BOS Journal - July, 1997 - Volume 12, Number 2

The Journal of Bangladesh Orthopaedic Society

July, 1997	Volume 12, Number 2
CONTENTS
EDITORIAL
1. Road traffic accident pattern of victims admitted at Rehabilitation Institute & Hospital for the Disabled Dr. Md. Iqbal qavi, Assistant Professor, Dept. of Orthopaedic Surgery, DMCH. Dr. Nazma sultana, M. Phil (PSM) student, NIPSOM Dr. A. B. M. Fazlur Rahman, Assistant Professor, Dept. of Orthopaedic Surgery, DMCH. Dr. Rafiqul Islam, Assistant Professor, Dept. of Orthopaedic Surgery, RIHD.
2. Arthroscopic Surgery of the Knee at the Rehabilitation Institute & Hospital for the Disabled Md. Iqbal Qavi, Assistant Professor, Dept. of Orthopaedic Surgery, DMCH. Jinyoung Jeong, Korea Overseas Volunteer (KOICA), RIHD. Ayjaz Ahmed Khan, Assistant Professor, Dept. of Orthopaedic Surgery, RIHD. A. F. M. Ruhal Haque, Professor & Chairman, Dept. of Orthopaedic Surgery, BSMMU.
3. A One Year Clinical Audit of a Newly Formed Orthopaedic Unit in a District Hospital Dr. Shakeel Akhtar, MBBS. MS (orth.), Junior Consultant in Orthopaedic Surgery, Chittagong General Hospital, Chittagong.
4. Deformed Limbs Operated in “Impact Jibon Tori” A Floating Hospital, Dhaka Dr. Md. Mofazzel Hoque, Assistant Professor of Orthopaedic Surgery, RIHD, Dhaka. Dr. K. A. Rivi, Associate Professor of Orthopaedic Surgery, RIHD, Dhaka. Dr. Jibananda Halder, Medical Officer, “Impact Jibon Tori”, Floating Hospital, Dhaka.
5. Alternative Method of Fracture Compression in the Absence of DCP or Compression Device Kh. Abdul Awal. Associate Professor of Orthopeadic surgery Rehabilitation Institute & Hospital For Disabled (RIHD). M. A. Samad. Assistant Professor of Orthopeadic surgery Rehabilitation Institute & Hospital For Disabled (RIHD)
REVIEW ARTICLE
6. On Writing, Publishing and Presenting Papers Geoffrey Walker, FRCS, Honorary Member World Orthopaedic Concern.
7. Results of Double Tension Band Wring for Intercondylar Fractures of Humerus Through Posterior Trans – Olecranon Approach Dr. Naresh Kumar Roy, Medical Officer, Bogra Sadar. Prof. Sk. Nurul Alam, Prof. of Orthopaedic Surgery, Dhaka Medical College & Hospital. Dr. MD. Amjad Hossain, Assoc. Prof. RIHD, Dhaka. Dr. Dipankar Nath Talukder, Consultant, Sadar Hospital, Brahmin Baria. Dr. Muztaba Ali, Registrar, RIHD, Dhaka.
8. Evaluation of the Operative Treatment of the Fractures of the Proximal Humerus with Dislocation of the Shoulder Joint Dr. A. B. M. Fazlur Rahman, Assistant Professor of Ortho. Surgery, DMCH, Dhaka. Dr. M. Amjad Hossain, Assistant Professor of Ortho. Surgery, RIHD, Dhaka. Dr. Md. Iqbal Qavi, Assistant Professor of Ortho. Surgery, DMCH, Dhaka.

Dr. Ayjaz Ahmed Khan

I have been given the hhnour again to write the editorial after a long time. Inspite of best efforts to publish the journal regurlarly, we have failed due to inevitable circumstances.

We celebrate a milestone in our society due to the fact that Bangladesh Orthopaedic Society has been registered with the Directorate of Social Welfare which was a long demand of the members. A professional obligation has now become binding on all of us is the consistant upgrading of the Orthopaedic knowledge base that each of the Members possess today. Despite personal confidence in our clinical ability, the sad truth is that many gaps still exist in our knowledge base and the gaps make it impossible for us to know with certainly which among several course of action or inaction will produce the best or even acceptable outcome for patients.

Orthopaedic Society have a professional image problem today because of our failure to completely fulfill our obligation to be of service to our patients. Some of the unflattering comments made by the public about our professional attitude that we tent to be uncomunicative, arrogant adn uncaring towards them as patients. A frequent patients complain about Orthopaedic surgeon in our perceived lack of balance between emphasis on curing and an emphase on caring.

We are a professional organisation must behave as a family using the strength of the individual members one can withstand the wind of change that buffet us and our patients. The best interest of the patient is the only interest to be considered.

