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Complicated Tibial Plateau Fractures in Young Patients: Functional Outcome with Dual Plating through two Incision Technique

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Vol 5 | Issue 1 | Jan-April 2019 | page: 28-31 |Abdul Qadir, Muhammad Muzzammil, Muhammad Tahir Lakho, Maratib Ali. Author: Abdul Qadir [1],Muhammad Muzzammil [1], Muhammad Tahir Lakho [1], Maratib Ali [2] 1 Dept. Of orthopaedic surgery, Dr. Ruth K.M Pfau Civil Hospital Karachi – Pakistan. 2 Dept. Of orthopaedic surgery, Jinnah Postgraduate Medical […]

Chronic osteomyelitis in Sarajevo, Bosnia-Herzegovina: Long-term health consequences of warfare

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Vol 5 | Issue 1 | Jan-April 2019 | page:14 -16 |Katherine O. Ryken, Semin Becirbegovic, Ismet Gavrankopetanovic, J Lawrence Marsh, Marin Schweizer. Author: Katherine O. Ryken [1], Semin Becirbegovic [2], Ismet Gavrankopetanovic [2], J Lawrence Marsh [1], Marin Schweizer [1] 1 Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 2 […]

Complicated Tibial Plateau Fractures in Young Patients: Functional Outcome with Dual Plating through two Incision Technique

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Chronic osteomyelitis in Sarajevo, Bosnia-Herzegovina: Long-term health consequences of warfare

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

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Complicated Tibial Plateau Fractures in Young Patients: Functional Outcome with Dual Plating through two Incision Technique

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Vol 5 | Issue 1 | Jan-April 2019 | page: 28-31 |Abdul Qadir, Muhammad Muzzammil, Muhammad Tahir Lakho, Maratib Ali.

Author: Abdul Qadir [1],Muhammad Muzzammil [1], Muhammad Tahir Lakho [1], Maratib Ali [2]

1 Dept. Of orthopaedic surgery, Dr. Ruth K.M Pfau Civil Hospital Karachi – Pakistan.

2 Dept. Of orthopaedic surgery, Jinnah Postgraduate Medical Center, Karachi Pakistan.

Address of Correspondence

Dr. Abdul Qadir

Orthopedic surgeon

Dr. Ruth K.M Pfau civil hospital

Dow university of health sciences

Karachi pakistan

Email : capricorncious1@hotmail.com

Abstract

Objective: Motorbike accidents contribute one of the most important factors of tibial plateau fracture among young populations in Karachi Pakistan. Most surgeons feel challenging to treatment complicated bicondylar fractures of the tibial plateau.This prospective study was designed to evaluate the functional outcomes of dual plating through a two-incisions technique for the fixation of complicated bicondylar tibial plateau fractures in young patients in Karachi Pakistan.

Methods: This prospective study includes 94 cases of Type V and VI tibial plateau fractures of young patient’s age range from 15 to 45 years, operated between January 2014 and December 2016 conducted in two public sector hospital of Karachi Pakistan (Jinnah Post Graduate Medical Center, Civil Hospital Karachi). Exclusion criteria include patients with multiple fractures on the same side or same bone, age >45 years, open contaminated fracture, open fracture,and patients with head injuries. All cases were operated either by lateral locking plate fixation by anterolateral approach or dual plating through double incisions. These all cases were followed for a minimum of 24 months radiologically and clinically. The statistical analysis was performed using software SPSS 20.0 to analyze the data.

Results: A total of 94 patients (45 Single Plating and 49 Dual Plating)were operated during the study period of 2 years. However, four patients (4 single plating and 0 dual plating) were lost during follow-up who could not be tracked. Both groups were somewhat similar in relation to the age, mechanism of injury, fracture pattern, and soft tissue injury. Preoperatively, there was a significant increase in surgical time with the dual plating group; however, the mean time of reduction between the two groups was not significant. The decision to put bone graft was at the choice of the operating surgeon and was an intra operative decision with 74 (78.7%) patients receiving the bone graft. Post-operatively, there was no immediate difference in between the groups considering thermal alignment and reduction. It took approximately 4–5 months for the fractures to get united. There was normal union,non union or implant failure seen among those patients. There were 10 cases with superficial infection in wounds of dual plating group which were treated with culture sensitive antibiotics for average 2 weeks, healed subsequently. There were three patients found having an incidence of deep infection in a double plating group, wherein 2 patients were positive with Staphylococcus aureus and 1 patient with Escherichia coli was isolated. Extensive wound irrigation and lavage with antibiotic cement beads were given. Repeated irrigation and lavage were done again after 2 weeks with the removal of beads followed by prolonged course of antibiotic therapy for 6 weeks after which the infection resolved.A total of 38 (77%) patients in a double plating group regained full flexion (135°) and full extension (0°) with a good alignment and no pain and instability as compared to single plating group, seen in 30 (66%) patients at follow-up.

Conclusion: Dual plating by two-incision method resulted in better functional outcome regarding limb alignment and range of movements at knee joint with an acceptable soft tissue complication rate in young patients.

Keywords: Complicated tibial plateau fracture, Young patients, Double incision, Dual plating.

References

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17. Yoo BJ, Beingessner DM, Barei DP. Stabilization of the posteromedial fragment in bicondylar tibial plateau fractures: A mechanical comparison of locking and nonlocking single and dual plating methods. J Trauma 2010;69:148-55.

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How to Cite this article: Qadir A, Muzzammil M, Lakho M T, Ali M. Complicated Tibial Plateau Fractures in Young Patients: Functional Outcome with Dual Plating through two Incision Technique. Trauma International Jan-Aprl 2019;5(1):28-31.

