Welcome to Journal Of Pakistan Medical Association

 Supplement Vol:65, No:11 November, 2015

Editorial >>

Dear colleagues

Welcome to the special issue of JPMA 2015. It is an absolute pleasure that we have successfully managed to carry the torch ignited by scientific committee 2014. The insight and objectivity required for this pursuit was possible only with a vigorous team....

Original Article >>

Glomus tumours: Outcome based on tumour location in hand

Rana Dawood Ahmad Khan, Muhammad Zain-ur-Rehman, Usama Bin Saaed, Tariq Mehmood Chaudhary, Muhammad Qasim Saeed, Ajmal Yasin,

Objective: To determine the clinical outcome of patients with glomus tumour in nail matrix and nail bed that were excised with transungual approach.
Methodology: The case series was conducted at the Allied and District Headquarter Hospital, Faisalabad, Pakistan,from January 2....

New technique: tendon interposition arthroplasty in Distal Interphalangeal Joint arthritis in Chinese population - New horizon for treatment

Muhammad Zeeshan Aslam, Syed Kamran Ahmed, Boris Fung,

Objective: To evaluate the clinical outcome of managing distal inter-phalangeal joint arthritis by using excisional arthroplasties with soft-tissue interposition to provide pain-free joint with adequate range of motion and preserving the bone stock.
Methods: The case series w....

Awareness of osteoporosis in men

Nusrat Rasheed, Ghulam Mustafa Kaim Khani, Naseem Rasheed,

Objectives: To assess the awareness in office workers about osteoporosis in men.
Method: The cross-sectional study was conducted in different offices in the 5 districts of Karachi from June to December 2014, and comprised office workers not related to the medical profession a....

Does tranexamic acid reduce blood transfusion following surgery for inter-trochanteric fracture? A randomized control trial

Yasir Mohib, Rizwan Haroon Rashid, Moiz Ali, Akbar Jaleel Zubairi, Masood Umer,

Objective: To compare the frequency of blood transfusion after surgery for fixation of inter-trochanteric fractures in patients given tranexamic acid versus placebo.
Methods: The randomised control trial was conducted at the Aga khan university hospital from May 1 to October....

Do delays in surgery affect outcomes in patients with inter-trochanteric fractures?

Adil Aijaz Shah, Santosh Kumar, Amarah Shakoor, Rizwan Haroon, Shahryar Noordin,

Objective: To study the differences in outcomes of early versus delayed surgery in patients with intertrochanteric fractures.
Methods: The retrospective chart review was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients who underwent surgery f....

Functional outcome following olecranon osteotomy approach for fixation of T/Y fractures of distal humerus

Kashif Mahmood Khan, Suresh Kumar, Muhammad Saeed Minhas, Anisuddin Bhatti,

Objectives: To evaluate the functional outcome of fixation of T/Y fracture distal humerus through olecranon osteotomy
Study Design: Quasi experimental study.
Place and duration of study: Department of Orthopedics, Jinnah Postgraduate Medical Centre, Karachi from June 2....

A comparative review of three techniques of syndactyly release

Sadaf Saeed, Syed Kamran Ahmed, Muhammad Amin Chinoy, Mansoor Ali Khan,

Objective: To compare the outcome of three techniques of congenital syndactyly release; to identify factors leading to difference in outcome, and to identify the incidence of neurovascular abnormalities in various types of syndactyly.
Methods: The chart review was conducted a....

Effect of continuous passive motion on knee flexion range of motion after total knee arthroplasty

Naveed Baloch, Akbar Jaleel Zubairi, Rizwan Haroon Rashid, Pervaiz Mahmood Hashmi, Riaz Hussain Lakdawala,

Objective: To compare mean knee flexion in patients on continuous passive motion and those without it after total knee arthroplasty.
Methods: The randomised controlled study was conducted at Aga Khan University Hospital, from July 2013 to June 2014, and comprised patients who....

