Beruflich Dokumente
Kultur Dokumente
A Bi-Annual Magazine
PIPOS
Pakistan Institute of Prosthetic
and Orthotic Sciences
Prof. Dr. Bakht Sarwar
Patron in Chief
Mr. Riaz-ud-Din
Volume V (January - June, 2010)
Editor
CONTENTS
Editorial.................................................................................................................................. 03
Introduction........................................................................................................................... 05
Reminiscence........................................................................................................................ 18
PRSP Section......................................................................................................................... 20
Articles Section...................................................................................................................... 22
Students Corner..................................................................................................................... 31
PIPOS
Plot# 6-B, Sector B-3, Phase 5, Hayatabad,
Peshawar, Pakistan.
+92 91 9217150/ 9217520
+92 344 9797980
Email: piposexplorer@hotmail.com
pipos.info@gmail.com
Electronic copy of PIPOS EXPLORER can
be obtained from: www.oppak.com/pipos.html
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VOLUME V (January-June, 2010)
EDITORIAL
ALHAMDO-LILLAH! By the grace of almighty ALLAH and the kind support from PIPOS
th
administration; we have been able to publish the 5 consecutive issue of “PIPOS EXPLORER”.
We know that you all have been waiting eagerly for it and at last your curiosity ends here by holding
this issue in your hands.
PIPOS EXPLORER, the only prosthetic/orthotic magazine in Pakistan, has entered an explosive
phase in its growth that has surprised and gratified both its editors and its readers. This magazine is
posted free of cost to all the prosthetists/orthotists, orthopaedic surgeons, orthopaedic workshops,
universities and NGO's throughout Pakistan and is also downloaded by hundreds of users from
the internet.
Although PIPOS EXPLORER has changed both in design and content, it has never changed its
basic aim. Its aim is to provide the latest information regarding PIPOS and prosthetic/orthotic field
to all the people who are helping the physically disabled people. Let me repeat my words once
again “PIPOS EXPLORER is for all those who believe in serving the humanity”.
Dear readers! you all are indeed a part of PIPOS EXPLORER because without your participation
we would have been in wilderness. It is your contributions which makes this magazine an
th
exclusive one. The feedbacks for the 4 issue that we received from the readers have really helped us
improving the quality and standard of this magazine. I am very thankful to all those who have sent
us their worthy suggestions and ideas and I hope to receive many more this time too.
Finally, I would like to say thanks to all the members of the editorial board for their hard work,
support and contribution that they extended towards me and the magazine.
Regards,
Riaz ud Din
Editor
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VOLUME V (January-June, 2010)
EDITORIAL BOARD
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VOLUME V (January-June, 2010)
ABOUT PIPOS
Pakistan Institute of Prosthetic and Orthotic Sciences (PIPOS) previously known as PETCOT, is the only
unique institute of its kind in the field of prosthetics and orthotics in Pakistan. PIPOS was established
in 1981 under bi-lateral assistance cooperation program between Pakistan and Germany and has
transitioned into a centre of excellence awarding B.Sc (Hons) degree in prosthetics and orthotics
from the University of Peshawar. PIPOS has been awarded as Category-II accreditation for training
and education in the field of Prosthetics and Orthotics by ISPO (International Society for Prosthetics
and Orthotics) based in Copenhagen, Denmark. Each year 12 students including both locals and
foreigners are trained in the field of Prosthetics and Orthotics. The students after graduation
undergo an exam here in Pakistan conducted by a delegation of ISPO. After passing the exam;
students are awarded a Category II certificate of orthopaedic technologist. Along with the provision
of B.Sc (Hons) degree, PIPOS is also providing all types of Prosthesis (Artificial
limbs) and Orthosis (Braces) for almost every kind of physical disability. For this
purpose institute maintains a model production centre providing assessment,
rehabilitation services to thousands of people annually. Each year more than 6000
orthopaedically disabled patients including amputees are fitted with the artificial
limbs and supports in PIPOS rehabilitation centre located at Hayatabad, Peshawar.
