National Institute Of Traumatology And Orthopedic Rehabilitation Research Articles

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, ...

Injury Characteristics, Infection and Resistance Pattern of Open Fracture Tibia in Tertiary Orthopaedic Centre

Background: Open fractures are a frequent occurrence in the in accident and emergency department that requires immediate care. As a pedal bone, the tibia is very prone to accidental injury, easily becomes bare following the trauma and very prone to infection. Updated knowledge about microbial aspects of open tibia fracture infection is essential for proper management. Objective: This study evaluated the injury characteristics and resistance patterns of microorganisms involved in the infection of open fracture tibia in a single-centred study. Methods: This was a cross-sectional study on a total of 384 patients presented at the emergency department with open fractures of the tibia (all Gustilo types) from January 2020 to July 2020 at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Bangladesh. Three successive culture sensitivity tests were carried out-one at the emergency room (surveillance culture), 2nd at the emergency theatre after debridement and third at ward after 1 week (7 to 10 days). Results: Average age of the patients was 36.2± 15.5 years, with motor vehicle accidents being the predominant cause (72.9%). Gustilo III fractures were most prevalent (54.4%). The maximum infection rate was in Gustilo IIIB Fractures (40.4%). There was a significant difference in contamination rate between on admission culture (37.0%) and post debridement culture (26.3%). The infection rate from the ward samples was 44.5 %, where the postdebidement contamination was less only 26.3%. But from the ward sample, it again increased to 44.5%. Among the patient entering the ward after debridement with no contamination (73.7%) became infected in 34.62% cases, which indicates hospital-acquired infection. The bacterial resistance patterns from the ward samples were more virulent with multidrug resistance, predominantly Pseudomonas spp. and Kliebsiella spp. Conclusion: The present study provided insight into the injury characteristics and infection patterns of open fractures of the tibia. Early debridement reduced the contamination, but there was still hospital-acquired infection with more virulent multidrug resistance phenotypes. Bangladesh Med Res Counc Bull 2021; 47(2): 205-211

Effects of Application of Night Splint in the Management of Plantar Fasciitis

Background: Plantar fasciitis is one of the most common causes of heel pain. The condition usually comes on gradually without any injury. Clinically there is pain and tenderness in the sole of the foot, mostly under the heel, with standing or walking. The diagnosis of patient with planter fasciitis is essentially clinical. Treatment options for planter fasciitis include rest, stretching, strengthening exercise, shoe modification, arch supports, orthotics, night splints, anti- inflammatory agents, and surgery. Although injections and Non-steroidal anti-inflammatory drugs (NSAIDs) bring relief, their effects are often only temporary. Stretching of the calf and plantar fascia may provide some benefit. In chronic planter fasciitis, surgical treatment is only advocated where adequate conservative management fails.
 Objective: The aim of this study is to evaluate the effects of the application of night splint in the management of plantar fasciitis.
 Materials and Methods: This randomised clinical trial included 50 (fifty) patients with planter fasciitis who were seen in the Physical Medicine and Rehabilitation department of the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR) in Dhaka. The patients were divided randomly into two groups, Group A and Group B. Patients in Group A were treated with NSAID, ADL and Night splint, whereas Group B patients were treated with NSAID and ADL. The patients were evaluated clinically, and data was collected from both groups in a pre-designed data collection sheet for Pain score, Tenderness index, and Visual analogue scale in every 2 weeks interval from the first visit for up to 6 weeks. All the data were analyzed by SPSS version 16.1.
 Results: The present study showed pain and tenderness were significantly improved in Group A, who were treated with Night Splint, NSAID & ADL instructions than in Group B who were treated with NSAID & ADL instructions after 6 weeks( P<0.05).
 Conclusion: Night splint is an easy, non-surgical and cost-effective one which can be applied with other modalities. Night Splint, along with NSAIDs and ADL instructions, is more effective in the reduction of pain and other symptoms in a patient with planter fasciitis.

Study on Post-Traumatic Stress Disorder (PTSD) Among Traumatic Amputated Patients Using DSM-5 Revised Criteria

Background: Limb amputation is a common surgical procedure done for therapeutic reasons to prevent further deterioration and save lives.Objective: To assess the level of post-traumatic stress disorder (PTSD) among trauma related amputated patients.Methods: This cross-sectional study was conducted between January and December of 2016 on 296 amputated patients who were admitted in the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, and BDM Hospital and Diagnostic Center, Dhaka, Bangladesh. A semi-structured, questionnaire was developed both English and Bangla (local language) using the variables of the study and validated. Using that tool, face to face interview was taken. The checklists were used to collect their socio-demographic characteristics, information regarding amputation and stress severity and diagnosis of PTSD, collectively termed as DSM-5.Results: Among 296 respondents, 213(72%) were male and 83(28%) were female. The mean age of the respondents was 32.013±5.35 years. PTSD was found in221 (75%), while the rest 75 (25%) had acute traumatic stressdisorder. Among PTSD patients, 10(50%) with digit amputated, 41(68.33%) of upper limb amputated, 155(77.11%) of lower limb amputated, and 15(100%) of both or multiple limbs amputated respondents. 61% had extreme level of stress. PTSD had significant association with sex, age, habitat, occupationposition and part of limb loss (P<0.05).Conclusion: In our country, PTSD is very common in amputated patients and has significant association with sex, age, habitat, occupation as well as part of limb loss. Multidisciplinary team of health professionals should emphasize on the need of amputees, both physically and psychologically and provide an effective rehabilitation plan.International Journal of Human and Health Sciences Vol. 06 No. 02 April’22 Page: 183-187

