BOS Journal - January, 1993 - Volume 8, Number 1

The Journal of Bangladesh Orthopaedic Society

January, 1993	Volume 8, Number 1
CONTENTS
EDITORIAL: The Challenge of Trauma - Traumatology Unit Prof. Md. Muazzam Hossain, MBBS, FCPS (Surgery), Project Director RIHD, Dhaka.
1. Double Contrast Arthrography of Knee Joint - An aid to diagnosis of lesions of the menisci Md. Anowar Hossain, MBBS, MS(Ortho), Registrar, Orthopaedic Surgery, Chittagong Medical College Hospital. Prof. Moazzam Hossain, Head of the Department of Orthopaedic Surgery, Chittagong Medical College Hospital.
2. Treatment of the Fracture Angle of the Mandible by open reduction and internal fixation. Mohammad Imam Uddin, M.S.(Orth), Assistant Professor of Orthopaedic Surgery IAHS, USTC. Mohammad Manzurul Islam, , M.S.(Orth), Associate Professor of Orthopaedic Surgery, Chittagong Medical College Hospital.
3. Postoperative Analgesia For lower limb surgery: Experience with Intrathecal Morphine. K. Rahman, MBBS, MCPS, DA, FFARCS: Associate Professor, Anaesthesia Department, R.I.H.D., Dhaka. A. K. M. S. Alam, MBBS, FCPS (ANAES.), Medical officer, R.I.H.D., Dhaka.
4. Radionuclide (Isotope) Bone Imaging for Monitoring Bone Metastasis and Detection of Bone diseases Faridul Alam, Nuclear Medicine Centre, Dhaka. Fauzia Moslem, Dhaka Medical College Campus. Atia H. Jehan, Bangladesh Atomic Energy.
5. Dislocation of the elbow joint in the adult-Review of the results after closed treatment Ramdew Ram Kairy, Associate Professor (cc.), Orthopaedic Surgery Department, Sher-e-Bangla Medical College, Barisal. Aziz Rahim, Assistant Professor (cc.), Orthopaedic Surgery Department, Sher-e-Bangla Medical College, Barisal.
6. Surgical emergency Patients – Admitted in six Months at MMCH Md. Shelim Bhuiyan, FCPS, Assistant Professor of Surgery, Mymensingh Medical College Hospital.
7. Epineural Suture of Traumatic Median Nerve Injury: Report of 20 Cases Md. Amjad Hossain, Assistant Professor, RIHD. A. F. M. Ruhal Haque, Associate Professor, DMC. M. A. Hannan, Assistant Professor, RIHD. R. Islam, M.S (Orth), Clinical Asstt. RIHD. Md. Ziauddin, D (Orth) Student. RIHD.
8. Reconstruction After Resection of Chondrosarcoma Involving The Proximal Femur by Low Cost Custom – Made Prosthesis A. K. M. Eshaque, D. Ortho, M. S.,(Ortho), Associate Prof. Orthopaedic Surgery, Rehabilitation Institute and Hospital for Disabled (RIHD), Sher – E – Bangla Nagar, Dhaka. K. A. Awal, Asstt. Prof. Orthopaedic Surgery, Rehabilitation Institute and Hospital for Disabled (RIHD), Sher – E – Bangla Nagar, Dhaka. Debashish Roy, Student of D. Ortho. Dhaka University.
9. Eosinophilic granuloma – a rare variety of histocytosis – x A. K. M. Sayedul Islam D.Orth, Phd (Tohoku University), Associate Professor, Orthopaedic Surgery, Mymensingh Medical College and Hospital. A. B. M. Fazlur Rahman MS (Ortho), Registrar, Orthopaedic Surgery, Mymensingh Medical College and Hospital. Md Hedayetul Islam, MBBS, Assistant Registrar, Orthopaedic Surgery, Mymensingh Medical College and Hospital.
10. Chondro Myxoid Fibroma – a case report Nakul Kumar Datta, MBBS, D Orth. Jr. Consultant (cc), Joypurhat Sadar Hospital

The Challenge of Trauma -Traumatology Unit

Prof. Md. Muazzam Hossain
MBBS. FCPS (Surgery), Project Director RIHD, Dhaka

Last year, WHO declared their Annual slogan as “Handle life with care-prevent violence & negligence”. We have observed the world day on 7th April in a befitting manner & expressed our ideas on the theme of WHO throughout the year. In reality, the present situation of our society is very alarming in respect of RTA, violence & terrorism. Negligence is the rule in all spheres of life. In hospitals, number of casualty patients are increasing manifold from traffic accidents & from violence of different activities. This large amount of trauma patients offers a challenge to the existing health care facilities of our country.