PROSTHETICS: It is the branch of orthopaedic science that deals with the study of
design, manufacture, and use of prosthesis (Artificial limbs) as a replacement for
a patient's limb loss caused through amputation or congenital limb loss. The aim of
this replacement is to provide an artificial limb, which looks and functions in a
manner, close to the natural limb as modern technology allows. The professionals
in this field are called a Prosthetist.
National Level:
Chal Network, AFIRM (Armed Forces Institute for Rehabilitation Medicine), PPL (Pakistan Petroleum
Limited), ERRA ( Earthquake Reconstruction and Rehabilitation Authority), PSRD (Pakistan Society for
the Rehabilitation of Disabled, Lahore), Al Khidmat Foundation Quetta, UET Peshawar, DOW Medical
university Karachi, MARDEA ( Medical Rehabilitation of the Disabled in Earthquake Affected Area).
International Level:
ISPO (International Society for Prosthetics and Orthotics), ICRC (International Committee of Red
Cross), WHO (World Health Organization), HI (Handicap International, France), DRI (Direct Relief
International, USA), The Parkwood Institute USA, University of Stathclyde Glasgow, Nippon
Foundation Japan, APOS (Alliance of Prosthetic and Orthotic Schools, Asia), George Brown College for
Prosthetics and Orthotics, Toronto, Canada.
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With this Vision PIPOS and the ICRC are working together on different projects. Some of them are
as follow:
It is the basic right of every disable to get access to rehabilitation services. Due to poor
economic conditions a majority of the population does not have access to physical
rehabilitation. The MoU between PIPOS and ICRC has given a great benefit to the people of NWFP
province of Pakistan, as
under this program the
major part of patient's
rehabilitation in PIPOS is
financially sponsored by
the ICRC. The patients
(who are part of the ICRC
target group) of far flung
areas are also provided
free accommodation and
food by the ICRC. In 2009,
2351 patients received
prosthetic and orthotic
services which were mainly
sponsored by the ICRC.
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Introduction of PMS
The Patient Management System (PMS) has been
introduced in the reception and two
receptionists were provided training for its
operation.
References:
Information and patient data obtained from Mrs. Jantien Faber (Team leader, ICRC PRP in Peshawar)
and Mr. Fazal Muhammad (Field officer, ICRC PRP, Peshawar)
Information obtained from ICRC SUPPORT FOR LIFE DVD.
www.icrc.org, accessed on 14/3/10
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VOLUME V (January-June, 2010)
APOS
Alliance of Prosthetic and Orthotics Schools Asia
The initiative was taken in 2003 by the Cambodia School of Prosthetics and Orthotics (CSPO) and
supported by the Nippon Foundation. Annually, the alliance has promoted the development of
staff exchange programs, annual meetings and the sharing of resources.
The core membership comprises of the four prosthetics and orthotics schools, three out of which
(Cambodia, Sri Lanka, Thailand) are directly supported by the Nippon Foundation, Japan and
the fourth school is from Pakistan.
APOS was initially managed by the international staff/leadership of the four founding schools,
the president of International Society for Prosthetics and Orthotics (ISPO), the Nippon
Foundation and the Cambodia Trust. However in 2009, the leadership was handed over to a
regional board from the four core schools, plus the school in Vietnam (VIETCOT). The founders
will maintain a presence as an advisory group from February 2009, eventually phasing out in 3-5
years. The newly formed APOS board had its first meeting in Thailand and the second meeting
was conducted in Sri Lanka in Feb, 2010.
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VOLUME V (January-June, 2010)
Participants of APOS Meeting 2010 at SLSPO (Sri Lanka School of Prosthetics and Orthotics) Sri Lanka
The Agenda of the meeting was to monitor the objective of APOS, set the criteria for staff
exchange programs and mentoring of some specific topic in member schools and monitoring the
activities of repository group.
