National Institute Of Traumatology And Orthopedic Rehabilitation Research Articles

Evaluation of split flexor carpi ulnaris tendon transfer for fingers and thumb extension, pronator teres transfer for wrist extension in high radial nerve palsy

Background: The radial nerve is the largest terminal branch of the brachial plexus. Loss of radial nerve function creates a significant disability in the hand. The grip is severely impaired following loss of radial nerve function as a result of loss of extension of wrist, metacarpophalangeal joints of fingers and interphalangeal joints of the thumb. Methods: Prospective, quasi experimental study carried out for 3 years at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR). Forty-eight patients of high radial nerve palsy were selected for tendon transfer (split FCU tendon to EDC and EPL) and PT transferred to ECRB. Results: Mean age of the patients was 28.92 years (range 15-45 years), significantly higher in 26-35 years age group. There was preponderance of injury to the dominant right side (58.33%) than the none-dominant left side (41.67%). Motor vehicle accident (66.67%) was the common cause of injury followed by assault (33.33%). Out of 48 patients, 28 patients score 8-9 (excellent), 16 patients score 7 (good), 4 patients scores 5 (fair). So that, total 44 patients achieved satisfactory outcome (91.67%) and 4 patients achieved unsatisfactory outcome (8.33%). All patients can extend their wrist, fingers and thumb. Beyond this, all patients can flex their fingers up to mid palmar crease and thumb can be extended separately-independent of EDC function. Conclusions: Transfer of split FCU tendon to EDC and EPL for fingers and thumb extension in irreparable and neglected long standing high radial nerve palsy results significant functional outcome.

Effectiveness of Soleus Muscle Flap for The Coverage of Wound in Open Tibia Fracture in The Mid Shaft

Introduction: An open fracture of the tibia has been one of the most common long bone injuries. Soleus muscle flap supply can be a remedy for this kind of soft tissue difficulties. The soleus muscle flap’s blood supply may help in the construction of a longer, safer, and more functional flap. When the incision is clinically fit for covering, the flaps from the same leg are elevated between 0 and 14 days following the damage. In the majority of these cases, the flaps are covered with a split-thickness skin graft taken from the anterior aspect of the thigh in the same sitting. This can be a great solution. Aim of the study: The study aimed to assess the effectiveness of soleus muscle flap for the coverage of wound in open tibia fracture in the mid shaft. Methods: This prospective interventional study aimed to evaluate the outcomes of early coverage using the soleus muscle flap in the management of Gustilo type-IIIB fractures of the mid-shaft tibia. The study followed a quasi-experimental design and was conducted over an 18-month period from January 1, 2010, to June 30, 2011. The research took place in the Department of Orthopaedics and Traumatology at Dhaka Medical College Hospital (DMCH) and the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) in Dhaka. The study population included all 15 patients admitted to the hospitals with clinical and radiological evidence of open Gustilo type-IIIB fractures of the mid-shaft tibia followed by the inclusion and exclusion criteria. Informed written consent was taken before data collection and confidentiality was maintained. The analysis was done by SPSS version 15. Result: Among 15 patients most (12) were male, 3 were female. Mean age was 38 ± 12 years. Majority were in 31-45 years. Male female ratio was 4:1. The selected study subjects were predominantly motor driver (26.66%), followed by day labor, housewife, service holder, farmer, and businessman (each was-13.33%), and student was 6.66%. ...

Assessing Functional Outcome of PHILOS Plate Fixation in Proximal Humerus Fractures- A Prospective Study

Introduction: Despite the availability of numerous treatment options, managing unstable proximal humeral fractures remains a significant surgical challenge. Utilizing a PHILOS plate is an effective surgical technique for addressing these fractures. This approach provides stability and support to the fracture site, promoting proper healing and potentially improving patient outcomes. Aim of the study: The aim of this study was to assess the functional outcome of PHILOS plate fixation in proximal humerus fractures. Methods: This prospective study was conducted in the the Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Sher-e-Bangla Nagar, Dhaka, Bangladesh during the period from January 2009 to December 2010. A total of 80 patients aged over 18 years were included in the study. Patients with open, pathological and ipsilateral distal fractures in the same limb were excluded from the study. Result: The youngest and the oldest one were 23 and 78 years respectively. Majority of the patients were male and business was their main occupation. Fifty patients (62.5%) presented with 3-part fractures, ten (12.5%) with four-part fractures and twenty (25%) with fracture dislocation. The interval between injury and plate fixation was 18 days and minimum and maximum interval was 2 and 78 days respectively. Majority (92.5%) of the injury was caused by high-velocity accident. Evaluation of the outcome at 6 months showed that 62.5 percent of patients had good outcome, 25 percent patients had fair outcome. Conclusion: PHILOS plate fixation for proximal humeral fractures provides stable fixation and good functional outcomes, particularly in elderly patients.