The pulley suture: A reliable option for closure of selected soft tissue defects under tension- three years experience of a tertiary care hospital

Sadaf Saeed, Syed Kamran Ahmed, Muhammad Amin Chinoy, Mansoor Ali Khan,

Objective: To assess the outcome of closure of soft tissue defects through pulley suture in different clinical situations.
Methods: The descriptive chart review was conducted at The Indus Hospital, Karachi, and comprised data from May 2008 to November 2011. A detailed questio....

Protection of heel flaps with Ilizarov fixator as an elevation frame: A case series and review of literature

Sadaf Saeed, Syed Kamran Ahmed, Muhammad Amin Chinoy, Mansoor Ali Khan,

Objectives: To compare outcome of Ilizarov fixator for protection of heel and foot flaps with that of plaster of Paris boot technique.
Methods: The retrospective chart review was conducted at The Indus Hospital, Karachi, and comprised data of patients who underwent flap recon....

Early experience of dynamic hip screw with spiral blade and locking side plate for the stabilization of trochanteric fractures

Akbar Jaleel Zubairi, Rizwan Haroon Rashid, Marij Zahid, Masood Umer, Pervaiz Mahmood Hashmi,

Objective: To evaluate early experience with helical hip system in osteoporotic elderly patients with per-trochanteric fractures.
Methods: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised records of patients having low-velocity per....

Clinical outcome of cemented bipolar hemiarthoplasty versus Austin Moore hemiarthroplasty for displaced intracapsular fractures of hip in terms of anterior thigh pain in elderly

Ahmed Mushtaq Khan, Syed Faraz Anwar, Sohail Hafeez,

Objective: To explore a less pain-inciting implant in terms of anterior thigh pain after hip hemi-arthroplasty in displaced intra-capsular fractures of the neck of femur.
Methods: The cross-sectional comparative study was conducted at the Combined Military Hospital, Rawalpind....

Hip fragility fractures: Anaemia, calcium and vitamin D supplementation

Iqra Khan, Ambreen Jawaid, Khabir Ahmad, Shahryar Noordin,

Objective: To assess the burden of anaemia and osteoporosis in hip fracture patients, to determine the rate of blood transfusion per-operatively, to assess the use of calcium and vitamin D supplements and the use of anti-osteoporotic medications postoperatively.
Methods: A re....

Intertrochanteric hip fractures in octogenarian patients: Do we need to rethink fixation strategy?

Shahryar Noordin, Shahbano, Tashfeen Ahmad, Idrees Shah,

Objective: To compare outcomes in octogenarians with younger patients up to 1 year after undergoing dynamic hip screw fixation for intertrochanteric fractures to see the effectiveness of the implant.
Methods: The retrospective case-control study was conducted at The Aga Khan ....

Improvement in Harris Hip Score after cementless total hip arthroplasty in young active adults with secondary hip arthritis- A short-term follow-up result

Tariq Siddique, Ranjit Kumar Sah, Faisal Masood, Syed Muhammad Awais,

Objective: To determine the improvement in Harris Hip Score after non-cemented total hip replacement in younger patients with secondary hip joint arthritis.
Methods: The quasi-experimental study was conducted at Unit I, Department of Orthopaedic Surgery and Traumatology, Mayo....

Giant cell tumour of foot bones - 25 years experience in a tertiary care hospital

Muhammad Saeed Minhas, Kashif Mahmood Khan, Muhammad Muzzammil,

Objective: To determine the incidence of giant cell tumour in foot, its clinical features, stage of tumour, treatment and outcome of surgery.
Methods: This retrospective case series study was conducted at Jinnah Postgraduate Medical Centre, Karachi, and comprised cases of gia....