The first day was allocated for the meeting of APOS sub groups. In the first session, APOS board
and Advisory group (Dr. Bakht Sarwar and Mary Scot) met together. At the same time task
officers and repository task officers were meeting in their respective groups.
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The Formal session was started on next day with registration of participants followed by elegant
ceremony of oil lamp lighting. Dr. Panagla from Ragama Rehabilitation Hospital, Advisory group
and APOS Board, Lise Hjelstoms (School Manager, SLSPO) lit the lamp.
Lise Hjelstoms, Uzma Jabeen(PIPOS) and Dr. Panagla delivered their speeches on behalf of
SLSPO, APOS board and Ragama Rehabilitation Hospital, respectively.
In Second session of the day, presentations were made about the objective Monitoring and APOS
budget. Representatives from Laos, Indonesia, Thailand, India, Pakistan and Cambodia
presented progress of their schools. Delegate from Bangladesh came with proposal of upcoming
school.
The final session of the second day mainly consisted of discussion about proposed criteria for
staff exchange and Mentoring topics. Mr. Teap Odom (CSPO, Cambodia) and Mr. To Sicheun
(CSPO, Cambodia) facilitated this session.
The Third and Last day was mainly about the activities of repository group. Mr. Aziz Ahmad
(PIPOS) coordinator repository group coordinated the meeting on 3rd day. Mr. Dan Blocka (ISPO)
and Mr. Thanit (SSPO, Thailand) did the demonstrations about the use of web page
(www.google.com/a/apos-aisa.org) and http://www.apos-asia.org/mod/system_home/.
The repository development for the APOS-Asia is getting its shape, but there are many
challenges to overcome. The legality and the process for documentation, copy rights, structure
and policy for the repository will be discussed in the coming days. Although the “walk through”
document has been developed even then the two main objectives of this year will be to give
some shape to the repository policy and the structure.
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Improving:
To arrange communication protocol for task officers, repository officers, and board need to have
regular reports.
To develop proper agenda for board meetings
To monitor the work plan against action regularly
Conclusion:
APOS board meeting, 2010 ended successfully. Action Plan for year 2010-11 was developed and
the criteria for staff exchange program and mentoring was also formulated. APOS web pages
were introduced to participants. Next APOS meeting and ISPO seminar will be conducted in
Indonesia (Jakarta School of Prosthetics and Orthotics) as the school offers to host the ISPO
Seminar to raise awareness of P&O services in the country.
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On Sunday, February 14th 2010 at 09.00 am, the opening ceremony of a regional seminar hosted by
the SLSPO at the Cinnamon Grand Hotel, Colombo Sri Lanka began with a traditional oil lamp
ceremony to welcome faculty and participants from more than 12 countries.
The seminar, on Prosthetic and Orthotic Services including Rehabilitation related to Diabetes
and other Neuropathic Disabilities, was part of a range of SLSPO activities to support
rehabilitation professionals in continuing education and professional development in Sri Lanka and
the region. The seminar was co-ordinated by the International Society for Prosthetics and Orthotics
(ISPO) and funded by the Nippon Foundation of Japan and ISPO.
The seminar focused on the
needs of people affected by
diabetes and leprosy. The world
is facing an epidemic of
diabetes, with up to 70% of all
leg amputations as result of this
disease.
Although leprosy is consider to
be eliminated, new cases persist
in many countries and the
rehabilitation needs for people
who have had leprosy are
ongoing and present similar risks
for foot complications and Participants of the seminar
amputation as for individuals who have diabetes. In spite of its curable nature leprosy remains
highly stigmatized often resulting in discrimination and displacement for individuals who have been
affected. Timely, appropriate care of neuropathic condition has been shown to reduce disabilities
and may help to lessen the associated stigma and burden of disease.
The faculty comprised experts from Argentina, Netherlands, Sri Lanka, Sweden and USA.
