BOS Journal - July, 1995 - Volume 10, Number 2

The Journal of Bangladesh Orthopaedic Society

July, 1995	Volume 10, Number 2
CONTENTS
EDITORIAL 1. Avascular Necrosis of the Femoral Head Qazi Shahidul Alam, Associate Prof. & Head, Orthopaedic Surgery, DMCH, Dhaka.
2. Elmslie Trillat Medialization for Patellar Dislocation M. A.SAMAD, Consultant, Dept. of Orthopaedic Srugery, IPGMR, Dhaka. M. HABIBUR RAHMAN, Consultant, Dept. of Physical Medicine, IPGMR, Dhaka. MOHAMMAD ABDUL HANNAN, Prof. of Orthopedic Surgery, RIHD, Dhaka. SOHEKY RAHMAN, Medical Officer, Dept. of Physical Medicine, IPGMR, Dhaka.
3. Study on Non-Union Fracture Shaft of the Humerus after Traeatment in Adult Patient - A Comparative Study MD.SAJJAD HUSSAIN, Consultant Orthopaedic Surgery, RIHD, Dhaka. MD. ABDUL HANNAN, Consultant Orthopaedic Surgery, RIHD, Dhaka.
4. "Resin Coated Modified External Skeletal Fixator"- A Consideration For Developing Countries K. A. AWAL, Associate Professor of Orthopaedic, RIHD, Dhaka. MD. ISHAQ, Associate Professor of Orthopaedic, RIHD, Dhaka. O.F.G. KIBRIA, MS (Ortho), RIHD, Dhaka. RAFIQUL ISLAM, MS (Ortho), RIHD, Dhaka.
5. Incidence and Etiological Pattern of Low Back Pain M. MOYEENZZAMAN. Asst. Prof. of Physical Medicine, IPGMR, Dhaka. K.K. BARUA. Asst. Prof. of Neurosurgery, IPGMR, Dhaka. Q.D. MOHAMMAD. Assoc. Prof. of Neuromedicine, DMCH, Dhaka. M.A.SAMAD. Consultant, Orthopaedic Surgery, IPGMR, Dhaka. M. HABIBUR RAHAMAN. Consultant, Orthopaedic Surgery, IPGMR, Dhaka. M.Q. ISLAM. Prof. of Physical Medicine, IPGMR, Dhaka.
6. Evaluation of the Result of Mc. Murray's Displacement Osteotomy in the Treatment of Intracapsular Fracture Neck Femur in Adult MD. SHAHIDUZZAMAN, Consultant, Orthopedic Surgery. 250 Beded Hospital, Khulna.
7. Management of Open Tibia Fibula Fractures – A Short Term Study on the Method of Immobilization SIRAJ-UL-ISLAM, Asstt. Prof., Orthopaedic Surgery, R.I.H.D., Dhaka. NAZRUL ISLAM, Consultant Orthopedic Surgeon, R.I.H.D., Dhaka. SK. NURUL ALAM, Asso. Prof., Asso. Prof. R.I.H.D., Dhaka. MAHBUB HOSSAIN, Consultant Orthopaedic Surgeon, Police Hospital, Dhaka.
8. Clinical Presentation of Frozen Shoulder M. HABIBUR RAHMAN, Student Physical Medicine IPGMR, Dhaka. M. MOYEENUZZAMAN, Assistant Professor of Physical Medicine IPGMR, Dhaka. M. A. SAMAD, Consultant, Orthopaedic Surgery, IPGMR, Dhaka. M. HILALUL ISLAM, Student Physical Medicine IPGMR, Dhaka. MONIRUZZAMAN KHAN, Student Physical Medicine IPGMR, Dhaka. M. Q. ISLAM, Professor of Physical Medicine IPGMR, Dhaka.
REVIEW ARTICLE
9. Nontraumatic Avascular Necrosis of the Femoral Head A. F. M. RUHAL HAQUE. Directior & Professor of Orthopaedic Surgery.R.I.H.D, Dhaka. MD. IQBAL QAVI. Jr. Consultant (c.c) R.I.H.D, Dhaka.
SURGICAL AUDIT
10. Routine Operation in RIHD in the year 1994 MD. SHAMUZZAMAN, MO, Orthopaedic Surgery, RIHD, Dhaka. M. A. HANNAN, Professor, Orthopaedic Surgery, RIHD, Dhaka.
CASE REPORT
11. Acute Carpal-Tunnel Syndrome Following Wrist Trauma – A Report of two Cases S. U. AHMAD, Registrar, Dept. of Orthopaedic Surgery, Chittagong Medical College Hospital, Chittagong. F. R. AOLAD, Professor & Head of the Dept. of Orthopaedic Surgery, Chittagong Medical College Hospital, Chittagong.

