BOS Journal - January 1991 & 1992

The Journal of Bangladesh Orthopaedic Society

January 1991 & 1992	Volume 6 & 7
CONTENTS
EDITORIAL
1. Primary Health Care & Management Of Accident Injury And Common Emergencies & Concept Of Trauma Center Prof. K. M. Serajul Islam, MBBS (Dac), FRCS (E), FICS (USA), Director, RIHD (Orthopaedic Hospital), Sher-e-Bangla Nagar, Dhaka.
2. Tuberculosis Of The Spine Revisited Dr. Ronald J Garst, M.D, FACS., DIP. AME. BD. Orth. Surg., Founder Project Director, RIHD.
3. Primary Hyperparathyroidism With Exclusive Multiple Bone Lesion Dr. Md. Khademul Islam, FCPS, Asstt. Prof. Of Surgery, Dhaka Medical College & Hospital. Dr. Ruhal Huque, FRCS, Assoc. Prof. & Head of the Dept. of Orthopaedics, DMCH. Dr. S. M. Moazzem Hossain, MBBS, Research Asstt. (Hon.) to the Department of Surgery, DMCH. Dr. (Major) MD. Saiful Islam, FCPS, Radiologist, Combined Military Hospital, Dhaka Cantt. Dhaka. Dr. Fauzea Moslem, MBBS, Director, Nuclear Medicine Centre, DMCH. Dr. Zwahurul Moula Choudhury, FRCS, Prof. & Head of the Dept. Of Surgery, DMCH.
4. Established non union of fracture of the shaft of tibia due to intact fellow bone (fibula) - treated by osteotomy of fibula and autogenous iliac cancellous (pheimister graft) bone graft Dr. Md. Muazzam Hussain, MBBS., F.C.P.S. (Surgery), Professor & Head of Dept. Of Orthopaedic Surgery, Chittagong Medical College Hospital. Dr. Md. Anwar Husain, MBBS. M.S. (Orth.) Register, Orthopaedic Surgery Dept. Chittagong Medical College Hospital.
5. Pattern Of Injuries And Outcome Of Patients Admitted In A Casualty Unit Dhaka Medical College Hospital Md. Amjad Hossain. Consultant, Casualty Lock, DMCH. A. B. M. Kawsar Kamalz. Assttistant Registrar, Casualty Block, DMCH. Bipul Chakr. Asstt. Registrar, Casualty Block, DMCH. M. Ziauddin. Medical Officer, Casualty Block, DMCH.
6. Disabling Retrocalcaneal Bursitis: Surgical Treatment DR. Sk. Nurul Alam, Assistant Professor Orthopaedic Surgery, R.I.H.D. Dhaka. DR. Ayjaj Ahmed Khan, Associate Professor Orthopaedic Surgery Rajshahi Medical College Hospital, Rajshahi, Bangladesh.
7. Bristow Procedure For Recurrent Anterior Dislocation Of Shoulder Dr. F. H. Serajee, M.S.(Orth), D (Orth.), R/S (Casualty Block), Dhaka Medical College Hospital.
8. Spinal Osteotomy For Ankylosing Spondilitis Dr. Md. Imam Uddin, MS(Ortho), Orthopaedic Surgeon, Chittagong.
9. Schwannoma Presenting As A Mobile Tender & Gluteal Lump - A Case Report And Review Of Litrature DR. Md. Abdul Hannan. D.Orth., M.S.(Orth), Associate Professor, RIHD, Dhaka.
10. Traumatic Myositis Ossificans: The Unsolved Problem Dr. Mohammad Abul Bashar Chowdhury, M.S. Ortho, Assistant Professor of Orthopaedic Surgery Chittagong Medical College.
11. Assessment Of Depression In Orthopaedic Patients M S I Mullick, MBBS (Dhaka), FCPS (Psych),Assistant Registrar, Institute of Mental Health & Research, Dhaka Medical College Hospital. E Karim, MBBS, FCPS (Psych), Assistant Professor of Psychiatry, SSMC Mitford Hospital, Dhaka. M Khanam, MBBS (Dhaka), DPM (D.U.), Assistant Professor of Psychiatry, IPGMR, Dhaka. Ruhal Haque Ruhal Haque FRCS Associate Professor & Head of Dept. of Orthopaedic Surgery, DMCH.
12. Angiosarcoma – A Case Report COL Syed Fazle Rahim, MBBS, MS (ORTHO), Orthopaedic Surgeon, Combined Military Hospital, Dhaka.
13. Low Back Pain – Review Of Its Incidence And Aetiology In A Northern District Dr. A. K. M. Eshaque, D(Orth)., MS (Orth), Associate Prof. of Orthopaedic Surgery, Rangpur Medical College, Rangpur.
14. An atypicall aneurysmal bone cyst (abc) involving the upper humeral metaphysis inculuding epiphysis of 8 yrs. Old girl Dr. A. K. M. Anizur Rahman, MS Ortho, Asstt. Registrar, RHID, Dhaka. Dr. Sk. Nurul Alam, D. Ortho. MS. Ortho. Asstt. Prof, RIDH, Dhaka. Prof. K.M. Serajul Islam, Serajul Islam, FRCS, Director, RIHD, Dhaka.
15. Infected non-union of compound fracture of shaft of tibia treated by clearance operation and plaster immobilisation. Dr. Bidhan Chandra Roy, Asst. Professor of Orthopaedic Surgery, Mymensingh Medical College, Mymensingh.
16. An Experience Of Mass Casualty In The Earthquake Of Iran – 1990 Dr. Md. Amjad Hossin, MS Orth, Asst, Prof. RIHD, Dhaka. Dr. M. A. Hannan, D. Orth. Assoc, Prof. RIHD, Dhaka Dr. A. F. M. Ruhul Hauqe, FRCS, Assoc, Prof, DMCH. Prof. Rashiduddin Ahmed, FRCS, Professor of Neurosurgery, IPGMR, Dhaka.