From a district hospital to a medical college hospital, even in RIHD (Rehabilitation Institute & Hospital for Disabled) there is yet to develop a comprehensive unit for managing all sorts of casualty patients. Here, there is a hope, the 100 beded traumatology unit is waiting for its official inauguration. The project is taken under the scheme of ‘Further development of RIHD’ from development budget. In fact, RIHD should be kept as an academic Institute & the greater load of trauma patients could easily be dealt with the trauma unit. It is a challenge to the authority of the hospital to develop an ideal institution from the beginning. I hope with the cooperation of all corners the traumatology unit will fulfil our aspiration & would be able to face the challenge of trauma in ensuing years.

Md. Anowar Hossain
MBBS, MS(Ortho), Registrar, Orthopaedic Surgery, Chittagong Medical College Hospital
Prof. Moazzam Hossain
Head of the Department of Orthopaedic Surgery, Chittagong Medical College Hospital.

Abstract:

25 (Twenty five) cases of injuries of knee have been examined by double contrast arthrography admitted in RIHD, Dhaka during the period from Oct. ’85 to March, ’88. Careful history and clinical examination revealed some form of meniscus tear. The cases were prepared for arthrotomy. Arthrography was done as an aid to confirm diagnosis of meniscus tear of the knee joint and to evaluate the results of this new technique in Bangladesh.

We used the double contrast technique described and advocated by Nicholas J A and Freiberger The contrast medium used were:

Urotrast – 60% each ampoules of 20 ml produced by KRKA Yugoslavia. 2. Conray – 280 60% produced by May and Baker Ltd. England. 3. Room Air

Mohammad Imam Uddin
M.S.(Orth), Assistant Professor of Orthopaedic Surgery IAHS, USTC.
Mohammad Manzurul Islam
M.S.(Orth), Associate Professor of Orthopaedic Surgery, Chittagong Medical College.
From May, 1988 till May 1993 seven patients with fracture at the angle of the mandible were treated by open reduction and internal fixation by a simple figure of 8 wiring. All patients were male and the age ranged from 18 – 48 years. Three patients (43%) sustained fracture from road traffic accidents and the rest four (57%) from direct boxing over the angle of the mandible. One of the patients had associated vertical fracture of the last molar tooth. All patients had healing of the post operative wounds by first intention and left hospital or clinic on the 5th or 6th post operative day after removal of sutures. But surprisingly three patients (43%) reported with delayed signs of infection on the 16th , 18th & 21st post operative day respectively. After another course of antibiotic therapy according to culture & sensitivity and subsequent extraction of the fractured last molar tooth in the patient where it was involved, the infection came under complete control in further two to three weeks time in all three patients reported with delayed infections.

K. Rahman
MBBS, MCPS, DA, FFARCS: Associate Professor, Anaesthesia Department, R.I.H.D., Dhaka.
A. K. M. S. ALAM
MBBS, FCPS (ANAES.), Medical officer, R.I.H.D., Dhaka.

ABSTRACT:
Forty Patients undergoing Lower limb Orthopedic procedures were studied. Subarachnoid Bupivacaine (0.5%) 2.5 ml. mixed with morphine sulph. 0.3 mg (0.5 ml.) (preservative free) was introduced.

Post Operative Observation was carried out for 24 hrs. Satisfactory pain relief remained for 14.26 ± 6.36 hrs (mean ± SD). Common complications were pruritus, urinary hesitancy, vomiting etc. No patient suffer from respiratory depression.

Faridul Alam
Nuclear Medicine Centre, Dhaka.
Fauzia Moslem
Dhaka Medical College Campus.
Atia H. Jehan
Bangladesh Atomic Energy.

ABSTRACT:
In this article we are discussing how bone scan can help in monitoring the bone metastasis in different malignant diseases specially in Carcinoma (Ca.) Breast and Ca. prostate. Bone scan also identifies some other bone lesion. We have studied 283 patients predicting different bone diseases, 103 (34.4%) patients were found scan positive. In this study it is also found that in some cases radionuclide scan have superiority over x-ray in early diagnosis of bone lesion.

Ramdew Ram Kairy
Associate Professor (cc.), Orthopaedic Surgery Department, Sher-e-Bangla Medical College, Barisal.
Aziz Rahim,
Assistant Professor (cc.), Orthopaedic Surgery Department, Sher-e-Bangla Medical College, Barisal.

ABSTRACT:
Results after conservative treatment of simple dislocation of elbow in 42 adults were evaluated with regard to limitation of motion, pain and residual instability. All patients were treated with close reduction with or without anaesthesia. Patients were divided into two groups. Group 1, which constituted 22 patients, duration of immobilisation was less than 2 weeks & Group11 had 20 patients, immobilisation was 3 weeks or more.

Follow up of the patients ranged from thirteen to twenty seven months with an average of 18.4 months. 50% of the patients reported some symptoms at follow up which is contrary to popular belief of good prognosis. A flexion contracture of more than 300 was documented in 19% of patients. Residual pain in 24% of patients, 33% of patients had mild instability of joint. Prolonged immobilisation after injury was strongly associated with an unsatisfactory result. The results indicate that early active motion is the key factor in rehabilitation of the elbow after a dislocation.