AVASCULAR NECROSIS OF THE FEMORAL HEAD
Qazi Shahidul Alam
Associate Prof. & Head, Orthopaedic Surgery, DMCH, Dhaka.

Avascular Necrosis (AVN) is an interesting topic to the orthopaedic surgeon and is often encountered in their clinical practice. Traumatic AVN is very much evident with time. The femoral head is the most commonly affected bone. Non traumatic AVN comprises a large part which are increasingly detectable now a days with the advancement of modern imaging technique of CT scan & specially MRI. Avascular Necrosis of femoral head (ANFH) may either be (1) primary or idiopathic or (2) secondary to several known causative like alchol abuse, Gout, Caisson disease, Gaucher's disease, renal osteodystrophy, sickle cell anaemia and systemic steroid steroid use. NSAID has also been incriminated.

Regardless of its etiologic factor the histologic picture of ANFH is same having empty lacunae in trabecular bone. The standand classification of ANFH was developed by Ficat and Arlet and is based on roentgenographic changes. Scintigraphy help to evaluate early stages of the pathologic process. With advance in MRI, earlier diagnosis, more specific non invasive method of determining the exact stage of the pathologic process is possible MRI showed the exact location & extent of necrosis with no false negative results.

The incidence of nontraumatic ANFH is unknown but is relatively uncommon. It occurs in the third to fifth decade of life. There is a predisposition for males on the ratio of 4:1. The frequency of bilateral hip involvement (30%-80%)5 makes it imperative to keep on apparently normal hip under close observation.

Various surgical & nonsurgical treatment is advocated for ANFH. But with the constrain of facilities like MRI or operative microscopic the treatment of ANFH is limited in our country so far. In early stages of the disease, free bone graft or osteotomy in one from or the other is probably the ideal solution. In late stages, replacement arthroplasty, hemisurfacing, hemiarthroplasty, bi-polar prosthesis, total hip replacement seems to be the best solution.

In this issue a review article with extensive exploration of all relevant information is included for the interested readers.

Reference:

Liebergall M, Poman Y. and Mlgrome C : NSAID induced Avascular Necrosis and arthropathy of the femoral head. Orthop Rev. 1987 ; 16; 652.
Feat RP and J : In Hongerforsl DS editior : Ischaemia and necrosis of bone. Baltearone Willians & Wilkins. 1980.
Miki T, Yamamuro T-Okamum H, et al. Scintigraphy in nontraumatic femoral head necrosis. Acta vrthop scaund 1987; 58-375
Basset LW, Cold RH. Reicher M, er al : Magnetic resonance imaging in the early diagnosis of ischaemic necrosis or the femoral head . Clin Orthop 1987 ; 214-237.
Mont MA, Hungerfral DS. Curent concept Review - non traumatic Avascular Necrosis of femoral head. JBJS 1995 ; 77-A459.

M. A. SAMAD
Consultant, Dept. of Orthopaedic Srugery, IPGMR, Dhaka.
M. HABIBUR RAHMAN
Consultant, Dept. of Physical Medicine, IPGMR, Dhaka.
MOHAMMAD ABDUL HANNAN
Prof. of Orthopedic Surgery, RIHD, Dhaka.
SOHEKY RAHMAN
Medical Officer, Dept. of Physical Medicine, IPGMR, Dhaka.

SUMMARY:

Elmslie Trillat Medialization of the tibial tuberosity was used to treat 7 knees in 7 patients with recurrent dislocation of the patella. Three dislocations were on the right and 4 on the left. The patients were reviewed at an average follow- up of 24 months. Five patients were substantially improved by this procedure, two patients had sustained further dislocation. No major postoperative complication occurred in any patient.