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Chronic osteomyelitis in Sarajevo, Bosnia-Herzegovina: Long-term health consequences of warfare

January 10, 2019/in Jan. - April 2019 | Volume 5 | Issue 1

Vol 5 | Issue 1 | Jan-April 2019 | page:14 -16 |Katherine O. Ryken, Semin Becirbegovic, Ismet Gavrankopetanovic, J Lawrence Marsh, Marin Schweizer.

Author: Katherine O. Ryken [1], Semin Becirbegovic [2], Ismet Gavrankopetanovic [2], J Lawrence Marsh [1], Marin Schweizer [1]

1 Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
2 Department of Orthopedics&Traumatology, University of Sarajevo ClinicalCenter, Sarajevo, Bosnia-Herzegovina
Address of Correspondence
Dr. Katherine O. Ryken,
University of Iowa Carver College of Medicine, Iowa City, IA
E-mail: kryken@montefiore.org

Abstract

Introduction: Chronic osteomyelitis (COM) is a severely debilitating disease, causing both physical and psychological repercussions for patients. It is particularly common in austere environments and areas of armed conflict. 1,2,3 The most common cause across all age groups is neglected penetrating wounds.4 Often overlooked, COM is one of the many lasting health effects of warfare. Deep infections of the bone following penetrating and blast injuries are common in regions plagued by conflict and cause major physical and social disability.
Materials & Methods: Patient records at the University of Sarajevo Clinical Center Department of Orthopedics & Traumatology were analyzed retrospectively between 2003 and 2013 of patients hospitalized with diagnosed COM.
Results: 155 patients were hospitalized at UCCS for the treatment of chronic osteomyelitis between 2003-2013. Mean age of patients at the time of hospitalization was 56 years. The most common medical comorbidity of patients was diabetes mellitus type 2. Unemployment among patients was 46.1%. The most common cause of COM in this cohort was intentional injury associated with the war between the years of 1992-1995 (46.2%). These were caused by sniper or gunshot wounds (25.4%), landmines or unexploded ordnance (37.7%), and mortar shell explosions (28.8%). The mean hospital stay among patients with COM at UCCS was 31.10 days, although this varied widely depending upon the severity of symptoms and the type of treatment required.
Conclusion: The health burden of chronic osteomyelitis persists for many years beyond the original. Chronic pain and disability contribute to a lifetime of repeated treatments, hospital stays, and high rates of unemployment. This study describes the current burden of COM upon the population of Sarajevo, as well as serving as a foreboding prediction of what can be expected in war zones for many years in the future.
Keywords: Bosnia-Herzegovina, Sarajevo, chronic osteomyelitis, war injuries, orthopedics, infectious disease, social medicine.

References

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3. Yun, H. C., Branstetter, J. G. & Murray, C. K. Osteomyelitis in military personnel wounded in Iraq and Afghanistan. J. Trauma64, S163–168; discussion S168 (2008).
4. Baldan, M., Gosselin, R. A., Osman, Z. &Barrand, K. G. Chronic osteomyelitis management in austere environments: the International Committee of the Red Cross experience. Trop. Med. Int. Health TM IH19, 832–837 (2014)
5. Tice, A. D., Hoaglund, P. A. &Shoultz, D. A. Outcomes of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy. Am. J. Med.114, 723–728 (2003).
6. Casey, K., Demers, P., Deben, S., Nelles, M. E. & Weiss, J. S. Outcomes after long-term follow-up of combat-related extremity injuries in a multidisciplinary limb salvage clinic. Ann. Vasc. Surg.29, 496–501 (2015).
7. Beavis, J.P., Ryan, J.M. High Energy Transfer Missile Wounds in the Siege of Sarajevo and Their Relation to Mine Injuries. J. Conv. Weapons Destr.6, (2002).
8. Geiger, S., McCormick, F., Chou, R. &Wandel, A. G. War wounds: lessons learned from Operation Iraqi Freedom. Plast. Reconstr. Surg.122, 146–153 (2008).
9. Harris, P. A. et al. Research Electronic Data Capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inform.42, 377–381 (2009).
10. Spellberg, B. & Lipsky, B. A. Systemic antibiotic therapy for chronic osteomyelitis in adults. Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am.54, 393–407 (2012)
11. Conterno, L. O. & da Silva Filho, C. R. Antibiotics for treating chronic osteomyelitis in adults. Cochrane Database Syst. Rev. CD004439 (2009). doi:10.1002/14651858.CD004439.pub2
12. Murphy, R. A. et al. Multidrug-resistant chronic osteomyelitis complicating war injury in Iraqi civilians. J. Trauma71, 252–254 (2011)..

How to Cite this article: Ryken K O, Becirbegovic S, Gavrankopetanovic I, Marsh J L, Schweizer M. Chronic osteomyelitis in Sarajevo, Bosnia-Herzegovina: Long-term health consequences of warfare. Trauma International May – Aug 2019;5(1):14-16.

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Complicated Tibial Plateau Fractures in Young Patients: Functional Outcome with Dual Plating through two Incision Technique

Complicated Tibial Plateau Fractures in Young Patients: Functional Outcome with Dual Plating through two Incision Technique

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Complicated Tibial Plateau Fractures in Young Patients: Functional Outcome with Dual Plating through two Incision Technique

Author: Abdul Qadir [1],Muhammad Muzzammil [1], Muhammad Tahir Lakho [1], Maratib Ali [2]

Abstract

References

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