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Purpose: Reduction and stable fixation of the quadrilateral plate are challenging primarily due to its location in the true pelvis, limited bone stock, juxta-articular nature, and its comminution. The current study aimed to investigate the quality of reduction and functional outcomes after open reduction and internal fixation (ORIF) with infrapectineal buttress plating of the quadrilateral surface via an anterior intrapelvic approach. Materials and Methods: We conducted a retrospective review of twenty-one patients with acetabular fractures involving quadrilateral plate operated at Ghurki Trust Teaching Hospital between January 2017 and December 2018. Radiological assessment of the quality of reduction was conducted using criteria described by Matta. Functional outcomes were evaluated using a modified Postel Merle d'Aubigné score. Results: The current study included 15 males and 6 females with a mean age of 40.67±12.17 years (range, 22-62 years). The most common fracture pattern was anterior column and posterior hemi-transverse in eight patients followed by true bicolumn and T-type fractures in seven and four patients respectively. Both transverse fractures were transtectal. The quality of reduction according to Matta criteria was anatomical in 14 patients, imperfect in five and poor in two. Functional outcomes were excellent in 47.6% cases, good in 42.9%, and fair in 9.5% cases. Both patients with fair outcomes had non-anatomical reduction, and one required total hip arthroplasty at a later time. Conclusion: Quadrilateral plate reconstruction with an infrapectineal buttress plate applied though an anterior intrapelvic approach provides high rates of anatomical reduction and yields good functional outcomes. [ABSTRACT FROM AUTHOR]

Among orthopedics trauma, the Olecranon fractures are one of the most commonly seen in the emergency room. The cause of such injuries are either fall or road traffic accident. The coronoid process stabilizes the humerus against the distal ulna. There is loss of extensor mechanism at the elbow joint whenever there is fracture of Olecranon. So, its management is always operative. The main objective of this study was to determine the functional outcome of patients with olecranon fractures treated with tension band wiring and K-wires. Study Design: Descriptive case Series. Setting: Department of Orthopedics and Spine centre, Ghurki Trust teaching Hospital, Lahore. Period: 25th March 2016 to 30th September 2016. Materials and Methods: 85 patients were selected using Non Probability/Consecutive sampling technique. Informed consent was taken and demographic information was noted. Surgery was performed by single team of orthopedics surgeons. Patient was followed after 06 weeks. Post-operatively for the assessment of functional outcome in terms of very good to good, fair and poor according to Murphy's system. All the collected data was entered and analyzed on SPSS version 20. Results: In our study the mean age of the patients was 36.62±14.09 years, the male to female ratio of the patients was 0.7:1. The mean value of total Murphy's score of the patients was 5.98±2.03. In this study the good functional outcome was observed in 35(41.18%) patients, fair outcome was observed in 46(54.12%) patients. Conclusion: The tension band wiring with K-wires shows good and satisfactory functional outcome for the management of olecranon fractures. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to assess the clinical and radiological outcomes following one-stage hip reconstruction, consisting of open reduction femoral shortening and pelvic osteotomy, for neglected developmental dislocation of the hip (DDH). Materials and Methods: This is a retrospective analysis of 77 hips in 65 patients (46 females and 19 males; 12 had bilateral dislocations), operated at a Ghurki Trust Teaching Hospital in Pakistan between 2013 and 2015. The average age at surgery was 11.02±3.43 years. According to the Tönnis classification, there were 10, 14, 22, and 31 patients in grades 1, 2, 3, and 4, respectively. The pelvic procedure utilized in this study was triple osteotomy (47 hips) followed by double and Salter osteotomy (18 and 12 hips, respectively). Postoperative evaluations were conducted using the modified MacKay's scoring system (functional outcomes) and Severin's scoring method (radiological assessment). Results: Postoperatively, there were 38 (49.4%), 19 (24.7%), 14 (18.2%), and 6 (7.8%) hips in Severin grade I, II, III and IV, respectively. According to the modified McKay criteria, there were 22 hips (28.6%) in excellent condition, 44 (57.1%) in good condition, 9 (11.7%) in fair condition and 2 (2.6%) in poor condition. Both patients with poor outcomes had an unstable, painful hip with evidence of avascular necrosis of the femoral head. Conclusion: Based on the results presented here, we recommend the single stage procedure of open reduction, femoral shortening and pelvic osteotomy for treatment of DDH in older children with good to excellent functional and radiological outcomes. [ABSTRACT FROM AUTHOR]

Background: Worldwide millions of people undergo joint replacement surgery to decrease the morbidity. The main indication for these surgeries is loss of function and pain. Similarly, knee replacement is done when degeneration and destruction of the knee create disability and decrease function of the knee. There are a number of implant types available but the use of an all-polyethylene tibial component in primary total knee replacement remains an att ractive option, considering the durability and lower cost. Objective: The objective of the study was to evaluate the pre-operative and post-operative range of motion (ROM) After total knee replacement at 6th, 12th and 48th weeks follow up using all poly implants. Material and Method: It is a prospective case series in which 111 subjects with total knee replacement in whom all poly implants were used and were assessed for range of motion at knee using simple goniometry examination at regular intervals were included. All data were analyzed using SPSS 17.0 version. Results: On goniometry examination, ROM at 6 weeks averaged 700 and at 12 weeks averaged 1,000 and on last follow up was 1,100. Conclusion: Total knee replacement with all poly implants has excellent results in terms of range of the motion of the knee. [ABSTRACT FROM AUTHOR]

Purpose - This study aims to support the development risk management strategies towards improving the resilience of assets located in the estuary and lower level of the Swan River, Western Australia. The study evaluated the key role of Federal/State policies in adaptation planning and the communication and interface between various stakeholders, including State/Local governments, construction professionals, property developers and landowners. Design/methodology/approach - The study applied a mixed research approach through a questionnaire survey followed by an in-depth interview involving local construction experts. Collected data were analysed following the grounded theory methodology style of data analysis. Findings - The findings revealed a convoluted understanding of communication networks and responsibility for owning the future risks between relevant stakeholders. As a result, a framework illustrating clear process and roles in mitigating risk and implementing adaptive asset management measures has been formulated and presented in this study. Originality/value - Scientific evidence suggested that sea-level rise and increased frequency of major coastal flooding events are inevitable as early as 2100, and having a comprehensive risk management plan of assets to anticipate climate risks and to improve urban resilience is essential. The proposed framework is aimed at local stakeholders in improving current state of communication and adaptation planning as a pathway to develop a robust risk management strategy. [ABSTRACT FROM AUTHOR]