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STUDY ON NON-UNION FRACTURE SHAFT OF THE HUMERUS AFTER TRAEATMENT IN ADULT PATIENT - A COMPARATIVE STUDY

MD. SAJJAD HUSSAIN
Consultant Orthopaedic Surgery, RIHD, Dhaka.
MD. ABDUL HANNAN
Consultant Orthopaedic Surgery, RIHD, Dhaka.

SUMMARY:

30 patients of fracture shaft of the humerus aged between 20-60 years were treated by three different method. 1) Conservation with plaster cast and sling. 2) Internal fixation with intramedullary rush nail, 3) Internal fixation with normal plate and screw without compression. 10 patients of each method were studied. The cases were followed up from 6 months to 1 and half year for the results. Out of these three methods, 50% of the conservative type, 70% of the rush pin fixation and 40% of the screw plate fixation showed non-union.

K. A. AWAL
Associate Professor of Orthopaedic, RIHD, Dhaka.
MD. ISHAQ
Associate Professor of Orthopaedic, RIHD, Dhaka.
O. F. G. KIBRIA
MS (Ortho), RIHD, Dhaka.
RAFIQUL ISLAM
MS (Ortho), RIHD, Dhaka.
SUMMARY:

In our country open fractures are commonly managed by modified external skeletal fixators made of steinmann pins and Bamboo sticks incorporated with plaster of Paris. Simple modification of the commonly used external skeletal fixatures by a coating of Resin complex greatly improves the quality of the fixture and facilitates irrigation, dressing and early healing. The method of Resin application over improved external fixation devices in 20 cases are reported here.

M. MOYEENZZAMAN
Asst. Prof. of Physical Medicine, IPGMR, Dhaka.
K. K. BARUA
Asst. Prof. of Neurosurgery, IPGMR, Dhaka.
Q. D. MOHAMMAD
Assoc. Prof. of Neuromedicine, DMCH, Dhaka.
M. A. SAMAD
Consultant, Orthopaedic Surgery, IPGMR, Dhaka.
M. HABIBUR RAHAMAN
Consultant, Orthopaedic Surgery, IPGMR, Dhaka.
M.Q. ISLAM
Prof. of Physical Medicine, IPGMR, Dhaka.

SUMMARY:

Out of 1096 patients treated in the physical medicine department of IPGMR, Dhaka, during a period of 6 months from 1st March 1994 to 31st August 1994, 280(25.55%) were presented with the complaints of low back pain. Of the total 280 case 214 (76.42%) were male and (23.58%) were female with a male: female ratio of 3:1. The mean age was 35.47-+13.5 years in both sexes. Maximum patients 58.56% belongs to 21-40 years age group. 24.28% were student, 18.92% were serviceman, 16.44% were housewife and the rest belonged to other occupations. Nonspecific low back pain was found in 36.43% patients, 27.50% had lumber spondylosis and 19.28% had prolapsed lumber intervertebral disc. Ankylosing spondylitis was diagnosed in 6.07% patients, congenital anomalies in 6.42%, spondylolistheses in 2.85% patients. Old compression fracture was found in 1.45-% patients.

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EVALUATION OF THE RESULT OF MC. MURRAY'S DISPLACEMENT OSTEOTOMY IN THE TREATMENT OF INTRACAPSULAR FRACTURE NECK FEMUR IN ADULT

MD. SHAHIDUZZAMAN,
Consultant, Orthopedic Surgery. 250 Beded Hospital, Khulna.

SUMMARY:

The treatment of ununited and irreducible intracapsular femoral neck fracture in adults for developing countries with lack of modern facilities should entail a procedure which is simple, and is productive of a stable hip, without pain in the shortest time with least danger. Mc. Murray's displacement osteotomy has proved to be the treatment of choice for this distressing condition. Through the operative procedure is simple, the technical details of the procedure should be followed strictly to obtain a satisfactory result. The case chosen for the operation should be selected carefully. Viable head with fairly well preservation of femoral neck is a prerequisite. Patients should receive well guided physical therapy to improve their hip and knee function. 27 patients within the age group of 18 to 45 years were included in this study. An overall satisfactory result of 79.16% has been achieved from this study with 90% satisfactory functional result in relatively younger age group. Functional results were better in those treated in hip spica following osteotomy. So Mc.Murray's displacement osteotomy with plaster spica in young adults can be considered as a rational choice in the treatment of ununited or irreducible intracapsular femoral neck fratures, as this is the best solution for a bad situation.

