Background and Objectives: Elbow is the most common site of fractures in children. It accounts for approximately 60% of all injuries in children. These fractures are caused by direct or indirect low energy trauma. Immediate & late complications are common in fracture of this region. The objective of this study was to compare the outcome of two different modes of treatment i.e. crossed K-wires versus lateral wires for displaced type-III supracondylar fracture of Humerus in children. Methods: A total of 80 patients having age between 2-13 years with type-III supracondylar fracture of Humerus type III those fulfilling the inclusion criteria were admitted through emergency department of this hospital. All these patients underwent x-rays of the elbow joint both AP & Lat views before the surgery. Patients were randomly divided into 2 equal groups. In group A, all fractures were fixed with crossed K-wires after reduction of these fractures, one wire from the medial condyle and one from the lateral condyle while in group B all fractures were fixed from the lateral condyle with 2 parallel K-wires of 2mm size in a divergent way after reduction of these fractures. In both of these groups, all these fractures were reduced closely under G/A with the help of image intensifier. Results: In group A 62.5% patients presented with type-III A while 37.5% presented with type-III B fractures. In group B 70.0% patients had type-III A fractures while 30.0% patients type-III B fractures. Functional & radiological assessment was done with Baumann's angles & modified Flynn's criteria. At the final follow up the Baumann's angle was equal in both of these groups (78.15 + 3.32 in Group A) & (79.1 + 4.21 in Group B p>0.45). Conclusion: This study concluded that there is no statistical significant difference in both modes of treatment regarding the stability of fixation and in terms of functional outcomes. However there are more chances of ulnar nerve injury with crossed k-wires fixation.

Background: Platelet rich plasma (PRP) is a supra-physiological concentrate of growth factor. It is biologically safe, minimally invasive and low cost injectable technique for tendinopathies. Evidence suggests that PRP contains bioactive protein and growth factor that promote regeneration. Aim of this study is to assess the efficacy of PRP in tennis elbow and to evaluate its impact on pain and functional outcomes. Methods: It was a prospective observational study in department of orthopedics surgery, Services Hospital Lahore from December 2017 to June 2019. Forty 40 patients with chronic tennis elbow lasting 4-6 months, both males and females with aged between 18-60 years were included. Thirty milliliters of patient's autologous blood was taken from median cubital vein and 6-7ml of platelet rich plasma was injected at the point of maximal tenderness at extensor carpi radialis brevis (ECRB) tendon. Patients were followed at 2 weeks, 6 weeks, 3 months and 6 months. Functional outcomes were assessed at each visit using Oxford Elbow Score, while visual analogue score (VAS) was used to assess pain. Results: Mean Pre-injection VAS was 8.0 ± 2.01 in all patients. At six months, VAS was 1.06 ±1.90 in 34 patients. In six (15%) patients, VAS did not improve. Pre-injection Oxford Elbow Functional score (OES) was 20.12 ± 4.08 (range:22.2-26.8). After 6 month of injection, among 34 patients, it improved to 72.12 ± 12.25 (range: 42.34-90.52) Conclusion: PRP is effective in terms of pain and improvement of function of elbow in patients with tennis elbow. It is cost effective, minimally invasive, simple and safe. Although literature shows some controversy of PRP in tendinopathies but still the regenerative medicine has opened a new window for restoration of tendinopathies

Background and Objectives: In total Hip arthroplasty, thromboembolism prophylaxis is a standard practice with minimal recommended duration of ten days. Thromboembolism prevention leads to reduction in symptomatic venous thromboembolic complications without risk of major bleeding.To assess and compare the efficacy of oral rivaroxaban with subcutaneous enoxaparin for prevention of thromboembolism after total hip and total knee replacement. Methods: It was a Randomized Control Trial conducted at Department of Orthopedic Surgery, Services Hospital Lahore. After permission from the Institutional review board, a total number of 200 patients who underwent either total hip replacement (THR) were enrolled in the study. These patients were divided into 2 equal groups A and B, each group having 100 patients. In Group A, all the patients were given Rivaroxaban 10 mg daily while in Group B Enoxaparin 40mg s/c was given. In all the patients’ anticoagulant prophylaxis was started 3-5 days before the surgery and 7-10 days after the surgery during Hospital stay. Results: In group A where all patients were given Tab Rivaroxaban 10mg daily, did not show any signs of DVT in the final follow up. In Group B DVT occurred in 2 patients (2%) during the 1st week post operatively. This shows that Rivaroxaban causes lower incidence of thromboembolism when compared to enoxaparin (relative risk of 0.70 & 95% of confidence interval). Conclusion: Rivaroxaban showed better anticoagulant effects than enoxaparin. It has slight higher risk of bleeding than enoxaparin. Direct factor Xa inhibitors are effective to prevent thromboembolism after total hip and total knee replacement. The anticoagulant effects are not necessarily compromised with risk of high bleeding.