Outcome of surgical treatment of cervical spondylotic myelopathy: Experience in 120 patients

Ibrahim Farooq Pasha, Ahmed Bilal Khalique, Muhammad Asad Qureshi, Muhammad Talha, Maheen Farooq, Wasim Afzal, Junaid Ismail, Naveed Ahmad,

Objectives: To document the outcome of spinal surgery in patients of cervical spondylotic myelopathy.
Methods: The quasi-experimental study was conducted at the Department of Spine Surgery at Combined Military in a tertiary care hospital in Rawalpindi from 2006 to 2013. A pre....

Early release of tourniquet in total knee arthroplasty: Is it worthwhile?

Obaidur Rahman, Sohail Hafeez, M. Sohail Amin, Jahanzeb Ameen, Rana Adnan,

Objective: To compare the effects of duration and timing of tourniquet release on perioperative blood loss, transfusion requirement, duration of surgery, length of hospital stay and early complications in total knee arthroplastywith and without additional anti-fibrinolytic therapy.
....

Less invasive versus standard total knee replacement: Comparison of early outcome

Obaid-ur-Rahman, Muhammad Suhail Amin,

Objectives: To compare less invasive quads conserving (limited parapatellar) approach with standard medial parapatellar approach with respect to early functional outcome in cases of total knee arthroplasty.
Methods: The retrospective case-control cohort study comprised cases ....

Prophylaxis against heterotopic ossification after elbow and acetabular fractures - Do we really need it

Rizwan Haroon Rashid, Irfan Qadir, Waseem Ahmed, Masood Umer,

Objective: To compare the efficacy and safety of prophylactic modalities for heterotopic ossification prevention after elbow and acetabular surgeries.
Methods: The retrospective chart review was conducted at the Aga Khan University Hospital and comprised record of patients wh....

Single stage bilateral total hip replacement: Is it an option or a risk?

Talal Aqueel Quadri, Rizwan Haroon Rashid, Akbar Jaleel Zubairi, Masood Umer, Pervaiz Mehmood Hashmi,

Objective: To evaluate safety and feasibility of two-stage total hip arthroplasty and to compare it with single-stage procedure.
Methods: The retrospective study was conducted at The Aga Khan University Hospital and comprised all cases of total hip replacements between Januar....

Outcome of ilizarov fixator in tibial non-union

Muhammad Inam, Mohammad Saeed, Imran Khan, Alamzeb Durrani, Abdul Satar, Mohammad Arif,

Objectives: To evaluate the results of non-union of tibia treated with Ilizarov fixator.
Methods: The case series was conducted at Hayatabad Medical Complex, Peshawar, from January 2012 to April 2015, and comprised consecutive patients with non-union of the tibia. Patients of....

Effectiveness of platelets rich plasma versus corticosteroids in lateral epicondylitis

Abdul Khaliq, Imran Khan, Muhammad Inam, Mohammad Saeed, Husnain Khan, Malik Javed Iqbal,

Objective: To compare the treatment modalities of lateral epicondylitis in terms of pain relief.
Methods: The randomised controlled study was conducted at Hayatabad Medical Complex, Peshawar, Pakistan, from April 2013 to March 2014, and comprised cases of lateral epicondyliti....

Local recurrence of giant cell tumour of bone after intralesional treatment with and without adjuvant therapy, a single institution case series

Rana Dawood Ahmad Khan, Usama Bin Saaed, Muhammad Zain-ur-Rehman, Muhammad Qasim Saeed, Ajmal Yasin,

Background: Giant cell tumour (GCT) of bone is generally a benign tumour composed of mononuclear stromal cells and characteristic multinucleated giant cells that exhibit osteoclastic activity. It usually develops in long bones but can occur in unusual locations. The typical appearance is a....

Focal dome osteotomy for correction of varus deformity at elbow in children

Mohammad Akhtar, Rana Dilawaiz Nadeem, Muhammad Usman Khalid, Rohail Mumtaz, Shafqat Wasim, Umar Anwer,

Background: Cubitus varus is the most common complication of un-treated or mal-treated supracondylar fracture of humerus at elbow. Various osteotomies have been described to correct this deformity but each is associated with its own complications. In this study, focal dome osteotomy for co....

