National Institute Of Traumatology And Orthopedic Rehabilitation Research Articles

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.

Use of Perforator Propeller Flaps for Coverage of Soft issue Defects Around The Distal Leg and Ankle

Introduction: Perforator propeller flap is a suitable option to cover soft tissue defects in the distal leg and ankle which preserves the main vascular arteries of the lower extremity and muscle function. The aim of this study is to evaluate the use of perforator propeller flaps for coverage of soft tissue defects around the distal leg and ankle.
 Methods: This prospective study was donebetween December 2018 to November 2019in the Department of Burn & Plastic Surgery of National Institute of Traumatology and Orthopedic Rehabilitation ( NITOR), Dhaka. Total 32 patients with small to medium sized soft tissue defect over distal leg and ankle underwent reconstruction with perforator propeller flaps. Sixteen patients had defect over tendo achilles area, 6 had defect over lateral malleolus,7 over medial malleolus and medial aspect of distal third leg and only 3 had defect in front of ankle. Average Flap length and width were 12.72 (+4.19) & 5.63 (+1.78) cm respectively. Flap rotation was measured 180 degrees in 84.37% of the cases. The propeller flaps were based on a single perforator and it was observed from the posterior tibial artery in 62.5% and peroneal artery in 37.5% of the cases.
 Results: 81.25% of the flaps completely survived. Total flap loss was observed in one case (3%) while partial flap loss occurred in 6.2% cases. Marginal flap necrosis and epidermolysis were observed in 6.2% and 3% cases respectively.
 Conclusions: Propeller flapshavereliable vascular pedicle as well as greater freedom in design and arc of rotation that extend the possibility ofreconstructing difficult wounds with local tissues and minimal donor-site morbidity.
 J Bangladesh Coll Phys Surg 2021; 39(2): 87-93

Evaluate the results of Noncemented Total Hip Replacement (THR)

Introduction: Total Hip Replacement is one of the most successful orthopaedic procedures performed now-a-days. A British orthopaedic surgeon named Charnley first introduced with this treatment. A noncemented joint prosthesis, sometimes called a press-fit prosthesis, is specially textured to allow the bone to grow onto it and adhere to it over time. Aim of the study: The study aims to determine the results and the complications associated with non-cemented total hip replacement (THR). Methods: This cross-sectional study was conducted in the Department of Orthopaedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh during the period from February 2016 to February 2018. Sample size was 35. Statistical analysis of the results was done by computer software devised in the statistical packages for social scientist (SPSS-25) and MS excel-16. Results: In total 35 patients in this cross-sectional study from the total of 35 patients we found most of the patients were male 29(82.86%) and female 6(17.14%). Most of the patients found in 31-40 age group 14(40.00%), then 41-50 and that was 11(31.43%) respectively 5(14.29%) found in 21-30, 11(31.43%) in 41-50 and 4(11.43%) in >61. So most of them found excellent on the score of 90-100, 20(57.14%), then 11(31.4%) was 80-89 score as good, 3(8.6%) found in 70-79 score fair and below <70 score found 1(2.9%) as poor. Conclusion: There is many reasons that may have caused surgeons in the past to move away from the use of cemented implants have been found to be unwarranted and the evidence does not support the increasing using of noncemented implants. In particular, the risk of mortality in cemented THA has not been found to be higher than noncemented THA.

