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Papers by Maratib Ali

Journal of Pakistan Orthopaedic Association, Oct 13, 2020

The Professional Medical Journal, 2020

Objectives: To compare the functional outcome of dynamic compression plating with intramedullary ... more Objectives: To compare the functional outcome of dynamic compression plating with intramedullary interlocking nailing in closed fracture of the humeral shaft in adults. Study Design: Prospective comparative study. Setting: Department of orthopedics, Civil hospital, Karachi. Period: From 8th February to 7th August 2017. Material & Methods: A total of 82 patients with post-traumatic closed fracture shaft of the humerus were included. Patients were randomly allocated into two groups. Group I was offered Intramedullary Interlocking nail (ILN) and Group II was offered a dynamic compression plate (DCP). The functional outcome was measured by the “Disabilities of Arm, Shoulder and Hand” (DASH) score. Results: The average age of the patients was 32.87±6.65 years. The acceptable outcome was significantly high in DCP group as compared to the ILN group (87.8% vs. 61%; p = 0.005). Conclusion: We conclude that dynamic compression plating is functionally a better technique than interlocking naili...

Cureus, 2019

Introduction Motorcycles are common in a developing nation like Pakistan. In addition to their be... more Introduction Motorcycles are common in a developing nation like Pakistan. In addition to their benefits, motorcycles carry a high risk for accident and injury. Many factors can exacerbate the risk of motorcycle operation including the use of mobile phones while riding, a lack of knowledge of traffic rules, not following road rules or non-satisfactory vehicle health and road conditions. Along with these physical factors, some psychosocial aspects also impact risks, including aggressive behavior of drivers or variations in driving patterns associated with changes in driver mood. Objective We conducted this study to determine the association of rider/operator behavioral and psychosocial factors with motor vehicle crashes.

Journal of Medical Science And clinical Research, 2016

Background-Postoperative wound infection is an important cause of morbidity in surgical patients ... more Background-Postoperative wound infection is an important cause of morbidity in surgical patients and antibiotic prophylaxis forms one of the important preventive measures. Aims and Objectives-This study was performed in a major general hospital to establish the efficacy of antibiotic prophylaxis in clean general surgeries. Materials and Methods-The study was done in 100 cases divided in 2 groups, one of which was given a single dose of ceftriaxone within 2 hours of operative incision without any postoperative antibiotics and the other was given routine postoperative antibiotics. Postoperative evaluation was done for development of fever or wound infection. Observation and Results-Mean age was 35 and 33 in both groups while mean operative time was 45-53 minutes. Majority of cases performed were of hernioplasty. Various other factors such as length of incision, use of electrocautery and postoperative hospital stay were considered. Incidence of infection in both groups was similar but cost reduction of 88.11% was achieved in the first group. Conclusion-The restriction of antibiotic usage in preoperative period and omission of it in postoperative period didn't result in increase in incidence of surgical site infection. However significant cost reduction is achieved in the cases where preoperative prophylactic antibiotics were used and hence can be advocated in clean general surgeries.

Open Forum Infectious Diseases, 2015

Background. Fomites are objects that can become colonized and serve as vectors in the transmissi... more Background. Fomites are objects that can become colonized and serve as vectors in the transmission of pathogenic microorganisms. Literature examining the knowledge of healthcare personnel about this method of spread of infection is lacking. We conducted a study to assess the knowledge, attitude, and practices of healthcare personnel across different areas of patient care regarding the spread of infections at a tertiary care hospital in Karachi, Pakistan.Methods. A descriptive, cross-sectional study was conducted among healthcare personnel using a self-administered questionnaire. The questionnaire contained sections pertaining to demographic details and knowledge, attitude, and practices regarding fomites and their role in the transmission of pathogens.Results. Three hundred and fifty-three participants completed the questionnaire: 168 were male and 185 were female. Laboratory coats, stethoscopes, and bedside curtains were most frequently identified as fomites by the participants....

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2006

Use of auto-genous bone graft is commonly practiced in orthopaedic surgical procedure as in the t... more Use of auto-genous bone graft is commonly practiced in orthopaedic surgical procedure as in the treatment of fracture non-union, filling the defect after intraosseous lesions excision and for surgical arthodesis of joints [1]. The iliac crest is the commonest donor site for bone grafting as compare to other side because it is easily accessible, relatively large amount of graft can be taken safely [2].

