Objective: To determine the functional and radiographic outcome of supra-syndesmotic fibular fractures associated with syndesmotic disruption treated with syndesmosis-only fixation.Methods: A retrospective observational study was performed in 12 patients who had fracture patterns amenable to syndesmosisonly fixation. According to the Lauge-Hansen classification, 10 were pronation external rotation injuries and 2 were pronation abduction injuries. The treatment plan was followed only if the fibular length could be restored and if the syndesmosis could be anatomically reduced. Through a percutaneous or mini-open reduction and clamp stabilization of the syndesmosis, all but one patient each had a single tricortical cortical screw fixation across the syndesmosis. Patients were kept non-weight bearing for 6 weeks followed by screw removal at an average of 8 weeks. Outcomes were assessed using an objective (Olerud and Molander Scale) ankle scoring system and by radiographic assessment of the ankle mortise.Results: Ankle mortise was reduced in all cases and all but one fibular fracture united without loss of fixation. At a mean follow up of 13 months, functional outcome score was 75. Six patients had more than one malleolar injury needing either screw or anchor fixations. One patient with trimalleolar fracture had residual ankle stiffness which responded to intensive physiotherapy. One patient had late diastasis after removal of the syndesmotic screw and underwent revision surgery with bone grafting of fibula.Discussion: With the length of the fibula restored and the syndesmosis reduced anatomically, internal fixation using a plating device may not necessary for fibular fractures combined with diastasis of inferior tibio-fibular joint. In our series, good or excellent results were obtained in majority of the patients. The patient with late diastasis after syndesmotic screw removal was probably due to early screw removal before union of the fibular fracture. Essential to this method of treatment are restoration of the fibular length, anatomical reduction of the syndesmosis and delaying screw removal till the fibular fracture heals.Conclusions: Syndesmotic-only fixation for supra-syndesmotic fibular fractures associated with syndesmotic disruption is a safe and effective method.

Aim: To identify prevalence of different type of bacteria among patient of different diseases in orthopedic department. Methodology: It was cross-sectional study done in Department of Orthopedics, Saidu Group of Teaching Hospital Swat from 1st February 2022 to 31st January 2023. A total of 209 patients, both male and female with age between 10 years to 70 were included. The specimens including pus and/or fluids were collected from the effected site by orthopedic consultants for culture and sensitivity. Results: Bacteria were isolated from 198(94.70%) samples while 11(5.30%) samples showed no growth of any bacteria. Among them staphylococcus aureus was isolated from 117 samples making 55.98% of total samples, pseudomonas aeruginosa was isolated from 44 samples making 21.03% of total samples, Escherichia coli was isolated from 32 samples making 15.31% of total samples. Three species of Citrobacter (1.43%) and two species of Enterobacter spp. (0.95%) were also isolated from the samples. Sixty seven samples were taken from post-operative site, 44 samples from abscess, 39 samples from osteomyelitis, 38 samples from Septic arthritis and 21 from diabetic Foot. Pseudomonas aeruginosa (49.27%) was most prevalent in postoperative infections, Staphylococcus aureus (94.87%) in osteomyelitis, Pseudomonas aeruginosa (52.38%) in diabetic foot, Staphylococcus aureus (68.18%) in soft tissue abscess also in Septic Arthritis (86.84%). Practical Implication: The pattern of microbial infection varies in post-operative infections, septic arthritis, osteomyelitis, diabetic foot ulcer and abscess. Conclusion: Bacterial infections in musculoskeletal system are common and on time identification with use of specific antibiotics may help in early recovery and abutting complications. Keywords: Prevalence, Orthopedics, Post-operative site, Abscess, Osteomyelitis, Septic arthritis, Diabetic foot

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Aim: To determine the frequency of necrotizing enterocolitis in preterm infants Place and duration of study: It is a descriptive cross-sectional study in Pediatric Medicine Department, Nishtar Hospital Multan from March, 2021 to August, 2021 Methodology: The preterm neonates were called for follow up every week for 4 weeks to diagnose Necrotizing enterocolitis. Results; Out of 174 cases, 101 (58%) were males while 73 (42%) were females. Necrotizing enterocolitis (NEC) was noted in 61 (35.1%) while NEC in breastfeeding infants was 14/74 (18.9%) and in formula feeding infants NEC was 47/100 (47%). Conclusion; High frequency of necrotizing enterocolitis was observed in this study among formula fed preterm infants as compared to breastfed preterm infants. Keywords; Breastfeeding, formula feeding, Necrotizing enterocolitis

Objective: To determine the frequency of surgical site infection in ankle fractures fixed earlier or delayed. Methodology: This retrospective cohort study was conducted in the department of Orthopaedics and Traumatology Lady Reading Hospital Peshawar from March 2016 to August 2018. The medical records of all the patients with ankle fractures fulfilling the inclusion criteria were analyzed retrospectively. Demographic details of the included subjects, time of surgery and frequency of surgical site infection was noted. Results: A total of 128 patients with mean age 38.8 years± SD 9.76(range 18-58 years) were included in our study. Male patients were 99 (77.3%) while female were 29 (22.6%). The number of patients who had open reduction and internal fixation (ORIF) within the initial 24 hours after sustaining the fractures were 12 (9.3%) in number,58(45.6%) patients had surgery in 24 to 48 hours, 40 (31.4%) in 3 to 7 days and 18 (14.1%) had surgery in 8 to 14 days after the injury.The frequency of surgical site infection(SSI) was 42.5% (17/40) in patients operated in 3 to 7 days, 44.4%(8/18) in patients operated in 8 to 14 days while no surgical site infection was reported in 54.6% (70/128) patients operated in 24 to 48 hours. (P value < 0.05). Conclusion: The timing of ankle fracture surgery is very important. Open reduction and internal fixation of ankle fractures done earlier had no surgical site infection. Delayed fixation is associated with higher frequency of surgical site infection.