Treatment of posterior dislocation of the shoulder secondary to brachial plexus birth palsy

Twenty patients [12 males and 8 females] with posterior dislocation of the shoulder secondary to brachial plexus birth palsy were treated with open reduction of the shoulder joint via an anterior approach. Age range at the time of surgery was from one to 11 years [average of six years]. Ten of the palsies involved the fifth and sixth cervical nerve roots, five involved the fifth, sixth and seventh cervical nerve roots and five involved the whole plexus. The diagnosis was suspected on clinical grounds and confirmed by CT or MRI. The mean duration of follow-up was three years [range 1.5 to 4 years]. There was no redislocation in this period and all the children are free of any shoulder orthosis. With Mallet scoring, all patients had an average improvement of 1.2 grades for abduction, 1.7 grades for external rotation, 1.8 grades for hand to mouth ability and 1.4 grades for hand to neck ability and internal rotation contracture was improved in all patients. Patients with C5, C6 level involvement tended to experience greater abduction postoperatively. In addition, patients with diffuse plexopathy tended to have lower postoperative global Mallet scores. Open reduction of the shoulder joint via an anterior approach in children who have paralytic dislocation of the shoulder due to muscle imbalance secondary to brachial plexus birth palsy is effective and improved the function of the shoulder even in very late cases and release of the contracted muscles enabled to perform the reduction easily

Treatment of congential pseudoarthrosis of the tibia using the Ilizarov technique

Twelve patients suffering from congenital pseudoarthrosis of the tibia were treated using the Ilizarov technique. Seven patients were males and five were females with an average age 7 years 7 months [range 3 years 2 months to 16 years 3 months]. Various methods were used to treat the pseudoarthrosis site including compression in five cases, distraction in three cases, resection and bone transport in one case and resection and shortening in three cases. While, lengthening was performed in all cases, deformities were corrected in nine cases. The union rate was achieved in 58.3% with one treatment and 91.7% with two treatments with a mean follow up of 3.5 years [range 1.5 to 5.5 years]. Complications were four refractures and three residual deformities

Treatment of tibial non-union by reaming and interlocking intramedullary nailing

We treated 50 patients with nonunion of tibial shaft fractures by interlocking intermedullary nailing, 48 by open and two by closed techniques. All fractures were seen for follow up until they healed [average healing time was 22.83 weeks]. Union was achieved in 48 patients, failed in two cases [4%] only. There were 4 cases [8%] with malunion and 3 [6%] with deep infection. Our results of these 50 patients confirms that interlocking intramedullary stabilization is an effective method for achieving union. Relatively low risk technique has a clear advantage of maintaining anatomic and mechanical alignment allowing rapid return to full weight bearing on the extremity, without the need of external immobilization and allowing rapid rehabilitation

Results of instrumented postero-lateral fusion for isthmic spondylolithesis

To study the results of instrumented posterolateral fusion for low and moderate grade of isthmic spondylolisthesis, twenty-four adult patients [mean age 36 years] underwent surgical treatment for grade I and II isthmic spondylolisthesis. The indication for operation was persistent pain in the back and the lower extremities, despite non-operative treatment for at least six months. Average follow up was 26 months. All patients had bilateral postero-lateral fusion using cancellous autogenous bone from iliac crest and transpedicular fixation were performed. In all cases, no attempt to reduce the slip was carried out. The transpedicular fixation devices used were Rogozinski, TSRH and AO system. A clinical grading scale was developed to evaluate the results. Twenty-two patients were available for follow up. As an overall results, there were ten cases [45.5%] as good result, five cases [22.5%] as fair result, five cases [22.5%] as poor results and two cases [9%] considered as failure of treatment. The result of the instrumented postero-lateral fusion with single level and with or without decompress-sion gives a reasonable result and should be recommended for the management of such condition for such patients in this age group