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ROAD TRAFFIC ACCIDENT PATTERN OF VICTIMS ADMITTED AT REHABILITATION INSTITUTE & HOSPITAL FOR THE DISABLED

Dr. Md. Iqbal qavi
Assistant Professor, Dept. of Orthopaedic Surgery, DMCH.
Dr. Nazma sultana
M. Phil (PSM) student, NIPSOM.
Dr. A.B.M. Fazlur Rahman
Assistant Professor, Dept. of Orthopaedic Surgery, DMCH.
Dr. Rafiqul Islam
Assistant Professor, Dept. of Orthopaedic Surgery, RIHD.

ABSTRACT:

This study was conducted at the Rehabilitation Institute & Hospital for the Disabled (R.I.H.D), Dhaka for 3 weeks during May ’97 & June ’97. The object was to assess the pattern of road traffic accidents from victims admitted to R.I.H.D. with a view to identify the group of people injured, vehicles involved and the environmental circumstances under which the accidents took place. According to our findings two thirds of the casualties occurred outside Dhaka city. Adult males between 15 to 45 years of age were the most common victims. Pedestrians were found to be more vulnerable within the city. Collision and loss of control of vehicles was more common outside the city. There is gross under – reporting of accident cases to the police. Hospital and ambulance services outside the city are inadequate to cope with the magnitude of the problem. This paper presents a broad over view of the accident characteristics in Bangladesh.

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ARTHROSCOPIC SURGERY OF THE KNEE AT THE REHABILITATION INSTITUTE & HOSPITAL FOR THE DISABLED
Technical considerations and a preliminary analysis of the first 111 patients.

Md. Iqbal Qavi
Assistant Professor, Dept. of Orthopaedic Surgery, DMCH.
Jinyoung Jeong
Korea Overseas Volunteer (KOICA), RIHD.
Ayjaz Ahmed Khan
Assistant Professor, Dept. of Orthopaedic Surgery, RIHD.
A. F. M. Ruhal Haque
Professor & Chairman, Dept. of Orthopaedic Surgery, BSMMU.

ABSTRACT:

Knee joint arthroscopic examination of 111 joints were performed in 111 patients between Sept. ’96 to Aug. ’98 at the Rehabilitation Institute & Hospital for the Disabled (R.I.H.D), Dhaka. Of these 32 cases were solely diagnostic procedures, 78 joints were treated by arthroscopic Surgery and 1 case had open anteror cruciate ligament reconstruction done at the same sitting. Where surgery was performed, short – term follow – up was satisfactory and a reduction of pain was obtained in almost all patients. There were five complications, all of which were minor. This preliminary report demonstrates that operative arthroscopy of the knee is feasible and safe in our circustantces. It is also preferred by the patients. Arthroscopic surgery has progressed in a remarkable fashion during the last two decade, but it has remained as a rarely performed procedure in Bangladesh partly due to a lack of instruments and of experts. We have performed 111 arthroscopic procedures at R.I.H.D. since 1996 and this report constitutes a review of these 111 patients. This is the first report of operative arthroscopiy of the knee in Bangladesh.

Dr. Shakeel Akhtar
MBBS. MS (orth.), Junior Consultant in Orthopaedic Surgery, Chittagong General Hospital, Chittagong.

ABSTRACT:

The objective of this study was to assess the quantity and quality of clinical work mone during one year in the newly established Orthopaedic Unit at Chittagong General Hospital. Data regarding all the orthopaedic patients treated at the out patient department (OPD) and all the patients operated on by the unit between August 1998 and July 1999 were collected from the OPD register and the operation theatre register. Data regarding indoor patients between November 1998 and July 1999 were retrieved from audit forms (introduced in November 1998). The data were analyzed to produce a one – year clinical audit. During the study period, a total of 1563 patients (948 males and 615 females) were seen in consultation at the OPD. During teh same periom. 92 operations were performed. Forty – four (86%) out of 51 admitted patients were operated on, while 7(14%) were treated conservatively. Of the operated patients, the mean preoperative stay was 8 days (range 0 to 28 days). There was 1 (2%) operative death, and major infection of clean wounds was 1 (3%). It is concluded that clinical audit gives a useful baseline, and should encourage a better performance in future.

Dr. Md. Mofazzel Hoque
Assistant Professor of Orthopaedic Surgery, RIHD, Dhaka.
Dr. K. A. Rivi
Associate Professor of Orthopaedic Surgery, RIHD, Dhaka.
Dr. Jibananda Halder
Medical Officer, “Impact Jibon Tori”, Floating Hospital, Dhaka.

SUMMARY:

IMPACT is an international intiative against avoidable disablement. It is an effort to demonstrate convincingly that avoidable disablement, with all its consequences in frustrated lives & loss of economic potential, need no longer be an inescapable part of human predicament. IMPACT FOUNDATION BANGLADESH (IFB) started its journey in Bangladesh in 1993 with the inspiration & support from Sir John Wilson, CBE (Commander of British Empire) the architect of the Global IMPACT Movement, an international initiative against avoidable disablement.

The target beneficiaries of this project in most of the cases, are the poor rural mass such as landless, marginal farmer, fishermen & day labourers who not only benefited from the project but also participate in its successful implementation through mass mobilization. The purpose or the project is to provide primary health services in general & specialized both clinical & surgical health services to the poorest of the poor living in the remote riverine areas of Bangladesh, specifically focussing on the prevention & cure of avoidable disablement.