INCORPORATION OF THE MANAGEMENT OF TRAUMA IN PRIMARY HEALTH CARE IN BANGLADESH AND A PROPOSED SETUP OF TRAUMA CENTRE IN THE COUNTRY
The present status of trauma management in periphery has no definite plan, that is also true in the management of accident & mass accidents as experienced in recent past years.

The on going article is a suggestion of how to integrate trauma from grass root level to the National Institute based in Dhaka through Medical College Hospital.

The contents of the article was read in the Intercountry seminar on Road Accident Centres Programme Development, organized by the British Technical Assistance Programme (ODA), WHO & Ministry of Health & Family Welfare, Dhaka, Bangladesh.

A suggested setup of trauma centre based on Health Institution i,e, Thana Health complex, District Hospital, Medical College Hospital has been described; suggested manpower & the training aspect is also described. The plans has been based considering the hesth for all by the year 2000 AD.

Prof. K. M. Serajul Islam
MBBS(Dac), FRCS(E), FICS(USA), Director, RIHD, (Orthopaedic Hospital), Sher-e-Bangla Nagar, Dhaka.

COMMENTS:

In discussion the elements of the primary health cares, it is seen that entire curative medicine and rehabilitation has been put in one of the 8 components of the primary health care. It would not be unusual to this biggest, highly, scientific and greatest achievement of the human knowledge.

The present day health problems as we see in this country can be said to be the epidemics of child birth, diarrhoeal disease and epidemic of accidents and violence i.e. epidemic of trauma.

Now, coming to the main subject of primary health care in which how accidents and trauma can be incorporated as regards to its prevention, management and rehabilitation in the P.H.C.

Dr. Ronald J Garst
M.D, FACS., DIP. AME. BD. Orth. Surg., Founder Project Director, RIHD.
Visiting Professor in RIHD, Dhaka.

Tuberculosis had been almost eliminated in the western countries. Now this has been changed with the rapid rise of the H.I.V. infection and A.I.D.S. Tuberculosis is one of the main causes of death in the A.I.D.S. population. Strains of the Tubercle bacillus that are resistant to all of the standard anti-tuberculous medications are rapidly developing.

The purpose of this article is to bring a current re-evaluation of the management of Tuberculosis of the spine and to make us aware that very soon the standard mediations will have to be altered. We in the developing world have the opportunity to be in the forefront in developing newer medications to combat this disease, as we deal with it daily.

