This 42 year old patient presented to AO Clinic 3 months after she sustained a medium velocity gunshot injury to her left distal 1/3 Humerus. Initially she had an external fixator applied at a private hospital elsewhere in the city. On presentation she had high grade fever and pus discharge from pin tracts of the external fixator. Initially the external fixator was removed and sequestrectomy was performed and a brace was applied.  After her blood picture improved and wounds settled she had an anterior spoon plate applied with bone graft. Fully bony union was achieved after 4 months

This 7 year old young boy presented at AO Clinic after an accidental gunshot injury to his right distal Humerus. He presented 2 days after injury with a wrist drop .A distal radial plate was applied together with a Circlage wire and intra fragmentary screw. This young boy achieved fully bony union and recovered from partial tear of his radial nerve after repair.

This 56 year old diabetic gentleman presented to AO Clinic with an 11 month old non union to his left radius and ulna. He was initially treated at a local hospital in Karachi with rush nails. As you can see looking at his AP and lateral views he has a segmental fracture not only of his radius but also of his ulna.  He was treated with a compression plating of both his radius and ulna augmented with tricortical bone graft. He achieved full bone union with full range of movement and no restriction of supination and pronation.

This 50 year old gentleman presented to us with a fracture of his intramedullary fibula which was inserted into his humerus for a previous gunshot injury which was treated three years ago at a private hospital in Karachi. A sequestrectomy was performed and a locking plate was applied which was augmented with bone graft. It took about three months for the patient achieved full bone union and patient has resumed his job as a car driver.

This 40 year old patient attended AO Clinic with a three month old injury to his distal 3^rd of his radius which was treated primarily at a private hospital in Lahore with a one third tubular plate and six screws. Removal of metal was carried out and a mini dynamic compression plate was applied which was augmented with bone graft from his iliac crest. Full bone union was achieved in a few months and the patient is now using his upper limb with no restriction of movements.

This 50 year old gentleman presented three months after a comminuted fracture to his distal 3^rd of his left humerus which was treated initially in a private hospital with Steinmann pin which was inserted through his humeral head together with a back slab. A posterior approach was performed and a spoon plate was applied which was augmented with bone graft. Patient has achieved full bone union and has full extension, lacks about 10 degrees of full flexion.

This 13 year old girl presented to AO Clinic after an incision and drainage was performed in a local private hospital in the city. As you can see in the xrays there is a sequestrum present in the mid shaft of her humerus surrounded by an involucrum. She had multiple sinuses present over her arm and was in immense pain. An extensive sequestrectomy was performed with periosteum left behind and all of the mid shaft of humerus was excised. After about five months fixation was carried out to her right proximal humerus. After three months there was good radiological signs of union and the patient was able to use her right upper arm. She has excellent range of movement, as you can notice she has about 2-3 cm shortening of her right humerus. 

This 33 year old patient presented to AO Clinic six months after being operated abroad for distal humeral fracture. He was managed in a private hospital with an intramedullary nail together with three intrafragmentary screws applied at distal 3^rd of humerus. He was taken to theatres. His metal work was removed and a spoon plate augmented with bone graft was applied to his distal humerus. Radiological bone union was achieved in about three month’s time and this patient is back to his previous job as a forklift driver. At presentation this patient had a wrist drop and during surgery neurolysis was performed, 3-4 months post op he has made a full neurological recovery and has full wrist extension.

This 40 year old patient presented five months after being operative in a private hospital in the city of Karachi. He presented with immense pain around his right proximal tibia, there were multiple sinuses present over the lateral aspect of his proximal tibia as well. Looking at his previous xrays a lateral buttress T plate was applied. Removal of metal was performed with an extensive sequestrectomy of his right proximal tibia. After this patient’s wounds healed and his ESR and CRP came back to normal a condylar buttress plate was applied with tricortical iliac crest craft together with cancellous iliac crest craft. At about four months there were radiological signs of union and the patient was commenced on touch toe weight bearing status. The patient was allowed to full weight bear just at five months with full knee flexion and extension. As you can see from his last xrays he has achieved full bone union.

This 28 year old patient presented five months after a closed fracture of his mid shaft of his left humerus. He was initially treated in a local private hospital with an intramedullary nail which was proximally and distal locked together with a cerclage wire at the fracture site. As you can see in one of slides the yellow avascular piece of bone was excised and a broad dynamic compression plate augmented with bone graft was secured to this patient’s humerus. Patient went on to full bone union and has no complaints.

This 23 year old patient presented 3-1/2 months after a gun shot injury to his right radius and ulna treated with rush nails in a private hospital in the northern parts of Pakistan. At presentation in our casualty department he was in considerable pain. He was taken to theatres, metal work was removed and AO Plating of his radius and ulna was carried out which was augmented with cancellous bone graft from iliac crest. At around four months there was evidence of radiological union and the patient was pain free.

