rational approach to the management of deformities

In Collin's dictionary deform means to mar, alter the form of, to make misshapen, to disfigure; deformation is the art of altering for the worse; deformity is the state of being disfigured, a malformation of character, a moral defect. In Thorndike-Barnhart dictionary deform means that the part is not properly formed, or ugliness of mind or body

Tension band wiring of fractures of the phalanges and the metacarpals

The aim of this paper is to describe the technique of tension band wiring of the metacarpals. One hundred unstable closed fractures of metacarpals and phalanges were treated by open reduction and internal fixation using tension band wiring technique. Forty patients had metacarpal fractures and 60 phalangeal fractures. The youngest patient was 16 years old and the oldest 60; mean age was 29.8 years. There were 12 displaced transverse fractures, 38 displaced oblique fractures, 35 displaced spiral fractures and 15 comminuted fractures. The tension band wiring was applied using 0.0889 cm Kirschner wires and 26 - 28 gauge monofilament stainless steel suture. The period of follow up ranged from 6 - 30 months, average of 17.1 months. At the end of follow up, 87 patients achieved excellent results 10 achieved good results and 3 achieved fair results. encountered were superficial infection in 6 patients, tenderness over the fracture site in 21, local pain in 11, stiffness of the fingers in 16, deformity in 5 and non-union in 2. Problems of fixation occurred in short oblique and comminuted fractures. In such cases additional external splintage may be needed. Failure of tension band wiring was found to be due to the use of home-made cut tips Kirschner wires, repeated passage of the wires, improper knotting of the stainless steel sutures, presence of severe comminution and early use of the hands in heavy work before union of the fracture

Complications of traction

376 patients with different traumatic conditions affecting the femur, hip and pelvis were treated by either skin [15.2%] or skeletal [84.8%] traction. They were examined and followed up while on traction. Duration of traction ranged from 4 to 12 avenge 8.2 weeks. There were 262 males [69.7%] and 114 females [30.3%]. Their age was 7-92, avenge 59 years, 192 complications occurred in 111 patients [29.5%]; 41 patients [10.9%] developed. more than one complication. The complications were bed sores, stiffness of the knee, insomnia, chest infection, urinary infection, gastrointestinal troubles, pin track infection, psychological troubles, pressure sores, skin maceration, foot drop, deep vein thrombosis and death. Complications increased with advancing age. There were 170 patients over the age of 50, and 66 of them [38.8%] developed 133 complications [201.5%]. Females suffered more complications than males with a statistically significant difference. Skeletal traction in general was better than skin traction. The worst type of traction was skin traction in patients over the age of 50. Complications were more common when Bohler splint was used in skeletal traction. Trochanteric fractures showed the highest incidence of complications, while fractures of the pelvis showed the least complications. The longer the duration of traction the more frequently and seriously complications occurred. Patients with pre-existing medical problems had more complications than those who had no diseases

HLA-A, -B and -C specificities in osteosarcoma in the Egyptian population

HLA-A, -B and -C specificities were determined in 20 osteosarcoma cases and 30 normal subjects, by the microlymphocytotoxicity technique of Terasaki et al. Patients with osteosarcoma showed a trend to increased frequency of HLA-A2, a statistically significant increase of frequency of HLA-A2/A9 combination and HLA-Cw4 specificity. HLA-Aw23 antigen has been completely absent in all cases with osteosarcoma. These findings can be considered in harmony with the view of a genetic contribation, particularly through the HLA system, to the pathogenesis of the disease

Tibial torsion in osteoarthrosis of the knee joint

The incidence, direction and extent of tibial torsion in 311 patients with osteoarthrosis of the knee were studied [350 affected knees] using a tropometer. The control group consisted of 200 individuals [400 tibiae] of different ages, not suffering from osteoarthrosis. The tibiae of the first group on the nonaffected side were also measured and compared with the diseased and control subjects. In the control group there was no subjects with internal tibial torsion, zero torsion was present in 0.5% and all the remaining tibiae showed external tibial torsion [99.5%]. The range of external tibial torsion in them was 1-40, average 26.2. In the non-osteoarthrotic side in patients there was tibial internal torsion of 1- 20, average 9.2 in 17.7%, and external torsion of 1 to 29, average 19.9 in 78%, and zero torsion in 4.3%. In the non-osteoarthrotic side in patients there was zero torsion in 1.1%, external tibial torsion of 3 - 30, average 23.1 in 98.9%, and no tibiae with internal tibial torsion. It is concluded that internal tibial torsion is closely connected with osteoarthrosis of the knee joint, particularly when the medial compartment is affected, as a cause or as a result, most probably as an aetiological factor

study of the morphology of the patella in osteoarthritis of the knee joint

Fifty asymptomatic and 75 osteoarthritic knees were compared physically and radiologically. In the latter group side movements of the patella were limited, the Q-angle was increased and there were 13.3% with patellae altae. The mean congruence angle was -7° in the control group and -1.29° in the osteoarthritic group

Malgaigne fracture-dislocation: analysis of forces and end results of a method of treatment

Thirty-nine patients with Malgaigne fracture-dislocation of the pelvis constituting 10.8% of fractures of the pelvis were studied. There were 111 associated injuries or 2.85 injuries/patient and 17.9% mortality. Treatment was by bilateral skeletal tibial traction and dual pelvic sling, maintained for 4 weeks, then changed to skin traction for 4-6 weeks, followed by non weight-bearing excercises in bed for 4 weeks, then ambulation on crutches. Anatomical reduction was achieved in 65.6% of patients. Instability of fracture sites was demonstrated by stress x-rays in 6.8% of patients who could bear-weight. 3 patients 9.4% with gross neurological damage were disabled. 23 of the remaining 32 patients 71.9% were able to resume their pre-accident work. The remaining 6 patients had to change to a sedentary job because of pain over the sacroiliac joint; only two of these required surgical fusion of that joint. From analysis of the forces acting on the fracture sites, it seems that bilateral tibial skeletal traction is advantageous. It exerts compression at the sites of disruption thus stabilizing the fractures and helps healing

management of fractures of the distal end of the femur

Sixty-one patients with fractures of the distal end of the feumr were studied. The fractures were classified into three groups according to the site of the fracture and three grades according to the severity of displacement. Fractures with minimal displacement were treated conservatively. Fractures with moderate-to-severe displacement were subjected to traction and/or open reduction and internal fixation. Skeletal traction succeeded in 28.2% of the cases. Open reduction and internal fixation yielded better results; this was more evident when surgery was carried out primarily, i.e. as a first line treatment. Compression internal fixation was superior to the ordinary condylar blade-plate fixation but the difference was not statistically significant. The degree of displacement at the fracture site adversely affected the result of treatment. Stiffness of the knee joint was the commonest complication met with

Factors influencing bacterial contamination of open fractures

Bacterial contamination of open fractures is common; 72.0% in this series. This was found to be influenced by the cause and place of injury, the site and type of wound, presence in the wound of foreign bodies and dirt, and thoroughness of surgical debridement. First aid treatment as carried out in our country was not found to prevent primary bacterial contamination of open fractures. The effect of time lapse until definitive treatment was carried out remained conjectural. Additional infection of these wounds may occur in hospital if circumstances suitable for caring of these wounds are not fulfilled