Evaluation of The Treatment of Open Intercondylar Fracture Distal Femur by Transosseous Osteosynthesis Technique with Ilizarov External Fixator

Objectives: Treatment of Distal femoral fractures cannot be done following simple set of rules and when it is an open fracture the treatment is more difficult. Several methods were studied by different authors both at home and abroad, but none were conclusive. Methods: This prospective study was done between January 2011 to December 2012, 15 patients of the open intercondylar fractures of Distal femur were treated by transosseous osteosynthesis technique by Ilizarov External Fixator in NITOR (National Institute of Traumatology and Orthopaedic rehabilitation), Dhaka. 2 of the patients were not available for final follow up after removal of the fixator frame. So ultimately the final result based on the results of 13 Cases. Minimum 6 months follow up was done from the date of injury. No patient below age 16, no type IIIB or IIIC fractures and no patients having less than 6 months follow up were included in the study. Patients with severe injuries (Head injury, Abdomen and chest injury) were excluded from the study. Patients with medical illness such as Diabetes Mellitus, Peripheral Vascular diseases were not included in the study. Results: 12 male and 01 female patient between 16 and 56 years were studied. Most common age group in this series were 16-30 year age group (53.85%) and average age of the patients was 31.15 years. Most of the patients were male and road traffic accident was the leading cause of injury (92.31%). Right side involved in (69.23%) most of the cases. All patients were C3 type of fractures and G-II and G-IIIA types were same (38.46%). Most of the patients (53.85%) were operated within 1-2 weeks of admission. Average duration of hospital stay was 22 days ranging from 10 day to 45 days. Most of the patient had soft tissue healing by granulation tissue formation. Others were treated by primary closure, Delayed primary closure or secondary closure. Various complications were observed among them pintract infection, wire breakage, wire loosening, stiffness of joints, angulations and rotations, deep infection of the tissue, leg length discrepancy was observed in this study. According to the criteria of Neer et al, 1967 final results of the treatment were analyzed. Acceptable result was found in 61.54% of cases (Excellent 7.69% and good 53.85%). Results of the rest of 38.46% cases were not acceptable (Fair 23.08% and poor 15.38%). The result is similar with others done for open fractures of distal femur by Ilizarov External Fixator or other methods of fixation. Conclusion: So it can be concluded that transosseous osteosynthesis technique is a satisfactory method for treating open intercondylar fracture of distal femur as a primary and definite mode of treatment.

Pre- and Post-debridement Wound Cultures in Gustilo Type III Open Tibial Fractures to Predict Wound Infection at a Tertiary Care Hospital.

Gustilo type III open tibial fractures are difficult injuries that carry a higher risk of infection and other consequences. Open-fracture wound microbiology is dynamic and responsible for change over time. Effective antibiotic treatment plans are required, as detrimental microorganisms are often linked to these types of lesions. The study aimed to determine whether pre- and post-debridement wound cultures could predict wound infection in Gustilo type III open tibial fractures. This prospective study was carried out at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) in Dhaka, Bangladesh, on 344 patients who presented to the emergency department with a Gustilo type III open tibial fracture within 24 hours of injury from June 2018 to October 2019. Three successive cultures were carried out: one in the emergency room (surveillance culture), the second at the emergency theater after debridement, and the third in the ward after one week (seven to 10 days). Statistical analyses of the results were conducted using Microsoft Excel (Microsoft Corp., Redmond, WA) and IBM SPSS Statistics for Windows, version 27 (IBM Corp., Armonk, NY). The study included 344 patients with an average age of 37.15 years, with motor vehicle accidents being the primary cause (78.2%). Gustilo type IIIA fractures made up the majority (48.5%), followed by type IIIB fractures (44.8%). A significant reduction in contamination rates was observed from initial admission (48.8%) to post-debridement (36.6%) (p =.001). There was a significant positive correlation between pre-debridement cultures and wound infections (r =.311), as well as between post-debridement cultures and wound infections. The infection rate increased to 61.6% in ward samples, indicating a high rate of hospital-acquired infections. Pseudomonas and Klebsiella species were the most prevalent multidrug-resistant bacteria that caused these infections. The present study provides information on the relationship between contamination and infection. Gram-negative pathogens were dominant in this study, and the results of the antibiograms showed an alarming pattern of resistance. Nosocomial infection demands further urgent study.