Evaluation of Results of Open Reduction and Internal Fixation of Intraarticular Fracture of Distal Humerus AO type 13-C1 by 90-90 Plate Through Triceps Sparing Approach

Background & objective: The complex anatomy of the distal end of the humerus with its unique orientation of articular surfaces supported by cancellous bone makes its fracture a constant challenge to orthopaedic surgeons. Internal fixation techniques seek to stabilize these fractures by using a plate on both columns. Without this dual plate arrangement, stability of fixation can be inadequate. Materials & Methods: This observational, descriptive, longitudinal, prospective study was carried out in the outpatient and inpatient at Department of National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka over a period of two years, between July 2014 to June 2016. Participants were 18 in number and aged between 18 to 50 years. Fractures are classified according to AO classification system and only closed intra-articular fractures of distal humerus AO type 13-C1 was included in this study. Patients with open fractures, fracture more than 2 weeks old and fractures in children were excluded from this study. Majority of cases 11(61.11%) were operated within 1 week of injury. Open reduction internal fixation by pre-contoured 90-90 locking plate was performed in all cases through triceps sparing approach. The plaster cast was removed 2 weeks after operation and rehabilitation was encouraged during this period and afterwards. Patients were advised to come for follow up after discharge in different scheduled date till the fracture union was achieved. The final outcome of the patient was graded according to Mayo Elbow Performance Index (MEPI). Chi-square test was used for testing statistical significance. Statistical significance was set at p < 0.05. Results: Most of the injury was caused by motor vehicle accident 9(50.00%) and rest of the injury caused by fall 5(27.77%). Final outcome by MEPI showed that 15(83.33%) were excellent, 2(11.11%) were good, 1(05.56%) was fair, there was no poor Result. Complications were seen during the follow up period that included wound scar, delayed union which was treated conservatively and union occurred at 18th week. Conclusion: Open reduction and internal fixation of closed intra-articular fractures of distal humerus AO type 13-C1 by 90-90 plate in sagittal plane on medial column and in coronal plane on lateral column through triceps sparing approach is an effective procedure to provide sufficient stability for the postoperative rehabilitation with an excellent union rate and a very good clinical outcome. TAJ 2021; 34: No-2: 71-79

Evaluation of the results of arthroscopic anterior cruciate ligament reconstruction by quadruple semitendinosus and gracilis tendon autograft fixation with biodegradable interference tibial screw and endobutton for femur

Introduction: Anterior cruciate ligament is often injured in physical activities especially contact sports and road accidents. ACL injury is a debilitating condition which may result pain, swelling and instability especially during activities involving side stepping and pivoting. Arthroscopic reconstruction of the ACL with central one-third of the patellar ligament and the hamstring tendon construct are most commonly used for reconstruction of ACL. Hamstring tendon graft using semitendinosus or semitendinosus-gracilis tendons either tripled for quadrupled form has evolved as an alternative for ACL reconstruction.Materials and Methods: This was a quasi-experimental study (Prospective Study). This study was done from January 2015 to December 2016 at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka. Patients presented with unilateral knee complaints and clinically diagnosed as ACL injury of both sexes at OPD of NITOR were included in this study. Due to time limitation and financial constrain 30 cases were selected during the study period. Purposive sampling (nonrandomized) was done according to availability of the patients and strictly considering the inclusion and exclusion criteria. Results: Post operatively Lachman test improved significantly, 95% cases of grade I and grade II was in 5% patients. Anterior drawer was positive in 10% cases. Pivot shift test was negative in all cases. McMurry test negative in all cases. After operation 80% had 135o knee flexion and 20% had less than 130o flexion. Preoperative versus post operative Lysholm knee score in this series shows significant improvements (p

Thyroid status and treatment responses of hypothyroid infertile women: a study in a tertiary care hospital of Bangladesh

Background: Recently, the prevalence of hypothyroidism in the reproductive age group is found up to 4%. In many studies it had been claimed that, thyroid status is directly involved in women reproductive system. Hypothyroidism can be easily detected by assessing serum thyroid stimulating hormone (TSH) levels. The aim of this study was to dig out the prevalence of hypothyroidism in infertile women and to assess their responses in treatment procedures.Methods: This observational study was conducted National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh during the period from January 2019 to December 2019 in total 236 women of Endocrinology Department treatment. Patients were followed up for six months even if pregnancy was attained.Results: In total 22% (n=52) patients were hypothyroid. Among them 35 (15%) were subclinical hypothyroid and 17 (7%) were frank hypothyroid. Besides these, 73% (n=172) were euthyroid and the rest 5% (n=12) were hyperthyroid. On the other hand, in analysing the outcome (treatment responses) among the hypothyroid subjects we observed regular menstruation, normal ovulation, clinical pregnancy and chemical pregnancy were achieved by 92.31% (n=48), 88.46% (n=46), 50% (n=26) and 69.23% (n=36) subjects respectively.Conclusions: According to the study, the careful diagnosis and treatment of hypothyroidism can ensure benefit a lot rather than going for unnecessary hormone assays and costly invasive procedures in for women of infertility.