BOS Journal - July, 1998 - Volume 13, Number 2

The Journal of Bangladesh Orthopaedic Society

July, 1998	Volume 13, Number 2
CONTENTS
EDITORIAL 1. Femoral Anteversion, Angle Of Inclination And Their Clinical Importance Md. Imam Uddin, Associate Professor, University of Science and Technology, Chittagong.
2. Cross Finger Flap: A Reliable Versatile Flap For The ManagementOf Acute Hand Trauma Shafquat H. Khondakar, Associate Professor, Plastic Surgery Unit, DMCH, Dhaka. Md. Abul Kalam, Associate Professor, Plastic Surgery Unit, RIHD, Dhaka.
3. Rigid Fication Of Forearm Fractures In Adults With Particular Reference To Avoid Any External Support Ayjaz Ahmed Khan, Associate Professor. Orthopaedic Surgery, RIHD, Dhaka. Faruque Quasem, Registrar, RIHD, Dhaka. Akhter Morshed, Assistant Professor, Bangladesh Medical College. Mohammad Osman, D. Ortho.
4. Evaluation Of Treatment Of Open Monteggia Fracture-Dislocation By Rush Nail Fixation A. F. M. Anwar Hossain, Assistant Prof. (surgical oncology) MCRH Mohakhali, Dhaka. Gouranga Bairagi, Consultant Ortho surgery DMCH. O. F. G. Kibria, Consultant Ortho surgery, sadar Hospital Jhenidha. Dipankar Nath Talukder, Consultant Ortho surgery sadar Hospital, B. Baria. M. A. Hossain, Prof. of Ortho surgery RIHD.
5. Result Of Proximal Realignment By Campbell Operation In Habitual Dislocation Of Patella Paritosh Vhandra Debnath. Consultant, Ortho surgery, Suhrawardi Hospital, Dhaka. Naresh Kumar Roy. Consultant, Ortho surgery, Modernised District Hospital, JOYPURHAT. A. F. M. Ruhal Haque. Professor & Chairman, Dept of Ortho surgery, BSMMU. Sk. Nurul Alam. Professor of Ortho surgery. Dhaka Medical College & Hospital.
REVIEW ARTICLES
6. OSTEOPOROSIS: THE CHALLENGE OF THE NEXT MILLENNIUM Qazi Shahidul Alam, Director, Suhrawardi Hospital & Professor of Orthopaedic Surgery, RIHD, Dhaka. A. K. M. Majibur Rahman, Professor of Anaesthsiology, RIHD, Dhaka. M. Amjad Hossain, Associate Professor, Orthopaedic Surgery, RIHD, Dhaka.

Dr. Ayjaz Ahmed Khan

It is probably true to say as has been often said especially by young men, that over the age of 50 mind become a little fixed, that the flashes of inspiration and anthusiasm for new development which lead to real advances become diminished or even extinguished.

To compensate for this the older surgeon should have acquired experience, judgement, and authority which can be invaluable to younger surgeons, if properly used to guide rather to dictate and suppress. The older surgeons has particular responsibility specially in surgical education and research.

I define post graduate education in orthopaedic surgery as a training in which the orthopaedic surgeon is capable of handling all the major orthopaedic problems. In 1971 there were hardly any orthopaedic surgeon. But after the establishment of RIHD more orthopaedic surgeons are coming out each year, unfortunately they are being trained as a general orthopaedic surgeon. RIHD still not been able to develop orthopaedic speciality, as for example, spine surgery, arthoscopic surgery, replacement surgery etc.

Because of the litigation problem which was unheard of at the time of liberation young orthopaedic surgeons should be cautious in dealing with the patients. Behavioural changes are also necessary by orthopaedic surgeon. We simply need to be compassionate, warm, kind, gentle and very much concerned while practicing our speciality.

FEMORAL ANTEVERSION, ANGLE OF INCLINATION AND THEIR CLINICAL IMPORTANCE
Md. Imam Uddin
Associate Professor, University of Science and Technology, Chittagong.

ABSTRACT:

We have collected 200 fem from the Department of Anatomy, CMC & IAHS, USTC and studied the femoral neck shaft angle (angle of inclination) and the angle of anteversion. The angle of inclination varied from 120 – 140, and the angle of anteversion from 0 – 27.

Shafquat H. Khondakar
Associate Professor, Plastic Surgery Unit, DMCH, Dhaka.
Md. Abul Kalam
Associate Professor, Plastic Surgery Unit, RIHD, Dhaka.

SUMMARY:

Key Word: - Random pattern flap, Exposed tendons, bones and joints, Surgical excision, Joint stiffness.

Two hundred cases of exposed tendons and /or bones following finger injuries were treated by cross finger flap in the plastic surgery unit of Rehabilitation Institute and Hospital for the Disabled, Dhaka between September ’89 and September ’96 with a three years follow up. Sixty three percent of the patients achieved good results with no flap loss and attained good sensibility as measured by two – point discrimination at three years follow up. The results of the remaining thirty seven percent cases were acceptable with no flap loss but the sensibility was not definitely ascertained. Results were encouraging in terms of wound closure with significant reduction in morbidity and function loss and overall success rate of 100%.