This 50 year old patient presented at AO Clinic after one year of his initial injury, in which he fractured his left proximal femur. He was treated at a local Karachi hospital with an intramedullary nail which was locked proximally. Looking at his AP xray the butterfly fragment seems to be avascular and there was hardly any contact between the proximal and distal fracture ends, showing non union. Removal of metal followed by a DCS using extensive tricortical bone graft augmented with cancellous bone graft was carried out. It took him three months to achieve radiological union and the patient is walking pain free.

This 65 year old lady presented two months after a fracture to her proximal ulna which was initially treated elsewhere using a semi tubular plate with three cancellous screws at the proximal end and three screws of the distal end. This injury was compounded with a fracture of her radial head as well. Her radial head was excised together with application of a compression plate with bone graft through a single incision. Post operatively patient had signs of union in about three months and had no restrictions in flexion and extension supination and pronation of her right upper limb.

This 23 year old gentleman sustained a medium velocity gun shot injury to his left femur. He had been previously treated with an external fixator in the northern parts of Pakistan and presented to us a year after his injury with multiple sinuses on the lateral aspect of his left femur. An extensive sequestrectomy was performed and once his skin condition healed and blood ESR and CRP decreased. Fixation was carried out with using a dynamic compression plate which spaned the entire femur augmented with extensive tricortical bone graft. It took approximately 3-4 months before the union was present radiologically and patient was commenced weight bearing.

This 70 year old patient attended AO Clinic with a ten month old non united proximal tibial fracture on the left side. There were multiple sinuses present around the fracture site and therefore removal of metal together with a sequestrectomy of his proximal tibia was performed. Once his blood which included ESR, CRP settled down a broad compression plate augmented with bone graft was performed. Radiological union was evident in two and half months and patient was commenced full weight bearing three and half months after his surgery. Patient has no limitations of knee movement and has equal leg lengths.  

This 21 year old patient attended AO Clinic six months after he was operated for a closed distal 3^rd fracture with an inter locking nail done in a local hospital in Karachi. As you can see from the xrays the entry level of the nail was well below the desired area and distal locking screws were not placed appropriately, the length of the nail was inappropriate therefore it was pinging in his distal tibia causing him great discomfort. His metal work was removed and a broad DCP was applied at his distal tibia  which was augmented with bone graft. Patient went on to full bony union and is walking pain free with no leg length discrepancy.

This 48 year old banker presented after five years of his initial injury which was then operated with compression plating of his radius and ulna. On presentation he had a deformed forearm with prominence of the ulnar head and a sinus present. An ulnar screw was protruding out of his skin. Looking at his xrays radial plate had fractured because of non union and there was a shift of the ulna distally due to the disruption of the distal radial ulna joint. A distal radial oblique T-plate was applied on the volar aspect which was augmented with bone graft. The patient went on to full bony union.

This 27 year old patient attended AO Clinic five months after she was treated for an open humeral fracture with an external fixator in one of the major northern cities of Pakistan. On presentation there were multiple sinuses present and pus oozing from the pin tracks of the external fixator. She was taken to theatres and a sequestrectomy was carried out. Once her blood came back to normal (CRP + ESR) a broad compression plate was applied which was augmented with bone graft. She presented with a wrist drop and during surgery the radial nerve was found adhered to scar tissue and hence neurolysis was performed. Full union was achieved and full range of movement of her wrist joint was accomplished within six months of her surgery.

This 13 year old young girl presented to AO Clinic after complaining of pain in her right proximal femur. She was operated in a local hospital for intracapsular fracture with cannulated screws. She was taken to theatres. Removal of metal was done and an osteotomy at the level of lesser trochanter was performed and a Muller osteotomy plate was applied. This young girl went into full union and walks pain free. 

This 13 year old young boy attended AO Clinic six months after being treated elsewhere in a private hospital in the northern parts of Pakistan. On presentation he had a sinus around his proximal 3^rd of his left humerus. He was taken to theatres and an extensive sequestrectomy was performed. He was reoperated three months later once his CRP and ESR’s levels came to near normal. A clover leaf plate was applied which was augmented with a tricortical bone graft. After three months there were signs of radiological union and after seven months there was full bone union and child had full range of movement of his left shoulder joint.

This 24 year old patient attended AO Clinic after being treated elsewhere with an intramedullary nail and external fixator for an open fracture.  On admission there was a sinus at the distal 3^rd of his femur with pus discharge. Removal of metal together with a sequestrectomy was performed and an interval of two months took place before this patient had his final surgical fixation.  Broad dynamic compression plate was applied augmented with bone graft to his femur. At about three months radiological evidence of union was present and he was full weight bearing by four months. There was no leg length discrepancy.

35 Years

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