Legacy of Compassion: The Life and Contributions of Dr. Ronald Joseph Garst in Advancing Orthopaedic Surgery in Bangladesh.

Dr. Ronald Joseph Garst, a distinguished spine surgeon and missionary, significantly impacted the field of orthopaedic surgery in Bangladesh, especially during and after the country's Liberation War, when the nation had no orthopaedic specialists.His experiences during Bangladesh's struggle for independence inspired him to establish rehabilitation centers for injured freedom fighters and to found the Rehabilitation Institute and Hospital for the Disabled (RIHD), which later became the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Bangladesh's first tertiary-level trauma center. In Bangladesh, Dr. Garst was critical in organizing care for injured freedom fighters, setting up a central limb and brace center, and launching a post-graduate training program for orthopaedics, physiotherapists, and occupational therapists. He successfully raised funds, attracted international support, and provided essential training to Bangladeshi doctors, nurses, and limb-makers. Dr. Garst's legacy extends beyond his medical achievements; his humanitarian spirit and dedication to helping the underprivileged earned him honorary citizenship in Bangladesh. He remained committed to supporting ongoing efforts at RIHD, frequently visiting Bangladesh and contributing equipment and training materials until his passing. Dr. Garst's contributions, such as initiating morning academic sessions at RIHD, continue to influence the orthopaedic community in Bangladesh. Thisarticle explores Dr. Garst's remarkable journey, his influence on orthopaedic surgery in Bangladesh, and the enduring impact of his work.

Reverse sural island flap for reconstruction of ankle and posterior heel defect: clinical experience with surgical modifications of pedicle

Introduction: Soft tissue defects around the ankle and posterior heel need stable flap coverage for proper healing and satisfactory recovery of function. Constant and reliable vascular supply of reverse sural island flap (RSIF) have made it a popular choice for reconstruction of these defects. In this study, the outcome of RSIF with few modifications in the pedicle area were discussed. Methods: This prospective study was carried out in National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka duing April 2019 to June 2020. Total 31 patients with soft tissue defect around ankle and posterior heel were reconstructed with reverse sural artery island flap. The soft-tissue defects were located, infront of ankle in 3 cases, over lateral malleolus in 7 cases, over medial malleolus in 5 cases, over tendoachilles in 12 cases, involving two or more areas of posterior heel, tendoachilles and lateral malleolus in 4 cases. Average Flap length and width were 9.67(+1.60) cm & 6.38(+0.76) cm respectively. Pedicle area of flap was modified by including a 2 cm skin extension in the middle along with additional adipofascial tissue on both sides to improve venous return. Pedicle length to width ratio was maximum of 3:1. Average length of pedicle was 7.2 + 1.7 cm. Results: All flaps except three survived completely without any complications. One patient (3%) had partial necrosis and another one (3%) had marginal necrosis of flap due to venous congestion. Epidermolysis was observed in 3% cases. Conclusions: The distally based superficial sural artery island flap is a versatile, reliable procedure useful in reconstruction of the lower extremity. Modifying the design of pedicle area increases safety by reducing venous congestion which ultimately leads to increase flap survivability. J Bangladesh Coll Phys Surg 2024; 42: 126-132

Complications of Ilizarov method treatment for infected nonunion femoral shaft fracture

