Objective: To compare the effects of closed and open techniques with its associated complications used for the management of distal femoral fracture in younger to older populations. Methodology: This was a case series study conducted in the Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from Sept 2018- March 2019. A total of 66 adult patients were stratified according to treatment technique; closed technique group and open technique group with 33 patients in each group between age 18 - 65 years with fractured close distal 1/3rd shaft of femur distal femur fractures based on AO/OTA classification were included in the study. The Chi-square test was applied to contrast outcomes of closed and open technique and HSS score categories in both procedures. Results: The study findings showed that the mean age of the patient was slightly greater in the open technique group (41.5 + 23.5 years) compared to the closed technique (29.8 + 11.8 years). Most of the patients had type A femur fracture. The postoperative mean HSS knee score was 70.1 + 15.1 in the open technique group compared to 74.5 + 12.5 in the closed technique group with an insignificant difference between the two means (p<0.949). An insignificant difference was observed in postoperative infection, non-union, and implant failure between both groups. Conclusion: This study concluded that superior outcomes such as bony union without infection were achieved in patients with femur fractures treated with closed technique as compared to open technique, although the findings were statistically insignificant. Moreover, the functional outcome of the knee joint was also distinctly improved in the closed technique. Keywords:  Distal femur fracture, retrograde intramedullary femoral nail, locking compression plate, complications

Objective: To compare the frequency of a good functional outcome in unstable per-trochanteric fractures fixed with a dynamic hip screw and proximal femoral nail using the Harris Hip Score.  Methodology: A comparative study was conducted at the Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences, Islamabad, from June to December 2021. A total of 80 patients with per-trochanteric femur fractures were selected and divided into two groups based on the surgical procedure performed: dynamic hip screw or proximal femoral nail. A comprehensive history and thorough examination were performed for all patients during scheduled follow-up visits. Patients were called in for follow-up assessments at 1 month and 3 months to evaluate the functional outcomes using the Harris Hip Score. Results: The mean age of all patients was 58.73±6.78 years. At the 3-month follow-up, the mean Harris Hip Score was significantly higher in the proximal femoral nail group compared to the dynamic hip screw group (84.64±7.05 vs. 73.9±12.53; p = 0.005). The proportion of patients with good functional outcomes (Harris Hip Score ≥ 70 points) was significantly higher in the proximal femoral nail group compared to the dynamic hip screw group (97.5% vs. 72.5%, p = 0.002). Conclusion: In this study, the proximal femoral nail group demonstrated superior functional outcomes compared to the dynamic hip screw group. The use of proximal femoral nail fixation can provide better outcomes and facilitate an earlier return to pre-injury status for patients.

Introduction: Covid-19, a global pandemic has a huge impact on surgical practice. There is transmission risk of Covid-19 during the elective surgery and nowadays it is a part of informed consent process. This has an impact on patient decision making as it creates anxiety and fear. Objective: To evaluate patient experience (fear of getting Covid-19) from elective surgery and challenges of elective surgical practice and ways to overcome during this pandemic era. Materials and Methods: This study was an observational cross-sectional survey and it has been conducted in General Surgery Department of Dr Akbar Niazi Teaching Hospital, Islamabad, from May to August 2021 after approval by the Institutional Review Board (IRB). Participants for elective surgery and their negative report of Covid-19 infection by polymerase chain reaction (PCR) were included in the study. Fear of Covid-19 infection was measured through “fear of Covid-19 scale” by Ahorsu et al and analyzed. All findings were entered in a structured Proforma. Data was entered in SPSS version 26 and analyzed. Effect modifier chi-square was used to find out the patient’s dropout due to getting Covid-19 infection from surgery. Results: Total of 200 patients were included; 62% of patients were male and 38% were females. The mean age of the patients was 38.64±12.08 years. The statistical analysis showed that there was a very significant association between FCV-19 scale and getting Covid-19 infection from elective surgeries (p ≤ 0.05). When stratified FCV-19 scale with education status of all patients there was a very significant association between them (p=0.001). The patient’s observations regarding FCV-19 questionnaire, most of the patients were disagreed (46.3%) to getting Covid-19 infection from their elective surgeries or any fear of Covid-19 infection. The actual dropout of patients from elective surgery due to fear of getting Covid-19 infection during surgery or staying in hospital was 7.5%. Conclusion: Fear of getting Covid-19 is still present in some of the patients who visit hospitals for elective surgeries. Discussing the various steps taken by the institute to improve patient safety and minimize risk of Covid-19, greatly enhanced their confidence in elective surgery and improved satisfaction level.

Objectives: To evaluate and find the correlation of balance and functional ankle instability in elderly women. Methodology: A cross-sectional correlation study was conducted from June 2020 to December 2020, in which 61 participants (i.e., elderly women) were included. In the selected old age homes the self-reported questionnaire (Identification of Functional Ankle Instability [IdFAI]) had been distributed to the participants fulfilling the inclusion criteria as hand-outs and the performance-based questionnaire (Performance Oriented Mobility Assessment [POMA]) have been assessed and filled by the researcher. Chi square was used for associations and Pearson correlation for balance score and functional instability score. Results: The mean age of the participants was 64.89±4.30 years. According to the result of Tinetti Balance score, 31.1% elderly women with low risk of fall, medium risk of fall was 32.8% whereas with high risk of fall was 36.1%. The IdFAI showed, elderly women with Ankle Instability 62.3% while elderly women with No Ankle Instability were 37.7%. There was negative (inverse) Pearson linear correlation (r = -0.550) between age and balance (p ≤ 0.05) which means when the age increases, the balance decreases and also a weak association between age and functional ankle instability (p ≥ 0.05). Conclusion: This study concluded that there was not adequate evidence to propose an association between Balance and self-reported functional ankle instability.

Overuse or repetitive motion can develop De-syndrome, Quervain's which produces pain along the thumb side of the wrist. The thumb tendons get irritated or inflamed as a result of these motions. Activities that involve regular side-to-side extension of the thumb or wrist might trigger De Quervain's tenosynovitis. Objective: To assess the efficacy of therapeutic ultrasound in De-Quervain's Tenosynovitis. Methods: In this study, forty people were separated into two groups: interventional and control groups, each with 20 people. Results: The interventional group's mean age was 37.70 with a standard deviation of 7.921, while the control group's mean age was 36.60 with a standard deviation of 7.816. Out of 20 individuals in the intervention group, 10 were male and 10 were female, whereas in the control group, 11 were male and 9 were female. The interventional group's mean height and weight were 1.642m0.1740 and 75.9515.830, respectively, while the control group's mean height and weight were 1.675m01517 and 75.5013.296. Out of the 20 patients in the interventional group, one was underweight, seven were normal weight, four were overweight, and eight were obese. Eight patients in the control group were of normal weight, seven were overweight, and five were obese. Conclusions: It was determined that ultrasonic therapy is useful in treating De-tenosynovitis quervain's when the tendon is inflamed