BOS Journal - January, 1997 - Volume 12, Number 1

The Journal of Bangladesh Orthopaedic Society

January, 1997	Volume 12, Number 1
CONTENTS
1. Total Hip Replacement in Bangladesh Dr. Kh. Abdul Awal Rizvi, Associate Prfessor of Orthopaedics, RIHD, Dhaka.
2. Pattern of Bone Tumours Operated at RIHD Form July 1983 to June 1993 – A 10 years Survey Report MD. MOHSHINUL HUSSAIN MAJUMDER, Asstt. Prof. of Orthopaedic Surgery, Comilla Medical College & Hospital, Comilla. KH. ABDUL AWAL RIZVI, Asstt. Prof. of Orthopaedic Surgery, RIHD, Dhaka.
3. Surgical Management of de Quervain’s Disease M. A. SAMAD, Consultant, Department of Orthopaedic Surgery, IPGMR, Dhaka. A. MD. SHAMIMUL HAQUE, Registrar (Ortho, Surgery), SSMC Mitford Hospital, Dhaka. M. HABIBUR RAHMAN, FCPS Part – II Student, Physical Medicine, IPGMR, Dhaka. A. B. M. FAZLUR RAHMAN, Consultant, Orthopaedic Surgery, Narayanganj modern Hospital.
4. Incidence of Neural Injury Associated with Supracondylar Fracture in Children F. H. SERAJEE, Assistant Professor of Orthopaedic Surgery, RIHD, Dhaka. M. A. HANNAN, Professor of Orthopaedic Surgery, RIHD, Dhaka.
5. Comparative Study of Internal Fixation for Displaced Medial Malleolar Fractures by Malleolar screw and Tension Band wiring M. A. QUADER. Student D. Ortho, RIHD, Dhaka. PARVIZ SHAHIDI. Student MS (ortho), RIHD, Dhaka. SK. NURUL ALAM. Professor of Orthopaedic Surgery, RIHD, Dhaka.
6. A Study of Effectiveness of Diathermy on Patient with Osteoarthritis of Knee Joint A Study on 60 Cases M.A. RASHID, Asst. Prof. of Physical Medicine, RIHD, Dhaka. MD. MOYEENUZZAMAN, Asst. Prof. of Physical Medicine, IPGMR, Dhaka. MD. QUAMRUL ISLAM, Prof. & Head of Physical Medicine, IPGMR, Dhaka. M. A. SAMAD, Asst. Prof. of Orthopaedic – Surgery, RIHD, Dhaka. A. MD. SHAMIMUL HAQUE, Registrar, (Ortho Surgery) SSMC Mitford Hospital, Dhaka.
7. Different Approach of Brachial Plexus Block – An Analysis of Option for the Orthopedic Surgery of the Upper Extremity ABDUL KHALEQUE Jr. Consultant, Department of Anaesthesiology, Dhaka Medical College. KHALILUR RAHMAN Prof. of Anaesthesiology, Dhaka Medical College. SERAJUDDIN AHMED Asstt. Professor, Department of Orthopaedic, Dhaka Medical College.
REVIEW ARTICLE
8. Treatment of the Forearm Fractures in Adults MD. ABDUL HANNAN, Professor of Orthopaedic Surgery, RIHD, Dhaka. A. K. MD. GOLAM ROUF, Junior Consultant Orthopaedic Surgery, RIHD, Dhaka.
CASE REPORT
9. Shoulder Hemi – arthroplasty : A Case Report M. A. SAMAD. Consultant, Dept. of Orthopaedic Surgery, IPGMR, Dhaka. M. HABIBUR RAHMAN. Dept. of Physical Medicine, IPGMR, Dhaka. MOHD. MUSTAFIZUR RAHMAN. Asstt. Prof., Dept. of Orthopaedic Surgery, IPGMR, Dhaka. MD. GAZIUL IMAM. Assoc. Prof., Dept. of Orthopaedic Surgery, IPGMR, Dhaka. A. MD. SHAMIMUL HAQUE. Registrar, Dept. of Orthopaedic Surgery, SSMC, Mitford Hospital, Dhaka.

Dr. Kh. Abdul Awal Rizvi
Associate Prfessor of Orthopaedics, RIHD, Dhaka.

Total hip replacement (THR) is the most common adult re – constructive hip procedures in the developed countries. In USA alone more than 150,000 primary hip arthroplasties are performed annually.

> Since the introduction of the procedure by philli Wiles in 1958 and later developed by sir John charnley, G.k. Mc Kee & J Watson Farrar, it’s use spread rapidly and widely. Before that, the available modalities of treatment for osteoarthritis of hip, like osteotomy was unpredictable and arthrodesis had gorss morbidity with prolonged convalescence. On the other hand THR provided pain free movement of the joint with early mobility. So its result was a revolution. In the recent years the prognosis of the surgery has further improved due to the better understanding of bio – mechanics, improvement in the design and materials and use of newer generation of cementing techniques.