Background: Infected non-union of the femur is complicated by the involvement of soft tissue and bone, long-term resistant multi-bacterial infection, limb length discrepancy, deformities, joint stiffness, and multiple draining sinuses, and poses a challenge for orthopedic surgeons. This study aimed to analyze the complications of Ilizarov method treatment for infected non-union femoral shaft fracture. Methods: This prospective observational study was conducted at the national institute of traumatology and orthopedic rehabilitation (NITOR), Dhaka, Bangladesh, from May 2018 to August 2020. A total of 20 patients were selected as study subjects by purposive sampling technique. All data were collected using a pre-formed questionnaire. Data were processed and analyzed using computer software program SPSS version 22.0. Result: The mean bone gap created during the operation was 2.7±1.7 cm of them, in 12 (60%) patients, it was 0 to 2 cm, and in 8 (40%) patients it was more than 2 cm. The mean time needed for radiological union was 7.85±2.1 months ranging from 5 months to 11 months. In 10 (50%) patients, union was achieved within 4 to 7 months, and in 10 (50%) patients it was 8 to 11 months. Regarding limb length discrepancy, in 5 (25%) cases there was no limb length discrepancy (LLD). Twelve patients had 1 cm to 2.4 cm LLD and 3 (15%) patients had ≥2.5 cm LLD. The mean LLD was 1.2±0.9 cm. Regarding complications, in 10 (50%) cases, there was no complication and 10 (50%) patients had complications. The complications were pin tract infection in 7 (35%) patients and wire loosening in 3 (15%) patients. Conclusions: The study concludes that while the Ilizarov ring fixator proves to be a dependable and successful method for stabilizing, correcting length discrepancies, and eliminating infections, it is not without its share of complications. The findings of this research indicate a 50% complication rate among the patients undergoing this treatment.

Functional Outcome of Primary Repair of Long Flexors of Finger at Zone V with Early Mobilization

A prospective, observational study was conducted in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh, between September 2019 and March 2021, to observe the functional outcome of primary repair of long flexors of finger at zone V with early mobilization. Our study included 51 patients, who had follow-up visits up to 12 months after operation. Tendon functionality was assessed by Buck-Gramcko score, while grip strength was assessed by modified sphygmomanometer. The mean age was 30.08±13.38 years. Middle and index fingers were most involved with both flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) injury. In this study, most of the patients had excellent or good outcomes. The average return to work time was 32.82 weeks. 9.8% of the patients developed post-operative complications like infections, adhesion, and rupture. Most of the patients obtained good to excellent results (90%), while 3.92% had fair and only 2% had poor outcome. Early motion of the fingers seems to improve outcome in these patients. However, worse outcomes were seen in patients with a greater number of damaged structures, especially in concomitant nerve injury. CBMJ 2024 January: vol. 13 no. 01 P: 83-88

Epidemiological Study on Laboratory Confirmed 300 Bangladeshi COVID-19 Patients with Their Clinical Outcome at a Tertiary Care Hospital in Dhaka city

Background: The novel corona virus (COVID-19) pandemic is a major global health threat of the twenty-first century. Clinical presentation, rapid identification of causes and isolation are vital for containments of rapidly spreading disease. Objective: The objective of the study was to report early findings on demographic profile, clinical presentation of the confirmed COVID-19 patients with their clinical outcome. Methodology: This prospective cohort study was conducted in Laboratory Medicine department of National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh for the period of February 01, 2021 to March 31, 2021. The positive COVID-19 patients were included and interviewed. Informed written consent was ensured before participation. After collection, Data were analyzed to show the characteristics of COVID-19 cases and their clinical outcome after treatment. Results: Among the 300 cases 222 (74%) patients were male and 78 (26%) patients were female. Average age of thepatients was 38 years. The most commonly observed symptoms were fever (71%), followed by cough (54%), breathlessness (40%), dysgeusia (38%), anosmia (24%). Respiratory symptom was the dominant feature of clinical presentation. The most prevalent affected age groups were 108(36%) patients in 41 to 50 years’ age, 102 (34%) patients in 31 to 40 years’ age. Among the total cases 252(84%) patients were Urban residents and 225 (75%) had contact history. Among 300 patients 108(36%) patients had co-morbidities and presence of co-morbidities (p<0.01) were significantly associated with mortality. The death rate was 2.0% cases. Conclusion: Male patients were more affected than female. Typical presentations were fever, cough, breathlessness, dysgeusia and anosmia. Bangladesh Journal of Medical Microbiology, July 2022;16(2):60-64

Relationship between Time to Surgical Debridement and Rate of Wound Infection in Open Tibia Fracture in a Tertiary Care Hospital