Participants included doctors, physiotherapists, nurses and prosthetist/orthotists and included
guests from Pakistan, Bangladesh, Cambodia, India, Indonesia, Lao PDR, and Vietnam. The seminar
provided opportunities for building professional networks, learning from each other and sharing
knowledge and experience to improve services for patients in the future. Three days of lectures
were compliments by practical sessions on casting, assessment and diagnosis.
Prosthetics and orthotics as a part of the multi-disciplinary team are essential for mobility and
prevention of disabilities to reduce the burden of disease; the seminar in Colombo allowed for a
valuable collaboration across disciplines from around the region.
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Dr. Khan Haider delivering his farewell speech Audience during the farewell speech
During the seminar many areas of neuropathic disorders were explained, such as identifying the
neuropathies, rehabilitation of neuropathies, the diabetic foot, neuropathy in leprosy,
conservative treatment of charcot foot, different levels of amputation, etc.
The seminar also aimed to increase the collaboration among the regional schools in developing
countries including PIPOS (Pakistan), SLSPO (Sri Lanka), CSPO (Cambodia), VEITCOT (Vietnam),
etc. Many expatriates from ISPO and other countries participated and delivered lectures during
the seminar.
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VOLUME V (January-June, 2010)
Mrs. Tabassum Rana (2nd from right) with other participants Practical session during seminar
During their visit a complete tour to different areas of PIPOS/PRSP was arranged and the
participants were briefed about the prosthetic/orthotic treatment and fabrication procedures.
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VOLUME V (January-June, 2010)
REMINISCENCE
When I was a student in PIPOS
George Bernard Shaw says “Reminiscences makes one feel so deliciously aged and sad”. This is
very true, as we go ahead in life we find new dimensions and when we look back there is a
combination of pleasant and unpleasant memories.
It is always difficult to recall the past and write reminiscence because it is like holding the sand
in hand. We want to hold the memories tightly in our fist and still they slip out of hand, but the
important events always shine around us. Among them one memory is like North Star which
always guides us in Life. Such an event in my life is entrance in PIPOS. As I am moving forward in
my life my vision revolves around P&O.
It was September 1996, when I entered the lecture room where Dr. Altaf Ahmad (Principal of
PIPOS at that time) was delivering the introductory lecture. After the lecture we went to Lab
where a set of different tools were waiting for us. First question in my mind was “what am I
gonna be?”
Although in practical entry test I faced the drill machine, hack saw and rasp file (at that time I
didn't know the names of tools) and I never had an experience to hold them before. Anyway it
had gone well. I remember the first ever demonstration in PIPOS. It was about filing a metal
piece and was demonstrated by Miss Seema Ishaq (she was my inspiration as gorgeous and caring
personality), it was a long demo and ended only after I fainted. I was then taken to Gym in
Khyber Teaching Hospital's campus. After drinking a glass of water I felt better. The dream or
nightmare which I faced at night was” am I gonna be a Blacksmith?” But latter in First year when
we started the casting I felt relieved.
In the end of First year in March 1997, the International seminar on Dysmilia was organized by
PIPOS in the special education building. It was the first great event that I attended.
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VOLUME V (January-June, 2010)
In second year, we started with SACH Foot and Ankle block, the question in my mind was” Am I
gonna be a carpenter?” But when we started Prosthetics my vision was changed but not cleared
because we never observed any patients until then. In third year when I fabricated a knee
disarticulation prosthesis; my vision was cleared and I felt proud. I made KDP for a 12 years old
girl (Uzma Rasheed) and the level of my joy and satisfaction knew no boundaries when I saw her
happy and smiling during gait training.
I still remember the Words of Mr. Liaquat Ali Malik who said at that time “there is no alternative
of satisfaction which you feel when a patient comes by crawling and goes upright because of
devices you provide to him”.
It was in January 2005, when I was going to passport office for my passport; because I was going
to Cambodia for my further studies and my mother was reluctant to send me abroad. But my
father's support and Dr. Sarwar's convincing power came in action and I went there for two years.