Dr. Md. Khademul Islam
FCPS, Asstt. Prof. Of Surgery, Dhaka Medical College & Hospital.
Dr. Ruhal Huque
FRCS, Assoc. Prof. & Head of the Dept. of Orthopaedics, DMCH.
Dr. S.M. Moazzem Hossain
MBBS, Research Asstt. (Hon.) to the Department of Surgery, DMCH.
Dr. (Major) MD. Saiful Islam
FCPS, Radiologist, Combined Military Hospital, Dhaka Cantt. Dhaka.
Dr. Fauzea Moslem
MBBS, Director, Nuclear Medicine Centre, DMCH.
Dr. Zwahurul Moula Choudhury
FRCS, Prof. & Head of the Dept. Of Surgery, DMCH.

ABSTRACT:

A young female of 30 yrs. came to an orthopaedician with the complains of inability to walk for last 2 yrs and sudden severe pain and swelling in lower part of right thigh for last 6 months. She looked crippled and lower extremity was flexed both at hip and knee joint that Seemed to be a case of Osteosarcoma. Biochemical parameters could not give any clue, as they were normal. Bone biopsy and histopathology reported as giant cell lesion suggestive of Hyperparathyroidism, Giant Cell tumour, or Aneurysmal bone cyst. High resolution ultrasonography of neck detected a mass in the posterolateral aspect of right thyroid suggestive of enlarged right parathyroid. CT scanning of neck confirmed the diagnosis & further mentioned this tumour as adenoma of right parathyroid Exploration of the neck has shown a large Rt. Upper parat hyroid, it was excised keeping other three normal glands in situ, histopathology proved this as parathyroid adenoma.

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ESTABLISHED NON UNION OF FRACTURE OF THE SHAFT OF TIBIA DUE TO INTACT FELLOW BONE (FIBULA) - TREATED BY OSTEOTOMY OF FIBULA AND AUTOGENOUS ILIAC CANCELLOUS (PHEIMISTER GRAFT) BONE GRAFT.
A CASE REPORT

Dr. Md. Muazzam Hussain
MBBS., F.C.P.S. (Surgery), Professor & Head of the Dept. Of Orthopaedic Surgery,
Chittagong Medical College Hospital.
Dr. Md. Anwar Husain
MBBS.,M.S. (Orth.), Register, Orthopaedic Surgery Dept.
Chittagong Medical College Hospital.

Key Word: - Non Union, Isolated Tibia, Intact Fibula.

ABSTRACT:
Non Union of Isolated Fracture of Tibia is a recognised condition observed by many authors in the world. Isolated fracture of shaft of tibia is not an uncommon condition in our country. This type of fracture in adult usually takes more time to unite than the fracture of both tibia & fibula. The intact fellow bone fibula causes a distraction force so that fractured segments can not be compressed or impacted. As a result delayed union or non-union results. One such case with fracture shaft of tibia with intact fibula developed established non-union both clinically & radiologically. We treated him by osteotomy of fibula, autogenous cancellous iliac bone graft (Phemister Technique) and plaster immobilisation for about 6 (six) months. The results were excellent so that both the tibia and fibula were solidly united in proper alignment & position. A follow up of nine months is presented herewith.

Md. Amjad Hossain,
Consultant, Casualty Block, DMCH.
A. B. M. Kawsar Kamalz,
Asstt. Registrar, Casualty Block, DMCH.
Bipul Chakr,
Asstt. Registrar, Casualty Block, DMCH.
M. Ziauddin,
Medical Officer, Casualty Block, DMCH.

** This paper was read in 1st International Scientific Conference of Bangladesh College of Physicians and Surgeons on 22nd-24th January, 1991

ABSTRACT:
Total 2018 patients were admitted in one of the two casualty units of the Department of Surgery of Dhaka Medical College Hospital from July, 89 to December, 89. Out of these cases major and minor soft tissue with or without bone and joints involvement were 82%. Amongst these only soft tissue were 40% and rest 42% were skeletal related. Other admitted cases were Burn 08%, Abdominal trauma O5%, & Chest injuries 05%. Regarding the cause road traffic accident (RTA) topped the list which stands more than 50%. Next in line is due to assault which is about 22%. The main causes of burn cases were due to domestic reasons and acid throwing. Regarding mortality bone and joints cases were highest about 32% of total death.