Md. Shelim Bhuiyan,
FCPS, Assistant Professor of Surgery, Mymensingh Medical College Hospital

ABSTRACT:
A total of 2750 surgical emergency patients were admitted during the period of six months beginning from January 85 – in this hospital.

An effort has been made to give a fair idea about the nature and extent of the surgical emergency particularly intended for the young doctors and for those who desire to build their career in surgery in future.

It has been observed that the number of patient with traumatic injury greatly exceeds (about 205 times more) that of patients with non – traumatic condition.

On an average 15 patients get admitted in 24 hours in cycle of one patient every 11/2 hour in our Medical College as surgical emergency patient. These lead to a high work load in surgical wards. Establishment of causality hospital is essential. Teaching hospital will be only for teaching purpose – only the patients of academic interest will get admitted in the teaching hospital. This will provide fair chance to improved academic atmosphere.

Md. Amjad Hossain
Assistant Professor, RIHD
A. F. M. Ruhal Haque
Associate Professor, DMC
M. A. Hannan
Assistant Professor, RIHD
R. Islam
M.S (Orth), Clinical Asstt. RIHD.
Md. Ziauddin
D (Orth) Student. RIHD.

SUMMARY:
Peripherial nerve injury of the upper extremity is a common disorder sometimes associated with the other injuries of the musculoskeletal system. It is well known that major peripheral nerve lesion frequently cause significant & prolonged disability – if they are not properly managed. It is also known that Median nerve plays a vital role in the upper extremity particularly for the precision grip through its sensory and motor function. In Rehabilitation Institute & Hospital for the disabled (RIHD) 20 cases of median nerve injury were managed surgically from July 88 to July 92 in a unit. Victims were mainly of young age group ranging the age from 20 to 40 years. Male predominating 90% & 10% were female. Most of the victims were inflicted by sharp cutting weapon. All the patients came to Hospital late except two, who reported within 4 hours of injury. Clinically each patient presented with total motor & sensory loss distal to the site of injury. All the patients were managed surgically with secondary epineural suture except the early reported two cases in which primary repair was done. Postoperatively all the patients received physiotherapy. During two and a half year follow up period patients presented with good recovery 20%; Fair 30%; Poor 20%; and Bad 30%; No motor recovery was achieved after 12 months of duration.

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Reconstruction After Resection of Chondrosarcoma Involving The Proximal Femur by Low Cost Custom – Made Prosthesis
A CASE REPORT

A. K. M. Eshaque
D. Ortho, M. S.,(Ortho), Associate Prof. Orthopaedic Surgery, Rehabilitation
Institute and Hospital for Disabled (RIHD), Sher – E – Bangla Nagar, Dhaka.
K. A. AWAL
Asstt. Prof. Orthopaedic Surgery, Rehabilitation Institute and Hospital for Disabled
(RIHD), Sher – E – Bangla Nagar, Dhaka.
Debashish Roy
Student of D. Ortho. Dhaka University.

ABSTRACT:
Prosthetic replacement of slow growing malignant tumor in a limb is not a new method of treatment. It is a limb saving widely practiced method of restoring skeletal continuity after proximal femoral resection. This method allows rapid return to maximal function, provides immediate stability and increase life expectancy. A. C. Bringold, Edward D Henderson and David R Duhlen MD also showed in their series that life expectancy of patient would increase by prosthetic replacement of different part of limb in some malignant tumors. So this method becomes choice of treatment for the patient with limited life expectancy. At R.I.H.D., Lower one right limb of chondrosarcoma in proximal femur has been reconstructed by locally made custom – made – prosthesis. A short term (4 months) follow up result is satisfactory. Long follow up is necessary to get final result.

A. K. M. SAYEDUL ISLAM
D.Orth, Phd (Tohoku University), Associate Professor, Orthopaedic Surgery, Mymensingh Medical College and Hospital.
A. B. M. FAZLUR RAHMAN
MS (Ortho), Registrar, Orthopaedic Surgery, Mymensingh Medical College and Hospital.
Md Hedayetul Islam
MBBS, Assistant Registrar, Orthopaedic Surgery, Mymensingh Medical College and Hospital.

ABSTRACT:
Eosinophilic Granuloma of bone is a rare variety of tumor. Here four cases were presented initially diagnosed as Giant cell tumor. At surgery gross histopathologically the tumor revealed the features dissimilar to Giant Cell Tumor. All four cases were histopathologically confirmed as Eosinophilic Granuloma, treated by curettage and cancellous bone graft. Maximum follow up period was 22 months. In all patients the lesion healed perfectly without any recurrence and remained pain free. Patients went back to their normal activities. Here per operatively through curettage of the granulomatous lesion became helpful to prevent further recurrence of the tumor. Cancellous bone graft initiates healing of the lesion properly.