These two years were the most difficult time for me in a totally different culture. But thanks
God; this period ended up with success.
The greatest achievement was the moment when I was introducing APOS in front of people from
more than 15 countries. It is only PIPOS that provided me the platform from where I developed
myself.
I dedicate my success to my father, who died in March, 2009. It was his encouragement that gave
me strength to spend time in Cambodia and strive for the best. His death is a great loss to me, I
still feel as it was yesterday when he was with me but now no more. Dr. Abdul Zahir said about my
father “Physically he will not be in this world but his name would remain a live whenever you and
your sibling achieve success”. His words echo around me and give me courage.
I will always be thankful to my parents, teachers especially to Dr. Sarwar and friends who
contributed a lot in my life. But on top of everything, thanks to PIPOS because it is the axis
around which my professional achievements are revolving.
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VOLUME V (January-June, 2010)
PRSP SECTION
PRSP (PIPOS Rehabilitation Services Project)
Prosthetics 228
New 499
Repair 117
Replacement 41
Review 101
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CENTER PROFILE
PIPOS CHALL REHAB CENTER, BESHAM
Besham
Besham is one of the most beautiful area in district Shangla. It
has two sub divisions which are Puran and Alpuri. Shangla has
28 union councils having population of 10 lacs. Most of the
population is pashto speaking pashtoons.
According to the WHO the disability ratio in this area is 0.03%.
BESHAM & THE EARTHQUAKE Mr. Murad Ali
Center Manager/ Prosthetist & Orthotist
On Saturday October 08, 2005 at 8:52 am a devastating
earthquake 7.6 on Richter scale struck the Kashmir and five
northern districts of Pakistan. Among them Shangla was
one of the disaster prone areas of the earthquake wreckage
which affected almost whole of the population. The
earthquake disaster caused serious damages including
2000 deaths and leaving about 5000 people injured. Apart
from death and serious injuries the infrastructures like
health facilities, education institutions, link roads,
drinking water supply schemes, and many other
infrastructures of the district were completely destroyed.
PIPOS CHALL REHAB CENTER, BESHAM
PIPOS being the pioneer in rehabilitation, started its
services with DRI (DIRECT RELIEF INTERNATIONAL) and
Chall network for the PWDs.
A center was established in THQ Hospital Besham to
provide prosthetics/orthotics & physiotherapy services.
CENTER STATISTICS
Total registered patients : 653
Orthotic : 393
Prosthetic patients : 260
Physiotherapy patients : 7300
Prosthetic appliances delivered : 264
Orthotic devices delivered : 580
Total appliances delivered : 844
COORDINATION WITH OTHER ORGANIZATIONS
PIPOS rehab center has strong coordination with various national and international
organizations such as Chall network, ICRC, MRDEA (ERRA), HI (Handicap International), DRI
(Direct Relief International) etc.
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VOLUME V (January-June, 2010)
ARTICLES SECTION
Comparing the effectiveness of different orthotic techniques for treatment of
Legg-Calve-Perthe's disease
Fig.1 (a) shows Anterior Perthes disease of fourteen month child after the onset. The appearance is that
of a clean cut removal of the anterior half of the femoral head, leaving a normal posterior half.
Fig.1 (b) shows Petrthes diease of whole femoral head none month after the first symptom. The entire
epiphysis appears to be fragmented and flattened.
Treatment for LCPD includes observation (Goff, 1959), recumbency (Brothertorn, 1976;
Brothertorn & Mc Kibbin, 1977; Danforth, 1958), and containment of femoral head with in the
acetabulum through surgery, casts and Orthosis (Axer, 1965; Lioyd-Roberts, Catterall, &
Salamon, 1976; Pemberton, 1979).The choice of treatment is still a point of considerable
debate(Purvis, Dimon III, Meehan & Lovell, 1980)
The purpose of this assignment is to find out different orthotic techniques and compare them for
their advantages and disadvantages regarding patient's comfort and prognosis, which require a
deep knowledge of epidemiology, etiology and classification of this inexplicable disease.
