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A 19-year-old morbidly obese man presented with infected nonunion of femoral shaft fracture. Patient had history of 13 failed fixation surgeries, assessment revealed 3-centimetre limb-length discrepancy with 3-centimetre gap nonunion. Wound debridement, primary compression and external fixation using a customised Ilizarov external fixation assembly were planned. A four-ring customised assembly was applied. Partial weight bearing was allowed from first postoperative day on walker. Patient was kept on a monthly follow-up. After complete union at 10 months after surgery, frame was dynamised. After 6 months of dynamisation, frame was removed, at that time patient was full weight bearing. Knee was still stiff with a range of motion of 0°–20°, and there was 6 cm of limb length discrepancy, which was managed with a shoe raise. At 9 months after frame removal, patient is mobile with fully united bone. Ilizarov external fixator can be a good managing option in such difficult and complicated cases.

OBJECTIVE: To compare functional outcome in patients managed with dynamic compression plating or locked intramedullary nailing for humeral shaft transverse fractures in Ghurki Trust Teaching Hospital. METHODS: This randomised control trial was conducted in Ghurki Trust Teaching Hospital, Lahore from September 15 to March 15, 2020. Patients of either gender and all ages with humerus shaft transverse fracture fulfilling the inclusion criteria were assessed and treated with either DCP or locking intramedullary nail. Post-operative functional outcome was graded as excellent,good, fair and poor. Results: The total number of patients in our study were 60. Mean age was 38.7±12.79 years. Male patients were 45(75%) and female 15(25%). Mean follow up period minimum was of 6 months.In the Intramedullary nail group(I), the Neer scores were 13 (43.3%) excellent,11 (36.7%) good, 4 (13.3 %) fair and 2( 6.7%) poor. Whereas, functional outcome Neer scores of Dynamic compression plate group (II) were 23(76.7%) excellent,6 (20%) good, and only single case( 3.3%) shows poor result. Conclusion: The functional outcome with both modalities were excellent with mean Neer score of respective Nail and DCP with 85.90% and 91.03%.

Objective: To evaluate functional outcomes of Judet’s Quadriceptoplasty in posttraumatic stiff knees according to Judet’s criteria and Hospital for special surgery score of knee. Study Design: Retrospective Cohort Study. Setting: Ghurki Trust Teaching Hospital, Lahore, Pakistan. Period: January 2015 to June 2017. Material & Methods: 74 patients 61 males and 13 femal with stiff knees underwent Judet’s Quadriceptoplasty and followed by 12 weeks of aggressive rehabilitation and followed by aggressive rehabilitation for 12 weeks. Range of motion was measured with goniometer at last follow up. Outcomes were measured in terms of Judet’s criteria and Hospital for special surgery score of the knee. Results: Mean age at time of operation was 33.70±10.66 years. According to Judet’s criteria 68.9% (51) patients have excellent range of motion, 21.6% (16) have Good, 6.8% (5) patients have fair, 2.7% (2) have poor outcome. According to Hospital for special surgery score of the knee (HSS) mean score was 86.68±5.92 (60-96). There were 83.8% (62), 13.5% (10) and 2.7% (2) cases in excellent, good and fair group respectively. Blood loss was minimum 250ml max 650ml mean 443ml. Conclusion: Judet’s quadriceptoplasty for knee extension contracture is a useful procedure to increase the range of motion of stiff knees.

Fracture of the humerus usually result in radial nerve injury. This study was done with the aim to determine the incidence of Radial Nerve Injury in patients with closed fracture of the humerus shaft in high-energy trauma cases.This descriptive study was conducted in the Department of Orthopaedics and Emergency room, Ghurki Teaching Hospital, Lahore from January to December 2021 recruiting consecutive such patients. Standard ward protocol was followed to manage the patients initially including fracture stabilization and analgesia requirement. All the patients were carefully assessed to detect radial nerve injury. Data analysis was done through SPSS 26.0.A total of 80 patients were included with the confirmed diagnosis of fracture of the humerus. There were 55(68.5%) males and 25(31.25%) females. The age range was 20 to 60 years and the mean age of males and females was 31.62±8.35 and 38.43±5.06 respectively with overall mean age±SD was 38.93±6.19. There were 32 (40%) cases of spiral fracture, 17 (21.25%) cases of transverse fracture, 16 (20%) cases of communized fracture, and 15 (18.75%) cases of segmental fracture. Radial nerve injury was present in 7 (8.75%) patients. Out of these 7 cases of radial nerve injury; 4 (57.1%) cases were recorded in patients with spiral closed fracture of midshaft of humerus, 1 (14.3%) cases were recorded in transverse closed fracture of humerus shaft, 1(14.3%) cases in comminuted closed fracture of midshaft of the humerus while 1 (14.3%) were segmental fractures.Our study highlighted the frequency of radial nerve palsy in humeral shaft cases with most common in spiral closed fracture of the midshaft of the humerus.