V-Y Plasty in the Treatment of Fingertip Injuries

Background: Hand is a highly specialized organ as it has grasping, pinching and hooking function. The hand is prone to domestic and industrial trauma with fingertips being the most frequently injured portion of the hand. Fingertip injuries are commonly seen by emergency physicians&#x0D; Objectives: To see the functional outcome after V-Y flap in fingertip injuries.&#x0D; Methods: Prospective, observational study carried out for 2 years at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR). Fifteen patients of fingertip injuries were selected for V-Y flap.&#x0D; Results: V-Y plasty was performed in 15 patients who suffered from a transverse amputation of the finger tip. Out of 15 patients, functional outcome was satisfactory (good) in 13(86.7%) cases and unsatisfactory (fair plus poor) in 2 cases (13.3%). 3 patients had postoperative complications. The results showed that V-Y plasty is indicated in transverse amputations through the distal one-third to one-half of the nail bed.&#x0D; Conclusion: Fingertip injury can achieve almost normal sensibility and satisfactory motion by V-Y flap and patients can expect to return to work on average approximately 3 weeks after operation.&#x0D; TAJ 2020; 33(2): 107-112

Assessment of Depression among Musculoskeletal Fracture Patients in a Tertiary Referral Hospital in Bangladesh

Psychological therapy is very important in musculoskeletal fracture patients for mental support. The study was conducted National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka. 102 participate in this study. Patients with a musculoskeletal disorder are commonly treated by physical therapists; it influences clinically relevant outcomes such as pain and disability but not influence a treated psychological disorder. Psychological therapy is very important relatively to treat of physical therapy. It found that the severity of injury moderate 20%, serious 2.4%, severe 77.1% depression on musculoskeletal fracture, he/she feel sad 41.0%, sad all the time 44.0%, so sad 14.5%, Indicates minimal depression 1.2%, mild depression 12%, moderate depression 81.9%, severe depression 4.8%. It is found that the mean depressed mood of the respondent’s sadness 94.0%, frequent weeping 6.0%, in agitation occasional 7.2%, frequent 92.8%, anxiety no difficulty 1.2%, tension irritability 89.2%, fear 9.6% depression on musculoskeletal fracture. So that the Musculoskeletal fracture in our country is more vulnerable and mental health is not so good.

Outcome of Surgical Decompression of Cauda Equina Syndrome by Laminectomy and Discectomy

Background: Cauda equina syndrome (CES) is a relatively uncommon condition typically associated with a large, space occupying lesion within the canal of lumbo-sacral spines. This syndrome is characterized by varying pattern of low back pain, sciatica, lower extremity sensorimotor loss, saddle anaesthesia and bowel and bladder dysfunction.&#x0D; Objective: The objective of this study was to evaluate clinical and functional outcome and operative complications in case of CES who underwent surgical decompression by laminectomy and discectomy.&#x0D; Materials and method: This prospective interventional study was carried out at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) and different private hospitals in Dhaka from January 2017 to December 2019. Patients were selected on the basis of history, clinical examinations and Magnetic Resonance Imaging (MRI) findings. Patients with fracture and compression due to other than disc prolapse were excluded from the study.&#x0D; Results: Out of 23 patients, 18 patients (78%) were male and 5 patients (22%) were female, age ranged from 20-60 years, with the average age 37.5 years. Twenty one patients (91%) had single level and 2 patients (9%) had two level disc herniation. The mean follow up duration was 9 months (range 6-12 months). Patients were evaluated with respect to age, time to surgery and scoring system for CES before and after operation. Those who were treated within 48 hours and those after 48 hours showed significant difference in outcome (p &lt;0.05). Complete recovery was documented in 12 patients (52%). There was infection in 01 case (4%), 03 patient (13%) had persistent low back pain, 02 patients (9%) had sciatica, 01 patients (4%) had bowel and bladder dysfunction and 01 patients (4%) had saddle anaesthesia in delayed operative group. Evaluation of final outcome was satisfactory in 17 patients (74%).&#x0D; Conclusion: Laminectomy and discectomy is an effective, safe and acceptable modality of treatment in CES.&#x0D; Delta Med Col J. Jul 2020;8(2): 83-85

Outcome of decompressive operative procedure in the treatment of degenerative lumbar spinal canal stenosis: experience of managing consecutive 25 cases