Trauma International

Objective: Motorbike accidents contribute one of the most important factors of tibial plateau fra... more Objective: Motorbike accidents contribute one of the most important factors of tibial plateau fracture among young populations in Karachi Pakistan. Most surgeons feel challenging to treatment complicated bicondylar fractures of the tibial plateau.This prospective study was designed to evaluate the functional outcomes of dual plating through a two-incisions technique for the fixation of complicated bicondylar tibial plateau fractures in young patients in Karachi Pakistan. Methods: This prospective study includes 94 cases of Type V and VI tibial plateau fractures of young patient’s age range from 15 to 45 years, operated between January 2014 and December 2016 conducted in two public sector hospital of Karachi Pakistan (Jinnah Post Graduate Medical Center, Civil Hospital Karachi). Exclusion criteria include patients with multiple fractures on the same side or same bone, age >45 years, open contaminated fracture, open fracture,and patients with head injuries. All cases were operated ...

Cell and Tissue Banking

To share our experience of establishing a bone bank in Pakistan, and the clinical use of these in... more To share our experience of establishing a bone bank in Pakistan, and the clinical use of these indigenously produced bone grafts. We retrospectively reviewed our experience of the procurement, processing, and storage of bone grafts at a bone bank in Karachi, Pakistan, the first bone bank to be established in a public sector hospital in Pakistan. The bone bank was established at Sindh Institute of Urology and Transplantation (SIUT), Karachi, in collaboration with Department of Orthopaedic Surgery, Dow University of Health Sciences/Civil Hospital, Karachi (CHK) in May, 2015. Since then, a large number of bone grafts from the tissue bank have been used for various orthopedic procedures. This paper describes the problems and challenges faced in establishing and running a tissue bank in a Muslim and a developing country and the progress of the bone bank over the first 4 years. A total of 93 bone grafts were retrieved and preserved in the bone bank over the 4-year period. Among these, 56 (60.2%) bones were retrieved from male donors and 37 (39.8%) from females. The mean age of all donors was 55.9 ± 15.34 years (range: 16-90 years). All bone donors were living patients. No c bones were obtained from deceased donors. Types of bone grafts included: femoral heads, 68; head with neck of femur, 19; radius and ulna, 1; lower femur, knee joint, lower leg and foot bones, 4; and skull bone, 1. All grafts were subjected to aerobic and anaerobic bacterial cultures, as well as fungal cultures. Microbiological contamination was observed in 18/93 (19.35%). All culture positive bones were discarded. Bone grafts issued from the bank and transplanted were 51/93 (54.8%) in all. Bone grafts were used in a variety of tumor and non-tumor orthopaedic procedures in CHK. Nine bone grafts were donated to the other hospitals to be used for revision total hip replacement and tumor surgeries. There were no service charges. Two patients (3.92%) developed infections postoperatively, one superficial and one deep. No other complications were noted. This is the preliminary report on the establishment and functioning of a bone bank in a public sector hospital in Pakistan. The favorable outcome has inculcated confidence in orthopedic surgeons for greater use of bone allografts for a variety of indications in this country.

Journal of the Pakistan Medical Association

Objective: To explore the present state of competency in clinical ethics among postgraduate train... more Objective: To explore the present state of competency in clinical ethics among postgraduate trainees in a tertiary care hospital. Methods: The interview-based cross-sectional study was conducted at the Civil Hospital, Karachi, from September 2018 to March 2019, and comprised postgraduate trainees of either gender in any year of the training program across all specialties. Data was collected using self-reported questionnaire seeking opinion about present working conditions regarding clinical ethical issues on the hospital ground and problems they face from day to day. Data was analysed using SPSS 23. Results: Of the 153 subjects, 96(62.7%) were females, 73(47.7%) were from Medicine and allied disciplines, and 80(52.3%) were from Surgery and allied disciplines. The primary source of their clinical ethics’ understanding was derived from their workplace [116(75.82%)]. While only 104 (68%) of the subjects knew about the Hippocratic Oath’s contents, less than 10% knew about Nuremberg Code...

Rawal Medical Journal, 2021

Journal of Ayub Medical College, Abbottabad : JAMC, 2021

Adamantinoma is a rare neoplastic bone tumor that has the potential to metastasize. The classic p... more Adamantinoma is a rare neoplastic bone tumor that has the potential to metastasize. The classic presentation is in the tibial region however; cases involving other bones of the body have been noticed. The tumour is very likely to be mistaken for other bone diseases and therefore it is important to investigate and study about its nature and thus differentiate it from other differentials. Nevertheless, literature on the presentation, findings, investigations and treatment options of adamantinomas are limited. In this case series, we report four cases from a local hospital in Karachi who were diagnosed, treated and followed up for adamantinoma. Studies regarding the disease will help us understand more about its features.

