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ABSTRACTIntelligent Transportation System (ITS) is a management tool used to improve traffic efficiency in a transportation network. This study investigates the travelers’ awareness of ITS and their responses toward the effectiveness of implemented system under a safe city project in the road traffic of Lahore city. A questionnaire was developed and administered to a sample of 600 respondents. The study showed that a significant number of road users were aware of the ITS and acquainted with different ITS tools, that is, surveillance camera, electronic challan, variable message sign, and radio as a source of traffic updates, etc. Awareness with ITS increases the dependency of travelers on the implemented system. Moreover, the study infers that travelers are willing for the deployment of such traffic management system in other areas of the city, which is a step toward the success of the executed system.

Study Design: Retrospective cohort study.Objective: We aimed to evaluate the improvement in neurological deficit following early versus late decompression and stabilization of thoracolumbar junctional fractures.Methods: This is a retrospective evaluation of all patients with a traumatic spinal cord injury (SCI) from T11 to L2 treated at a teaching hospital between 2010 and 2017. Grouped analysis was performed comparing the cohort of patients who received early surgery within 24 hours (group 1) with those operated within 24 to 72 hours (group 2) and more than 72 hours after SCI (group 3). The primary outcome was the change in ASIA (American Spinal Injury Association) motor score at 12-month follow-up.Results: There were 317 patients (225 males and 92 females with mean age of 31.55 ± 12.43 years). A total of 144, 77, and 96 patients belonged to groups 1, 2, and 3 respectively. Improvement of at least 1 grade on ASIA classification was observed in 80, 45, and 33 patients in groups 1, 2, and 3 respectively (P= .001). Overall, 32, 12, and 10 patients improved ≥2 grades on ASIA classification in groups 1, 2, and 3, respectively (P= .069). On logistic regression analysis, early surgery and severity of initial injury (complete [ASIA A] vs incomplete SCI [ASIA B-D]) were found to significantly influence the potential for neurologic improvement (P= .004 and P< .0001, respectively).Conclusion: We believe that the earlier the decompression, the better. The 72-hour cutoff represents the most promising time window during which surgical decompression has the potential to confer a neuroprotective effect in the setting of incomplete SCI (ASIA B-D) in the distal region of the spinal cord (conus medullaris).

AimsIt has been generally accepted that open fractures require early skeletal stabilization and soft-tissue reconstruction. Traditionally, a standard gauze dressing was applied to open wounds. There has been a recent shift in this paradigm towards negative pressure wound therapy (NPWT). The aim of this study was to compare the clinical outcomes in patients with open tibial fractures receiving standard dressing versus NPWT.MethodsThis multicentre randomized controlled trial was approved by the ethical review board of a public sector tertiary care institute. Wounds were graded using Gustilo-Anderson (GA) classification, and patients with GA-II to III-C were included in the study. To be eligible, the patient had to present within 72 hours of the injury. The primary outcome of the study was patient-reported Disability Rating Index (DRI) at 12 months. Secondary outcomes included quality of life assessment using 12-Item Short-Form Health Survey questionnaire (SF-12), wound infection rates at six weeks and nonunion rates at 12 months. Logistic regression analysis and independent-samples t-test were applied for secondary outcomes. Analyses of primary and secondary outcomes were performed using SPSS v. 22.0.1 and p-values of < 0.05 were considered significant.ResultsA total of 486 patients were randomized between January 2016 and December 2018. Overall 206 (49.04%) patients underwent NPWT, while 214 (50.95%) patients were allocated to the standard dressing group. There was no statistically significant difference in DRI at 12 months between NPWT and standard dressing groups (mean difference 0.5; 95% confidence interval (CI) -0.08 to 1.1; p = 0.581). Regarding SF-12 scores at 12 months follow-up, there was no significant difference at any point from injury until 12 months (mean difference 1.4; 95% CI 0.7 to 1.9; p = 0.781). The 30-day deep infection rate was slightly higher in the standard gauze dressing group. The non-union odds were also comparable (odds ratio (OR) 0.90, 95% CI 0.56 to 1.45; p = 0.685).ConclusionOur study concludes that NPWT therapy does not confer benefit over standard dressing technique for open fractures. The DRI, SF-12 scores, wound infection, and nonunion rates were analogous in both study groups. We suggest surgeons continue to use cheaper and more readily available standard dressings.Cite this article: Bone Joint J2020;102-B(7):912–917.

Optimal implant density for posterior spinal fusion in adolescent idiopathic scoliosis (AIS) remains controversial. We aimed to examine radiographic outcomes of AIS cases treated with limited density pedicle screw constructs.