SIRAJ-UL-ISLAM,
Asstt. Prof., Orthopaedic Surgery, R.I.H.D., Dhaka.
NAZRUL ISLAM,
Consultant Orthopedic Surgeon, R.I.H.D., Dhaka.
SK. NURUL ALAM,
Asso. Prof., Asso. Prof. R.I.H.D., Dhaka.
MAHBUB HOSSAIN,
Consultant Orthopaedic Surgeon, Police Hospital, Dhaka.

SUMMARY:

Out of 1806 emergency operation, 230 cases were open fracture of tibia and fibula. Like other fracture elsewhere, every tibia and fibula fracture is to be dealt with a realistic attitude individually. Hence seven different types of management were adopted in this series. Most of type I and II fracture were treated by sufficient irrigation, debridement and immobilization by long leg cast with dressing of the wound through the window. Primary fixation in reasonable clean would gives the best result in terms of union, preservation of function and hospital stay.

M. HABIBUR RAHMAN
Student Physical Medicine IPGMR, Dhaka.
M. MOYEENUZZAMAN
Assistant Professor of Physical Medicine IPGMR, Dhaka.
M. A, SAMAD
Consultant, Orthopaedic Surgery, IPGMR, Dhaka.
M. HILALUL ISLAM
Student Physical Medicine IPGMR, Dhaka.
MONIRUZZAMAN KHAN
Student Physical Medicine IPGMR, Dhaka.
M.Q. ISLAM
Professor of Physical Medicine IPGMR, Dhaka.
SUMMARY:

To see the clinical pattern of capsulitis of the shoulder, 50 case were examined, among which 32 were male. Mean age of the patients was 56.24 +8.00 years. Twenty-six cases had left shoulder involvement and 2 bilateral. Eight had diabetes mellitus and 4 were hypertensive. Morning stiffness was not marked in capsulitis. Abduction, external and internal rotation of the shoulder were almost equally affected. Our findings were consistent with that of international findings.

NONTRAUMATIC AVASCULAR NECROSIS OF THE FEMORAL HEAD
A. F. M. RUHAL HAQUE
Directior & Professor of Orthopaedic Surgery.R.I.H.D, Dhaka.
MD. IQBAL QAVI
Jr. Consultant (c.c) R.I.H.D, Dhaka..

ABSTRACT:

The pathogenesis and optimal management of avascular necrosis of the fermoral head (ANFH) remain an unsolved problem. This article reviews the relevant literatures, and reports on factors and the roentgenographic staging system of Ficat and Arlet and of Steinbergh et al. Early detection by core biopsy or magnetic resonance imaging, and newer surgical technique such as rotational osteotomy of Sugioka and free vascularized fibular graft using micro-surgical techniques are discussed. The various diagnositic method and surgical procedures that are feasible for management of ANFH in underdeveloped countries like ours, where there is constraint of facilities like MRI or operative microscopy, are outlined in this review article.

ROUTINE OPERATION IN RIHD IN THE YEAR 1994
MD. SHAMUZZAMAN
MO, Orthopaedic Surgery, RIHD, Dhaka.
M.A. HANNAN
Professor, Orthopaedic Surgery, RIHD, Dhaka.

RIHD, the only orthopaedic and traumatic hospital in Bangladesh, is a 500 bedded hospital with all the limitation like other hospitals in our country. There are five units in this institute including plastic surgery department. In the year 1994 a total of 1689 patients were operated as routine procedure. In yellow unit 377 patients, in green unit 266, in red 343, in blue 336 and in plastic surgery unit 367 patients were operated. Patients attended RIHD either directly or by referral by doctors or patients from near and remote places of the country.

ACUTE CARPAL-TUNNEL SYNDROME FOLLOWING WRIST TRAUMA – A REPORT OF TWO CASES
S. U. AHMAD
Registrar, Dept. of Orthopaedic Surgery, Chittagong Medical College Hospital, Chittagong.
F. R. AOLAD
Professor & Head of the Dept. of Orthopaedic Surgery, Chittagong Medical College Hospital, Chittagong.

SUMMARY:
Two cases of acute median nerve compression following trauma in wrist are presented. The first highlights problem of plaster in Cotton-Loder position in Colles’fracture. The second illustrates an unusual presentation of nerve compression following an intra-articular fracture of distal radius. following an intra-articular fracture of distal radius.