Background: A host of different methodologies have been implemented in the management of distal humerus fractures, including conservative measures and surgical fixation with a variety of plates. This study was conducted to evaluate the functional outcome of open reduction and internal fixation of extra articular distal humerus fractures with distal humerus locking compression plate. Methods: This is a retrospective cohort study of patients with close extra articular distal humerus fractures who underwent open reduction and internal fixation with a distal humerus locking compression plate at Ghurki Trust Teaching Hospital from July 2017 to December 2019. Various demographic indicators were used for data analysis and radiological union was assessed in serial follow-ups. Functional outcome was evaluated using the Mayo Performance Elbow Score at the final follow-up. Results: Thirty-one patients presented with extra-articular fracture of humerus (N=31) with average age 33.5±9.90 years. The average follow-up period was 13.8 months. Radiological union was achieved in 14.8 weeks (range 12–20 weeks). Out of 31 patients, 28 had excellent results with mean Mayo Elbow Performance Score of 94.8. Two patients (6.5%) had radial nerve palsy post-operatively. Conclusion: This study shows that open reduction and internal fixation of extra-articular distal humerus fractures with distal humerus locking compression plates allows for stable fixation, good functional outcome, and low complication rates.

Safety of simultaneous bilateral TKA (simBTKA) and staged BTKA (staBTKA) have been compared in previous systematic reviews but functional outcome remains neglected aspect of the debate. We performed a systematic review of contemporary literature to compare the functional outcome of simBTKA and staBTKA. We searched PubMed/MEDLINE, EMBASE and Cochrane Central Database to identify all articles published between 2000 and July 2020 that evaluated the outcome of patients undergoing BTKA either in simultaneous or staged manner. Ten articles were identified which met the inclusion criteria. Functional outcome was reported in terms of Knee Society score (KSS), range of motion (ROM), Oxford Knee Score (OKS) and Western Ontario and McMaster University score (WOMAC) in seven, five, four and two studies respectively. KSS gained on average 66.6 points (47.5-95.3) for simBTKA and 65.1 points (44.4-97.2) for staBTKA without significant difference between two groups. There was no difference in post-operative ROM (maximum post-operative flexion being 124.4 and 125.1 for simBTKA and staBTKA groups respectively). Mean improvement in OKS ranged from 20 to 32.6 for simBTKA and 21.6 to 33.1 for staBTKA. There was moderate evidence to suggest that both simultaneous BTKA and staged BTKA produce equivalent improvement in functional scores.

Intelligent 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 respon...

Purpose: Reduction and stable fixation of the quadrilateral plate are challenging primarily due to its location in the true pelvis, limited bone stock, juxta-articular nature, and its comminution. The current study aimed to investigate the quality of reduction and functional outcomes after open reduction and internal fixation (ORIF) with infrapectineal buttress plating of the quadrilateral surface via an anterior intrapelvic approach. Materials and Methods: We conducted a retrospective review of twenty-one patients with acetabular fractures involving quadrilateral plate operated at Ghurki Trust Teaching Hospital between January 2017 and December 2018. Radiological assessment of the quality of reduction was conducted using criteria described by Matta. Functional outcomes were evaluated using a modified Postel Merle d’Aubigne score. Results: The current study included 15 males and 6 females with a mean age of 40.67±12.17 years (range, 22- 62 years). The most common fracture pattern was anterior column and posterior hemi-transverse in eight patients followed by true bicolumn and T-type fractures in seven and four patients respectively. Both transverse fractures were transtectal. The quality of reduction according to Matta criteria was anatomical in 14 patients, imperfect in five and poor in two. Functional outcomes were excellent in 47.6% cases, good in 42.9%, and fair in 9.5% cases. Both patients with fair outcomes had non-anatomical reduction, and one required total hip arthroplasty at a later time. Conclusion: Quadrilateral plate reconstruction with an infrapectineal buttress plate applied though an anterior intrapelvic approach provides high rates of anatomical reduction and yields good functional outcomes.

Objectives: There is currently no clear consensus on the benefits of performing simultaneous bilateral total knee arthroplasty (SBTKA) for patients with bilateral knee osteoarthritis. The purpose of this study was to analyze whether SBTKA provides equivalent reduction in pain and functional outcome as comparable with unilateral surger­ies (UTKA). Study Design: Cross sectional study. Setting: Ghurki Trust Teaching Hospital, Lahore, Pakistan. Period: January 2013 and July 2016. Material & Methods. 637 TKAs in 386 consecutive patients, who underwent total knee arthroplasty for bilateral knee osteoarthritis between Patients were split into 2 groups: those who underwent unilateral TKA (n=135) and those who underwent si­multaneous bilateral TKA (n=251). Knee range of motion, Knee Society Scores (KSS) and knee function scores were obtained pre­operatively and 2 or more years postop­eratively. Results: Mean±SD flexion was 111.6°± 8.6° for patients in the bilater­al group and 110.8°± 9.02° for patients in the unilateral group (p=0.34). Mean±SD KSS was 86.4 ± 9.3 in the bilateral group and 85.34 ± 10.5 in the unilateral group (p=0.236). Mean±SD function score was 83.4± 5.4 in the bilateral group and 80.90 ± 7.2 in the unilat­eral group (p

Aims It 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. Methods This 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. Results A 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). Conclusion Our 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 J 2020;102-B(7):912–917.

