BOS Journal - July 1994 - Volume 9, Number 2

The Journal of Bangladesh Orthopaedic Society

July 1994	Volume 9, Number 2
CONTENTS
EDITORIAL 1. Microsurgical Techniques in Orthopaedics Dr. MA Hannan, Associate Professor of Orthopaedic Surgery, RIHD, Dhaka.
2. Major causes of mortality among the casualty patients admitted in Dhaka Medical College Hospital – An Overview ABU MUSA MD. AHSANULLAH, Asstt. Registrar. Casualty Surgery unit – 1 Dhaka Medical College Hospital. M SAJJAD HUSAIN, Consultant. Orthopaedic Surgery, R.I.H.D. Dhaka. Ex. Consultant, Casualty Block, DMCH, Dhaka.
3. Synovectomy of knee Joint in Rheumatoid Arthritis S. M. IDRIS ALI, M.S. (Ortho) R.S. (Casualty), Sir Salimullah Medical College and Mitford Hospital, Dhaka. MD. OMAR FARUQUE, M.B.B.S. Registrar (Ortho), Sir Salimullah Medical College and Mitford Hospital, Dhaka.
4. Out patient treatment of Supracondylar Fracture of Humerus MD. SIRAJ – UL – ISLAM, M.S. (Ortho), Assistant Professor (Current charge), Orthopaedic surgery RIHD, Dhaka.
5. Conservative Treatment of the Fractures of the Femur in Children A. RAHMAN. MS (Orth) Asst. Registrar, RIHD, Dhaka. P. K. BHOWMIK. MS, Orthopaedic Surgeon, RIHD, Dhaka. A. R. M. PRODHAN. MS (Orth).
6. Surgical reconstruction of established leprotic foot drop M.M. BARI, Senior Consultant, Reconstructive Surgery Unit, Leprosy Control Institute and Hospital Mohakhali, Dhaka. DR. Ayjaj Ahmed Khan, Associate Professor Orthopaedic Surgery A. K. M. S. ISLAM, Junior Consultant, Skin & VD, Leprosy Control Institute and Hospital Mohakhali, Dhaka. A. K. M. A. HAQUE, Medical officer, Leprosy Control Institute and Hospital Mohakhali, Dhaka.
7. Results of Anterior Cruciate Reconstruction A. F. M. RUHAL HAQUE, FRCS, Associate Prof. Orth. Surgery, DMCH. MD. AMJAD HOSSAIN, Asstt. Prof. Orth. Surgery, RIHD. RAFIQUL ISLAM, Jr. Consultant (cc), Sadar Hospital, Hobiganj.
8. Old Fracture of Medial Epicondyle with entrapment into the elbow joint MD. AMJAD HOSSAIN, Asstt. Prof. Orth. Surgery, RIHD. MD. IQBAL HOSSAIN, Orthopaedic Surgeon, RIHD. SYED ANWARUZZAMAN, Orthopaedic Surgeon, RIHD.
9. Lateral Medullary Syndrome HARUN – AR – RASHID. Director, Bangladesh Medical Research Council, Mohakhali, Dhaka. QAZI SHAHIDUL ALAM. Associate Professor of Orthopaedic Surgery, Dhaka Medical College Hospital, Dhaka.
10. Intramuscular Fragmental Entrapment in type – IV Fracture of the head of the Radius: A case report M. K. I. QUAYYUM CHOUDHURY, MS(Orth), FICS (USA), Consultant Orthopaedic Surgeon, BIRDEM Hospital, Dhaka.

MICROSURGICAL TECHNIQUES IN ORTHOPAEDICS
Dr. MA Hannan
Associate Professor of Orthopaedic Surgery, RIHD, Dhaka.

Microsurgery includes surgical procedures for structures so small that magnification by an operating microscope is required for their performance.

In last few years, microsurgical techniques have been applied to an expanding range of orthopaedic problems. The surgical methods useful in the treatment of acute injuries and a variety of reconstructive problems caused by acquired and congenital disorders now include microsurgical procedures as the preferred treatment. Microsurgery developed and advanced in the century as surgeons attempted to operate on increasingly finer structures of the body. In 1886 Murphy performed the first end – to – end connection between vessels (anastomosis). A few years later, German surgeon Hoepfner amputated and successfully replanted the limbs in dogs. Alexis Carrel and Charles Guthrie successfully transplanted kidney, blood vessels, blocks of composite tissues viz entire scalp & ear. Their combined work received recognition and Carrel received the Nobel Prize in 1912. In 1921, Nylan & Holmgren first described the use of microscope in surgery for otosclerosis. For more than 20 years, however, their technique was not widely used. Then, in '50 Barraquer & Perit sutured a cornea under an operating microscope. In 1962 Malt and McKhann in Boston replanted an above elbow amputation in a 12 year old boy for the first time. Since those pioneering efforts several hundred digits, hands, feet & limbs have been successfully replanted by surgeons around the world. Microsurgical techniques were adopted for use in other branches of surgery brain surgery, urology, opthalmology, obstetrics, gynaecology as well as surgery of Lymphovascular system.