In Bangladesh THR has not gained much popularity though the procedure was started in the early ‘80s in the Rehabilitation Institute & Hospital for the Disabled (RIHD), Dhaka. In the beginning only one or two surgeons used to perform THR infrequently with limited available facilities. This was only possible due to individual interest & extra ordinary skill of the surgeons. However, in the past several years the scenario has changed to an extend. Now we have trained surgeons, improved theater facilities and co – operation of the prosthesis producing companines.

> We know that doing the THR is not a big deal. The success of the operation depends on the proper patient selection and strict adherence to the every detail of the surgical techniques and performed in as ideal atmosphere. Otherwise the procedure will fail and bring more miseries to the patient. So it is my request to the young enthusiastic surgeons to become very critical about the indications of the surgery in selecting patients.

Still we have long way to go. There are some socio – economic implications. The high expense, local customs and ignorance of the general and professional people about the availability of the service in the country are the main hindrance of the wide acceptability of the procedure.

> THR does not give life long guarantee. It is bound to fail. So revision arthroplasty is gradually becoming an important work for the orthopaedic surgeons world wide. In UK several thousands of revision THR are performed every year. In out country as well this is going to be a problem very soon. So we should prepare out self to deal with challenge of the coming days.

MD. MOHSHINUL HUSSAIN MAJUMDER
Asstt. Prof. of Orthopaedic Surgery, Comilla Medical College & Hospital, Comilla.
KH. ABDUL AWAL RIZVI
Asstt. Prof. of Orthopaedic Surgery, RIHD, Dhaka.

SUMMARY:

Total 1171 tumour patients operated at Rehabilitation Institute and Hospital for the Disabled (RIHD) were included in this 10 years retrospective study from June 1983 to June 1993. 781 patients were male and 390 patients were female. Of which osteosarcoma were in 334 patients. GCT in 294 patients, osteochondroma in 170 patients, simple bone cyst in 131 patients and Ewings sarcoma in 94 patients. Sites of affection were lower end of radius in 250 patients, upper end of tibia in 243 patients, upper end of humerus in 148 patients and upper end of femur in 145 patients in order. Various types of operations like Incision a biopsy done in 288 patients, Excision and bone grafting done in 213 patients. Different types of amputations done of which above knee in 400 patients. In this series 575 patients were between 0 – 20 yrs and 515 patients were between 21 – 50 yrs. Ostersarcoma occupied about 28.52% of the total number of Tumours.

M. A. SAMAD
Consultant, Department of Orthopaedic Surgery, IPGMR, Dhaka.
A. MD. SHAMIMUL HAQUE
Registrar (Ortho, Surgery), SSMC Mitford Hospital, Dhaka.
M. HABIBUR RAHMAN
FCPS Part – II Student, Physical Medicine, IPGMR, Dhaka.
A. B. M FAZLUR RAHMAN
Consultant, Orthopaedic Surgery, Narayanganj modern Hospital.

SUMMARY:

This was a prospective study of surgical treatment for de Quervain’s disease (DQD) done at orthopaedic Department of IPGMR and some private hospitals in Dhaka, during the period of January 1993 to December 1994. 45 cases were operated among which 40 were resistant to conservative treatment including local injection of steroid and 5 were fresh cases. Age range of the patients were 35 to 55 years. 10 (22.22%) were male and 35 (77.77%) were female. After operation 43 (95.55%) cases improved fully. Only 2 (4.44%) cases complained of persistent pain and stiffness. Minimum complication like neuroma, hypothesia, infection were developed among 5 (11.11%) patients.

F. H. SERAJEE
Assistant Professor of Orthopaedic Surgery, RIHD, Dhaka.
M. A. HANNAN
Professor of Orthopaedic Surgery, RIHD, Dhaka.

SUMMARY:

Supracondylar fracture of the humerus in children are of interest not only to the Orhopaedic Surgeons but also to the general practitioners. Purpose of this paper is to call attention again to the complications of this fracture aspecially the neural complications, so that early recognition can prevent irreversible damage. 7 cases have been recognised as neural complications and were treated conservatively except one, who required neurolysis but all recovered fully.

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COMPARATIVE STUDY OF INTERNAL FIXATION FOR DISPLACED MEDIAL MALLEOLAR FRACTURES BY MALLEOLAR SCREW AND TENSION BAND WIRING

M. A. QUADER
Student D. Ortho, RIHD, Dhaka.
PARVIZ SHAHIDI
Student MS (ortho), RIHD, Dhaka.
SK. NURUL ALAM
Professor of Orthopaedic Surgery, RIHD, Dhaka.

SUMMARY:

15 patients aged from 22 to 56 years with displaced medial malleollar fractures were treated by open reduction and internal fixation with two methods namely malleolar screw and tension band wiring at RIHD from July 1995 to December 1996 with follow up for 12 weeks. (33%) patients had open (Gustilo type) fractures and 9 (60%) out of 15 suffered from bimalleolar fractures. Majority (9) of the patients were operated within the first day of injury, the rest were operated between 5 – 7 days. Eight patients were treated with tension band wiring.

> In malleolar screw fixation radiological union took place in all the 8 patients (100%) in 12 weeks while in tension band wiring union occured as early as 6 weeks. The group treated with malleoar screws showed better range of motion.