Background: The most frequent open long bone injury requiring immediate surgical intervention is an open tibial fracture. Within 6 hours of the injury, emergent surgical debridement of an open tibia fracture is advised by current guidelines. Recently, the 6-hour rule became challenged and delaying in debridement of an open fracture may be unethical. Methods: This cross-sectional study was carried out to assess the relationship between time of surgical debridement and rate of infection after open fracture tibia at National Institute of Traumatology and Orthopedic Rehabilitation (NITOR) on 608 patients with open fracture tibia (all Gustilo types) within 24 hours of injury from January 2018 to October 2019. Results: The mean age of the 608 patients was 36.2±15.5 years. The foremost mechanism of injury was road traffic accident (72.0%) and among the associated injuries, concomitant soft tissue injury (32.5%) was prevalent. Gustilo III was predominant injury (72.1%) and infection rates among the Gustilo subtype II was predominant (31.3%). After debridement 73 (12.0%) patients were contamination free. A significant association was found in the contamination rate between surveillance culture and post-debridement culture (p=0.000). Positive correlation found between debridement done ≥6 hours and infection present in 3rd culture from ward (r=0.237). Conclusion: The study insights that injury characteristics, infection pattern and infection rate of open fracture tibia. Delay in debridement has a significant relationship with wound infection, with more virulent multidrug resistance phenotypes.

Outcome of treatment of Unstable Intertrochanteric Fracture by Proximal Femoral Nail (PFN)

Background: Proximal Femoral Nail (PFN) is a surgical technique used to treat unstable intertrochanteric fractures, which are fractures that occur in the upper portion of the thigh bone (femur). The procedure involves using a nail-like device that is inserted into the femur and secured in place with screws to stabilize the fracture and promote healing. It is a commonly used treatment option for this type of fracture and can lead to good outcomes in most cases. The aim of the study was to observe the outcome of Unstable Intertrochanteric fracture by Proximal Femoral Nail (PFN). Material Methods: This prospective observational study was conducted at the Department of Orthopedics, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh. The study duration was 2 years, from July 2017 to June 2019. A total of 34 cases were included in the study sing purposive sampling (non-randomized) according to availability of the patients and considering inclusion and exclusion criteria. Results: The participants’ age range was 16-90, with a mean of 56.91 ± 17.76. Most (35.29%) were 61-75 years old. 61.76% were female and 38.24% were male. 50% were housewives, 14.71% ex-service holders, 14.71% service holders, 11.76% businessmen, 5.88% students, and 2.94% farmers. The leading cause of injury was falls on slippery ground (55.88%), followed by motor vehicle injuries (44.12%). 70.59% of injuries occurred on the right side and 29.41% on the left. 76% had Kyle Type III fractures, 24% had type IV. 85.29% had open reduction, 14.71% had closed reduction. The mean duration of injury to operation was 15.59 days and the mean hospital stay was 19.15 days. 70.59% had no complications and 55.88% reported no pain at last follow-up. 58.82% had a good Harris hip score and 58.82% had excellent outcomes by final follow-up. Conclusion: The majority of patients in this study were in the 61-75 age range and female, with the most common cause of injury being falls on slippery ground. The most common fracture type was Kyle type IV, with a major portion of cases requiring open reduction. The rate of complications was relatively low, and the functional outcomes were acceptable and comparable to other studies. The duration of injury to operation and hospital stay were slightly longer than other studies, likely due to the busy nature of the study location. Overall, the Proximal Femoral Nail is a safe and effective treatment option for unstable proximal femoral fractures.

Outcome of two knots tension band wiring (TBW) in Mayo type-IIA olecranon fracture