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VOLUME V (January-June, 2010)
Etiology
A number of causative factors in LCPD have been explained in different research papers. These
ideas include vascular factors especially obstruction of posterior circumflex artery (Joseph, et
al. 2001; Sanctis & Rondinella, 2000; Hayek, Kenet, & Lubetsky, 1999), traumatic factors for
example repetitive micro traumatism in hyperactive children (Goff, 1954; Carpenter,1975) ,
congenital malformations like delay in skeletal maturation (Bogaert, Rosa & Moens, 1999; Boss &
Misselevish, 2003), hormonal growth abnormalities (Matsumoto, Enomoto, & Takahashi, 1998;
Kim, Randall & Bian, 2005), malnutrition like increased incidence in low income families(Orban
& Adam, 2007) and racial factors for example Japanese, Asians and Central Europeans have high
frequency of this syndrome while native Australians and Americans have decreased occurrence
(Orban & Adam, 2007).This disease remains somewhat of a mystery and the exact cause of the
ischemic necrosis of femoral head cannot be identified (Carpenter,1975).
Classification
Several classification methods have been developed, however
Catteral classification is most important one which is based on the
amount of femoral epiphysis involvement and has four groups of
LCPD (see Fig.2) (Nochimson, 2008; Canale, et al. 1972).Group 1
has limited involvement of anterior femoral epiphysis (least
severe) and Group IV has the involvement of entire epiphysis (most
severe) while Groups II and III are in-between to the other two and
held in reserve prognosis (Orban & Adam, 2007; Carpenter, 1975).
Fig. 2 shows Catterall classified Legg-Calve-Perthes disease in to
four stages. In stages 1; necrosis is present at the anterior aspect of
the femoral head as noted by the dotted areas. Lysis is present,
but there is no bony sequestration. In stage 2, bony sequestration is
present as noted by the central areas of radiopacity. A medial and
lateral column of normal bone protects the central area from
collapse. In stage 3, extensive bony sequestration dimishes support
and increases the chance of residual deformity. Metaphyseal cyst
formation is noted by the lines lashed areas. In stage 4, total
involvement produces significant residual deformity shown by the
jagged areas that indicate sclerosis and decreased size of the
femoral head. Retrieved from Gerberg & Michael, 1996.
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VOLUME V (January-June, 2010)
Prognosis
The prognosis of LCPD is generally influenced by factors like age and sex of the patient along
with stages of the disease at the time of diagnosis (Catterall, 1971). It is directly proportional to
the degree of femoral head necrosis; the more extensive the involvement, the poorer the
prognosis (Canale, et al, 1972; Carpenter, 1975). Prognosis of LCPD is good with Catteral I and II
,while it is poor with III and IV (Orban & Adam, 2007; Herring, Kim & Browne, 2004).The central
position and distribution of forces over the femoral head can be achieved by conservative
approaches and surgical methods (Roposch, Mayr & Linhart, 2003). Surgical treatment consists
of innominate osteotomy and varisation osteotomy of proximal part of femur (Salter, 1973;
Harrison & Menon, 1966) while for conservative treatment abduction orthoses are considered
effective (Roposch, et al. 2003).
Containment splint enforces the femoral head with in the acetabulum by abduction, flexion and
internal rotation of hip and is better in containment than Synder sling (see Figs.3-A, 3-B)
(Bowen, et al. 1984; Harrison, Turner, & Nicholson, 1969) while in SRO which is the most widely
used orthosis(Martinez et al. 1992), hips are held abducted, flexed and externally rotated (see
Figs. 4-A & 4-B) (Meeham, Angel & Nelson, 1992; Orban & Adam, 2007).