Study Design Cross sectional comparative study.Objectives The current study aims to explore the calcification potential (BMP2 expression) of intervertebral discs and its association with the presence of vertebral endplate defects visible on MRI.Methods Forty-seven herniated lumbar disc samples obtained from patients aged 20-76 (31 M/16F) undergoing surgery. Five-µm thin sections were stained with H&E in order to assign a histological degeneration score (HDS) from 0-15 on the basis of cell density (0-5), structural alterations (0-4), granular changes (0-3) and mucus degeneration (0-3). Sections were immuno-stained with anti BMP-2 antibodies to observe the calcification potential in these discs. In addition, pre-operativeT2-T1 W MRI images of the lumbar spine were analyzed for the presence and type (typical or atypical) of vertebral endplate defects, grade of disc degeneration (Pfirrmann grade I-V), presence of high intensity zones (HIZ), and Modic changes at the operated level.Results Vertebral endplate defects, Modic changes & HIZ were observed in 81%, 29% and 21% of patients respectively. Mean HDS & BMP-2 expression was 9 ± 2 and mean 71 ± 36 spots/mm2respectively. Discs with adjacent vertebral endplate defects showed increased cell density (P= .004), mucus degeneration (P= .002), HDS (P= .01) and BMP-2 expression (P= .01). Discs with HIZ also had increased HDS, but significance was seen with increased BMP2 expression (P= .006). HDS showed a positive correlation with BMP 2 expression (r = .30, P= .04).Conclusion These findings suggest that the altered mechanical environment of discs is strongly associated with BMP-2 expression which is an important marker of intervertebral disc calcification.

Improper utilization of surgical antimicrobial prophylaxis frequently leads to increased risks of morbidity and mortality.This study aims to understand the common causative organism of postoperative orthopedic infection and document the surgical antimicrobial prophylaxis protocol across various institutions in to order to strengthen surgical antimicrobial prophylaxis practice and provide higher-quality surgical care.

•Pomegranate peels aqueous extract is lethal for Ascaridia galli in vitroand in vivo.•Pumpkin seeds ethanolic extract showed a lethal effect against Ascaridia galli in vitroand in vivo.•Pumpkin seeds ethanolic extract was more effective than pomegranate peels aqueous extract in vivo.

Introduction: Treatment of developmental dysplasia of hip (DDH) diagnosed after 10 years of age is extremely difficult because of the soft tissue and bone deformities. In this study, we evaluated short-term results of a single-stage procedure performed with surgical hip dislocation, femoral shortening and capsular arthroplasty.Patients and Methods: A retrospective review of charts of five patients with DDH, older than 10 years, who underwent capsular arthroplasty at Ghurki Trust Teaching Hospital between 2013 and 2015 was performed. Post-operative functional evaluation was performed using modified McKay’s scoring system and radiographic assessment using Severin’s scoring method at a minimum of 2-year follow-up.Results: We present results of five patients (six hips) with a mean age of 18.16 years. All patients had limping gait and International Hip dysplasia Institute classification (IHDI) class 4 hip dislocation. Harris hip score showed a significant improvement (53.13 vs 84.16; p= 0.0001). Femoral shortening of 2–2.5 cm was done. Additional shelf procedure was required in one patient. This patient persistently has post-operative hip subluxation. All patients had good to excellent outcomes according to McKay classification. Post-operative Severin classification was 1A in all patients. No case of avascular necrosis of the femoral head was noted during the follow-up.Conclusion: Capsular arthroplasty with subtrochanteric shortening is a useful procedure for neglected cases of DDH in patients older than 10 years.

Introduction Tuberculosis is the leading cause of death in third world countries, from a single infectious disease. It paralyses the society when it affects the spine due to its residual neurological deficit in the form of Quadriplegia, paraplegia, loss of bladder and bowel control, bedsores, as well as from continuous financial burden it exerts on the affected family and whole society. Early spinal decompression and stabilization with a locally made stand alone cage have dramatic results in terms of improvement in neurology, relief of pain and correction of deformity as well as improvement in the patient's quality of life.Methods The objective of the study is to determine the outcome after Anterior Decompression and Stabilization with locally made stand alone Cage & Bone Graft in caries spine in terms of improvement of neurology, relief of pain, improvement of Kyphotic angle as well as quality of life improvement. It is a prospective case series study including 600 cases, which were treated at GTTH from 2005–15. After pre-operative assessment of pain, neurology, measurement of angle of deformity, and QOL analysis using the SF-36®, all patients were treated with Ant. Decompression and then stabilization was achieved using morcellized bone graft with a locally made stand alone cage. After surgery patients were followed at 06 weeks, 03 months, 06 months & 01 year to assess neurology, relief of pain and Kyphotic angle and their SF-36®scores.Results Neurology improved in 88% of patients, pain was relieved in 92% of cases and there was mean correction of 18° in Kyphotic angle at the end of 01 year follow up with a significant improvement in the patient's quality of life.Conclusion Early diagnosis and early intervention gives excellent results in Tuberculosis of the spine. After anterior decompression, stabilization with cage and bone graft results in significant improvement of neurology, relief of pain and correction of Kyphotic deformity, as well as the patient's quality of life. There is no need for added instrumentation.