A comparison of functional outcome of intercondylar fracture of distal humerus managed by olecranon osteotomy approach versus triceps sparing approach in adults

Muhammad Usman Khalid, Kazi Muhammad Saeed, Muhammad Akhter,

Objective: To compare the frequency of satisfactory functional outcome of intercondylar fractures of distal humerus managed by the triceps-sparing approach and olecranon osteotomy approach.
Methods: The randomised controlled study was conducted at Mayo Hospital, Lahore, from ....

Effect of the silicone heel pad on plantar fasciitis

Noman Shakeel Niazi, Suhail Niaz Khan Niazi, Khalid Niazi Khan Niazi, Madiha Iqbal,

Objectives: To evaluate the effect of silicone heel pad in the management of pain in plantar fasciitis patients.
Methods: The descriptive case series study was conducted at Hope Rehabilitation Centre, Lahore, from March 1 to September 30, 2013, and comprised patients aged >....

Role of addition of Dexamethasone and Ketorolac to lignocaine intravenous regional anesthesia (Bier's Block) to improve tourniquet tolerance and post-operative analgesia in hand and forearm surgery

Muhammad Akram, Faheem Mubashir Farooqi, Muhammad Irshad, Syed Faraz Ul Hassan, Syed Muhammad Awais,

Objective: To compare tourniquet tolerance and postoperative analgesia using lignocaine intravenous regional analgesia alone or with addition of dexamethasone and ketorolac.
Methods: The randomised, prospective study was conducted at Mayo Hospital, Lahore, from June 2013 to J....

Bomb blast injuries: Tertiary care hospital in-patient experience over the last 20 years

Naveed A. Pasha, Raja Samir Khan, Shahryar Noordin,

Objective: To examine the distribution and nature of limb injuries in young bomb blast victimsand their management in a tertiary healthcare setting.
Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi and data was searched using the Uni....

Antibiotic prophylaxis in hip surgery: A comparision of two vs. three doses of cefuroxime

Rana Dilawaiz Nadeem, Mohammad Akhtar, Omer Iqbal Cheema, Ali Raza Hashmi, Mohammed Jazib Nadeem, Aliza Nadeem,

Objective: To compare the efficacy of two-dose regime with a three-dose regime of cefuroxime in the prevention of post-operative wound infection in hip surgery patients and to determine the most effective regime of antibiotic prophylaxis for such patients.
Methods: The prospe....

Outcome of hemivertebra resection in congenital thoracolumbar kyphosis and scoliosis by posterior approach

Muhammad Asad Qureshi, Ibrahim Farooq Pasha, Ahmed Bilal Khalique, Muhammad Talha, Waseem Afzal, Naveed Ahmad, Junaid Ismail, Sohail Amir, Max Aebi,

Objective: To find out the long term outcome of deformity correction by hemivertebra resection in congenital thoracolumbar spinal deformities by a single posterior approach.
Methods: This is a retrospective study carried out at the Department of Spine Surgery, Combined Milita....

Outcome of ilizarov fixator in complex non-union of long bones

Muhammad Shoaib Khan, Waqas Raza, Hidayat Ullah, Abdus Samad Khan, Muhammad Siraj, Zahid Askar,

Objectives: To evaluate the efficacy of Ilizarov fixator in the management of complex non-union of long bones.
Methods: The retrospective study was conducted at Ayub Teaching Hospital, Abbottabad, and Khyber Teaching Hospital, Peshawar, Pakistan, and comprised data of patient....

Multi level lumbosacral spinal fusion including lumbo-Sacral (L5-S1) junction fixation in adult deformity surgery; is postero- lateral fusion at (L5-S1) alone adequate?

Ahmed Bilal Khalique, Ibrahim Farooq Pasha, Akmal Sultan, Waseem Afzal, Muhammad Asad Qureshi,

Background/aims: To assess the revision rate at L5-S1 when only posterior fixation with pedicle screws is done with multi-level spinal fixation.
Patients and Methods: The Retrospective quasi experimental study was conducted at the Combined Military Hospital, Rawalpinidi and ....

