BOS Journal - January, 1994 - Volume 9, Number 1

The Journal of Bangladesh Orthopaedic Society

January, 1994	Volume 9, Number 1
CONTENTS
EDITORIAL 1. Introducing Medical Audit in Orthopaedics DR. A F M RUHAL HAQUE. FRCS(Edin), Editor, Journal of Bangladesh Orthopaedic Society.
2. Traumatic Spinal Cord injuries and Epidemiologic perspective SALEH UDDIN AHMAD, MBBS, MS (Ortho), Registrar, Chittagong Medical College and Hospital.
3. Traumatic Amputation Through Lower Limb - A 5 Years Study at R.I.H.D. Dhaka. KH. ABDUL AWAL. MS (Orth) Assistant Professor, R.I.H.D., Dhaka. MD. SHAMIMUL HAQUE. MS(Orth), R.S. (Casuality), Mymensingh Medical College Hospital. RAFIQUE ISLAM. MS (Orth) Clinical Asstt., RIHD, Dhaka.
4. Cervical Rib – Excision through axillary approach A F M RUHAL HAQUE. M S (Ortho) Asstt. Professor, Orthopaedic Surgery Dept. Dhaka Medical College Hospital. SERAJUDDIN AHMED. D. Orth., M. S. Orth., Lecturer of Orthopaedic Surgery, R.I.H.D. Dhaka.
5. Primary Bony Lymphoma – A Case Report MD. MOKHLES UDDIN. F.C.P.S. (Radiothherapy), Radiotherapist, Radiotherapy Department, Dhaka Medical College Hospital, Dhaka. ABDUR ROB BHUIYAN. F.C.P.S. (Radiotherapy), Assistant Professor of Radiotherapy, Dhaka Medical College Hospital, Dhaka.
6. Evaluation of Results of Management of Abdominal Trauma in a Casualty Unit of Dhaka Medical College Hospital, Dhaka. KAOSAR KAMAL. M.B.B.S, (Dhaka), MS (Ortho) AMJAD HOSSAIN. Consultant , Causalty Unit-1, Dhaka Medical College Hospital, Dhaka. BIPUL CHAKI. Assistant Registrar , Causalty Unit-1, Dhaka Medical College & Hospital.
7. Surgical reconstruction of leprotic claw hand M. M. BARI. Senior Consultant Reconstructive Surgery Unit, Leprosy Control Institute and Hospital, Mohakhali, Dhaka. K. M. ISLAM. Junior Consultant Skin VD, Leprosy Control Institute and Hospital, Mohakhali, Dhaka. M. ISLAM. Junior Consultant Skin VD, Leprosy Control Institute and Hospital, Mohakhali, Dhaka. A. K. M. A. HAQUE. Medical officers, Leprosy Control Institute and Hospital, Mohakhali, Dhaka.
8. Surgical Approach to late cases of Giant Cell Tumour of bone: 2 Cases reports BIDHAN CHANDRA ROY. MS (Ortho), Fellow in Accident Surgery (Australia), Assistant Professor, Department of Orthopaedic Surgery, Mymensingh Medical College, Mymenshigh
9. CASE REPORT: Multiple Pseudo Cystic Tuberculosis Bone DR, SIRAJ-UL-ISLAM. M.S (Orth) Student, RIHD. Dhaka

INTRODUCING MEDICAL AUDIT IN ORTHOPAEDICS
Dr. A. F. M. Ruhal Haque
FRCS(Edin), Editor, Journal of Bangladesh Orthopaedic Society.

It is about time that we understand the need for Medical Audit: By introducing audit to different departments in our hospitals we can look into our work and scrutinize them and try to modify them to improve ourselves. Medical Audit is now seen throughout the world as a necessary requirement to improve the health care. Pressures from public has been instrumental in creating present environment in Medical Audit. In Bangladesh we are not yet auditing most of our departments and hospitals. I feel there is great need for introduction of audit into our department.

Orthopaedic Audit will lead to improvements in the quality of care through the setting of standards by reviewing our work and implementing the changes that may be needed. Audit educates us through fuller understanding of the patients and providers.

What audit can measure:

The structure of an organization i.e. the resources and personnel available to you.
The process i.e. what happens in your hospital or department.
The outcome i.e. the results of your care.
Patients satisfaction

Some of the features that should be emphasized in medical audit:

Improvement of patients care
Proper feed back to all concerned
Patient’s satisfaction
Continuous review at certain intervals always initiating new questions to be negotiated.
Ensuring application of full knowledge, attitude and practice by all service providers.