Pakistan Journal of Medical and Health Sciences, 2021

Background: Wagner proximal femur prosthesis is the versatile modular implant. Study Design: Pros... more Background: Wagner proximal femur prosthesis is the versatile modular implant. Study Design: Prospective study Setting: Department of Orthopaedic Surgery Dow University of Health Sciences / Civil Hospital Karachi, from January 2013 to December 2019. Methodology: Total 19 patients of both genders with proximal femur bone loss due to tumor, implant failure for proximal femur fixation, comminuted intertrochanteric fracture, and failed arthroplasty included in the study. After taking written informed consent, detailed demographics including age, gender, indication of wagner prosthesis, and wagner stem type were recorded. Among all the patients 11 patients received total hip replacement and 8 patients received bipolar. Complications associated with procedure were recorded. Outcomes were assessed by Merle D Aubgine scale. Results: Total 19 patients were included in the study who were operated with wagner prosthesis for proximal femur bone deficit problems. 7 (37%) patients were male and 1...

Pakistan Journal of Medical and Health Sciences, 2021

Objective: The aim of this study is compare the outcomes among three different approaches (latera... more Objective: The aim of this study is compare the outcomes among three different approaches (lateral approach, medial approach and posterior approach) for supracondylar humerus fractures in children. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Orthopedics department of Ayub Teaching Hospital, Abbottabad for duration of one year from January 2020 to December 2020. Methods: There were one hundred and thirty five children had supracondylar humerus fracture were presented. Patients were aged between 3-12 years. Informed written consent was taken from authorities for detailed demographics age, sex, cause of fracture and side of fracture. Patients were categorized into three equal groups, group A had 45 patients and received lateral approach, group B had 45 patients and received medial approach and group C received posterior approach with 45 cases. Shaft Condylar Angle (SCA) and Baumann angle were used to analyze the radiological result. All child...

Journal of Ayub Medical College, Abbottabad : JAMC, 2021

BACKGROUND Osteoarthritis is the most common degenerative disease of the synovial joints in the e... more BACKGROUND Osteoarthritis is the most common degenerative disease of the synovial joints in the elderly population with hip osteoarthritis as the second most commonly affected joint. A multitude of conservative treatments is used for pain relief and functional improvement including acetaminophen, NSAID, intra-articular corticosteroid, and viscosupplementation (VS). Different preparations of VS based on different molecular weights are commercially available. No systematic review or meta-analysis regarding the use of intra-articular high molecular weight hyaluronic acid (HMWHA) injection for the hip joint was published before. This review analyzes the efficacy of intra-articular HMWHA for hip osteoarthritis. METHODS PubMed, Google Scholar, Cochrane Library for randomized trials describing the efficacy of HMWHA for hip osteoarthritis was searched. The search terms were osteoarthritis, hip joint, outcomes, viscosupplementation, and high molecular weight hyaluronic acid in different comb...

Objective: To describe the medial approach for open cross-pinning of paediatric displaced supraco... more Objective: To describe the medial approach for open cross-pinning of paediatric displaced supracondylar elbow fractures and to assess the morbidity and its clinico-radiological outcome. Methods: A total of 36 Children operated via medial approach for closed displaced supracondylar elbow fractures (Gartland extension type III) without associated neurovascular complications were selected for assessment of radiological (Baumann's angle difference and bony union) and clinical (elbow motion and loss of carrying angle) outcome. The final Results were evaluated at six monthsA¢â‚¬â„¢ time using Flynn's criteria. Results: Out of the 36 analyzed Children, 10(27.7%) were female and 26 (72.3%) were male. 22 (61.2%) had left elbow while 14 (38.8%) had right elbow involvement. The Mean age at the time of fracture was 6 years (range, 2 - 11 years). Mean time from fracture to surgery was 6.8 days (range, 0 A¢â‚¬â€œ 15 days). We had no instance of postoperative deep infection, neurovascular ...

Rawal Medical Journal, 2016

Objective: To assess the outcome of bifocal bone transport (trifocal distraction compression) for... more Objective: To assess the outcome of bifocal bone transport (trifocal distraction compression) for defective bone loss in tibia. Methodology: This prospective study was conducted at department of orthopedic surgery, Dow University of Health Sciences/Civil Hospital, Karachi, Pakistan from 2000 to 2015. It included 15 patients with traumatic bone loss and infective nonunion with bone loss in tibia. Patients with bone loss in tumors were excluded from the study. Results: Out of 15 patients, 12 were male and 3 female. Bone loss was 12 cm in 8 patients, 15 cm in 4 and 10 cm in 3 patients. All were treated with bifocal bone transport (trifocal distraction compression). Total duration of treatment in transport and consolidation was around 15 months in 8 patients, 17 months in 4 patients and 1 year in 3 patients. Additional bone graft was placed in four patients. Pin track infection was universal problem in all patients. There was no major complication. Union was achieved in all cases. Funct...