Kh. Abdul Awal
Associate Professor of Orthopeadic surgery Rehabilitation Institute & Hospital For Disabled (RIHD)
M. A. Samad
Assistant Professor of Orthopeadic surgery Rehabilitation Institute & Hospital For Disabled (RIHD)

ABSTRACT:

Fracture fixation by plate & screws is a standard method of treatment. To achieve a primary union compression at the fracture is essential. Compression at the fracture site is usually given either by the use of DCP or compression device. In our country most of the hospital & clinics do not have necessary ideal implants and devices. In this circumstances a simple method of fracture compression was choosen & practiced on 8 cases of fracture non union of humerus. All 8 cases showed primary union in 6/8 weeks. So this procedure may be of help when the surgeons have to work in a below ideal situation.

Geoffrey Walker,
FRCS, Honorary Member World Orthopaedic Concern.

ABSTRACT:

The Clinical Research Project is finished or at least it seems to be. All the relevant data has been collected and coordinated and of possible tabulated. It should have been edited and condensed to cover preferably one sheet of paper although occasionally two or more may be necessary. Any relevant tables will have been prepared, diagrams constructed, X – ray printed, photographs carefully scrutinised and thought given to means for making either slides or transparencies. None of these items are easy, thought has to be invested and the necessary work done.

The next stage is to review and probably revise the original ideas for prblication or presentation. Is the work of sufficient importance to merit possible inclusion in a major International Journal or would it be better in a specialised publication? More likely a first attempt at research is going to be of interest to a relatively local orthopaedic community and therefore could be published in a National Journal.

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RESULTS OF DOUBLE TENSION BAND WRING FOR INTERCONDYLAR FRACTURES OF HUMERUS THROUGH POSTERIOR TRANS – OLECRANON APPROACH

Dr. Naresh Kumar Roy,
Medical Officer, Bogra Sadar.
Prof. Sk. Nurul Alam,
Prof. of Orthopaedic Surgery, Dhaka Medical College & Hospital.
Dr. MD. Amjad Hossain,
Assoc. Prof. RIHD, Dhaka.
Dr. Dipankar Nath Talukder,
Consultant, Sadar Hospital, Brahmin Baria.
Dr. Muztaba Ali,
Registrar, RIHD, Dhaka.

This paper was presented by the first author at the scientific seminar of the 3rd international conference of Bangladesh Orthopaedic society held at the Sonargaon Pan Pacific Hotel, Dhaka in February, 1999.

ABSTRACT:

Sixteen patients with a closed intercondylar fracture of the distal humerus were treated at the R.I.H.D. from Jan. ’97 to Dec. ’98 by open reduction and internal fexation using double tension band wiring and a trans – olecranon approach. A scoring system that included pain, range of motion, radiological results and post operative activity level was adopted to study the result. A satisfactory result (excellent or good) was achieved in ten of the 16 patients (62.5%).

A condylar block was reconstructed by using one or two cancellous screw & one K – wire. This block was then fixed to the shaft by tension band wiring on both sides. The olecranon osteotomy was also fixed by tension band wiring.

Double sided tension band wiring represents an alternative method of fixation for intercondylar fractures of the humerus. It is easy, simple, safe and the implant used is inexpensive. It is therefore a suitable technique for poor patients in developing countries like Bangladesh.

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EVALUATION OF THE OPERATIVE TREATMENT OF THE FRACTURES OF THE PROXIMAL HUMERUS WITH DISLOCATION OF THE SHOULDER JOINT

Dr. A. B. M. Fazlur Rahman
Assistant Professor of Ortho. Surgery, DMCH, Dhaka.
Dr. M. Amjad Hossain
Assistant Professor of Ortho. Surgery, RIHD, Dhaka
Dr. Md. Iqbal Qavi
Assistant Professor of Ortho. Surgery, DMCH, Dhaka.

ABSTRACT:

Fracture of the proximal end of the humerus with dislocation of the shoulder joint is a complex injury. It is generally accepted that these injuries require either open reduction alone, or with cuff repair, or with internal fixation, or by prosthetic replacement except in patients who are too old and infirm or when there is gross comminution 4,5. We report a prospective study of 18 years patients who were treated by open reduction and internal fixation floolwed by immobilization with a bandage and a triangular sling. Different types of unstable fractures with dislocations were encountered, but articular crushing in large impression fractures and head splitting fractures were not included in the series. Satisfactory results were obtained in about 50% of the patients that necessitated many months of physiotherapy to achieve maximum recovery. The age of the patient was from 22 – 65 years (Average 42 years). Duration of immobilization after surgery was between 2 – 3 weeks. The follow up period extended from 6 months to 3 years (Average 1.2 years). The male female ratio was 13.5. Better results were obtained in patients below the age of 50 years. There was no excellent result. 8 patients have satisfactory results, and 3 patients resulted a poor out come. 2 were lost from follow up.