Introduction: There are two techniques for reconstruction of anterior cruciate ligament (ACL), open technique and arthroscopic assisted technique. Arthroscopic assisted technique has many advantages over open procedure but it needs more expertise and cost comparatively.The objective of this study is to identify the clinical outcomes on basis of lyshlomknee score (LKS) system and find out patients satisfaction after performing both procedures in two groups separately. Material and Methods: Retrospective analysis of 600 patients undergoing open ACL reconstruction and arthroscopic reconstruction from 2005 to 2018 was done, at the Department of Orthopaedics, Ghurki Hospital, Lahore. We included all those patients who were 18 to 45 years of age and had at least 1 year follow up.

Objective: Rehabilitation is considered vital aspect of treatment strategy post total hip replacement and results in improvement in functional activities as well as reduction in pain. Telerehabilitation is emerging as alternative to traditional face to face rehabilitation in home care. To explore the current evidence on effectiveness of telerehabilitation as compared to face to face rehabilitation for patients after total hip replacement. Methodology: A systematic review was conducted. Data bases were searched including Cochrane, Medline, Embase and PEDro from 2000 to latest. A thorough search was performed to retrieve articles missed through databases as well as unpublished grey literature. Methodological quality assessment was performed using Cochrane risk of bias tool and included studies were critically appraised using PEDro scale. Results: 13 articles finally met the inclusion criteria and were included in the review based on eligibility. However data was not extractable from 1 study due to which 12 studies were finally reviewed. There were 4 Randomized trials, 3 randomized controlled protocols, 3 randomized pilot studies and 1 prospective cohort study. The summary of critical appraisal of included studies through Physiotherapy Evidence Database scale was done which showed that majority of studies had high quality and few studies fall under the category of fair. Conclusion: Telerehabilitation group reported similar improvement in terms of activities of daily living and quality of life as compared to traditional rehabilitation. This systematic review has established that home based telerehabilitation mode of health care services delivery is an acceptable practical alternative among patients who underwent Continuous...

The current research focused on the designing of questionnaire for factors that impact student learning outcomes in tertiary educational system in underdeveloped nation Pakistan. A pilot study was conducted for the designing of questionnaire to collect data on perceived factors that impact student learning outcomes. The selected Higher Education Commission (HEC) recognized private educational institutions were contacted and permission of data collection was obtained from the authorities. Ninety eight students of final semester from HEC recognized tertiary universities at Bachelors level from the department of Science were approached for this study. Participants were informed that the data will be kept in a laptop under password protection. There were 41 total items in the questionnaire. It has been divided into 2 sections. Section A includes the demographic characteristics of participants and includes 7 questions. Section B is divided into 6 subsections, each section capturing the true essence of independent and dependent variables. The results of the study concluded that student perception questionnaire has good to excellent intra rater reliability and indicates that all components have factor loading exceeding 0.50 that also shows the importance of all components. Thus, the questionnaire can be used for the assessment of factors that impact student learning outcomes from educational institutes.

Aim: To appraise cases that presented with posterior dislocation of the hip secondary to trauma in paediatric age group and to analyse difficulties along with challenges that arise in the diagnosis (both radiological and clinical), treatment plan, complications and the outcome of such injury in children. Methods: Three children with traumatic posterior hip dislocation and a mean age of 3.3±0.47 years who were followed-up at 6 months were assessed. Results: The primary early treatment was closed reduction, executed within six hours of injury. The three subjects were treated with reduction under anaesthesia. The adjuvant treatment was immobilization via hip spica. Follow up was uneventful. Conclusion: Dislocation of the hip joint due to trauma should be attended to as early as possible with emphasis on achieving anatomical reduction preferably via reduction and close follow up. Keywords: Hip joint, posterior dislocation, trauma

Aim: To observe the workload of fractures of the femur (shaft and distal femur) and their fixations along with complications in terms of infection and mortality at our hospital during COVID 19 pandemic. Study design: Prospective study. Place and duration of study: Dept of Orthopaedic, Ghurki Trust Teaching Hospital, Lahore from 01-03-2020 to 31-07-2020 Methodology: One hundred and thirty-one diagnosed patients with femur fracture (shaft and distal) during pandemic period of COVID were enrolled. Demographic data included (age, sex, implant type, surgical site infection (SSI) and mortality).Since study was done during COVID-19 pandemic, positivity of COVID symptoms was noted as yes/ no on data collection proforma. Results: There were 105 (80.15%) males while 26 (19.84%) were females with mean age was 39.20±13.02 years. Majority of the surgical interventions were done based on Intramedullary nailing 74.05%, the second prevalent surgeries were done on AO external fixation 8.4%. Infection rate was observed in 7(5.32%) patients. No mortality was seen in any of the cases. Four infected cases were observed after intramedullary nailing procedure, two from AO external fixation and one after locking plate. Conclusion: There is no significant higher complication rate due to COVID-19 pandemic to patients whom femur fracture fixation was done. None of admitted patient suffered COVID-19 symptoms during hospitalization. It was only pointless fear about orthopaedic intervention during this interval. Key words: COVID-19, Femur, Infection