Introduction The aim of surgical treatment for adolescent idiopathic scoliosis (AIS) is correction of the three dimensional deformity, achievement of stability and preservation of as many distal motion segments as possible. In Thoracolumbar/ Lumbar adolescent idiopathic scoliosis (TL/L AIS) correction of C-shaped coronal curve into S-shaped saggital curve is a considerable challenge to a spine surgeon. In this regard, selection of Lowest Instrumented Vertebra (LIV) is of particular importance and remains controversial in literature. We conducted a retrospective study involving Lenke V patients to determine the exact distal fusion level (LIV) in the management of thoracolumbar/lumbar adolescent idiopathic scoliosis (TL/L AIS) using pedicle screw instrumentation.Material and Methods Analysis of radiographic parameters of 32 TL/L AIS was done. The patients were grouped according to the Lowest Instrumented Vertebra; Group I (fusion to L3, n= 25) and Group II (fusion to L4, n= 7). The Group I was subdivided into Group IA (L3 crosses the mid-sacral line with rotation of less than grade II on bending films, n= 14) and Group IB (L3 does not cross the mid-sacral line or rotation is grade II or more on bending films, n= 11). All of the patients in the Group II had the same location and rotation of L3 in bending films as that of patients in the Group IB. Patients with lowest instrumented vertebral tilt (LIVT) of more than 10° or coronal balance of more than 15 mm were considered to have unsatisfactory results.Results In these 3 groups, there was a significantly lesser correction in the TL/L curve and LIVT in the Group IB. Unsatisfactory results were obtained in 1 patients (7.1%) of the Group IA, in 7 patients (63.3%) of the Group IB, and in 1 patient (12.5%) of the Group II, which was found to be statistically significant.Conclusion In TL/L AIS patients undergoing treatment with pedicular screw instrumentation, the curve can be fused to L3 with good radiographic outcomes when L3 crosses the mid-sacral line with rotation of less than grade II on bending films. Otherwise, L4 should be selected as the Lowest Instrumented Vertebra.

Introduction Low Back pain and lumbar radicular pain due to Lumbar spine stenosis is one of the most common complaint in the Spine outpatient department or hospital admissions. Epidural steroid injection have well established role in the treatment of lumbar radicular pain, but the exact dose of Epidural Steroid injection has yet to be decided. The aim of this study is “To Compare three doses of epidural steroid injection with single dose of epidural steroid injection for Lumbar Radicular pain in spinal stenosis patients.”Materials and Methods 95 patients with lumbar radicular pain due to spinal stenosis were randomly allocated into 2 groups. In group A 42 patients were given 120 mg of Depo-medrol (40 mg per day for 3 days) and in group B, 43 patients were given 40 mg of Depo-medrol as a single dose. Both group A and Group B were matched in terms of age and gender. On visual analogue score pain was assessed after 2 weeks, 3 months and 6 months.Results In group A (3 doses of depomedrol) VAS improvement at 2 weeks, 3 months and 6 months were more than group B(single dose of depomedrol) which was statistically significant (p< 0.05). There were no major complications like epidural hematoma or abscess formation in both groups. The overall minor complications like flushing, transient hyperglycemia and headache due to CSF hypotension were more in Group A than Group B but statistics shows no significant difference. All the complications resolved without any morbidity and no patient required further hospitalization.Conclusion In the case of lumbar radicular pain, Epidural Steriod Injection with 3 doses of Depo-medrol is more effective than a single dose of epidural steroid without significant increase risk of complications.