A comparison of treating Unicameral bone cyst using steroids and percutaneous autologous bone marrow aspiration injection

Muhammad Akram, Faheem Mubashir Farooqi, Muhammad Latif Shahzad, Syed Muhammad Awais,

Objective: To compare the results of percutaneous autologous bone aspiration injection and steroids injections in the treatment of unicameral bone cyst.
Methods: The prospective study was conducted at Mayo Hospital, Lahore, from January 2008 to March 2014, and comprised patie....

Comparison of titanium elastic nails versus Thomas splint traction for treatment of pediatric femur shaft fracture

Muhammad Naseem, Rahat Zahoor Moton, Muhammad Aslam Siddiqui,

Objective: To compare titanium elastic nails with Thomas splint traction treatment for femur shaft fracture in children.
Methods: The descriptive randomised study was conducted at Abbasi Shaheed Hospital, Karachi, from January 2013 to December 2014, and comprised children age....

Trends in management of neck of femur fracture

Tashfeen Ahmad, Umair Ashraf, Omar Irfan, Zehra Abdul Muhammad,

Objective: To identify trends related to surgical procedure for the management of neck of femur fracture to see how the choice is changing over time in relation to different age groups.
Methods: The retrospective audit was conducted at Aga Khan University Hospital, Karachi, a....

Assessment with Oswestry disability index in surgically treated patients with lumbar spondylolisthesis: experience in 96 patients

Ibrahim Farooq Pasha, Muhammad Asad Qureshi, Maheen Farooq, Muhammed Talha, Naveed Ahmed, Junaid Ismail,

Objectives: To assess the outcome of surgical treatment in spondylolisthesis of lumbosacral region using Oswestry disability Index.
Methods: The quasi-experimental study was conducted at the Combined Military Hospital, Rawalpindi from 2006 to 2013 and comprised surgically tre....

Calcaneal fractures: An audit of radiological outcome

Tashfeen Ahmad, Zehra Abdul Muhammad, Bilal HumayunMatin, Azeem Tariq Malik, Talal Aqueel Quadri,

Objective: To assess radiological outcome of management of calcaneal fractures.
Methods: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data of calcaneal fractures managed between February , 2008 and February, 2014 Cases were ide....

Clinical outcome of patients with isolated tibial shaft fractures treated with S.I.G.N interlock nails in terms of surgical site infection and radiological bone healing on follow up

Muhammad Zain-ur-Rehman, Rana Dawood Ahmad Khan, Usama Bin Saeed, Ajmal Yasin,

Objective: To determine the clinical outcome of patients with isolated tibial shaft fractures treated with Surgical Implant Generation Network interlock nails.
Methods: The observational study was conducted from January 2010 to October 2014 at Allied Hospital, Faisalabad, Pak....

Effectiveness of ilizarov frame fixation on functional outcome in aseptic tibial gap non-union

Rana Dawood Ahmad Khan, Muhammad Asif Maqbool, Ajmal Yasin,

Objectives: The Objective of the study is to evaluate the effect of Ilizarov frame fixation on functional outcome in aseptic tibial gap non-union cases
Methods: In this clinical study, 15 cases of post-traumatic aseptic tibial gap non-union were selected in department of orth....

Outcome of open reduction internal fixation with cross K-wires for supracondylar fracture of humerus in terms of Flynnís criteria in children

Rana Dawood Ahmad Khan, Muhammad Nadeem Yousaf, Muhammad Zain-ur-Rehman, Muhammad Irfan Fareed, Ajmal Yasin,

Objectives: To determine the outcome of open reduction and internal fixation of supracondylar fracture of humerus in children using Flynn\'s criteria.
Methods: The quasi-experimentalstudy was conducted at Punjab Medical College/Allied Hospital, Faisalabad, Pakistan from Jul....