Correspondence: Dr. Muhammad Noman Parekh 1* Orthopaedics Unit-I Dow University of Health Science... more Correspondence: Dr. Muhammad Noman Parekh 1* Orthopaedics Unit-I Dow University of Health Sciences Karachi Email: dr_noman-parekh@hotmail.com like age, type and location of fracture and associated injuries. Traditionally these fractures were treated conservatively with immobilization with pavlik harness, skin or skeletal traction and spica in younger patients due to rapid healing, while surgical management was reserved for select ive cases. Conservat ive management is associated with prolong hospital stay and psychological disturbances. Therefore surgical management is more superior as it provides accurate reduction without interference with growth and malunion.

Rawal Medical Journal, 2018

Objective: To assess the functional outcome of distal femur locking plate in patients with fractu... more Objective: To assess the functional outcome of distal femur locking plate in patients with fracture of distal femur, in terms of rate of union and range of knee motion Methodology: This study was conducted at Department of Orthopedic Surgery, Dow University of Health Sciences, Civil Hospital, Karachi, Pakistan from May 7, 2015 to May 3, 2017 with fracture classification AO type A-1, 2, 3 and C-1, 2, C3. Those with AO type B-1, 2, 3 were excluded. Functional outcome was measured in terms of union of fracture and range of motion of knee joint. Results: There were 40 patients with mean age of 35.01±8.78 years (range 22-72). Twenty six (65%) were male and 14 (35%) were female. Road traffic accident was responsible for 28(70%) fractures while in 12(30%) patients fractures were caused by fall from height. Right limb was affected in 21(52.5%) patients while 19(47.5%) patients had affected left limb. Using Schatzker and Lambert’s criteria, satisfactory functional outcome was observed in 85%...

The Journal of Orthopaedics Trauma Surgery and Related Research, 2018

This study was executed to address the burden of orthopedic trauma presenting in Trauma Centre Ci... more This study was executed to address the burden of orthopedic trauma presenting in Trauma Centre Civil Hospital, Karachi, Pakistan. 500 bedded trauma center is serving all kinds of trauma 24 hours a day with all state of the art facilities and is fully equipped with latest machinery. It is the largest emergency institute of Sindh till date. This study also presents the pattern of injuries categorically, that we are encountering in daily emergency. Method: This descriptive study was conducted from Sept 2017 to Dec 2017. An informed verbal consent was taken and preformed questionnaire was filled. Patient brought dead and those who were having injuries other than the orthopedic injury were excluded. Data was analyzed using SPSS 21 for statistical significance. Result: The study was conducted on 2850 patients of all age group, which makes an average of 30 patients per day, including 1957 males (68.7%) and 893 females (31.3%). Among the total, the number of patients of pediatric age group (1 to 12 years) were 942 (33.05%). Mean age was 35 in adults. SD 28. 69 maximum injuries occurred in age group of 10-30 years. By occupation most were found to be students and children-659 (23.1%). Most traumas occurred due to road traffic accidents-2193 (76.9%) and other occurred at home-657 (23.05%). Road traffic accidents are found to be major cause of injuries and rest was due to other causes. Majority of patients were brought by ambulance service with any first aid given. By addressing the categorical arrangement of patients with their pattern of injuries, the cases with mild type of injury like foreign body, soft tissue trauma and muscular pain of sudden onset-446 (15.6%). The patients with single bone closed fractures including clavicle fracture-180 (6.31%), humerus neck and shaft fracture-83 (2.91%), supra-condylar humerus fractures-355 (12.4%), radius/ulna shaft-90 (3.1%), colles fracture-389 (13.6%), neck of femur fracture-56 (1.96%), intertrochanteric fracture 62 (2.1%), femur shaft fracture-186 (6.5%), fracture of tibia/fibula-133 (4.6%) and bi-malleolar fracture-45 (1.57%). The patients which suffered from joint dislocations like shoulder-48 (1.68%), elbow dislocation-17 (0.59%), hip dislocation-22 (0.77%) were also addressed. Some patients were having severe injuries including multiple fractures, major contaminated open wounds, traumatic amputations, crushed limbs or with head injury-43 (3.06%). Very few cases were cold-42 (5.6%) and some patients were included which are unknown and those whose data were lost-695 (24.3%). Conclusion: We concluded that huge number of trauma patients are presenting to trauma center with polytrauma, trauma to pelvis and acetabulum, more than one bone fractures. Extensive trauma is disabling to young population throughout life. So, trauma patients should be properly evaluated and treated according to advanced trauma life support to prevent the second hit injury to patient. We suggest that primary prevention is the key that we can achieve by strict traffic rules; otherwise the burden can lead to mismanagement of trauma patient.