Dr. Sk. Nurul Alam,
Assistant Professor Orthopaedic Surgery, R.I.H.D., DHAKA.
Dr. Ayjaj Ahmed Khan,
Associate Professor Orthopaedic Surgery, Rajshahi Medical College Hospital, Rajshahi.

SUMMARY:
There are two separate bursae in the posterior part of the heel; the tendo achillis and the retrocalcaneal. The retrocalneal bursa is constantly present according to both Duvries and Spaltehoz. It lies between the posterior smooth surface of the tuberosity of the calcaneus and the Achillis Tendon.

In 1945 Fowler and Philip noted that the postero-superior angle of the calcaneus is often congenitally prominent in patients with retrocalcaneal bursitis and that this predisposes to traumatic irritation of the bursa. Surgical treatment have been described when the bursitis is disabling, the failure of conservative treatment.

Seventeen patients affected by disabling bursitis have been treated surgically, 82.35% giving acceptable result.

Dr. F. H. Serajee
M.S.(Orth), D (Orth.), R/S (Casualty Block), Dhaka Medical College Hospital.

ABSTRACT:
This study was under taken at R.I.H.D, Dhaka to evaluate the results of Bristow procedure for preventing recurrence of anterior dislocation of shoulder joint. Basic technique is to transfer the conjoint tendon (short head of biceps and coracobrachialis) to the neck of scapula. During the period from August 85 to May 87, 19 operated shoulder in 18 patients were evaluated in detailed. One patient was operated bilaterally. 66.6% dislocations occurred in ages between 21-30 years and Male-Female ratio was 17:1. Most causative injury was sports injury. Good results were in 52.75% cases, excellent in 15.7% cases, fair in 26.5% cases and poor in 5.26° cases. Limitation of external rotation ranged from 10°-80° with an average 18.4.

Dr. Md. Imam Uddin
MS(Ortho). Orthopaedic Surgeon, Chittagong.

ABSTRACT:
Ankylosing spondilitis with it's dreadful kyphotic deformity is a rare condition. Spinal osteotomy was performed in five patients in R.I.H.D. since 1977 till 1980. The principle of the osteotomy is a measured wedge of bone to be removed from the posterior element of the spinal column at the L2; L4 level after which the spine is gently hyper extended. The functional and cosmetic correction was always satisfactory.

Dr. Md. Abdul Hannan
D.Orth., M.S.(Orth), Associate Professor, RIHD, Dhaka.

ABSTRACT:
Clinically tender mobile subcutaneous gluteal lump mimiking a sebaceous cyst, lipoma, neurofibroma, proved otherwise from gross description and microscopic appearance.

Dr. Mohammad Abul Bashar Chowdhury
M.S.(Ortho.), Assistant Professor Of Orthopaedic Surgery, Chittagong Medical College.

ABSTRACT:
Passive stretching of joints, muscles etc. always aggravate the stiffness instead of increasing the range and sometimes responsible for the complication known as traumatic myositis ossificans. This is an avoidable complication. This is an acute ossification which progresses rapidly and is extensive. The theory of ossification still not clear as because the ossification occurs in different muscles (e.g; quadriceps), & tendon (e.g ; biceps), joint capsule without any dislocation (e.g ; elbow), subperiosteal area followed after dislocation or fracture-dislocation (e.g; lower humerus, upper end of ulna).

M S I Mullick
MBBS (Dhaka), FCPS (Psych),Assistant Registrar, Institute of Mental Health & Research, Dhaka Medical College Hospital.
E Karim
MBBS, FCPS (Psych), Assistant Professor of Psychiatry, SSMC Mitford Hospital, Dhaka.
M Khanam
MBBS (Dhaka), DPM (D.U.), Assistant Professor of Psychiatry, IPGMR, Dhaka.
Ruhal Haque
Ruhal Haque FRCS Associate Professor & Head of Dept. of Orthopaedic Surgery, DMCH.