Regardless of his surgical proficiency the surgeon should not expect that he can become a master of microsurgery spontaneously or immediately. The acquisition of microsurgical techniques requires many hours of practice in the animal laboratory before sufficient skill is mastered to apply the techniques to a patient. Since many hour frequently are required for microsurgical procedures, efficiency of the surgeon and his team is of prime consideration in keeping operative time to a minimum. As interest in this new field grew, facilities for training microsurgeons opened throughout the world.

With increase in number of traffic accidents, violence, workplace injury, homestead injury large number of patients suffer from open fractures, crush injuries, loss of digits or other parts of the limbs. Microsurgical procedures if adopted in these cases can save many limbs. Microsurgery is being practiced by some speciality in Bangladesh. Ocular surgeons operate under microscope for long. Time has reached that this technique should be introduced in the greater arena of orthopaedics surgery in Bangladesh.

References:

Daigle Op, Kleinert Jm, Major limb Replantation in children. Microsurgery, 1991:12.
Kleinert HE, Kasda ML Salvage of devascularised upper extrimeties including studies on small blood vessel anastomasis. Clin Orthop, 1963; 29: 29 – 38.
Lister GD, Kalisman M, Tasi T, Reconstruction of the hand with free Microvascular toe to hand Transfer. Plast Reconstr Surg 1983; 71 – 372.
Urbaniak JR, Rotn, JH, Nunley J, et al, The Results of replantation after amputation of a sungle digit, J Bone Joint Surg. 1985; 67A: 611 – 619.

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MAJOR CAUSES OF MORTALITY AMONG THE CASUALTY PATIENTS ADMITTED IN DHAKA MEDICAL COLLEGE HOSPITAL – AN OVERVIEW

ABU MUSA MD. AHSANULLAH
Asstt. Registrar. Casualty Surgery unit – 1 Dhaka Medical College Hospital.
M SAJJAD HUSAIN
Consultant. Orthopaedic Surgery, R.I.H.D. Dhaka. Ex. Consultant, Casualty Block, DMCH, Dhaka.

SUMMARY:

A prospective hospital based study was undertaken in casualty surgery unit – 1, Dhaka Medical College hospital for a period of six months. During this period a total of 1388 patients were admitted and death recorded among them were 57 (4.10%)- 50 male and 7 female. Incidence of death from trauma was highest among male and 19 – 35 years age group (49.12%). Low and middle class people were the more common victims of casualty & were mostly due to accidental injury (89.48%) and pre – operative in nature (85.96%). Among the types of trauma Thermal burn (47.38%) and Road traffic accidents (29.83%) were most common, followed by Electric burn (7.01%), Blunt trauma (7.01%) Sharp cutting (3.51%), Fall from height (3.51%) and Fire arms (1.75%). Among the major causes of death, the most common was multiple organ failure (45.01%), followed by Irreversible shock (24.56%), Injury to vital organs (15.79%) Septicaemic shock (10.53%) and Electrolyte imbalance (3.50%).

S.M. IDRIS ALI
m.s. (Ortho) R.S. (Casualty), Sir Salimullah Medical College and Mitford Hospital, Dhaka.
MD. OMAR FARUQUE
M.B.B.S. Registrar (Ortho), Sir Salimullah Medical College and Mitford Hospital, Dhaka.s

SUMMARY:

Even in the day of great advancement in Medical Science the treatment of rheumatoid arthritis is a great challenge possibly due to its recurring course. Contrary to Rheumatric fever which heat the joints but leaks the heart, rheumatoid arthritis though a systemic disease it affects mainly the joints especially the synovial joints.

MD. SIRAJ – UL – ISLAM
M.S. (Ortho), Assistant Professor (Current charge), Orthopaedic surgery RIHD, Dhaka..
ABSTRACT:

Supracondylar fracture of humerus is a common problem in hospitals of underdeveloped countries like ours where patients, hospital beds and anaesthetic facilities have got a clear disparity. Retrospective study offers the scope to improve the management of the subject with minimum facilities available as well as lowering the cost of treatment. In out patient department no general anaesthesia is available. There is not enough beds for admission of cases like supracondylar fracture of humerus.

From December ’86 to June ’91 (four and a half year) 477 cases of supracondylar fracture of humerus were treated at O .P. D. of Mymensingh medical college hospital. The incidence of such fractures among all the fracture cases was 2% and 6% of fractures of upper extrimity bones. In our country a considerable cases of fractures are managed by bone setters though frequently with immediate and delayed complications. The supracondylar fracture is one where rate of compication is higher and may end in serious consequences like gangrene of the limb. Hence the fracture is to be treated with due care and confidence.