Journal of Pakistan Orthopaedic Association, Oct 13, 2020

The Professional Medical Journal, 2020

Objectives: To compare the functional outcome of dynamic compression plating with intramedullary ... more Objectives: To compare the functional outcome of dynamic compression plating with intramedullary interlocking nailing in closed fracture of the humeral shaft in adults. Study Design: Prospective comparative study. Setting: Department of orthopedics, Civil hospital, Karachi. Period: From 8th February to 7th August 2017. Material & Methods: A total of 82 patients with post-traumatic closed fracture shaft of the humerus were included. Patients were randomly allocated into two groups. Group I was offered Intramedullary Interlocking nail (ILN) and Group II was offered a dynamic compression plate (DCP). The functional outcome was measured by the “Disabilities of Arm, Shoulder and Hand” (DASH) score. Results: The average age of the patients was 32.87±6.65 years. The acceptable outcome was significantly high in DCP group as compared to the ILN group (87.8% vs. 61%; p = 0.005). Conclusion: We conclude that dynamic compression plating is functionally a better technique than interlocking naili...

Cureus, 2019

Introduction Motorcycles are common in a developing nation like Pakistan. In addition to their be... more Introduction Motorcycles are common in a developing nation like Pakistan. In addition to their benefits, motorcycles carry a high risk for accident and injury. Many factors can exacerbate the risk of motorcycle operation including the use of mobile phones while riding, a lack of knowledge of traffic rules, not following road rules or non-satisfactory vehicle health and road conditions. Along with these physical factors, some psychosocial aspects also impact risks, including aggressive behavior of drivers or variations in driving patterns associated with changes in driver mood. Objective We conducted this study to determine the association of rider/operator behavioral and psychosocial factors with motor vehicle crashes.

Journal of Medical Science And clinical Research, 2016

Background-Postoperative wound infection is an important cause of morbidity in surgical patients ... more Background-Postoperative wound infection is an important cause of morbidity in surgical patients and antibiotic prophylaxis forms one of the important preventive measures. Aims and Objectives-This study was performed in a major general hospital to establish the efficacy of antibiotic prophylaxis in clean general surgeries. Materials and Methods-The study was done in 100 cases divided in 2 groups, one of which was given a single dose of ceftriaxone within 2 hours of operative incision without any postoperative antibiotics and the other was given routine postoperative antibiotics. Postoperative evaluation was done for development of fever or wound infection. Observation and Results-Mean age was 35 and 33 in both groups while mean operative time was 45-53 minutes. Majority of cases performed were of hernioplasty. Various other factors such as length of incision, use of electrocautery and postoperative hospital stay were considered. Incidence of infection in both groups was similar but cost reduction of 88.11% was achieved in the first group. Conclusion-The restriction of antibiotic usage in preoperative period and omission of it in postoperative period didn't result in increase in incidence of surgical site infection. However significant cost reduction is achieved in the cases where preoperative prophylactic antibiotics were used and hence can be advocated in clean general surgeries.

Open Forum Infectious Diseases, 2015

Background. Fomites are objects that can become colonized and serve as vectors in the transmissi... more Background. Fomites are objects that can become colonized and serve as vectors in the transmission of pathogenic microorganisms. Literature examining the knowledge of healthcare personnel about this method of spread of infection is lacking. We conducted a study to assess the knowledge, attitude, and practices of healthcare personnel across different areas of patient care regarding the spread of infections at a tertiary care hospital in Karachi, Pakistan.Methods. A descriptive, cross-sectional study was conducted among healthcare personnel using a self-administered questionnaire. The questionnaire contained sections pertaining to demographic details and knowledge, attitude, and practices regarding fomites and their role in the transmission of pathogens.Results. Three hundred and fifty-three participants completed the questionnaire: 168 were male and 185 were female. Laboratory coats, stethoscopes, and bedside curtains were most frequently identified as fomites by the participants....

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2006

Use of auto-genous bone graft is commonly practiced in orthopaedic surgical procedure as in the t... more Use of auto-genous bone graft is commonly practiced in orthopaedic surgical procedure as in the treatment of fracture non-union, filling the defect after intraosseous lesions excision and for surgical arthodesis of joints [1]. The iliac crest is the commonest donor site for bone grafting as compare to other side because it is easily accessible, relatively large amount of graft can be taken safely [2].