Background: Scoliosis is the main three-dimensional pathological backbone deformation with direct effects on the thoracic cage and a prevalence of 0.3 to 15.3% of the population. Aim: To assess the comparison of pulmonary function impairment in adolescent idiopathic and congenital scoliosis. Place and duration of study: Department of Orthopedic & Spine Center, Ghurki Trust Teaching Hospital Lahore from 1st January 2020 to 31st August 2020. Methodology: In this cross-sectional study 30 patients diagnosed with Idiopathic congenital scoliosis after the approval from the Ethical Committee of the hospital (15 idiopathic and 15 congenital scoliosis) were enrolled. The data were collected using predesigned proforma, including demographics (gender, age, BMI, Cobb's angle, and side of deviation) and outcome variables to measure pulmonary function impairment. In all patients, pulmonary function tests were performed. Results: In group A, the mean value of FVC (%) was lower than 80% of the predicted normal value as 59.8±12.0 as compared to group B 78.32±21.35%. The average predicted value of FEV1 was 62.3±13.5%slightly decreased in group A (below 80% of the predicted normal value) compared to group B81.47±19.88%. The FEV1/FVC ratio was normal in both groups (>70% predicted). The result also revealed a significant difference in both groups as (p-value

Background: Degenerative lumbar spinal stenosis (DLSS) is a condition where degenerative and arthritic state of the disc and facet joints respectively results in the displacement of the vertebra resulting in lower back pain in association with radiculopathy. In patients with degenerative lumbar spine, the rate of fixation has increased. Aim: To identify the difference in outcome of decompression alone versus decompression with spinal fixation in DLSS. Place and duration of study: Department of Orthopaedic & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore from 1st January 2017 to 31st December 2019. Methodology: All the discharged patients with primary diagnosis of DLSS were identified. Two subgroups were studied i.e. Decompression only and Decompression with TranspedicularScrew Fixation .Primary outcome among patients was assessed using Swiss Spinal Stenosis Score (SSS). All the data were entered and analyzed using SPSS software and p-value≤0.05 considered to be significant. Results: Total number of patients included in study was 87.out of the total,34(39%) patients had underwent decompression alone, whereas in 53(60.9%) patients decompression with transpedicular fixation were done. Significant difference was not observed among cases with respect to mean score on SSS based on two different types of surgical interventions. In decompression with fixation group, the average length of stay of patients in hospital was 6.4 days as compared to decompression only group as 4.4 days. Conclusion: Both surgical procedures decompression plus transpedicular fixation and decompression alone produce similar outcome at 2 years follow-up. Keywords: Decompression, Swiss Spinal Stenosis Score, Degenerative spine, Transpedicular screw fixation

BACKGROUND Orthopedic infections are difficult to manage. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most dangerous and harmful bacteria and is difficult to eradicate because of its changing strains as well as sensitivity to different antibiotics. The main aim of this study was to determine the prevalence of pathogens, especially MRSA, associated with orthopedic wounds and their sensitivity to different antibiotics. METHODS A prospective study was conducted from September 2015 to August 2016. Pus samples of 1,350 patients who presented at the out-patient department or admitted with a wound infection after an orthopedic intervention were taken with the help of culture swab and were sent for culture and sensitivity according to hospital protocol. Data analyses were made using the SPSS software, version 17 (IBM). RESULTS Adults aged between 15 and 30 years were most affected, with 444 (32.9%) cases. Of the patients, 268 (19.9%) had negative cultures. Among the patients with positive cultures, the gram-positive cocci and gram-negative rods were 497 (36.8%) and 377 (27.9%), respectively. The most common pathogen was MRSA (240; 17.8%), followed by Escherichia coli and methicillin-sensitive S. aureus. CONCLUSIONS Multiple pathogens are involved in patients having an orthopedic surgical intervention. The high occurrence of MRSA and E. coli has an increasing economic burden on patients because of these pathogens high resistance to antibiotics. Thus, proper preventive measures should be done to decrease the occurrence of such infections as well as their associated morbidity.

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).

