lateral extracavitary approach all through posterior

The Lateral extra cavitary approach [LECA] is a one stage approach allowing simultaneous ventral and dorsal exposure in the more familiar prone position without repositioning of the patients. It provides the ability to re-attack the ventral graft site after application of dorsal instrumentation. The neural elements are visualized early in the procedure allowing safe decompression. The aim of this work was to study the safety and technical difficulties of the LECA in different spinal pathology and the value of using a midline skin incision. 40 patients with different spinal pathology including trauma, tumours, infections, deformity and thoracic disc prolapse were treated via the LECA. 37 patients were operated via mid-line skin incision and only 3 patients via the hockey stick incision. All patients had decompression, anterior column reconstruction and posterior stabilization simultaneously. Mean follow up period was 21 months. Neither significant perioperative complications nor mortality were reported. The midline skin incision is more cosmetic and offers good exposure. The LECA is a safe approach better than combined anterior and posterior approaches

Oblique wedge osteotomy for treatment of adolescent tibia vara

Several surgical procedures have been described for treatment of adolescent tibia vara. Closing or open wedge osteotomies had been used for decades. Gradual correction by use of ring fixator had come in focus in the last two decades. Twenty-two tibiae with adolescent tibia vara in twenty patients were treated by oblique wedge osteotomy. The mean age at time of surgery was 13.7 years [range 11 tols years]. Sixteen patients were male and 70% of patients were obese. Twenty-one osteotomies had united uneventfully in an average time of 12 weeks [range 10 to 15 weeks]. One osteotomy showed delayed union with resorption at the osteotomy site had been treated by revision of the fixation device and union was achieved thereafter. One patient had weakness of big toe extension which resolved completely by 8 weeks. The tibiofemoral angle had been corrected from an average of 24.7° varus [range 16 to 38 degrees] to an average of 4.6° valgus [range 3° varus to 8° valgus]. Five patients had an average limb length difference of 1.3 centimeter [range 0.8 to 2.4 centimeter]. All patients had regained full range of motion and return to their routine activities. We had 16 tibiae with good, two with fair and 4 with poor clinical results according to Schoenecker criteria. We conclude that oblique wedge osteotomy is a valid option for treatmat of adolescent tibia vara. The use of the anatomical tibiofemoral angle is a simple and popular method for preoperative planning

Traumatic patellar tendon rupture mid-term results of primary repair and early mobilization

Patellar tendon rapture is not a common injury. Immediate surgical repair is the treatment of choice. Augmentation of the repair site, immobilization and post operative protocol are subjects of debate. Nine patients were included in this study, eight of them were males; all had primary surgical repair, neutralization wire and early mobilization program. The mean age was 32 years [range, 27- 38 years] with the mean period of follow up was 54 months [range, 39 - 96 months]. All patients but one had returned to their previous activity level. Three patients had residual anterior knee pain. There was no loss of extension of the knee with the mean flexion loss was 5° [range, 0-15 degrees]. The quadriceps power was grade 5 in all patients; three patients had a mean of 2.5 centimeters difference of quadriceps girth. The patellar height remains unchanged; the mean Insall-Salvati ratio was 1.08 +/- 0.59 compared with 1.07 +/- 0.73 of the uninjured knee. Six patients had excellent results, three patients had good with no unsatisfactory functional results. Excellent functional and subjective results with low complication rate support the use of this technique as a good alternative for management of traumatic patellar tendon rupture

Total knee replacement in severe deformities

Total knee replacement in severe deformities is a challenging procedure. Varus and flexion are the commonest deformities seen. Thorough soft tissue release and balancing is the key to a successful outcome. We tried to correct these cases without the need for expensive augments and specialized prosthesis. Our study included 30 knees in 23 patients with severe flexion and varus deformities. The average preoperative varus deformity was 20° [range, 14-38°] and the average flexion deformity was 15.6° [range, 5-30°]. Bone graft was used in 8 cases [26%] and tibial stems in 2 cases [6%]. No constrained prosthesis was used. The average follow up was 31 months [range, 8-65 months]. The average postoperative range of flexion was 115° [range, 90-147°], range of extansion between 0-6° and the average varus correction was 26° [range, 12-42°]. At the final follow up, we had 15 excellent, 12 good, 2 fair and 1 poor functional result, giving a 90% success rate. Our techniques resulted in restoration of alignment and stability without the need for wedges or constrained prosthesis with encouraging early and mid-term results