Trauma International

Objective: Motorbike accidents contribute one of the most important factors of tibial plateau fra... more Objective: Motorbike accidents contribute one of the most important factors of tibial plateau fracture among young populations in Karachi Pakistan. Most surgeons feel challenging to treatment complicated bicondylar fractures of the tibial plateau.This prospective study was designed to evaluate the functional outcomes of dual plating through a two-incisions technique for the fixation of complicated bicondylar tibial plateau fractures in young patients in Karachi Pakistan. Methods: This prospective study includes 94 cases of Type V and VI tibial plateau fractures of young patient’s age range from 15 to 45 years, operated between January 2014 and December 2016 conducted in two public sector hospital of Karachi Pakistan (Jinnah Post Graduate Medical Center, Civil Hospital Karachi). Exclusion criteria include patients with multiple fractures on the same side or same bone, age >45 years, open contaminated fracture, open fracture,and patients with head injuries. All cases were operated ...

Cell and Tissue Banking

To share our experience of establishing a bone bank in Pakistan, and the clinical use of these in... more To share our experience of establishing a bone bank in Pakistan, and the clinical use of these indigenously produced bone grafts. We retrospectively reviewed our experience of the procurement, processing, and storage of bone grafts at a bone bank in Karachi, Pakistan, the first bone bank to be established in a public sector hospital in Pakistan. The bone bank was established at Sindh Institute of Urology and Transplantation (SIUT), Karachi, in collaboration with Department of Orthopaedic Surgery, Dow University of Health Sciences/Civil Hospital, Karachi (CHK) in May, 2015. Since then, a large number of bone grafts from the tissue bank have been used for various orthopedic procedures. This paper describes the problems and challenges faced in establishing and running a tissue bank in a Muslim and a developing country and the progress of the bone bank over the first 4 years. A total of 93 bone grafts were retrieved and preserved in the bone bank over the 4-year period. Among these, 56 (60.2%) bones were retrieved from male donors and 37 (39.8%) from females. The mean age of all donors was 55.9 ± 15.34 years (range: 16-90 years). All bone donors were living patients. No c bones were obtained from deceased donors. Types of bone grafts included: femoral heads, 68; head with neck of femur, 19; radius and ulna, 1; lower femur, knee joint, lower leg and foot bones, 4; and skull bone, 1. All grafts were subjected to aerobic and anaerobic bacterial cultures, as well as fungal cultures. Microbiological contamination was observed in 18/93 (19.35%). All culture positive bones were discarded. Bone grafts issued from the bank and transplanted were 51/93 (54.8%) in all. Bone grafts were used in a variety of tumor and non-tumor orthopaedic procedures in CHK. Nine bone grafts were donated to the other hospitals to be used for revision total hip replacement and tumor surgeries. There were no service charges. Two patients (3.92%) developed infections postoperatively, one superficial and one deep. No other complications were noted. This is the preliminary report on the establishment and functioning of a bone bank in a public sector hospital in Pakistan. The favorable outcome has inculcated confidence in orthopedic surgeons for greater use of bone allografts for a variety of indications in this country.

Journal of the Pakistan Medical Association

Objective: To explore the present state of competency in clinical ethics among postgraduate train... more Objective: To explore the present state of competency in clinical ethics among postgraduate trainees in a tertiary care hospital. Methods: The interview-based cross-sectional study was conducted at the Civil Hospital, Karachi, from September 2018 to March 2019, and comprised postgraduate trainees of either gender in any year of the training program across all specialties. Data was collected using self-reported questionnaire seeking opinion about present working conditions regarding clinical ethical issues on the hospital ground and problems they face from day to day. Data was analysed using SPSS 23. Results: Of the 153 subjects, 96(62.7%) were females, 73(47.7%) were from Medicine and allied disciplines, and 80(52.3%) were from Surgery and allied disciplines. The primary source of their clinical ethics’ understanding was derived from their workplace [116(75.82%)]. While only 104 (68%) of the subjects knew about the Hippocratic Oath’s contents, less than 10% knew about Nuremberg Code...

Rawal Medical Journal, 2021

Journal of Ayub Medical College, Abbottabad : JAMC, 2021

Adamantinoma is a rare neoplastic bone tumor that has the potential to metastasize. The classic p... more Adamantinoma is a rare neoplastic bone tumor that has the potential to metastasize. The classic presentation is in the tibial region however; cases involving other bones of the body have been noticed. The tumour is very likely to be mistaken for other bone diseases and therefore it is important to investigate and study about its nature and thus differentiate it from other differentials. Nevertheless, literature on the presentation, findings, investigations and treatment options of adamantinomas are limited. In this case series, we report four cases from a local hospital in Karachi who were diagnosed, treated and followed up for adamantinoma. Studies regarding the disease will help us understand more about its features.