FLOW CHART

What actually is happening

By audit

Formulate the desired changes

Implement the desired changes

What is desired to be done

For assessing patients satisfaction, questionnaire may be developed and used and example is given below

Q.1.1.D.No.
Q.2, Age
Q.3.Gender M/F
Q.4. Are you happy with the treatment? very happy happy uncertain unhappy very unhappy
Q.5. Are you happy with the service? very happy happy uncertain unhappy very unhappy

Similar questionnaires may be formulated to look into different aspect of our service delivery system.

It is about time that we audit ourselves. There has been some thought about the matter in different quarters but full effort has not yet been given in this respect. Individual effort can not take us very far. It should be a part of the hospital management to assure quality service and accountability.

SALEH UDDIN AHMAD
MBBS, MS (Ortho), Registrar, Chittagong Medical College and Hospital.
M MUAZZAM HOSSAIN
MBBS, FCPS (Surgery), Director, RIHD, Dhaka.

SUMMARY:

In order to survey the epidemiological characteristics of traumatic spinal cord injuries (TSCI), a retrospective study was conducted based on hospital records of patients admitted to the paraplegic ward of the Rehabilitation Institute and Hospital for Disabled (RIHD), Dhaka from July 1991 to December 1992. During period, 410 traumatic SCI patients were admitted. As a result of injury 123 (30%) were tetraplegic and 187 (70%) were paraplegic. The mean age of onset was 32 year. The male / female ratio was 10:1, The major causes of SCI were falling from height (50%), followed by accidental fall of heavy object on the body (20.50%) and traffic accident (18.50%). The mortality rate was 6.0%. The frequency of decubitus ulceration and urinary infection were unacceptably high. The study highlights the necessity for appropriate preventive measures and also reemphasizes the short coming of treatment of spinal cord injury patients.

KH. ABDUL AWAL,
MS (Orth) Assistant Professor, R.I.H.D., Dhaka.
MD. SHAMIMUL HAQUE,
MS(Orth), R.S. (Casuality), Mymensingh Medical College Hospital.
RAFIQUE ISLAM,
MS (Orth) Clinical Asstt., RIHD, Dhaka.

SUMMARY:

This study of amputation through the lower limb was carried out at R.I.H.D., Dhaka from 1986 to 1990. This is a restrospective study and it was found that 512 Traumatic amputation through different levels of the lower limb were performed at R.I.H.D. during this period. This study revealed that the incidence of the above mentioned amputations has increased gradually. There were 88,96,102,108 & 118 cases of amputation performed in the year 1986,1987,1988,1989 & 1990 respectively. 85% of the patients were male, incidence was highest among the younger age group 21-30 yrs (157 patients = 30.66%). Regarding the level of amputation cases of amputation through thigh (above knee) were 152 (29.6%) and below knee (through leg) were 215 (41.9%). Amputation following road traffic accident was 318 (62%), machinery injury 98 (19.14%), assault 56 (10.93%) and following train accident, cyclone and other causes were 40 (8%). Autoamputation at the time of injury occurred in 90, primary amputation with immediate closure of the stump done in 120 and open amputation were performed in 302 cases.

A. F. M. RUHAL HAQUE
FRCS. Associate Professor, Orthopaedic Surgery Dept. Dhaka Medical College Hospital.
SERAJUDDIN AHMED
M S (Ortho) Asstt. Professor, Orthopaedic Surgery Dept. Dhaka Medical College Hospital.

SUMMARY:

We are reporting here 5 cases of cervical rib excision through the axillary route, done in the department of Orthopaedics, Dhaka Medical College hospital, from March, 1991 to May, 1994. This approach is not a common one in our country, but is very well practiced in order developed countries, e.g. the United State.

In our experience, all cases have done very well post-operatively, except one case, which developed temporary brachilgia in the immediate post-operative period. Although meticulous dissection and care have to be taken during surgery, we do not consider this approach any more difficult than the traditional anterior approach, and from a cosmetic point of view, it is much better and acceptable.