Among orthopedics trauma, the Olecranon fractures are one of the most commonly seen in the emergency room. The cause of such injuries are either fall or road traffic accident. The coronoid process stabilizes the humerus against the distal ulna. There is loss of extensor mechanism at the elbow joint whenever there is fracture of Olecranon. So, its management is always operative. Objectives: The main objective of this study was to determine the functional outcome of patients with olecranon fractures treated with tension band wiring and K-wires. Study Design: Descriptive case Series. Setting: Department of Orthopedics and Spine centre, Ghurki Trust teaching Hospital, Lahore. Period: 25th March 2016 to 30th September 2016. Materials and Methods: 85 patients were selected using Non Probability/ Consecutive sampling technique. Informed consent was taken and demographic information was noted. Surgery was performed by single team of orthopedics surgeons. Patient was followed after 06 weeks. Post-operatively for the assessment of functional outcome in terms of very good to good, fair and poor according to Murphy’s system. All the collected data was entered and analyzed on SPSS version 20. Results: In our study the mean age of the patients was 36.62±14.09 years, the male to female ratio of the patients was 0.7:1. The mean value of total Murphy’s score of the patients was 5.98±2.03. In this study the good functional outcome was observed in 35(41.18%) patients, fair outcome was observed in 46(54.12%) patients. Conclusion: The tension band wiring with K-wires shows good and satisfactory functional outcome for the management of olecranon fractures.

Background: Halo-traction device has been seen with favorable outcome in managing the patients with severe kyphotic deformities preoperatively, however, associated complications are inevitable. Slight modifications can improve the outcome and clinical efficacy. Case Description: A 14-year-old boy was presented with severe kyphotic deformity of 141° from T1 to T10 thoracic vertebrae with diffuse paraspinal calcification in thoracic spine and complete loss of power of both lower limbs. A modified halo-pelvic distraction device was applied before the definitive surgery. The device comprised halo and pelvic assembly, the halo ring was connected to the head with 06 pins, while pelvic assembly had Ilizarov half pins connected to the arches. The assembly construct had four threaded rods, two of them were placed anterolateral and the other two were posterolateral. Distraction at the rate of 3 mm/day was started from 1st postoperative day for 35 days. The neurology improved in both lower limbs and kyphotic angle reduced to 56° from 141°. Surgery at this stage was done and a standalone solid titanium cage was placed from T1 to T10 vertebral body after debridement. No peri- or post-operative complications were observed. Conclusion: The application of halo-pelvic distraction before corrective surgeries can not only reduce the severity of the kyphotic deformity making the definitive surgery easy but neurology can also be improved. The high-risk complications associated with acute correction of deformities can be minimized using our modified halo-pelvic distraction device.

With increasing urban populations, high vehicle miles have made the concept of a compact city imperative. A compact city is characterized by high-density development and mixed land use with no urban sprawl. City managers are trying hard to make their cities compact and livable. The potential conformance to a compact city development requires scaling before any significant intervention. Several studies have been conducted on the different aspects of the compact city in the developed world, but there is limited understanding in the South Asian context. This study aimed to fill this research gap and proposes a theoretical matrix to gauge the potential compactness of Lahore, Pakistan. It comprises some key attributes, such as landscape ecology, measurement of density, density distribution, transportation network, accessibility, dispersion index, and mixed-use land consumption, which were analyzed in this research. The data were analyzed using Geographical Information System (GIS) and ERDAS IMAGINE software to make a scaling matrix. The research findings show that Lahore is a semi-compact city, with high potential to become a true compact city. The paper recommends that the urban extent should not be extended until targeted colonization is achieved, and the spatial growth of the city should be managed by encouraging infilled development, high-density living, and public transport provision. This research will help policymakers, urban planners, and transport planners devising policies for compact city development.

Aim: To assess the functional outcome after metacarpal fracture fixation with mini fragment plates. Study design: Prospective cohort study Place and duration of study: Department of Orthopaedic Surgery, GTTH, Lahore from 01-01-2015 to 31-07-2020. Methodology: Sixteen patients who were operated with mini fragment plates for metacarpal fractures. Functional outcome was evaluated with help of American Society for Surgery of the Hand (ASSH) Total Active Flexion (TAF) score and the disabilities of the arm, shoulder. Results: Union was achieved in all patients. The functional outcome was excellent in 13 and good in 2 and poor in 1. Three cases of infection (all superficial) were noted, which settled with dressings and antibiotics. Conclusion: Mini fragment plates for metacarpals fractures are a good option, providing early mobilization and excellent functional outcome. Keywords: Functional outcome, Metacarpal fracture, Mini fragment plat, Open reduction internal fixation (ORIF)