Introduction Tuberculosis is a common problem specially in under developed countries. Tuberculosis of the vertebral column constitutes nearly 50% of all lesions of osteoarticular tuberculosis. The commonest site for the disease is in the peridiscal region. Treatment option usually is anti tuberculous chemotherapy but in some patients usually with severe pain and involving neurology, instability, large abcess, surgery is recommended. To our knowledge there is not a single publication in literature in which standalone titanium cage and bone graft without anterior plating is used in the treatment of TBS. The aim of this study is to evaluate the efficacy of standalone titanium mesh cages in TB cervical spine.Material and Methods A retrospective study of 47 patients with cervical tuberculous spondylitis (TBS) was performed at Ghurki trust teaching hospital. This study approved by the Institutional Review board and the ethics committee, included 47 patients with TBS of cervical spine who gave their informed consent to be included in the research. All patients had radical debridement, decompression, anterior coloumn reconstruction and instrumentation with standalone titanium cage without anterior plating filled with autologous iliac bone graft. The diagnosis of TBS was based on clinical correlation including night fever, loss of weight, fatigue and neck pain, laboratory investigations including ESR, CRP and tuberculin test were done in all patients. Visual analogue score (VAS) and frankel scoring system was used to score pain severity and grade neurological status. ATT was started preoperatively. The radiographic assessment included preoperative standard anteroposterior and lateral views. Cobbs methos was used to measure the sagittal profile.Results 61.6% patients fell in age group 3–35 years and 28.4% fell in group 36–70 years of age. 26 were men and 21 were women. Out of all patients 26 had pre op frankel grade E and 4pts had grade D and 10 pts had grade C and 2 pts had grade B and five pts had grade A preoperatively. Post operatively one patient of grade A remained same while other four improved to grade C in follow up and rest of all pts. improved to grade E in two year follow up. Pre-op cob's angle was 39.06 ± 10.92 (Mean±SD) which improved to -5.51 ± 4.77 (Mean±SD). P value is < 0.05. In comparison of visual analogue score there is also statistically significant difference in pain improvement. All patients had single stage radical debridement, decompression and instrumentation. Anterior coloumn reconstruction was done in all patients using standalone titanium cage.Conclusion The use of titanium cages effectively restores the sagittal deformity in TB spine with no donor site morbidity.

Introduction Spinal epidural hematoma is a well-known complication of spinal surgery. To prevent hematoma formation its routine that suction drain is placed for 24 to 48 hours after laminectomy. But Clinically insignificant small epidural hematomas develop after Lumbar disc excision through interlaminar fenestration. The aim of this study is to find out Frequency of Post-Operative Hematoma in Lumbar Disc Excision through Fenestration without closed-suction drainage.Materials and Methods This was a descriptive case series done at Ghurki trust teaching hospital Lahore from from January 2009 to January 2014. Total 423 cases who underwent Lumbar Disc Excision through Fenestration were included in the study. All the patients were followed for 7 days for postoperative Spinal Hematoma Formation which was considered positive in patients who either develop a new postoperative neurological deficit or pain and on mri shows Spinal Epidural Hematoma at the site of surgery.Results Frequency of post-operative hematoma after lumbar disc excision through fenestration without using closed-suction drainage reveals 2.13%(n= 9) while 97.87%(n= 414) had no findings of hematoma.Conclusion We concluded that frequency of post-operative hematoma after lumbar disc excision through fenestration without using closed-suction drainage is determined as insignificant.

Introduction Tuberculosis is the leading cause of death in third world countries, from a single infectious disease. It paralyses the society when it affects the spine because of its resultant neurological deficit in the form of quadriplegia, paraplegia, loss of bladder and bowel control, bed sores, and continuous financial burden on family and whole society. Early spinal decompression and stabilization with standalone cage have dramatic results in terms of improvement in neurology, relief of pain, and correction of deformity. The objective of the study is to determine outcome of anterior decompression and stabilization with locally made standalone cage and bone graft in caries spine in terms of improvement of neurology, relief of pain, and improvement of kyphotic angle.Patients and Methods It is a prospective case series study including 850 cases who were treated at GTTH from 2003 to 2010. After preoperative assessment of pain, neurology, and measurement of angle of deformity, all patients were treated with anterior decompression and then stabilization was achieved with bone graft and standalone locally made cage. After surgery, patients were followed at 6 weeks, 3 months, 6 months, and 1 year to assess neurology, relief of pain, and kyphotic angle.Results Neurology improved in 92% of patients, pain relieved in 95% of cases, and there was mean correction of 18 degrees in kyphotic angle at the end of 1-year follow-up.Conclusion Early diagnosis and early intervention give excellent results. After anterior decompression, stabilization with cage and bone graft results in significant improvement of neurology, relief of pain, and correction of kyphotic deformity. There is no need for added instrumentation.