Background: Lumbar spinal canal stenosis (LSCS) is a common medical disorder due to degenerative changesin the middle age and older individual. In this condition, narrowing of lumbar spinal canal and nerve rootcanal leads to painful, debilitating compression of spinal nerves and blood vessels. Decompressive surgery inlumbar spinal canal stenosis is one of modern methods of treatment.The objective of this study was to evaluate the outcome of decompressive operative management in degenerativelumbar spinal canal stenosis.&#x0D; Methods: Thiswas a prospective interventional study carried out at National Institute of Traumatology andOrthopaedic Rehabilitation (NITOR) and City Hospital, Lalmatia, Dhaka from October 2012 to December2014.Total number of patients were 25 who underwent decompressive surgical procedures. Each of patientswas evaluated by the visual analogue scale (VAS) for pain, disability by using Oswestry disability index (ODI)and ModifiedMacnab Criteria (MMC)for assessment of improvement.&#x0D; Results: This was a prospective interventional study carried out at National Institute Of Traumatology and OrthopaedicRehabilitation (NITOR) and City hospital, Lalmatia, Dhaka from October 2012 to December 2014. Out of 25patients, 19 patients(76%)were male and 6 patients (24%) were female, age ranged from 38-65 years with the meanage 48.50 ± 8.65 years. Sixteen (64%) patients were manual worker and 9 patients (36%) were sedentary worker.Sixteen (64%) patients had multilevel stenosis and 9 patients (36%) had single level stenosis. The mean follow upduration was 1.5 years (range: 1-3 years). Mean estimated blood loss was 150ml (range : 100-200ml), meansurgery time was 130mutes (range: 80-180min) and average hospital stay was 7 days (range: 4-10 days). Only 1patient (4%) had discitis, 1 patient (4%) had superficial wound infection and 1 patient (4%) had dural tear. AsMMC, 21 (84%) patients was poor before operation and after operation at 12 months follow up 8 patients (32%)had excellent, 12 patients (48%) had good, 4 patients (16%) had fair and 1 patient (4%) had poor functionaloutcome. Mean (SD) ODI were 75.40 (± 5.01) before operation and reduced to 8.36 (± 13.54) after operation at 3rd(12 month) follow up. Mean (SD) VAS was 7.12 (± 0.86) before operation and reduced to 1.46 (± 1.31) afteroperation at 3rd (12 month) follow up. Twenty (80%) patients had satisfactory functional outcome.&#x0D; Conclusion: Decompressive operation is an effective, safe and acceptable method of treatment in degenerativelumbar spinal canal stenosis (LSCS).&#x0D; Birdem Med J 2020; 10(2): 103-107

Evaluation of the Results of Closed Antegrade Interlocking Intramedulary Nail for Proximal and Mid Shaft Femur Fracture

Background: Fractures of the shaft of the femur are among the most common fractures encountered in orthopedic practice. Various treatment options are available but closed interlocking intramedullary nail for fracture shaft of the femur is the gold standard treatment.&#x0D; Objectives: This randomized clinical trial was conducted to evaluate the results of closed intramedullary interlocking nailing for proximal and mid shaft femoral fractures in adult in our country.&#x0D; Materials and Method: This study was conducted at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka and private Hospital of Dhaka and Rajshahi over a period of four and half years (August 2013-August 2017). Adult patients with closed fracture of proximal and mid shaft of the femur were the study population. A total of 50 patients (50 femoral shaft fractures) aged 18-65 years irrespective of sex were included in the study. The mean age of the patients was 36.52 ± 15.24. Majority of the patients were male. Twenty seven (54%) patients were operated on left side and twenty three (46%) patients were operated on right side. Average time interval between injury and date of surgery was 8.26 days and average time of operation was 95 minutes.&#x0D; Results: 42 patients (84%) has found union within 20 weeks, 6 patients (12%) has found delayed union and was dynamized and united, 01(2%) patient has lost follow up and 01(2%) patient has died at home at 16th post-operative day. Full range of knee movements was found in all cases.&#x0D; Conclusion: Closed locking intramedullary nailing for fracture proximal and mid shaft of the femur is a good option due to less infection, early healing and less scar formation, good range of knee and hip movement.&#x0D; TAJ 2019; 32(2): 27-35