Ayjaz Ahmed Khan
Associate Professor. Orthopaedic Surgery, RIHD, Dhaka.
Faruque Quasem
Registrar, RIHD, Dhaka.
Akhter Morshed
Assistant Professor, Bangladesh Medical College.
Mohammad Osman
D. Ortho.

ABSTRACT:

A retrospective study was done in 61 patients who had 122 diaphyseal fracture of radius and ulna, were treated with fixation using A. O. Dynamic compression plate, 99% of the fractures united and achieved an excellent satisfactory result. Rate of infection was 2%. 3.5 mm plate was used and gave excellent result. Our results demonstrated that all forearm fractures in adult should be operated and no attempt should be made at close reduction causing sufferings to the patient.

There is still considerable difference of opinion in RIHD about the manner in which fracture of the adult forearm should be treated. We believe that rigid internal fixation provide the most satisfactory results for these injuries. The union of these fractures can be achieved without the need for plaster immobilization so that the limb can be used without delay and without impairment of ultimate function.

To achieve a satisfactory functional result, a diaphyseal fracture of the radius and ulna needs a nearly anatomical reduction as well as correction of displacement and restoration of normal length, axial alignment & rotational alignment.

Using compression plate fixation Anderson et al in 1975 reported rates of union of 98 percent for fractures of the radius and 96 percent for ulna.

Before 1990, fractures of the radius and ulna were mostly treated by plaster or by open reduction and internal fixation with intramedullary Rush pin. Plaster was usually put in both these forms of treatment leading to loss of movement of elbow and forearm.

This study showed that rigid fixation using A. O. technique gives better stability and there is no need for external support.

A. F. M. Anwar Hossain
Assistant Prof. (surgical oncology) MCRH Mohakhali, Dhaka.
Gouranga Bairagi
Consultant Ortho surgery DMCH.
O. F. G. Kibria
Consultant Ortho surgery, sadar Hospital Jhenidha.
Dipankar Nath Talukder
Consultant Ortho surgery sadar Hospital, B. Baria.
M. A. Hossain
Prof. of Ortho surgery RIHD.

SUMMARY:

It is a prospective study with was carried our at Rehabilitation Institute and Hospital for the Disabled (RIHD) from July 1993 to June 1995, in which 20 patients of average age of 27 years with Gustilo Type 1 open Monteggia fracture dislocation were selected. Amongst them 60% were male and 40% were female. After adequate wound toileting fixation of fracture was done with Rush nail along with closed reduction of radial head. Automobile accident was most common causes of injury (40%) and (60%) was on the left side. Most of them were oblique fracture of the shaft of the ulna and 15% cases had associated injury. Operation was performed within 6 to 12 hours after injury and immobilisation period was from 45 to 60 days. Stiffness of elbow was most common complication, minimal hospital stay was 2 days and mean follow up was 7 months. Excellect result obtained in 40% cases.

Paritosh Vhandra Debnath
Consultant, Ortho surgery, Suhrawardi Hospital, Dhaka.
Naresh Kumar Roy
Consultant, Ortho surgery, Modernised District Hospital, JOYPURHAT.
A. F. M. Ruhal Haque
Professor & Chairman, Dept of Ortho surgery, BSMMU.
Sk. Nurul Alam
Professor of Ortho surgery. Dhaka Medical College & Hospital.

ABSTRACT:

Proximal realignment and stabilisation of the patella by Cambell operation with adequate release of lateral contracture and medial reefing in the early childhood is safe, simple, active and dynamic method of preventing patellofemoral instability due to habitual dislocation of patella.

This prospective study comprises 9 patients (11 knees) to whom the procedure have been done from July 1994 to June 1996 in R.I.H.D. Ages of the patients were from 6-17 years out of which 6 were female. The satisfactory result (excellent and good) was 8 (81.81%). The result was found better in the earlier age group.

OSTEOPOROSIS: THE CHALLENGE OF THE NEXT MILLENNIUM
Qazi Shahidul Alam,
Director, Suhrawardi Hospital & Professor of Orthopaedic Surgery, RIHD, Dhaka.
A. K. M. Majibur Rahman,
Professor of Anaesthsiology, RIHD, Dhaka.
M. Amjad Hossain,
Associate Professor, Orthopaedic Surgery, RIHD, Dhaka.

ABSTRACT:

In the 20th century major metabolic bone disease has changed from Rickets and Osteomalacia to Osteoporosis. “Osteomalacia “ means a reduction in bone mass and microarchitectural deterioration in of bone. Bone density is a continuous variable: the lower the bone density, the higher the risk of fragility fracture.

The strain on health care services caused by osteoportion related fractures has reached an epic proportion. It is the morbidity and mortality that accomrtion fracture that make osteoporosis a Public Health Problem.