Olecranon fracture is relatively common and accounts for approximately 40% of elbow joint fractures. It is an intra-articular fracture, so the aim of treatment is anatomic reduction, stable fixation and early mobilization. Tension band wiring (TBW) may be a popular and widely practiced method using either single knot or two knots techniques. Now two knots TBW are widely accepted by AO foundation as well as various countries. But single knot technique is commonly practiced in Bangladesh. The present study was done to see the clinical, radiologi- cal and functional outcome of two knots Tension band wiring (TBW) in Mayo type IIA olecranon fracture. This observational study was carried out by the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh. A total of 32 patients with Mayo type IIA olecranon fractures were treated with two knots TBW, out of which 30 cases had completed at least 24 weeks of follow-up and analyzed for final functional outcome with Mayo Elbow Performance Score (MEPS). The mean age was 32.58±14.21 years and the male to female ratio was 2.6:1. The mean radiological union time was 8.15±2.25 weeks. In 6 (18.75%) cases, it took 6 weeks, in 18 (56.25%) cases, it took 8 weeks and in 8 (25.0%), it took 12 weeks. Complications were found in 21.9% of patients. At first follow-up after the operation showed that 21 (70.0%) had moderate pain and the final follow-up showed 21 (70.0%) had no pain. The mean arc of elbow motion at first follow-up and final follow-up were 61.090±16.2340 and 122.820±15.2870, respectively. The mean functional score at 1st follow-up was 6.75±5.63 and the last follow-up was 24.76±1.69. The mean total Mayo Elbow Performance Score (MEPS) scores at first and last follow-up were 40.65±14.48 and 94.13±8.35, respectively. Excellent and good outcomes were found among 21 (70.0%) and 9 (30.0%) patients, respectively. Two knots TBW technique is safe regarding overall complication rate, pain status and excellent outcome. BSMMU J 2022; 15(2): 90-95

The clinical and radiological outcome of uncemented primary total hip arthroplasty in case of AVN of femoral head in middle age group

Background: The appropriate treatment of avascular necrosis (AVN) of the femoral head has become a serious problem around the world, particularly in adult instances. Objective was to evaluate the clinical and radiological outcome of uncemented primary total hip arthroplasty in case of AVN of femoral head in terms of pain relief, functional capacity, range of motion, absence of deformity, radiological assessment and comparing pre-operative and post-operative functional status.Methods: This was a prospective observational study of 44 hips of 37 patients at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh.Results: Here, majority (70%) belong to 30-35 years age group, and 75% were male. The affected site of arthroplasty among patients where highest (51.35%) patients had been affected on right side and right side number of hip was (40.42%). Among all, 30 patients underwent unilateral total hip replacement (THR), 7 patients who were affected bilaterally underwent staged bilateral THR at an interval of 6-12 weeks. According to the position of the acetabular component, anteverted in 70% patients, retroverted in 0% patients, neutral in 25% patient, <35º inclined in 0% patients, 35º-50º inclined in 65% patients, and >50º inclined in 20% patients at follow-up cases. Based on modified Harris hip score (HHS), 92% cases rated this treatment as excellent.Conclusions: Uncemented total hip arthroplasty in individuals, who have arthritis of the hip joint secondary to AVN, provides satisfactory clinical and radiographic outcome. Though the procedure is not free of complications, the overall functional and clinical outcome had shown excellent result.

Assess Clinical Improvement Regarding Joint Line Tenderness and Childress’ Test (Duck Walk Test) after Arthroscopic Partial Meniscectomy in a Tertiary Care Hospital

Background: Clinical weight bearing provocation tests, like to determine the sensitivity and specificity of the childress’ test (duck walk test) and joint line tenderness in diagnosing meniscal tears and to determine whether the location of tear and severity of injury is important. However, evidence of the diagnostic accuracy of the childress’ test (duck walk test) and joint line tenderness test are lacking and the cause of tear (traumatic versus degenerative), and ACL insufficiency were associated with differences in the sensitivity and specificity of the test. Objectives: The aim of this study was to assess the clinical improvement regarding joint line tenderness and childress’ test (duck walk test) in a tertiary care hospital. Methods: This is a prospective interventional study. The study used to be carried out in the admitted patient’s Department of Orthopedic, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR) Sher-E-Bangla Nagar, Dhaka, Bangladesh. In Bangladesh for the duration of the period from January 2013 to December 2014. Results: This study conducted on 20 patients aged 16 to 40 years, Childress test (Duck walk test) was positive in case of 80% patients and post operatively the test became negative in all patients Out of 20 patients 90% regained normal to near-normal knee function and stability after surgery. Pain and swelling were also significantly reduced. Conclusions: Meniscus injury frequently takes place in young adult population who are very active, which reduces their endeavor level and ultimately become an economic burden. So, early intervention and partial meniscectomy, which offers very accurate momentary result, is imperative to make them healthy and return to their normal activity.