Outcome of Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy

Background: Cervical spondylotic myelopathy (CSM) is a progressive degenerative disease and the most common cause of cervical spinal cord dysfunction (SCD) in older patients. Anterior cervical discectomy andfusion (ACDF) is a common procedure for patients with severe neurological deterioration. The goals of this study were to evaluate the clinical and functional outcome, radiological fusion and operative complications in case of CSM who underwent ACDF by autogeneous-tricortical bone graft and stabilized with plate and screws.&#x0D; Methods: This prospective interventional study was carried out at National Institute of Traumatology and Orthopaedic Rehabilitation ( NITOR) and different private hospitals in Dhaka from January 2012 to December 2014. Within this period total 12 CSM patients were included as study sample. All were surgically treated by ACDF and stabilized by plate and screws. All patients were clinically and radiologically evaluated before and after surgery.&#x0D; Results: Single level ACDF by autograft and stabilization by plate and screws was done in 10 (83.33%) patients and 2 (16.67%) patients had two level fusion. The mean follow up period was 12 months. The satisfactory result was found in 10 (83.33%) patients. Post-operative complications were donor site morbidity in2 (16.67%) patients and transient dysphagia in 1 (8.33%) patient. The fusion rate was 100% in this series.&#x0D; Conclusion: ACDF with anterior plating for CSM is a safe and effective procedure. It results in highest fusion, least complication and relatively lower cost.&#x0D; Birdem Med J 2019; 9(2): 133-137

Socio-demographic Characteristics and Mode of Traumatic Thoraco-Lumbar Spine Injuries at a Referral Tertiary Care Hospital in Bangladesh

Background: Traumatic thoraco-lumbar spine injuries occur in different ways during working.Objectives: The purpose of the present study was to find out the-demographic Characteristics and Mode of Traumatic Thoraco-Lumbar Spine Injuries.Methodology: This cross-sectional study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh from July 2004 to June 2006 for a period of 2(two) years. Patients with diagnosed cases of traumatic thoraco-lumbar spinal injury with complete or incomplete cord lesion irrespective of sex were selected as study population. An elaborate history of the selected patient was taken with an emphasis of mechanism, time of injury, past history of illness.Result: A total number of 17 patients with thoracolumbar spine injury were recruited. Out of 17 patients, 7(41.2%) patients were in the age group of 21-30 years that is very younger age group. The mean age was 29.29 years. The male and female ratio was 4.7:1. In this series most affected people are farmer (47.05%). Most affected groups are injured by fall from height (70.58%) especially from tree and from roof of the buildings.Conclusion: Young age group male workers are most commonly affected in traumatic thoraco-lumbar spine injuries.Journal of National Institute of Neurosciences Bangladesh, 2018;4(1): 51-53

Features of Neck Pain and its Related Factors Among Patients With Cervical Spondylosis

Background and aims: The prevalence of cervical spondylosis is rising. The objective of this study was to figure out the various features and their related factors among cervical spondylosis patients in Dhaka, Bangladesh. Methods: A descriptive cross-sectional study was conducted enrolling 40 patients from NITOR (National Institute of Traumatology and Orthopedic Rehabilitation) in Dhaka, Bangladesh. Data were collected from the physiotherapy department of NITOR using convenient sampling technique. A structured questionnaire was used for data collection. Patients who were diagnosed with cervical spondylosis were included in this study. Data were analyzed using SPSS version 22.0. Descriptive analysis was done using frequency measures, mean and percentages. Results: Among our respondents, the majority of them were female (62.5%). Majority of the participants were in the age group of 35 to 50 years (62.5%). Many of them were urban population engaged in service or housewives. Stressful job (55%), duration of working hour &gt;8 hours (62.5%) were the most common characteristics among patients. The main location of pain was in the shoulder (82.5%) followed by the neck (77.4%) and forearm (70%). Most patients had intermittent pain (57.5%), numbness (55%), tingling sensation (47.5%) and paresthesia (42.5%). Moderate type of pain (65%), the involvement of both upper limbs (35%) and radiating pain to shoulder (72.5%) were the most reported features by patients. No response to medication was also observed. Conclusion: Being female, middle age group, stressful occupation, location and radiation of pain to shoulder are some of the common features revealed in this study. The findings will help the practitioner to plan their treatment goals and techniques considering the characteristics of patients.