Craig abduction walking splint is a bit different from the above in which containment of hip is
achieved through abduction, internal rotation and extension instead of flexion at the same time
as using regular axillary crutches (Craig, Kramer, & Watanab, 1963).While Toronto Legg-Perthes
brace allows walking maintaining hips at 45 degrees abduction and the remaining hip and knee
motions are permitted (Fig.7) (Bobechko, McLaurin & Moyloch, 1968).
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VOLUME V (January-June, 2010)
Weight bearing orthosis which is not much popular in use provides maintenance by abduction
and flexion of the hip (Wang et al, 1995) but it also allows medial and lateral movements that
leads to deterioration of femoral head (Bobechko et al, 1968).
Fig. 3- A (Anterior view) and Fig.3- B (Side view): The containment splint. The Right hip is held in
abduction, flexion, and full internal rotation. Adapted from Harrison et al. 1969.
Fig. 4-A: The Scottish Rite abduction orthosis. Frontal view of orthosis, showing the pelvis band. Single
axis hinge joints and pistoning the abduction bar. Retrieved from Meehan, et al. 1992
Fig. 4- B: Anteroposterior radiograph of the pelvis, made with the patient standing while wearing the
orthosis, showing coverage of the affected right hip with 30 degrees of abduction. Retrieved from
Meehan, et al. 1992
Figs. 5-A (Anterior view) and 5-B (Posterior view) :The Newington brace; Note careful molding and
setting of stabilizing shells, as well as foot-ankle components to maintain slight internal rotation.
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VOLUME V (January-June, 2010)
Fig. 6 shows Tachdjian trilateral socket hip abduction orthosis, Retrieved from Tachdjian, 1972
Fig.7 Shows the Toronto brace for Legg-Perthes disease in use. Retrieved from Bobechko, et al. 1968
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VOLUME V (January-June, 2010)
Fig.8 (A & B) show a good result assessed by method of Mose, in frontal and lateral views respectively.
Retrieved from Petrie & Bitenc, 1971.
Although SRO is a popular method of treatment ( Meechan et al. 1992,; Martinez, et al. 1992)
even though the results reported by Wang et al. (1995) treating patients with SRO, were
significantly worse for Mose measurements than those for hips treated with Petrie cast,
exercises and non-weight bearing orthoses. But in Cooperman and Stulberg (1986) study, 71%
patients have achieved spherical heads through the use of SRO; while 64% through Newington
brace. Martinez, et al. (1992) and Meehan, et al. (1992) concluded in their reports that SRO did
not offer any advantage as compared with other methods, or with no treatment. Authors of early
reports found SRO to be successful in spherecity of femoral head compared to other braces but
recent studies did not show a positive response to its outcome (Martines, Weinstein & Dietz,
1992; Kamegaya, 1987). Kelly, et al. (1980) reported 80% good results (100% spherical heads) in
their study relative to the use of Synder sling. Herring, (1994) has shown deep concern that
despite having good results why Synder sling method has been abandoned.
Comparison on prognostic factors
Majority of the studies stated that the prognosis of LCPD depends on the age of onset and stage
of the disease i-e Caterall classification (Sticker & Barone, 2001).It is also mentioned in these
articles that the proportion of poor results increases with the age of onset, especially after the
age of six ( Catterall, 1971; Gossling, 1973; Katz, 1967; Mose, 1964)
Fulford, Lunn & Macnicol (1993) compared the outcome of Ischial Weight Bearing Brace with
osteotomy in patients with average age of 6 years and 4 months and hips in catterall groups III
and IV. It is found with 26% good and 30% poor result compared with 20% and 23% that had
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VOLUME V (January-June, 2010)
osteotomy. The results obtained by Kelly et al. (1980) through using Synder Sling Orthosis for
patients with same age and catterall groups as in Fulford et al. (1993) study, were 50% good and
26% poor. It means that the results of Synder sling orthosis are better than ischial weight bearing
brace and osteotomy.