Evaluation of the Short-Term Results of Arthroscopic Partial Meniscectomy in Adults

Background: Arthroscopic partial meniscectomy is one of the most common orthopedic procedures; yet enormous evidence of its efficacy is under trial in comparison to repair of the meniscal injury. Objective of this study is to confirm of the clinical findings arthroscopically in case of meniscal injury of the knee joint and find out the results of Arthroscopic partial meniscectomy among the adult people. Methods: This prospective interventional study was conducted from January 2013 to December 2014 at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka. Twenty (20) patients with meniscus injury were treated in the form of arthroscopic partial meniscectomy. Accelerated rehabilitation protocol was followed. Patients were visited routinely and final outcome evaluation done at 6 months. Lysholm knee scoring scale was used to compare preoperative and postoperative score and to evaluate final outcome. Results: This study was carried out on 20 Patients. Preoperatively all patient had significant knee pain with positive joint line tenderness, McMurrey test, Apley’s grinding test, squat test and Thessaly test. Post operatively significant improvement was found (p<0.05). Mean preoperative Lysholm knee score was 52.8 with SD ± 2.97 and postoperative score was 93.8 with SD ± 4.24. According to Lysholm knee scoring scale, excellent results (95– 100 points) were obtained in 14 patients, good results (85–94 points) in 4 patients, fair in 2 (10%) patient. Conclusion: Arthroscopic partial meniscectomy shows excellent short-term result if the procedure performed early in the adult patients.

Short Term Clinical, Functional and Radiological of Fixation of Paediatric Femoral Shaft Fracture by Titanium Elastic Nail in Paediatric Patients

Introduction: Femoral shaft fracture is the most common major paediatric orthopaedic. For generations traction and casting was the standard treatment for all femoral shaft fractures in children. Elastic stable intramedullary nailing is one for treating these fractures and has a reliable methodology. Over the past two decades the advantages of fixation and rapid mobilisation have been increasingly recognised. Objective: To evaluate the short term clinical, functional and radiological outcome of intramedullary fixation of displaced femoral shaft fractures in skeletally immature children using titanium elastic nails. Methods: A prospective study was conducted in the Department of Ortho Surgery, National Institute of traumatology and orthopedic rehabilitation (NITOR), Dhaka, Bangladesh from July to December 2020. 52 femoral shaft fractures in child aged 6-14 years were fixed with titanium intramedullary elastic nail in the department of Orthopaedics, NITOR, Bangladesh. Two nails of proper and equal diameter were used for fracture fixation. No external splint was used after surgery. Outcomes assessed on the basis of Flynn et al., scoring criterion. Results: The results of the 52 included in our study. All patients achieved complete healing at a mean of 9.1 (Range 8- 10) weeks. 44 fractures were reduced by closed means but 8 needed open reduction. No major complication was recorded. Most common minor complication was entry site skin irritation recorded in 8 patients. 84.61% had excellent result and 15.38% had satisfactory. Conclusion: The treatment of paediatric shaft femur fracture has been drastically changed over the last two decades to internal fixation by elastically stable intra- medullary nail (ESIN). It allows early ambulation and shorter hospital stay and higher parent satisfaction. It also provides flexural, translational and rotational stability as well.

Awareness and Acceptability of Total Joint Replacement among Patients Suffering From Severe Osteoarthritis

Introduction: Osteoarthritis (OA) is one of the most common joint disorders with pain, function loss, and disability among the older population. Osteoarthritis (OA) affects millions of people all over the world and accounts for a vast burden of pain, debility, functional limitations, loss of man hour and productivity, disability, and loss of quality life expectancy. Total joint replacement is the most effective and a successful treatment for the elderly patients suffering from end stages of osteoarthritis. Objectives: To study of the awareness and acceptance of total joint replacement surgery among patients suffering from severe osteoarthritis of the hip and knee joints. Methods: A prospective study was contacted at the Department of Ortho Surgery, National Institute of traumatology and orthopedic rehabilitation (NITOR), Dhaka, Bangladesh from January to June 2021. Forty nine (49) patients included in our study. A well-structured questionnaire was administered to the patient requiring information about their biodata, educational level, the joint affected by osteoarthritis, the level of pain using numeric rating scale (NRS), their knowledge of total joint replacement, their willingness to accept total joint replacement, reasons for not accepting the surgery, X-ray findings and radiological classification of the osteoarthritis using Kellgren and Lawrence classification. Results: A total of 49 patients were recruited for the study. The age ranged 13-88years with mean age 48 years ± SD 18.2 years; male and female ratio of 1:1.7. Of the 49 patients recruited for the study 32(65.30%) were aware of the role of total joint replacement in the treatment of osteoarthritis and among these 32(65.3%) (figure1) and among these 29(59.18%) accepted the procedure while 20(40.81%) of them rejected it. Thirty one (34.69%) patients had no knowledge of joint replacement but when they were educated on its relevance in their management 10(32.3%) accepted but 21(67.7%) rejected the surgery.