Study of Bone Tumors in a Tertiary Care Hospital of Dhaka City

Background: The wide spectrum of bone tumors, their rarity, diverse origin and tendency to produce overlapping anatomic patterns pose a definite diagnostic challenge to the orthopedic surgeons and the pathologists.Objective: The present study was intended to find the pattern of bone tumors and their anatomical locations, and histopathological characteristics in a tertiary care hospital of Dhaka.Methodology: A retrospective review of the histopathological records of patients with established diagnosis of bone tumors at National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh was done from January 2015 to December 2016 for a period of two (02) years. The demographic data such as the age and sex, anatomical location and histopathological findings were studied from the existing records of the patients and their slides were reexamined. Bone lesions of inflammatory origin were excluded from this study leaving the lesions of both neoplastic and tumor-like origin for further study.Result: A total 283 cases of bone lesions were primarily included in the study. Bone lesions of inflammatory origin (n = 65) were excluded from this study leaving 218 lesions of both neoplastic and tumor-like origin for further study. The median age of the patients was 22 (range: 3 – 75) years. In terms of anatomical site of the tumors, over one-third (36.6%) was located in femur 21.1% in tibia, 12.2% in humerus, 6.1% in radius and 5.6% in ulna. In terms of types of bone tumor, 105(48.2%) were benign, 66(30.3%) malignant, 47(21.5%) tumor-like lesions. About 65% of the benign tumors were of Giant cell tumor, 28.5% were osteochondroma, 1% osteoma and 5.7% were of other types. Of the malignant tumors, one-third (33.3%) was of metastatic type, 27.3% Ewing’s sarcoma, 22.7% osteosarcoma, 9.1% chondrosarcoma and 4.6% were of other varieties.Conclusion: Primary bone tumors are mainly benign; however, giant cell and metastatic tumors are the most common benign and malignant bone tumors respectively.Journal of Current and Advance Medical Research 2018;5(1):23-28

Treatment of open fracture of shaft of tibia-fibula Gustilo type III-B by SIGN interlocking nail and wound coverage by muscle flap within 72 hours of injury

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The open fracture of tibia-fibula Gustilo type III-B may threaten the survival of the injured leg. The objective of&lt;strong&gt; &lt;/strong&gt;the study purpose was to see the effect of early coverage following fixation of open tibial shaft fracture&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This clinical trial was carried out in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka from July 2004 to June 2006 for a period of two (2) years. Patients at age group of 18 years or above with both sexes presented with open fracture shaft of tibia-fibula Gustilo type III-B were selected as study population. The patients were surgically managed by SIGN Interlocking nail and wound coverage by muscle flap within 72 hours of injury. Bacteriological study of the wound was done in all cases.&lt;strong&gt; &lt;/strong&gt;All fixation and coverage were performed within 72 hours of injury. Patients grading improved on subsequent follow up. Evaluation of results was done at every post-operative follow up.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total number of&lt;strong&gt; &lt;/strong&gt;12 young patients with open fracture tibia-fibula Gustilo III-B were recruited for this study. Their age varies from 18 years to 48 years. A total number of 83.33% cases wound debridement was done within 12 hours of injury. Most of the soft tissue healed (91.67%) within 0 to 20 days. There were no cases developed limb length discrepancy angulations or rotation. Superficial infections were occurred in 1(8.33%) case but no evidence of deep infection. In this study excellent result were obtained from 9 cases (75%), good results were found in 2 cases (16.67%), fair results from 1 case (8.33%)&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In conclusion early intramedullary fixation and exposed bone coverage by muscle flap is very important for prevention of infection, minimizing bone death simultaneously enhances bone healing&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Management of Giant Cell Tumour by Curettage and Bone Cement in Weight Bearing Bone - A Study Done in DMCH &amp; NITOR.

