Arthrogrypotic club foot

Arthrogryposis Multiplex congenita is a rare disorder, characterized by multiple joint deformities i.e. multiple congenital contractures, with shapelessly cylindrical limbs and absent skin creases. Club foot can be the only obvious deformity of this widespread disorder. To assess the most frequent recurrent deformity after extensive soft-tissue release operations for arthrogrypotic club foot and its appropriate treatment regarding combined tendon transfer and bony operations. A retrospective study of 14 patients with arthrogrypotic club foot [28 feet], had been operated on by multiple soft tissue and bony operations and followed in a period between January [1993] till February [1999]. Both clinical assessment including goniometer use to measure the recurrent deformity, and radiological assessment, was used in this study. In this series, 4 patients [7 feet] had recurrent deformity, 3 patients [5 feet] out of these 4 had recurrent forefoot adduction, 2 of them had bilateral affection. The 4[th] patient had bilateral recurrent varus heel. The main problem in arthrogrypotic club foot is the liability for recurrence. The most frequent recurrent deformity was forefoot adduction. Combined tendon transfer and bony operations can correct the deformity once performed at the same session forefoot adduction. All required 2[nd] operation, in the 1[st] 3 patient combined Evan's [calcaneocuboid wedge-excision] and tibialis anterior transfer operations were performed. Talectomy was performed on one foot in the 4[th] patient, combined with capsulectomy of the calcaneocuboid joint, while triple arthrodesis done on the other foot

Recurrence after surgery in lumbar disc protrusions

Persistent symptoms after operation for lumbar disc protrusions may be due to: [1] disc prolapse at another level [2] residual disc material in the spinal canal [3] nerve root pressure by a hypertrophic facet joint or a narrow lateral recess ['root canal stenosis']. After careful investigation, any of these may call for re-operation: but second procedures don't have a high success rate. This study is designed to verify the possible causes of recurrence after surgery for lumbar disc prolapse and their appropriate treatment regarding re-exploration. A follow-up and result of treatment in 100 cases operated upon for lumbar disc prolapse is presented. Clinical and radiological assessments including myelography and magnetic resonance imaging were done post-operatively in persistent symptoms including backache or sciatica. In this series, twelve patients required re-exploration, 9 patients had only one re-exploration and 3 patients had two explorations each. One patient had one re-exploration was subjected to sacro-iliac fusion. which improved his symptoms. In the majority of patients the causes of persistence of symptoms are beyond the control of the surgeon. Removal of disc prolapse is effective in most instances in relieving the pain in lower extremity but a large number of patients continue to suffer from further backache and a few from further leg pain of varying intensity. Re-exploration carries a bad prognosis but if a disc prolapse is found at re-exploration then the result is much more favorable