Study Design: Cross-sectional comparative.Purpose: To characterize the scores of disc degeneration, inflammation, and nerve density in herniated disc samples and associate findings with the presence of vertebral endplate (VEP) changes on magnetic resonance imaging (MRI).Overview of Literature: Considering the role of disc composition in spontaneous regression and persistence of pain during conservative management, it is important to identify the influencing factors. VEP changes are highly associated with disc degeneration, but their correlation with herniated disc composition has not yet been reported.Methods: Fifty-one discs were obtained from patients undergoing surgery for herniated disc. Their ages ranged from 19-65 years, and 31/51 were male. Pre-surgical T1 and T2 weighted lumbar-spine MRIs were analyzed to observe Pfirrmann grade, VEP defects, herniation type, Modic changes, and high-intensity zones (HIZ) at the affected level. Five-micron thick sections were stained with hematoxylin and eosin, Alcian blue periodic acid–Schiff stain; examined for histological degeneration scores (HDS; 0–15), inflammation (0 [absence]–3 [severe]), and presence of cartilaginous endplate (CEP). Three-micron thick sections were stained with protein-gene-product 9.5 and expression was counted/mm2. Data was analyzed, and pppp=0.01). Histological sections with CEP showed increased HDS (ppr=0.27, p=0.02).Conclusions: VEP changes can modulate degeneration and inflammation of herniated discs. Presence of these changes is highly predictive of the occurrence of CEP in herniated discs, which leads to slow resorption and persistent clinical symptoms.

Introduction The use of a tourniquet during total knee arthroplasty (TKA) is still a topic of debate, given the conflicting results in the literature with respect to complications, pain, functional outcome, and blood loss. However, due to a lack of convincing data on early patient-reported outcomes (PROMS), this study aims to compare pain and functional outcomes in total knee arthroplasty patients with and without a tourniquet. Methods A randomized controlled trial was set up at a tertiary care hospital that spanned from 1st February 2015 to 31st July 2018. We included all primary total knee arthroplasties performed for patients aged between 50 and 80 years. Oxford Knee Score (OKS), Numerical Pain Rating Score (NPRS), Visual Analogue Scale (VAS) for satisfaction, active range of knee motion, and Short Form-12 Survey (SF-12) scores were collected pre-surgery and then at six-weeks and six-months interval with a p-value of 0.05 considered to be significant. Results Two hundred and forty patients participated in the study; 117 patients were randomized to surgery with the tourniquet inflated and 123 to surgery with the tourniquet deflated. There were 43.4% males, and 56.6% females in the tourniquet inflated group with an average age of 62.29±9.63 years while in tourniquet deflated group, there were 46.7% males and 53.3% females with a mean age of 65.41±9.042 years (p-value for age is 0.404; the p-value for gender is 0.086). Despite the increase in intraoperative blood loss in both the groups, there was no significant increase in blood transfusions as both groups recorded the need for postoperative blood transfusion - 12 patients in the tourniquet group and 19 in the non-tourniquet group, but this difference was statistically insignificant (p=0.231). The perioperative blood loss was significantly lower (p

It 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.This 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-samplesA 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).Our 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

City administration has given prime importance to public transport services in Lahore. But still desired level of convenience and efficiency has not been achieved because of the absence of any integrated public transport system. Metrobus, LTC operated buses and Qingqi Rickshaws are all operating through their independent schedules with least consideration to that of others. Travellers using more than one modes of transport for their complete trip do not find whole system well harmonized. There is a need to find whether integration of currently independently operating transport systems can bring any improvements in services. This research work significantly points out short comings in city’s existing transport system; quantifies the impact of related factors through chi-square, co-relation and other statistical analyses; and provides some policy guidelines for pragmatic improvements in the system.

Purpose: The purpose of this report is to describe the Global Spine Care Initiative (GSCI) contributors, disclosures, and methods for reporting transparency on the development of the recommendations. Methods: World Spine Care convened the GSCI to develop an evidence-based, practical, and sustainable healthcare model for spinal care. The initiative aims to improve the management, prevention, and public health for spine-related disorders worldwide; thus, global representation was essential. A series of meetings established the initiative’s mission and goals. Electronic surveys collected contributorship and demographic information, and experiences with spinal conditions to better understand perceptions and potential biases that were contributing to the model of care. Results: Sixty-eight clinicians and scientists participated in the deliberations and are authors of one or more of the GSCI articles. Of these experts, 57 reported providing spine care in 34 countries, (i.e., low-, middle-, and high-income countries, as well as underserved communities in high-income countries.) The majority reported personally experiencing or having a close family member with one or more spinal concerns including: spine-related trauma or injury, spinal problems that required emergency or surgical intervention, spinal pain referred from non-spine sources, spinal deformity, spinal pathology or disease, neurological problems, and/or mild, moderate, or severe back or neck pain. There were no substantial reported conflicts of interest. Conclusion: The GSCI participants have broad professional experience and wide international distribution with no discipline dominating the deliberations. The GSCI believes this set of papers has the potential to inform and improve spine care globally. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]

Background: Retrograde nailing for fracture of distal shaft of femur is commonprocedure but data about post-operative functional outcome in terms of knee range of motion,union and pain at 6 weeks, 6 months and 1 year follow-up is lacking. Objectives: The mainaim of this study was to determine post-operative functional outcome after performing nailingin a retrograde fashion for distal disphyseal femoral fracture in terms of knee range of motion,pain and union at 6 weeks, 6 months and at least 1 year follow-up. Study Design: Descriptivecase series. Setting: Orthopedics and Spine Centre, Ghurki Trust Hospital Lahore, Pakistan.Period: 1st July 2015 to Dec. 2016. Materials and Methodology: 140 patients of either sex andage with fractures of distal disphyseal femoral fracture and were operated using retrogradenailing were included in the study. All the data were analyzed using SPSS 17.0 version.Results: 140 patients were included with mean age of 31.81± 7.117 ranged from 16 to 75years of age.97 patients (69.3%) were male and remaining 43 patients (30.7%) were female.Pain was significantly decrease in all patients on Visual analogue scale. Mean union were 32.3± 5.3 weeks, Knee range of motion after last follow up were more than 1200 in 126 patients.Conclusion: Retrograde Nailing for distal diaphyseal fractures is an excellent option with goodfunctional outcome. It should always be considered while managing such fractures.