Giant cell tumour of bone (GCT) has been characterized as benign but often locally aggressive neoplasm that commonly occurs in proximity to weight bearing bone. Management of giant cell tumor of bone by curettage and bone cement in weight bearing bone is an effective method. This prospective experimental study was conducted among the patients with histologically proved giant-cell tumour who were admitted in the Department of orthopedic surgery, Dhaka Medical College Hospital (DMCH) and in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) over a period of 18 months from January 2010 to June 2011. A total of 18 consecutive patients with histologically proved giant-cell tumour were included in the study. Majority (55.6%) of patient was in 3rd decade and male female ratio was 1:1.3. More than one fourth (27.8%) of the patients had GCT in the lower end of right femur, 33.3% in lower end of left femur, 22.2% in upper end of right tibia, 16.7% in upper end of left tibia and all patients had painful gait and swelling. According to campanacci grading, Grade-2 was found in all patients, and giant cell tumour was found in all patients, as evaluated by pre-operative biopsy. Cosmetically near normal appearance was found in 88.9% and 88.9% were able to do normal daily work. According to Schatzker and Lambert (1979) criteria excellent outcome was found in 38.9%, good in 44.4%, fair in 11.1% and poor in 5.6%. Surgery in the form of intralesional curettage and filling the cavity with bone cement resulted in excellent relief of pain, cosmetically near normal appearance and patients were able to do normal daily work.Faridpur Med. Coll. J. Jan 2017;12(1): 9-13

Evaluation of the Braden Scale Implementation by nurses: a Case Study in a Specialized Hospital in the Dhaka City

Objective: The aim of this routine to research (R to R) developmental study was to implement the Braden Scale (BS) to identify risks of pressure ulcer (PU) development among hospitalized patients with spinal cord injury admitted in National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Bangladesh. Methods: Roger’s Diffusion of Innovation Theory and PU related literature were used to guide the development of the implementation. The subjects were 10 nurses and 13 doctors who were working at the NITOR. Different strategies were provided for the implementation of the BS including workshops to provide knowledge, persuasion, and decision making to implement the BS for the nurse participants. The outcomes of this study were to determine: (a) nurses’ adoption in terms of the rate of using the BS and the accuracy of using the BS to identify PU risks, (b) nurses’ satisfaction to use the BS, and (c) doctors’ satisfaction on the implication of the BS to identify the risks of PUs in hospitalized adult patients with paraplegia. Data were analyzed by descriptive statistics and percentage of agreement.Results: Weekly proportions of nurses’ adoption in terms of the rate of using the BS ranged from 96% to 100%. The accuracy of using the BS yielded percentage of agreement between 70.6% to 100% for each item of the BS. Nurses’ and doctors’ satisfactions were at very high levels. Mean score of nurses’ satisfaction was 98.5% (SD=1.23) and mean score of doctors’ satisfaction was 89.79% (SD=4.17).Conclusion: Nurses are capable to assess PU risks of paraplegic patients independently by using the BS and may be incorporated to identify PU risks in addition to their work protocol. After identifying the PU risks, effective nursing care should be implemented to the patients in order to prevent the PU formation. DOI: http://dx.doi.org/10.3329/bjms.v13i4.20587 Bangladesh Journal of Medical Science Vol.13(4) 2014 p.411-414