trial would help elucidate the best treatment options.

Objective: To compare outcomes of interlock intramedullary nails with Dynamic compression plates for the treatment of humerus shaft fractures in terms of hospital stay time and shoulder Impingement. Subjects and Methods: In this comparative study, a total number of 74 patients having age 20-60 years who presented with closed and open Gustilo type I or II in middle third of humerus were included. Study was conducted in Islam hospital Sialkot and and Rajib Tayyip Erdogan Hospital, Muzaffargarh from June-2019 to June-2020. Group A (n=37) patients underwent dynamic compression plating (DCP) for treatment of fractures and group B (n=37) underwent interlocking intramedullary nailing (ILN) for humerus shaft fractures. We noted post-operative hospital stay, shoulder impingement and bone union rate in all patients. Results: The mean of patients included in this study was 42.45 (SD 9.89) years. There were 57 (77.03%) males and 17 (22.97%) females. The mean duration of fracture at the time of surgery was 39.98±7.23 days. Mean hospital stay was 4.72±1.23 days in in group A and 4.89±1.40 days in group B (p-value 0.60). There were 4 (10.8%) patients in group B in whom shoulder impingement occurred but there was no patient in group A with shoulder impingement (p-value 0.04). Complete union occurred in 35 (94.6%) patients in DCP group and in 34 (91.8%) patients in ILN group (p-value 0.64). Conclusion: Both DCP and ILN are associated with high bone union rates. The complications rate of ILN is higher in comparison to DCP group. Keywords: Humerus shaft fractures, dynamic compression plates, interlocking intramedullary nailing.

Aims: This retrospective study was carried out to determine the incidence of mal-union following intra-medullary nailing of tibial shaft fractures.Methods: All cases undergoing intra-medullary nailing of tibia over an eighteen months period from January 2007 to October 2008 were identified. The cases of mal-unions were identified. The patients were divided into two groups, those with diaphyseal fractures and those who suffered peri-articular fractures of the tibia. The operating surgeons were also divided into trauma and nontrauma specialists.Results: There were thirty-one patients in this cohort. Nineteen procedures were performed by trauma specialists and twelve by non-trauma specialists. Five cases of mal-union were identified. There was one mal-union in trauma specialist group and the number rising to four in general orthopaedic group. This is statistically not quite significant with a P value of 0.0600. There were eight patients with diaphyseal fractures, out of which there was one case of mal-union. In this group the procedures performed by trauma specialists were 3 with 1 mal-union and there were 5 cases with no mal-union in non-trauma specialist group. This gives the P value of 0.076 which was not statistically significant. The results of peri-articular group were very interesting. The total number of cases in this group was 23. Trauma specialists performed 15 procedures with no mal-union and non-trauma specialists performed 8 procedures with 4 cases of mal-union giving rise to a statistically significant P-value of 0.0079.Conclusion: We conclude in view of the above results that intramedullary nailing for tibial shaft fractures should only be done by the trauma surgeons especially for the peri-articular fractures. The diaphyseal fractures seem to do equally well in each group. A longer-term study with larger numbers is hence required and is currently underway.

Objective: To compare the outcomes of antibiotic therapy with and without bone debridement in diabetic foot osteomyelitis (DFO) patients. Methods: The surgical and orthopaedics Units of Islam Medical College conducted a prospective randomized comparison study on 100 diabetic individuals with DFO between January 1, 2020, and June-2021. Patients were separated into two groups: those who got just antibiotic therapy and those who had debridement and/or contemporaneous minor amputation. Three outcome indicators were evaluated between treatment groups: hospitalization time, antibiotic therapy time, and wound healing time. Results: Patient’s demographics e.g., age, BMI and gender were almost similar among groups. The hospital stay duration was 39.7±18.4 days in antibiotic versus 43.4±23.9 days in the combination group. Duration of antibiotics was 42.8±15.6 days in the antibiotic group versus 45.3±18.0 days in the combination group (p-value 0.45). Mean duration of wound healing was 230.8±120.8 days in antibiotic group versus 217.1±95.3 days in combination group (p-value 0.53). Conclusion: Our study has demonstrated comparable outcomes amongst individuals who got antibiotic treatment alone and those who had debridement and/or contemporaneous minor amputations. Keywords: diabetic foot osteomyelitis (DFO), Antibiotics, amputation.

Objective: To evaluate the outcomes of surgical excision vs aspiration combined with intralesional triamcinolone acetonide injection in the treatment of dorsal wrist ganglion (DWG). Methods: A total of 60 patients with diagnosis of DWG from January-2020 to December-2020 from Islam Teaching Hospital Sialkot were recruited for this comparative study. Two groups of patients were formed based on the kind of therapy they received. Aspiration and Triamcinolone acetate (triamcinolone acetate) injections were used in Group A. Treatment in Group B was comprised of aspiration followed by surgical excision. Follow-up was done at one, three, six, and twelve months after therapy ended. The absence of the cyst on the patient's last visit was considered proof of a successful therapy. Treatment was deemed ineffective if recurrence occurred. Results: Among 60 patients, 37 (61.7%) were female and 23 (38.3%) were males. The most common presenting symptom was swelling found in 60 (100%) patients, followed by pain/discomfort in 48 (80%) patients. Recurrence occurred in 5 (16.7%) patients in group B and in 4 (13.3%) patients in group A. The 1-year success rate was 86.7% in group A and 83.3% in group B (p-value 0.71). Conclusion: Aspiration followed by triamcinolone acetone injection is a good alternative to surgical excision in DWG patients. Keywords: Aspiration, Surgical excision, Dorsal wrist ganglion.