Knee Osteoarthritis (OA) is considered as one of the leading cause of disability around the world1. Total knee Arthroplasty is known to be the best treatment option available for reduction in pain and symptoms in case of failure of conservative management2. Recently enhanced recovery pathways have been followed after knee replacement surgery which includes a combination of early mobility, education of patient and care giver, nutritional and fluid support. These enhanced pathways lead to shorter hospital stay3. Due to the shortened hospital stay, the aspect of self-management by patient becomes fundamental. Post-operative self-management of patients following knee replacement is a crucial factor for successful recovery. Self-management as defined by World Health Organization is the ability of patients, care givers and community to effectively manage with the disease, either with the support of health service provider or independently. In knee replacement, self-management includes pain management, physical therapy exercises, daily self-activities and precautionary measures4.

Objectives: To determine the outcome of pelvic support osteotomy with Ilizarovmethod in patients undergoing Girdle stone procedure in terms of pain relief and limb lengthdiscrepancy. Study Design: Descriptive case series. Setting: Department of Orthopaedicand Spine Surgery, Ghurki Trust Teaching Hospital/Lahore Medical & Dental College, Lahore.Duration of Study: Six months (19-11-09 to 18-05-10) for sample collection and follow upfor next one year after the procedure. Materials and Methods: Forty five patients having hipjoint problems were included. The radiographs would include plain radiographs of the pelvisin neutral and single limb standing position and the femur of involved side to assess the pelvicobliquity. Surgery was performed in the supine position under spinal anesthesia. A proximalfemoral osteotomy was performed at the level of ischial tuberosity. The other distal femoralosteotomy was performed to lengthen and adjust the mechanical axis. Both these osteotomieswere then stabilized with Ilizarov external fixator. The standard rate of distraction is 1 mm/dayfor lengthening. Results: There were 30 male patients and 15 were female patients with maleto female ratio was 2:1. The mean ± SD between the ages was 23.69±7.80 years. Among allpatients, 43 patients had pain relief and 41 patients of limb length discrepancy. Conclusion:By using the Ilizarov technique, we could prevent the valgus effects created by the valgusextension osteotomy while achieving lengthening of the femur through the distal osteotomy inthe femur. It is an excellent technique for those patients who are not fit for total hip replacement.

Vascularized or non-vascularized fibula transport is a novel procedure for limb salvage but has been associated with high failure rates and complications. Ipsilateral medial fibular transport (IMFT) using Ilizarov apparatus is a modification of the procedure to prevent complications and increase success rate. This article presents the largest series of limb salvage for massive tibial bone loss in children due to pan-osteomyelitis by IMFT with Ilizarov apparatus.A case series of 12 patients with a mean age of 12 (6-18) years is described. At the first stage of surgery, the excision of all dead bone was performed, and Ilizarov without traction apparatus was applied. In second stage, ipsilateral fibula is gradually transferred to tibial defect with the help of ilizarov olive wires. In the third stage, the freshening of docking sites of fibula to tibia was performed. The minimum follow up was of two years.Hypertrophy of the transported fibula accompanied by full weight bearing and satisfactory joint motion occurred in all patients. Removal of sequestrated bone resulted in control of infection in 27.17 ± 7.76 days. Fibular transport took 16.58 ± 4.14 days. The length of tibial bone loss replaced by fibula was 9.50 ± 2.23 cm. The mean days required for union after freshening of the docking site was 76.58 ± 6.20 days.Ilizarov frame for pan tibial osteomyelitis with bone excision and medial fibular transport works well for limb salvage in children.نقل الشظية بالأوعية الدموية أو من غير الأوعية الدموية هو إجراء جديد من إجراءات إنقاذ الأطراف، ولكنه ارتبط بمعدلات فشل ومضاعفات عالية. نقل الجزءالإنسي من الشظية بنفس الجهة باستخدام جهاز إليزاروف هو تعديل الإجراء الجراحي لمنع المضاعفات وزيادة فرص النجاح. وتعرض هذه المقالة أكبر سلسلة من إنقاذ الأطراف لفقدان جزء كبير من العظم الظنبوبي لدى الأطفال بسبب إلتهاب العظم والنقي الكامل، بواسطة نقل الجزء الإنسي من الشظية بنفس الجهة بجهاز إليزاروف.نَصف في هذه المقالة سلسلة من الحالات ل ١٢ مريضا بمتوسط عمر ١٢ عاما (٦-١٨). في المرحلة الأولى من الجراحة، تم استئصال جميع العظم الميت، وتم تثبيت جهاز إليزاروف من غير شد. وفي المرحلة الثانية، عادة بعد شهر من إعادة التشكيل تتم بواسطة النقل التدريجي للجزء الإنسي للشظية في نفس الجهة باستخدام جهاز إليزاروف للشد بواسطة أسلاك الزيتون، بعد عمل القص العظمي للجزءالقاصي والداني للشظية. في المرحلة الثالثة، تم تنضير مواقع استقبال الظنبوب للشظية. وكان الحد الأدنى للمتابعة عامين.يصحب تحمل كامل الوزن تضخم في حجم الشظية المنقولة، وحركة مرضية للمفصل تحدث عند جميع المرضى. وإزالة العظام المحجوزة تؤدي إلى التحكم في الإلتهاب في ١٧.٢٧ ±٧.٧٦ يوما. يأخذ نقل الشظية ٥٨.١٦ ± ١٤.٤ يوما. وكان طول الجزء المفقود من عظمة الظنبوب والمستبدل بالشظية ٩.٥ ± ٢.٢٣ سم. بينما كان متوسط الأيام اللازمة لإتحاد العظام بعد تنضير موقع الاستقبال ٧٦.٥٨ ± ٦.٢ يوما.يعمل إطار اليزاروف للإلتهاب الكامل للعظم والنقي الظنبوبي بواسطة استئصال العظم ونقل الجزء الإنسي من الشظية بشكل جيد لإنقاذ الأطراف عند الأطفال.