Short term evaluation of total hip arthroplasty; our experience at tertiary care center

Usama Bin Saeed, Rana Dawood Ahmad Khan, Muhammad Zain-ur-Rehman, Ajmal Yasin,

Background: Total hip arthroplasty is a common and successful treatment for osteoarthritis of the hip. Demographic trends in Pakistan suggest a significant increase in the demand for total hip replacement surgery.
Objectives: The current study was planned to assess the outcom....

Floating knee injuries: postoperative complications and outcome

Khawar Shahzad, Rana Dawood Ahmad Khan, Ajmal Yasin,

Objective: To evaluatepost-operative complications and functional outcome of floating knee injuries using Karlstrom\'s criteria.
Methods: The prospective randomised study was conducted at Allied Hospital, Faisalabad, Pakistan, from November 2013 to October2014, and comprise....

K Wire fixation of supra-condylar humerus fractures in children. Is ulnar nerve at risk?

Waseem Ahmed, Haroon Rasheed, Yasir Mohib, Rizwan Haroon Rashid,

Objective: To compare iatrogenic ulnar nerve injury in lateral entry pin fixation versus medial and lateral entry pin fixation in the treatment of supracondylar fractures of the humerus in children. Measurement of clinical parameters in terms of elbow range of motion and postop radiographi....

Clinic-based biopsy with a small curette: is it a reliable and safe option in extremity tumours?

Waseem Ahmed, Masood Umer, Yasir Mohib, Rizwan Haroon Rashid,

Objective: To establish the diagnostic accuracy and safety of clinic-based biopsy done with a small curette.
Methods: The retrospective study was conducted at Aga Khan University Hospital Karachi and comprised data of patients who underwent biopsy procedure of extremity tumou....

Clinic based biopsy vs. theatre biopsy of bone and soft tissue extremity tumours: comparable diagnostic modalities

Waseem Ahmed, Masood Umer, Yasir Mohib, Rizwan Haroon Rashid,

Objective: To compare the diagnostic accuracy of clinic-based biopsy versus theatre biopsy against final histopathology in patients presenting with extremity tumours.
Methods: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised record....

Efficacy of tranexamic acid in reducing blood loss in total knee replacements

Khalid Saleem Aslam, Abidullah Khan Niazi, Omer Nabi,

Objective: To assess the efficacy of tranexamic acid in reducing blood loss in total knee replacement.
Methods: The retrospective study was conducted at Quaid-e-Azam International Hospital, Islamabad, Pakistan, and comprised data of patients who underwent total knee replaceme....

Postoperative range of motion and stability after anterior cruciate ligament reconstruction using quadrupled hamstring autograft

Rana Dawood Ahmad Khan, Syed Muhammad Tayyab Hassan, Usama Bin Saeed, Ajmal Yasin,

Background: The incidence of anterior cruciate ligament (ACL) tear is increasing, especially in young active adults. Various surgical options like bone-patellar tendon-bone graft and hamstring autograft have been the focus of evaluation and comparison in various aspects, each having specif....

Factors affecting functional outcome after lower extremity amputation

Abdullah Bin Saeed, Usama Bin Saeed, Muhammad Zain-ur-Rehman, Rana Dawood Ahmad Khan, Ajmal Yasin,

Background: More than 100,000 major lower extremity amputations -- amputations at the metatarsal, below-knee or above-knee level -- are performed yearly in the United States. Despite improvements in long-term outcome, operative mortality following such amputations has remained stable at 9%....

Review Article >>

OSATS for total knee replacement: Assessment of surgical competence in the operating room

Shahryar Noordin, Salim Allana,

Traditionally the surgical and technical competence of Residents has been assessed inadequately and has received little attention among the core competencies defined by the Royal College of Physicians and Surgeons of Canada\'s CanMEDS programme and the Accreditation Council for Graduate Medical....

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