Journal of Orthopedic Education

Tibial fractures are the commonest long bone fractures encountered by orthopaedic surgeons, because one third of the tibial surface is subcutaneous throughout most of its length, Tibia is the commonest bone for open fractures than any other major long bone. The management of open tibial fractures is often difficult, and the optimum method of treatment remains a subject of controversy as these fractures are associated with high prevalence of complications. Intramedullary nails have been used successfully in the treatment of open tibial fractures after thorough debridement and and have been associated with low rates of complications and early mobilization. This led us to design a trial, to study the results of primary internal fixation in the treatment of compound fractures of the tibia.

Methods: Thirty patients who had open fractures of tibia were treated with wound debridement and primary internal fixation at Sri Aurobindo Medical College & P.G. Institute, Indore (M.P.). Patients more than 18 years of age with open fractures of Tibia with Type III A and B according to Gustilo Anderson classification are included. Our objectives is to evaluate the functional and radiological outcomes using Johner and Wruh’s criteria at 6 months and to assess the complications associated with study.

Results: Final assessment in our series was done at 6 months using Johner & Wruhs criteria. Excellent, good, fair and poor were the grading used for Functional Outcome. In our study higher proportion 63.3% was for excellent, followed by 30.0% for good, lower proportion 3.3% was for fair & poor respectively. The study was associated with very low rate of complications.Conclusion: We recommend early extensive debridement, aggressive antibiotic therapy and primary stabilization followed by early wound coverage if required. Advantage of this study in addition to early joint motion, early weight bearing allows earlier return to work.

Background of the Study: Rheumatoid arthritis (RA), is an autoimmune and inflammatory disease affecting joints of the hands, wrists, and knees. Rheumatoid arthritis has many physical and social consequences that can lower the quality of life. Moreover, RA affects many aspects of daily living. In this study, we aim to determine the functional health status and its association with selected demographic variablesof patients receiving biological therapy for rheumatoid arthritis at Ibrahim Bin Hamad Obaidallah hospital (IBHOH), Ras AlKhaimah, UAE.

Materials and Methods: A quantitative research approach with a descriptive observational survey design was used. Data were obtained from adult clients who fulfilled the inclusion criteria using the Health Assessment Questionnaire-Disability Index (HAQ-DI), Pain visual analog scale (P-VAS), and Global visual analog scale (G-VAS) tools to elicit demographic profile and functional disability index. Sample participation was voluntary, complying with the consent procedure in force, ensuring confidentiality and anonymity. A total of 100 valid responses were obtained. Descriptive statistics were utilized to analyze the frequency and percentage distribution of sociodemographic variables of the patients. Chi-square and Fischer’s exact tests were used to assess any association between demographic variables and functional health status.

Major findings of the Study: Among 100 patients were studied, of which (89%) were females, and (11%) were males, (10%) of them were aged between 20 – 30 years, (17%) between 31–40 years, (25%) between 41 – 50 years, (19%) between 51 – 60 years, and (29%) between 60 – 65 years. Most of the patients were on biological therapy from 1 – 12 months (29%), [median 36 months and range 2- 180 months]. The most frequently prescribed biological therapy was Adalimumab (21% of patients) and Etanercept was the second most frequently prescribed (13% of patients), followed by Tofacitinib (12% of patients) and Tocilizumab (10% of patients). The results showed a mean (SD) of 0.8775 (0.7797104) and a median (0.75) of the functional disability index. The data showed that mostof the patients had mild to moderate functional disability (46%); (25%) had moderate to severe disability, (18%) of patients had No functional disability, and (11%) had severe to very severe functional disability. The majority of patients (45%) had mild pain, (33%) and (13%) had moderate and severe pain correspondingly (median P-VAS 30, mean 32, and range 0 - 100). Furthermore, most of the patients (54%) reported mild disease effects on their global health, (33%) reported moderate effects, and (13%) severe effects

Cross leg flap is a conventional flap for lower limb defects for long years where the local flap and free flap is not possible in the patient. The raw area created after raising the cross-leg flap in the donor leg was grafted with split skin graft. Split skin graft is a type of graft that contains epidermis and a portion of dermis and is commonly used to cover a raw area following trauma. Split skin grafts are commonly done in India following road traffic accidents to cover the affected site and raw area of the donor site of the flap. Split thickness grafting depends upon the raw area environment for its uptake and effective procedure. Autologous platelet rich plasma is an effective way to improve the graft take and survival. It contains growth factors which improves the proliferation and also has properties to improve blood supply. Autologous platelet rich plasma was also used to inject in the flap distal site in the cross-leg flap to increase the vascularity of the flap. In this case report we highlight the role of Autologous platelet rich plasma in the cross-leg flap and application of skin graft in the donor site of the cross-leg flap.