Meehan et al. (1992) reported the use of SRO in patients who were more than 6 years of age and
their hips had catterall grades III and IV involvement, only 35% patients had good result. On the
other hand Martinez et al (1992) treated 31 patients of same age and catterall grades by using
Weight Bearing Orthosis. No hip had good result; only 35% hips had a fair result. It is clear from
these results that Weight bearing orthosis is contraindicated for treating severely involved hips
(Martinez et al. 1992).
Conclusion
Legg-Calve-Perthes' disease is a disorder that involves growth of the immature proximal femoral
epiphysis. Containment of the femoral head with in the acetabulum is currently the preferred
method which can be achieved by either surgical or non operative methods. The degree of
necrosis, age at the onset, and deformity of femoral head are important factors in predicting the
outcome of treatment. Most of the authors suggest that Catterral I and II stages should be
treated through non surgical treatment, while surgical intervention is best for Catterral III and
IV. Among the non surgical techniques, Scottish Rite abduction orthosis was preferred by authors
of early reports but recent studies have rejected it because of having several disadvantages. The
management of patients with LCPD is problematic because the best method is unknown.
References
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Disillusionment meets us on all path of life but every where it is hope that always succeeds in the
divine scheme of things. Hope keep on rising in human chest all the time, if one hope fails
another takes its place. Human heart usually contains several hopes simultaneously so that the
non realization of one hope doesn't cause much distress. Hope like all heavenly blessings reigns
everywhere: the sky, high palaces and the smallest ones. Dark hamlets all are lit up by hope, its
light may become dim but it never extinguishes even in the darkest hour of life. There is no limit
to hope. A dying man keeps on hoping for his recovery, he is hoping against hope. Hope is given up
only when death actually comes. Indeed hope is natural as breathing and as breathing ends with
death so hope also dies with it. Man's life is woven with dreams, ambitions and hopes. If he had
not experienced hope, ambitions and dreams, society and civilization would not have made any
progress. Hope & dreams are the main springs for advancement in life.
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VOLUME V (January-June, 2010)
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VOLUME V (January-June, 2010)
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VOLUME V (January-June, 2010)
Words of Wisdom
The selfish one letter word is 'I' avoid it.
! The most essential ten letter word is
!
“confidence” develop it.
The most satisfying two lettered word is
!
“WE” use it.
By: Anum Ishtiaq
The most poisonous three lettered word is
! Semester 5th
“EGO” kill it.
The most used four lettered word is “love”
!
value it.
The most pleasing five lettered word is
!
“smile” keep it.
The fastest spreading six letter word is
!
“rumor” ignore it.
The hardest working seven letter word is
!
“success” achieve it.
The most unenviable eight letter word is
!
“jealousy” distance it.
The most powerful nine letter word is
!
“knowledge” acquire it.
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VOLUME V (January-June, 2010)
Conversation of a
Computer Engineer with His Wife
Husband (returning late from work): Good
evening dear. I am not logged in.
Wife: Do you love me or do you only love computer or are you just being funny?
Husband: Too many parameters.
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VOLUME V (January-June, 2010)
37
VOLUME V (January-June, 2010)
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VOLUME V (January-June, 2010)
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VOLUME V (January-June, 2010)
FUNNY MOMENTS
This section has been included in the magazine on the demand of students and faculty members
PIPOS ka PIR aur MUREED Honey Bee kai kaatnai kay baad..
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VOLUME V (January-June, 2010)
Lagtha Hai Cake Kuch Ziyada Hi Meetha Tha Un-indentified object between two men
41
VOLUME V (January-June, 2010)
Akhir mai bhi final year mai poohanch gaya Pakhtoonkhwa……. zinda bad
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VOLUME V (January-June, 2010)
Jab basit hang ho jatha hai….tho waqas issay restart kartha hai Ala toto marchakai khuree
baraf kai sa gorai…margari da PIPOS kai nast di… Khul ja sim sim..Khana AA raha hai
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