This version is available at https://strathprints.strath.ac.uk/52649/ Strathprints is designed to allow users to access the research output of the University of Strathclyde. Unless otherwise explicitly stated on the manuscript, Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Please check the manuscript for details of any other licences that may have been applied. You may not engage in further distribution of the material for any profitmaking activities or any commercial gain. You may freely distribute both the url (https://strathprints.strath.ac.uk/) and the content of this paper for research or private study, educational, or not-for-profit purposes without prior permission or charge.Any correspondence concerning this service should be sent to the Strathprints administrator: strathprints@strath.ac.ukThe Strathprints institutional repository (https://strathprints.strath.ac.uk) is a digital archive of University of Strathclyde research outputs. It has been developed to disseminate open access research outputs, expose data about those outputs, and enable the management and persistent access to Strathclyde's intellectual output. AbstractIntroduction: The appropriate management of patients with osteoporosis and the rational use of antibiotics are growing concerns in Pakistan. The first step to improve patient care is to understand current prescribing patterns and the rationale behind these patterns. Aim: To assesses utilisation patterns, prescribing behaviour and the potential rationale among a range of medicines including bisphosphonates and antibiotics. Subsequently, use the findings to suggest potential future policies for all key stakeholders to improve patient care in the future. Methodology: A questionnaire based, cross-sectional study in both private and public health care facilities in Pakistan, conducted between January 2011 and December 2012, involving 438 physicians and15824 prescriptions. The second study involved 9984 outpatient prescriptions, 127 in-patient cases and over 100 prescribers and dispensers. Results: There was adequate history taking and examinations in approximately half of the physicians surveyed, with prescribing typically taking into account issues such as disease severity (84% of respondents) and the socioeconomic status of patients (53%). Prescribing of bisphosphonates was common certainly compared to medicines

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.