Comparison of Functional Outcome Like Range of Motion of Hip After Fixation of Trochanteric Fracture with Dynamic Hip Screw (DHS) and Proximal Femoral Locking Compression Plate (PF-LCP)

Trochanteric region of the femur is that part which connects the neck and shaft of femur. So head, neck, trochanter facilitates the movement at the hip joint causing the limbs to swing clear of the pelvis. Intertrochanteric fractures are divided into stable and unstable varieties. To assess the Comparison of functional outcome like range of motion of hip after fixation of trochanteric fracture with dynamic hip screw (DHS) and proximal femoral locking compression plate (PF-LCP) the present prospective randomized clinical trial was conducted in the Department of Orthopedic, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR) between January 2009 to December 2010. A total of 20 patients with post traumatic trochanteric fractures and osteoporotic fractures within three weeks of incidence were included in the study. The age distribution of the patients was identical between the groups with mean age of the patients being 56.2 and 55.6 years in DHS and PF-LCP groups respectively (p=0.626). Males were predominant in both groups (each of 70%). In both groups fractures were primarily caused by RTA (60% in DHS and 50% in PF-LCP) (p=0.327) with all patients having closed type of injury. Sixty percent of the injuries in each group had right-sided involvement. (p = 0.675). All patients of either group required open surgical procedure. DHS required shorter operation time than that required by PF-LCP (72.5±5.4 min vs. 96.5±3.3 min. p<0.001). Immediate postoperative outcome demonstrates that all of the patients in both groups had intact cut-out of lag-screw and implant failure did not occur. Thirty percent patients in DHS group needed blood transfusion, while only 10% patient needed the same in PF-LCP group (p = 0.291). At 4 weeks Follow up 30% of DHS group had infection as opposed to none in the PFL-CP group. Ninety percent of the patients in the former group had pain as opposed to none in the latter group (p<0.001). Visible callus formation was ..........

Effectiveness and Functional Outcome of Fenestration and Discectomy by Mini-Incision for the Prolapsed Lumbar Intervertebral Disc

Background: Lumbar intervertebral disc herniation is a common health problem in our country. Majority of the surgeries of the spine are done due to disc herniation in Bangladesh. Discectomy can be limited to partial discectomy where only extruded and sequestrated portion is removed, subtotal discectomy where the whole of nucleus pulpous is removed and total discectomy where the entire intervertebral disc of the affected level is removed. Aim of the study: To find out the effectiveness and functional outcome of fenestration and discectomy by mini-incision for the prolapsed lumbar intervertebral disc in our context. Material & Methods: This prospective observational study was conducted at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh during July 2015 to June 2017. A total of 31 patients with prolapsed lumbar intervertebral disc were included for the study according to inclusion and exclusion criteria. Results: The mean age was 35.98 ± 8.50 years with the range from 17 to 50 years. In this study, the most common muscle weakness in EHL. Out of 31 patients, 22 (70.96 %) patients were in this group. 08 (25.80%) cases had weakness in FHL and another group 01 (3.22%) had both muscle weakness. Out of 31 patients, 30 (96.78%) patients had preoperative sensory deficit and 03 (09.67%) patients had postoperative sensory deficit, which is statistically significant. In preoperative period, moderate pain in 27 (83.87%) patients, severe pain in 04 (12.90%) patients. In postoperative period had no pain in 22 (70.96%) patients, mild pain was noted in 08 (25.08%) patients, moderate pain in 01 (03.22%) patient. 20 (64.51%) patients had para spinal muscle spasm in the preoperative period, whereas no patient had any spasm in 3 months postoperatively. The success rate was 100% and the result was statistically significant. In this present series, functional outcome was assessed according to Macnab criteria. 08 (25.80%) cases were excellent, ...