MD. MOKHLES UDDIN
F.C.P.S. (Radiothherapy), Radiotherapist, Radiotherapy Department, Dhaka Medical College Hospital, Dhaka.
ABDUR ROB BHUIYAN
D.M.R.T., Assoc. Professor of Radiotherapy, Dhaka Medical College Hospital, Dhaka.
PARVEEN SHAHIDA AKTAR
F.C.P.S. (Radiotherapy), Assistant Professor of Radiotherapy, Dhaka Medical College Hospital, Dhaka.

SUMMARY:

A young male presenting with pathological fracture at the middle of the shaft of right humerus was diagnosed as a case of primary bony lymphoma and was treated by radiotherapy and chemotherapy. The fracture has united and healed up – thus permitting him normal function. The aim of this article is to draw attention to the facts that primary bony lymphoma is very rare, but may occur. This is a matter of great hope that primary bony lymphoma even with the pathological fracture may have complete remission if treated properly.

Back to Top

EVALUATION OF RESULTS OF MANAGEMENT OF ABDOMINAL TRAUMA IN A CASUALTY UNIT OF DHAKA MEDICAL COLLEGE HOSPITAL, DHAKA.

KAOSAR KAMAL
Asstt Registrar, Causalty Unit-1, Dhaka Medical College & Hospital.
AMJAD HOSSAIN
Consultant , Causalty Unit-1, Dhaka Medical College Hospital, Dhaka.
BIPUL CHAKI
Assistant Registrar , Causalty Unit-1, Dhaka Medical College & Hospital.

INTRODUCTION:

A case of False Aneurysm of femoral artery is presented here. False Aneurysm is caused by injury to an artery by pene-trating wound from without or from a fracture. The arterial wall may be partially lacerated or the entire thickness of the wall is divided resulting in ballooning out of the arterial wall or formation of a large haematoma. Clinically it presents as a pulsating tumour mass and may sometime be confused with Aneurysimal bone cyst or Angioma. Radiology of the part is unlikely to show any bone change. Treatment is surgery and prognosis of the aneurysm of extremity has a good result.

M. M. BARI
Senior Consultant Reconstructive Surgery Unit, Leprosy Control Institute and Hospital, Mohakhali, Dhaka.
A. K. M. ISLAM
Junior Consultant Skin VD, Leprosy Control Institute and Hospital, Mohakhali, Dhaka.
M. ISLAM
Medical officers, Leprosy Control Institute and Hospital, Mohakhali, Dhaka.
A. K. M. A. HAQUE
Medical officers, Leprosy Control Institute and Hospital, Mohakhali, Dhaka.

SUMMARY:

In the hand the commonest problem is the paralysis of the lumbrical muscles, resulting in a claw hand- it is the inability to flex the fingers at the metacarpophalageal (MCP) joint and associated with this is the inability to extend the fingers at the interphalangeal (IP) joints. 32 patients were included in this series and were operated in the Leprosy Control Institute and Hospital, Mohakhali, Dhaka during the period between February 1992 to September 1994. 4-EMFT (4-Extensor many Tailed Finger Transfer) with Fascia lata free tendon graft was done. There were 26 male and 6 female and ages ranged from 18-50 years with an average 30 years. Extensor Carpi Radialis Brevis with fascia late free tendon graft is the choice of all possible cases, because it is easier to re-educate and usually gives an excellent functional and cosmetic result.

BIDHAN CHANDRA ROY
MS (Ortho), Fellow in Accident Surgery (Australia), Assistant Professor, Department of Orthopaedic Surgery, Mymensingh Medical College, Mymenshigh.

SUMMARY:

Two late cases of Giant – cell tumour are presented here. Both were young persons. Amputation were not done. They were treated by excision of the tumour with a portion of healthy bone and autogenous bone graft was applied, one without additional fixation and another with additional metallic fixation. After long time follow up both the cases are free from recurrence. The limbs are saved.

CASE REPORT

SURGICAL APPROACH TO LATE CASES OF GIANT CELL TUMOUR OF BONE: 2 CASES REPORTS
BIDHAN CHANDRA ROY
MS (Ortho), Fellow in Accident Surgery (Australia), Assistant Professor, Department of Orthopaedic Surgery, Mymensingh Medical College, Mymenshigh.

SUMMARY:

Two late cases of Giant – cell tumour are presented here. Both were young persons. Amputation were not done. They were treated by excision of the tumour with a portion of healthy bone and autogenous bone graft was applied, one without additional fixation and another with additional metallic fixation. After long time follow up both the cases are free from recurrence. The limbs are saved.