ABSTRACT:
One hundred consecutively admitted major orthopaedic patients (age 18-70 years) were studied. By using DSM III-R criteria for Major depressive Episode and Hamilton Rating Scale for Depression 16 were found to have major depressive disorder after orthopaedic illness. Among them 3 were severe, 8 were moderate and rest 5 were mild. Another 33 showed evidence of depression as symptoms. Therefore, 49 of the total cases were identified to have depression. There was no statistically significant non-depressed and depressed orthopaedic patients. Patients having malignant neoplasia of bones are more vulnerable to develop depression. All the depressed orthopaedic patients had depressed mood and all of them expressed somatisation. None of them were getting psychiatric treatment which indicates lack of awareness about the existence of depression among the orthopaedic patients.

CASE REPORT: ANGIOSARCOMA
COL Syed Fazle Rahim
MBBS, MS (ORTHO), Orthopaedic Surgeon, Combined Military Hospital, Dhaka.

ABSTRACT:
A rare case of Angiosarcoma of shoulder is resented here. She was provisionally diagnosed as case of Fibrosarcoma but biopsy revealed Angiosarcoma. Forequarter amputation was carried out. Patient could not afford chemotherapy.

Dr. A. K. M. Eshaque
D(Orth)., MS (Orth), Associate Prof. of Orthopaedic Surgery, Rangpur Medical College, Rangpur.

SUMMARY:
Low back pain is one of the common clinical condition seen in day to day practice at northern area. 400 cases had been studied in this series in one year (Jan, 1991- Jan, 1992). In this study 33.25% patient had pelvic inflammatory disease (PID). 33.75% patient presented with low back pain with neurological complication. 49% patient attended in clinics only with low back pain with fever. Plain X-ray of lumbosacral spine showed 33.25% cases of PLID, 31.25 normal, 7.25% T.B. spine and 0.75% secondary metastasis in lumber spine. Plain x-ray of KUB region also showed 0.5% cases of stone is urinary system and 25% cases of enlarged kidney shadow. Rheumatoid factor were strongly positive in the cases. Among the investigations good plain x-ray of lumbosacral spine plays a major role to find out the cause of low back pain.

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CASE REPORT: AN ATYPICAL ANEURYSMAL BONE CYST (ABC) INVOLVING THE UPPER HUMERAL METAPHYSIS INCLUDING EPIPHYSIS OF 8 YRS. OLD GIRL

Dr. A.K.M. Anizur Rahman
MS Ortho, Asstt. Registrar, RHID, Dhaka.
Dr. Sk. Nurul Alam
D. Ortho. MS. Ortho. Asstt. Prof, RIDH, Dhaka.
Prof. K.M. Serajul Islam
Serajul Islam, FRCS, Director, RIHD, Dhaka.

ABSTRACT:
Aneurysmal bone cyst is a benign lesion of bone, consists essentially of fibrous tissue honeycombed by vascular spaces. The lesion has been observed in many parts of the skeleton but it occur especially in the shift of long bones and in the vertebral column. It causes localised distension and distension of the affected bone, limited peripherally by a thin bony shell. Usually involving the metaphysis of long bone but not the epiphysis. In this particular case the Aneurysmal bone cyst involves the upper humeral epiphysis. So this case has been considered as an atypical one.

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CASE REPORT: INFECTED NON-UNION OF COMPOUND FRACTURE OF SHAFT OF TIBIA TREATED BY CLEARENCE OPERATION AND PLASTER IMMOBILISATION.

Dr. Bidhan Chandra Roy
Asst. Professor of Orthopaedic Surgery, Mymensingh Medical College, Mymensingh.

ABSTRACT:
Compound fractures are very much prone to delayed union and non-union if not properly treated from the beginning i.e. proper surgical toileting and others. Once non-union develops with infection, its treatment is not easy. These cases usually need internal fixation and bone grafting after complete healing of the wound. Reporting a case which was treated by clearance operation followed by plaster immobilisation and subsequent treatment of the wound. The fracture was united rigidly and wound healed after about twelve months.