Orthopedic Khyber teaching hospital Peshawar

Knock knee (Genu vulgum) eight plates applied to both femur and tibia from medial side to stop growth and correct genu vulgum.

20 years old male with right tibia communated fracture after physical assault fixation done with illizarao external fixator.

Yes

Different sites at which the fixation of ACL can be done

Dr. Shahzad Ahmad
Lower Back Strain and Pulled Back Muscle.

Most episodes of low back pain are caused by damage to the soft tissues supporting the lower spine, including muscles, tendons, and ligaments.
The lower spine, also called the lumbar spine, depends on these soft tissues to help hold the body upright and support weight from the upper body. If put under too much stress, the low back muscles| or soft tissues can become injured and painful.

While a pulled back muscle or strain may seem like a minor injury, the resulting pain and muscle spasms can be surprisingly severe.

Types of Lower Back Strain
There are two common types of soft tissue injuries in the low back:

Muscle strain occurs when fibers in a muscle begin to tear from being overstretched or overused (commonly called a pulled muscle).
Lumbar sprain occurs when ligaments are overstretched or torn. Ligaments are tough, fibrous tissues that connect bones together.

A specific diagnosis of ligament sprain or muscle strain is usually not needed, as both have almost identical symptoms and receive the same treatment. This article refers mainly to lower back muscle strains, but applies to sprains or other soft tissues injuries as well.

The pain from a pulled back muscle can range from merely irritating to intense and debilitating.
Most cases of low back muscle strain start to abate within a couple of hours or days and do not lead to long-term problems. If pain has continued for more than a week or two, or if it is severe enough to disrupt daily activities, seeking medical attention is warranted.

Common Symptoms of a Pulled Back Muscle
Symptoms to expect from a pulled lower back muscle—or any type of lower back strain—typically include:

Dull, achy low back pain. Strained muscles usually feel sore, tight, or achy. Pain that feels hot, tingling, or electric is more likely caused by an irritated nerve root, not a pulled muscle.

Intensified pain with movement. Low back strain typically worsens with specific movements that activate the affected muscles. For example, there may be a flare-up of pain when getting up from a seated position, when bending forward, or when first getting out of bed in the morning.

Pain that is localized in the low back. Pain is usually concentrated in the lower back. It may also be felt in the buttocks and/or hips, as these muscles help support the low back. Rarely does pain travel down the legs and into the calves and feet, as in cases of sciatica.

Stiffness, difficulty walking or standing. Typical movements may be limited when a low back muscle is strained, making it difficult to bend, shift positions, or walk or stand for extended periods.

Local tenderness and inflammation. A muscle strain may become inflamed and feel tender to the touch. Muscle spasms and cramps can cause intense pain and temporarily limit mobility, as the affected area in the lower back may be swollen for a few days.
Pain relief when resting. Briefly resting the low back muscles allows them to relax, alleviating tension and spasms. Reclining in a supported position, such as sitting in a recliner with legs elevated or lying in bed or on the floor with the knees slightly elevated, may temporarily reduce pain. Pain will likely intensify when getting up to move again.
A common underlying component of the intense pain associated with a lower back muscle strain is from muscle spasms. The acute contraction of muscle fibers in the lower back, which are intertwined within and around an extensive network of nerves, can cause intense pain. This pain is often described as surprisingly severe.
Pain from a muscle strain or pulled muscle usually comes on suddenly and can be linked to a specific event or activity. The severe pain tends to resolve within one to two weeks.

It is not uncommon to feel a lower level of pain with intermittent pain flare-ups for up to 4 to 6 weeks after the initial injury.

Causes and Diagnosis of Lower Back Muscle Strain
Many lower back strains occur during everyday activities, such as while exercising or at work.

Common causes of—and risk factors for—low back muscle strain include:

Heavy lifting. Strain from heavy lifting, twisting the spine, lifting from the ground, or an item overhead are common causes of low back strain. Safe lifting practices include tactics such as keeping the item close to the chest and avoiding twisting the upper body while lifting.

Sudden impact. The impact from jarring motions can place heavy, immediate stress on the low back muscles. For example, high-impact sports such as football and lacrosse place excessive pressure on joints and muscles. The sudden impact from a car accident or a fall is another common contributor to back muscle injury. Deconditioned, stiff muscles are more prone to this type of injury.

Repetitive motions. Stressful, repeated motions can cause muscles to tighten or tear. Sports such as rowing, golf, or baseball may cause chronic strain due to repeated, forceful motions. Chronic strain may gradually become painful over time, or pain can suddenly worsen if a muscle is already sore and then put under intense stress.

Poor posture, weak abdominal or back muscles. When low back and core abdominal muscles are weak, the lower back becomes more susceptible to injury. Slouching forward puts added strain on the low back muscles and on the spine. Similarly, tight hamstring muscles place added strain on the lower back over time.

Taking on a new activity. Starting a new sport or activity may lead to a muscle strain by putting sudden, unfamiliar stress on a muscle or group of muscles.

The above list is not comprehensive—rather, it highlights some of the more common situations that lead to a pulled back muscle.

Several additional factors increase the risk of muscle strain, such as smoking (or any type of ni****ne intake), stiffness or limited range of motion in the back, and obesity.

Initial Treatments for Low Back Muscle Strain

Most cases of a pulled back muscle are treated using standard self-care or non-invasive treatments. Some typical first-step treatments for a pulled low back muscle include:

Anti-inflammatory medicines (NSAIDs) such as ibuprofen, aspirin, and naproxen reduce inflammation, which often contributes to pain. Anti-inflammatory medicines are available over-the-counter or with a prescription.

Over-the-counter pain medicines, such as acetaminophen, minimize pain by interfering with the way the brain interprets pain signals. Acetaminophen may also be included as an active ingredient in prescription medications, such as in combination with an opioid.

Muscle relaxants may be prescribed on a short-term basis to reduce muscle spasm. Most muscle relaxants do not affect muscles directly, but rather dampen pain receptors in the central nervous system. These medications have many side effects, and muscle relaxants also carry risk of addiction.

Ice packs reduce inflammation that can occur shortly after a muscle is injured. Typical recommendations include applying a cold or ice pack for 10 - 20 minutes at regular intervals throughout the day, and using a towel or other barrier between the ice and the skin to prevent an ice burn.

How to write Medico legal report Dr. Shahzad Ahmad