Pakistan Journal of Medical and Health Sciences, 2021

Background: Wagner proximal femur prosthesis is the versatile modular implant. Study Design: Pros... more Background: Wagner proximal femur prosthesis is the versatile modular implant. Study Design: Prospective study Setting: Department of Orthopaedic Surgery Dow University of Health Sciences / Civil Hospital Karachi, from January 2013 to December 2019. Methodology: Total 19 patients of both genders with proximal femur bone loss due to tumor, implant failure for proximal femur fixation, comminuted intertrochanteric fracture, and failed arthroplasty included in the study. After taking written informed consent, detailed demographics including age, gender, indication of wagner prosthesis, and wagner stem type were recorded. Among all the patients 11 patients received total hip replacement and 8 patients received bipolar. Complications associated with procedure were recorded. Outcomes were assessed by Merle D Aubgine scale. Results: Total 19 patients were included in the study who were operated with wagner prosthesis for proximal femur bone deficit problems. 7 (37%) patients were male and 1...

Pakistan Journal of Medical and Health Sciences, 2021

Objective: The aim of this study is compare the outcomes among three different approaches (latera... more Objective: The aim of this study is compare the outcomes among three different approaches (lateral approach, medial approach and posterior approach) for supracondylar humerus fractures in children. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Orthopedics department of Ayub Teaching Hospital, Abbottabad for duration of one year from January 2020 to December 2020. Methods: There were one hundred and thirty five children had supracondylar humerus fracture were presented. Patients were aged between 3-12 years. Informed written consent was taken from authorities for detailed demographics age, sex, cause of fracture and side of fracture. Patients were categorized into three equal groups, group A had 45 patients and received lateral approach, group B had 45 patients and received medial approach and group C received posterior approach with 45 cases. Shaft Condylar Angle (SCA) and Baumann angle were used to analyze the radiological result. All child...

Journal of Ayub Medical College, Abbottabad : JAMC, 2021

BACKGROUND Osteoarthritis is the most common degenerative disease of the synovial joints in the e... more BACKGROUND Osteoarthritis is the most common degenerative disease of the synovial joints in the elderly population with hip osteoarthritis as the second most commonly affected joint. A multitude of conservative treatments is used for pain relief and functional improvement including acetaminophen, NSAID, intra-articular corticosteroid, and viscosupplementation (VS). Different preparations of VS based on different molecular weights are commercially available. No systematic review or meta-analysis regarding the use of intra-articular high molecular weight hyaluronic acid (HMWHA) injection for the hip joint was published before. This review analyzes the efficacy of intra-articular HMWHA for hip osteoarthritis. METHODS PubMed, Google Scholar, Cochrane Library for randomized trials describing the efficacy of HMWHA for hip osteoarthritis was searched. The search terms were osteoarthritis, hip joint, outcomes, viscosupplementation, and high molecular weight hyaluronic acid in different comb...

Objective: To describe the medial approach for open cross-pinning of paediatric displaced supraco... more Objective: To describe the medial approach for open cross-pinning of paediatric displaced supracondylar elbow fractures and to assess the morbidity and its clinico-radiological outcome. Methods: A total of 36 Children operated via medial approach for closed displaced supracondylar elbow fractures (Gartland extension type III) without associated neurovascular complications were selected for assessment of radiological (Baumann's angle difference and bony union) and clinical (elbow motion and loss of carrying angle) outcome. The final Results were evaluated at six monthsA¢â‚¬â„¢ time using Flynn's criteria. Results: Out of the 36 analyzed Children, 10(27.7%) were female and 26 (72.3%) were male. 22 (61.2%) had left elbow while 14 (38.8%) had right elbow involvement. The Mean age at the time of fracture was 6 years (range, 2 - 11 years). Mean time from fracture to surgery was 6.8 days (range, 0 A¢â‚¬â€œ 15 days). We had no instance of postoperative deep infection, neurovascular ...

Rawal Medical Journal, 2016

Objective: To assess the outcome of bifocal bone transport (trifocal distraction compression) for... more Objective: To assess the outcome of bifocal bone transport (trifocal distraction compression) for defective bone loss in tibia. Methodology: This prospective study was conducted at department of orthopedic surgery, Dow University of Health Sciences/Civil Hospital, Karachi, Pakistan from 2000 to 2015. It included 15 patients with traumatic bone loss and infective nonunion with bone loss in tibia. Patients with bone loss in tumors were excluded from the study. Results: Out of 15 patients, 12 were male and 3 female. Bone loss was 12 cm in 8 patients, 15 cm in 4 and 10 cm in 3 patients. All were treated with bifocal bone transport (trifocal distraction compression). Total duration of treatment in transport and consolidation was around 15 months in 8 patients, 17 months in 4 patients and 1 year in 3 patients. Additional bone graft was placed in four patients. Pin track infection was universal problem in all patients. There was no major complication. Union was achieved in all cases. Funct...