A. RAHMAN
MS (Orth) Asst. Registrar, RIHD, Dhaka.
P. K. BHOWMIK
MS, Orthopaedic Surgeon, RIHD, Dhaka.
A. R. M. PRODHAN
MS (Orth)

SUMMARY:

Sixty – five patients who had fractures of the femoral shaft in the first twelve years of life were treated conservatively by Bryant’s traction and skin or skeletal traction followed by hip spica. One patient was treated by Bryant’s traction only without spica cast. Average period of follow – up was 9.8 months. The result was evaluated on the basis of both clinical and radiological findings. The study showed excellent result in 36 cases, good result in 19 cases, fair in 8 cases and poor result in 2 cases.

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

SUMMARY:

By established foot drop we mean a paralysis which has persisted for an arbitrary period of one year. Foot drop can be corrected by reconstructive surgery. We were able to operate 25 patients for foot drop from March 1992 to July 1994. Tibialis posterior transposition with lengthening of Tendo – Achilles was performed on these patients. 20 of the 25 patients with the tibialis posterior transposition with lengthening of Achilles tendon were pleased with the result, 5 were not. 20 patients could extend their feet above the neutral position. The surgical procedure which was done for foot drop gives a good result, provided they are followed by pre and post operative physiotherapy.

A. F. M. RUHAL HAQUE.
FRCS, Associate Prof. Orth. Surgery, DMCH.
MD. AMJAD HOSSAIN.
Asstt. Prof. Orth. Surgery, RIHD.
RAFIQUL ISLAM.
Jr. Consultant (cc), Sadar Hospital, Hobiganj.

SUMMARY:

Eleven patients all engaged in athletic activities were treated for chronic instability of knee in Dhaka Medical College Hospital & in Private clinics from 1991 to 1993. Two of them were female. Age ranged from 19 to 33 yrs. Out of eleven right side involved in 6(Six) & left in 5(five) patients. No acute injury cases were included in this series. All the knees were examined arthroscopically during operation. Jones procedures with minor modification was adopted in these cases.

4 patients returned to football playing. 5 patients performs normal activity but 3 give up sports, 2 patients gained normal activity with minor discomfort.

MD. AMJAD HOSSAIN
Asstt. Prof. Orth. Surgery, RIHD.
MD. IQBAL HOSSAIN
Orthopaedic Surgeon, RIHD.
SYED ANWARUZZAMAN
Orthopaedic Surgeon, RIHD.

SUMMARY:
A series of 10(ten) children with intra – articular entrapment of medial humeral epicondyle in the elbow were studied with an average of 11 weeks after the injury, from January 1993 to December 1994. All elbows were deformed and the average range of movement was 30 degree. Four children had ulnar nerve neuritis which recovered after anterior transposition. In two cases neurolysis were done besides anterior transposition. The epicondyles were removed from the joints, excised in five cases and reattached in five cases. At follow – up of an average of 14 months following operation movement at elbow increased about 60%. 8(80%)children achieved painless elbow movement. 2 cases (20%) did not recover at all.

HARUN – AR – RASHID
Director, Bangladesh Medical Research Council, Mohakhali, Dhaka.
QAZI SHAHIDUL ALAM
Associate Professor of Orthopaedic Surgery, Dhaka Medical College Hospital, Dhaka.

INTRODUCTION:

Cerebro – Vascular disease is the most common type of neurological disorder both in developed and developing countries . According to Charles Warlow cerebrovascular disease refers to all forms of vascular disease which affect the brain. The Lateral Medullary Syndrome (LMS) is a very frequent variant of medullary vascular lesions . The syndrome was first described by Wallenberg – a German Therapeuist and later on by a Russian Neuropathologist – Zakharchenko in 1911. The full eponym of the pathological condition is Wallenberg – Zakharchenko sysdrome.

INTRAMUSCULAR FRAGMENTAL ENTRAPMENT IN TYPE – IV FRACTURE OF THE BEAD OF THE RADIUS: A CASE REPORT
M. K. I. QUAYYUM CHOUDHURY
MS(Orth), FICS (USA), Consultant Orthopaedic Surgeon, BIRDEM Hospital, Dhaka.

SUMMARY:

A case is reported in which in association with posterolateral dislocation of the elbow, the radial head was found broken into two halves as a result of a transverse sub – capital and a vertical split. The antero – medial half failed to follow the displacement during the dislocation of the joint, remained in situ, got buried and trapped within the flexor muscles of the forearm. The fragment being buried changed its position along with the forearm during close reduction. It was possible to remove the fragment through the same incision for the excision of the head and the outcome was good.

tion. It was possible to remove the fragment through the same incision for the excision of the head and the outcome was good.