Background and Objective: The most common hand fractures among adult population are distal radius fractures and optimal management of these fractures remains controversial. Several surgical strategies are available to treat these fractures. Two most commonly used procedures volar locking plates and percutaneous K-wire fixation are used to treat distal radius fractures.The objective of this study was to compare outcome in distal radius fractures in volar locking plate and in K-wire fixation and in terms of functional and clinical outcome. Methods: We conducted a randomized control trial at department of orthopedic surgery, Services Institute of Medical Sciences Lahore. After approval from the Ethical Review Board, a total number of 80 patients with distal radius fractures fulfilling the inclusion criteria were included. In Group A, distal radius fractures were fixed with volar locking plate and in Group B, K-wires were used to fix the distal radius fractures. Patients with polytrauma, head injury and spine injury were excluded from the study. Follow up was done at 2, 4, 6 weeks, 3 months and final at 6 months. Functional and clinical outcomes were measured with DASH Score and PREW Score at 3 months and 6 months. Results:- Age range was 18-80 years, mean age was 61.3 + 14.5 years. Mechanism of injury was fall on outstretched hands in 45 (56.2%) patients, fall from height in 20 (25.0%) patients, motorbike accidents in 7 (8.8%) patients, injury after fight in 4 (5.0%) patients and 4 (5.0%) patients were having machine injury. No difference in radiological outcomes was recorded in the final follow up. There was no difference in volar tilt loss. It was 0.5o in plate group and 0.7o in K-wires group (p = 0.92). Radial length loss was 1mm in Group A and 1.2mm in Group B (p = 0.55). The loss of angle of radial inclination was 1.2o in Group A and 1.5o in Group B (p = 0.35) at the final follow up. There were 04 cases of superficial infection in Group B (10%) versus 01 in Group A (2.5%, p = 0.001). Conclusion:- Our study shows that no mode of treatment in distal radius fractures is superior to other. The results of volar locking plate as compared to K-wire fixation were slightly better in the initial period but on long term bases both of these techniques have excellent and comparable results. DASH Score and PREW Score were almost equal in both of these techniques. The functional outcomes were almost equal in both of these techniques The complication rate although slightly more in K-wires group but it was insignificant from functional point of view.

Background: Despite of conservative management for proximal humeral fractures, open reduction and internal fixation with proximal humeral locking plate has become the most frequent treatment for these fractures especially in elderly and osteoporotic population. Efforts have been made to improve the locking plate fixation technique and strengthen the fixation more resilient to head collapse, screws cut out, screw penetration and loss of fracture reduction. Methods: This was a cross sectional study conducted at Department of orthopaedic surgery Services Hospital Lahore after approval from the hospital ethical review board a total number of 30 patients with proximal humeral fractures having age between 40 - 75 years were treated at our institute with proximal humeral locking plate. There were Eight 2 – part, 15 with 3- part fractures and 7 with 4- part fractures. All these patients were followed at interval of 3 weeks, 6 weeks, 3 months, 6 months and at one year. Results: In all 30 patients, fracture united 3(10.0%) months after the surgery. In 05 (16.7%), patients there were screw penetration in the shoulder joint. In these 05(16.7%), patients , 3(10.0%) patients developed avascular necrosis( AVN) and underwent shoulder arthroplasty. Loss of reduction was present in 04 (13.3%) patients in whom the revision surgery was done with addition of bone graft. Range of movements were significantly less in patients with 4- part fracture( forward elevation was 95 degree and head shaft angle was 100 degree in these patients while external rotation was 22 to 30), in rest of 25(83.3%)  patients it was within the normal range. Mean DASH score at baseline was 74.02+ 8.04, after 6 weeks was 58.4 + 3.38 while after one year at the end of final follow up it was 48.6 + 13.32. ( p = .000) (Table no:1) Conclusion: PHILOS fixation technique is an acceptable stabilization procedure for proximal humeral fractures especially in 3- part and 4- part fractures in osteoprotic bone. But at the same time it has got high complication rate like screw penetration in the joint, loss of fracture reduction and varus malunion etc.