Correspondence: Dr. Muhammad Noman Parekh 1* Orthopaedics Unit-I Dow University of Health Science... more Correspondence: Dr. Muhammad Noman Parekh 1* Orthopaedics Unit-I Dow University of Health Sciences Karachi Email: dr_noman-parekh@hotmail.com like age, type and location of fracture and associated injuries. Traditionally these fractures were treated conservatively with immobilization with pavlik harness, skin or skeletal traction and spica in younger patients due to rapid healing, while surgical management was reserved for select ive cases. Conservat ive management is associated with prolong hospital stay and psychological disturbances. Therefore surgical management is more superior as it provides accurate reduction without interference with growth and malunion.

Rawal Medical Journal, 2018

Objective: To assess the functional outcome of distal femur locking plate in patients with fractu... more Objective: To assess the functional outcome of distal femur locking plate in patients with fracture of distal femur, in terms of rate of union and range of knee motion Methodology: This study was conducted at Department of Orthopedic Surgery, Dow University of Health Sciences, Civil Hospital, Karachi, Pakistan from May 7, 2015 to May 3, 2017 with fracture classification AO type A-1, 2, 3 and C-1, 2, C3. Those with AO type B-1, 2, 3 were excluded. Functional outcome was measured in terms of union of fracture and range of motion of knee joint. Results: There were 40 patients with mean age of 35.01±8.78 years (range 22-72). Twenty six (65%) were male and 14 (35%) were female. Road traffic accident was responsible for 28(70%) fractures while in 12(30%) patients fractures were caused by fall from height. Right limb was affected in 21(52.5%) patients while 19(47.5%) patients had affected left limb. Using Schatzker and Lambert’s criteria, satisfactory functional outcome was observed in 85%...

The Journal of Orthopaedics Trauma Surgery and Related Research, 2018

This study was executed to address the burden of orthopedic trauma presenting in Trauma Centre Ci... more This study was executed to address the burden of orthopedic trauma presenting in Trauma Centre Civil Hospital, Karachi, Pakistan. 500 bedded trauma center is serving all kinds of trauma 24 hours a day with all state of the art facilities and is fully equipped with latest machinery. It is the largest emergency institute of Sindh till date. This study also presents the pattern of injuries categorically, that we are encountering in daily emergency. Method: This descriptive study was conducted from Sept 2017 to Dec 2017. An informed verbal consent was taken and preformed questionnaire was filled. Patient brought dead and those who were having injuries other than the orthopedic injury were excluded. Data was analyzed using SPSS 21 for statistical significance. Result: The study was conducted on 2850 patients of all age group, which makes an average of 30 patients per day, including 1957 males (68.7%) and 893 females (31.3%). Among the total, the number of patients of pediatric age group (1 to 12 years) were 942 (33.05%). Mean age was 35 in adults. SD 28. 69 maximum injuries occurred in age group of 10-30 years. By occupation most were found to be students and children-659 (23.1%). Most traumas occurred due to road traffic accidents-2193 (76.9%) and other occurred at home-657 (23.05%). Road traffic accidents are found to be major cause of injuries and rest was due to other causes. Majority of patients were brought by ambulance service with any first aid given. By addressing the categorical arrangement of patients with their pattern of injuries, the cases with mild type of injury like foreign body, soft tissue trauma and muscular pain of sudden onset-446 (15.6%). The patients with single bone closed fractures including clavicle fracture-180 (6.31%), humerus neck and shaft fracture-83 (2.91%), supra-condylar humerus fractures-355 (12.4%), radius/ulna shaft-90 (3.1%), colles fracture-389 (13.6%), neck of femur fracture-56 (1.96%), intertrochanteric fracture 62 (2.1%), femur shaft fracture-186 (6.5%), fracture of tibia/fibula-133 (4.6%) and bi-malleolar fracture-45 (1.57%). The patients which suffered from joint dislocations like shoulder-48 (1.68%), elbow dislocation-17 (0.59%), hip dislocation-22 (0.77%) were also addressed. Some patients were having severe injuries including multiple fractures, major contaminated open wounds, traumatic amputations, crushed limbs or with head injury-43 (3.06%). Very few cases were cold-42 (5.6%) and some patients were included which are unknown and those whose data were lost-695 (24.3%). Conclusion: We concluded that huge number of trauma patients are presenting to trauma center with polytrauma, trauma to pelvis and acetabulum, more than one bone fractures. Extensive trauma is disabling to young population throughout life. So, trauma patients should be properly evaluated and treated according to advanced trauma life support to prevent the second hit injury to patient. We suggest that primary prevention is the key that we can achieve by strict traffic rules; otherwise the burden can lead to mismanagement of trauma patient.