The treatment of choice for osteoarthritic knee is Total knee arthroplasty (TKA)and the most important problem in it is the blood loss. Objectives: To compare the postoperativemean blood loss with Tranexamic acid versus control after Total Knee Arthroplasty.Study Design: Randomized controlled trial. Setting: Ghurki Trust Teaching Hospital Lahore.Period: 01 year. Methodology: 100 patients were included and divided in 2 groups, selectedby non-probability purposive sampling, fulfilling inclusion and exclusion criteria. Group T(Tranexamic) received 15mg/kg IV Tranexamic acid 10 minutes before inflating tourniquet andthe same dose intravenously 3 hours post-operatively. Group C (control) received placebo(normal saline) intravenously. Blood loss collected in a container was measured with syringe/jarafter 24 hours of surgery. Results: In group C there were 23(46%) males and 27(54%) femaleswith male to female ratio 1:1.7 with mean age of 64yrs ± 6.3 yrs. In group T there were 28(56%)males and 22 (44%) females with male to female ratio 1.2:1 with mean age of 65yrs ± 7.4 yrs.After 24 hours Mean blood loss in Group C were 694 ±151 ml with 74 % patient in range of600-900ml while Mean blood loss in Group T were 388 ml ±105 ml with 76 % patient in rangeof 300-600ml. Mean decrease in blood loss with the use of tranexamic acid { mean blood lossin T group – mean blood loss in T group } were 306 ml which were statistically significant(p

Schistosoma mansoni worms inhabit the portal triad affecting blood elements. Therefore, the current study aimed to compare ameliorative effects of Commiphora molmol extract (Mirazid, MZD) and praziquantel (PZQ) on some biochemical parameters in S. mansoni-infected mice. Accordingly, Swiss albino mice (n=72) were used and were divided into 4 equal groups; 18 mice each. Group (1) was uninfected non-treated control. Mice in infected groups administered 100 S. mansoni cercariae/mouse. Group (2) contained infected non-treated mice. Group (3) was infected and treated with MZD at a dose of 500 mg/kg for 5 successive days. Group (4) was infected and treated with PZQ in a dose of 500 mg/kg for 2 successive days. Treatment started 7 weeks post infection (WPT) by the oral route. Blood samples were collected at the 1st, 2nd and 4th weeks post treatment for liver functions (ALT, AST and ALP), kidney functions tests (blood urea and serum creatinine) and cholinergic function (serum cholinesterase level). PZQ ameliorated activities of serum enzymes; alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase more than MZD compared to infected untreated group. PZQ significantly decreased ALT at 1, 2 and 4 WPT as well as AST and ALP activity at 2 and 4 WPT whereas, MZD resulted in significant reduction in ALT activity at the 1st, 2nd and 4th WPT. AST and ALP activities appeared at the 2nd and 4th WPT. PZQ caused progressive significant reduction in elevated levels of urea and creatinine at the 1st, 2nd and 4th WPT, respectively that produced by MZD. PZQ and MZD induced a significant elevation in the level of AChE. Such effect was early detected MZD, and it was showed at the 2nd and 4th WPT for PZQ. It was concluded that PZQ and MZD were safe drugs with no adverse biochemical effects on S. mansoni-infected treated mice with potential action done by PZQ rather than MZD.