M. A. RASHID,
Asst. Prof. of Physical Medicine, RIHD, Dhaka.
MD. MOYEENUZZAMAN,
Asst. Prof. of Physical Medicine, IPGMR, Dhaka.
MD. QUAMRUL ISLAM,
Prof. & Head of Physical Medicine, IPGMR, Dhaka.
M. A. SAMAD,
Asst. Prof. of Orthopaedic – Surgery, RIHD, Dhaka.
A. MD. SHAMIMUL HAQUE,
Registrar, (Ortho Surgery) SSMC Mitford Hospital, Dhaka.

SUMMARY:

Osteoarthritis of knee is one of the common disability among our population specially elderly people both male & female. For Both subjective and objective improvement of osteoarthritis of knee physical therapy plays an important role. To see the effectiveness of physical therapy in osteoarthritis patients attending in physical medicine department of IPGMR, Dhaka during the period from January 1994 to December 1994, 60 patients were selected for this study. The patients were divided into three treatment groups. as short wave diathermy group, All the patients were provided with usual medical treatment and therapeutic exercise. The patients were treated for 8 weeks. Subjective and objuctive improvement were significant with ultrasound and short wave diathermy in comparison with placebo. There is no significant difference in between two form of diathermy i.e. UST & SWD.

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DIFFERENT APPROACH OF BRACHIAL PLEXUS BLOCK – AN ANALYSIS OF OPTION FOR THE ORTHOPEDIC SURGERY OF THE UPPER EXTREMITY

ABDUL KHALEQUE,
Jr. Consultant, Department of Anaesthesiology, Dhaka Medical College.
KHALILUR RAHMAN,
Prof. of Anaesthesiology, Dhaka Medical College.
SERAJUDDIN AHMED,
Asstt. Professor, Department of Orthopaedic, Dhaka Medical College.

SUMMARY:

There are multiple sites at which the brachial plexus block can be induced in selecting regional anaesthesia for upper extremity surgical patients. The most frequently used blocks are axillary. Infracavicular supraclavicular and interscalene, One must understand brachial plexus anatomy to use these blocks effectively, as well as the practical clinical differences between the blocks. Axillary brachial plexus block is most effective for surgical procedures distal to the elblw. This block is induced at a distance from both the centroneuraxis and the lung; since the catheter is easily secured to the anterior chest. Supraclavicular block provides anaesthesia of the entire upper extremity in the most consistent, time – efficient manner of any brachial plexus technique; however, the block needle on necessarily positioned near the lung during injection. Interscalence block is specialy effective for surgical procedures involving th shoulder or upper arm because the roots of the bracheal plaxus are most easily blocked with this technique. The final needle tip position with this block is potential near the centroneuraxis and arteries perfusing the brain, thus careful aspiration of the needle and incremental injection are imprortant. In summary, when an understanding of brachial plexus anatomy is combined with proper block technique and a patient and procedure – specific balancing will be coadvocates of out brachial plexus regional blocks.

TREATMENT OF THE FOREARM FRACTURES IN ADULTS
MD. ABDUL HANNAN
Professor of Orthopaedic Surgery, RIHD, Dhaka.
A. K. MD. GOLAM ROUF
Junior Consultant Orthopaedic Surgery, RIHD, Dhaka.

ABSTRACT:

The treatment of fractures of the shaft of the both bones of the forearm present special problems in adults. There are diversity of opinion regarding the treatment of fractures of the radius and ulna. This article reviews the relevant literatures and reports on the treatment of the fractures of the forearm bones in adults. A comprehensive way of treatment are discussed here on the basis of results obtained by various modalities of treatment concerned.

SHOULDER HEMI – ARTHROPLASTY : A CASE REPORT
M. A. SAMAD
Consultant, Dept. of Orthopaedic Surgery, IPGMR, Dhaka.
M. HABIBUR RAHMAN
Dept. of Physical Medicine, IPGMR, Dhaka.
MOHD. MUSTAFIZUR RAHMAN
Asstt. Prof., Dept. of Orthopaedic Surgery, IPGMR, Dhaka.
MD. GAZIUL IMAM
Assoc. Prof., Dept. of Orthopaedic Surgery, IPGMR, Dhaka.
A. MD. SHAMIMUL HAQUE
Registrar, Dept. of Orthopaedic Surgery, SSMC, Mitford Hospital, Dhaka.

INTRODUCTION:

Arthroplasty is an operation to restore motion to a joint and function to the muscles, ligaments and other soft tissue structures that control the joint1. The goals of joint arthroplasty are to relief pain, to improve motion with stability and to correct deformity1,2. Implant materials used in arthroplasty are stainless steel, ultrahigh molecular weight polyethylene, coblt – chromium and titanium – aluminum – vanadium alloys etc3.

> The earliest known report of shoulder arthroplasty dates back to 1894. In 1952 Neer successfully replaced the humeral head with a vatallium prosthesis4. The indications for replacing only the humeral head (hemi arthroplasty) are acute fracture, avascular necrosis, sickle cell infraction4,5, osteoarthritis6, retroversion of the proximal humerus7, irradiation necrosis, ocronosis, gout, humeral head deformity caused by old fracture, bone tumor8,9, tuberculosis10 etc.