treatment of flexion contracture of the knee joint in hemophilic patients using gradual manipulation and serial casting

Hemophilia is a bleeding disorder caused by deficiency of clotting factor VIII or IX; it is inherited as sex linked recessive pattern. Musculoskeletal complications in haemophilic patients are disabling. Bleeding in to the large joints and soft tissues are associated with arthritic changes in the joints and contractures in the soft tissues. Deformities of the large joints especially flexion contractures are commonly seen in knee joint. It is important to prevent deformities, treat existing contractures and prevent recurrence to improve the patient's quality of life. This is a retrospective study analyzing the effectiveness of gradual manipulation and serial casting for treatment of knee joint flexion contracture in Hemophilic Iraqi patients. We included ten Hemophilic patients type A, treated between 2006-2008, six with unilateral and four with bilateral knee joint flexion contractures, excluding patients with multiple joint contractures other than knees, have severe arthritic changes, have subluxated unstable knees or have acute bleeding. Their age is between 16-22 years, the duration of deformity is 4-9 months, knee flexion contractures between 20-80 degrees and all of them don't have significant pain but their daily life is severely restricted by the deformity. Under factor cover, general anaesthesia and haematological care, we started serial manipulations and plaster of Paris casting, the number of casts is between 2-6 casts, till we get straight knees. After that splints are prescribed for the patient and followed up for a minimum 6 months, physiotherapy to strengthen the muscles around knee is initiated from the start and gradually increasing after the application of the removable splints. We have ten patients with fourteen deformed knees, after manipulations and serial casting 8 knees get full correction, and 6 knees still have less than 10 degrees of flexion which is acceptable for the patients, all the patients have improvement of their quality of life and walk free of pain after 2 months. Serial manipulation and casting under general anaesthesia is a very good maneuver to correct knee joint flexion contractures in hemophilic patients

Evaluation of closed reduction and percutaneous iliosacral cannulated screw fixation for sacroiliac disruption or sacral fractures; a preliminary study

High energy pelvic ring fractures are serious injuries result from motor vehicle accidents or fall from height, unstable pelvic ring injuries usually associated with sacroiliac disruptions or sacral fractures. The ideal treatment for unstable pelvic fractures remains a matter of debate. The main purpose of the treatment is to save the patient s life and then to achieve an excellent functional outcome. Percutaneous fixation of Sacroiliac joint disruption or sacral fractures is evolved recently as a minimal invasive technique with low complication rate and morbidities. A preliminary study to evaluate prospectively the effectiveness of the percutaneous cannulated screws fixation of posterior pelvic ring injures in unstable fractures with associated injuries. Six patients have been treated in Medical City/Baghdad [during the period of Jan.2012 till July 2012] by one surgeon, four males and two females with mean age 27 years [range 20-36 years], who have unstable pelvic ring injuries associated with other skeletal, neural or visceral injuries are treated by gradual closed reduction using skeletal traction through lower femur and percutaneous sacroiliac fixations using a 7 mm Cancellous partially threaded screws following the technique described by Matta and Saucedo using C-arm fluoroscopy. A data for the duration of procedure, blood loss, intra-operative and post-operative complications and post-operative rehabilitation were collected analyzed and compared to data for open reduction and internal fixation for the same injuries from other studies. pre and post-operative radiographs and CT scans of the pelvis were studied to evaluate the procedure. A total of 13 screw where inserted percutanously to a six patients. The duration of the surgical procedure was 30 minutes to 60 minutes including the preparation time. Wound size was 5mm-10mm, Blood loss was negligible, no anesthetic complications no intra or post-operative complications, no wound complications, and a very good post-operative rehabilitation. Postoperative X-rays and CT scans show no complications and a very good reduction and fixation for the Sacroiliac joints and sacral fractures. Gradual closed reduction and Percutaneous sacroiliac fixations using cannulated screws have demonstrated a very good minimally invasive technique with no intra-operative or post-operative complications. This technique may be advantageous as it avoids using extensive approaches, bleeding, wound complications and prolonged surgeries

Primary below knee amputation in the management of compound comminuted fracture lower tibia and fibula due to high velocity missile injury associated with bone loss and tibial nerve injury

Compound comminuted fractures of lower tibia and fibula are very common in Iraq these days due to missile injuries [bullets and blasts], it could be associated with bone loss and neurovascular injury this will interfere with the patients rehabilitation and leads to major social and economic burden on the patient, his family and the community. To prove that primary below knee amputation in management of compound comminuted fracture lower tibia and fibula due to high velocity missile injury and complete tibial nerve injury is superior to limb salvage. This is a prospective comparative study including 25 patients age 30-60 years presented to the emergency department in Medical City with a history of missile injury during the period 2005-2007 they had compound comminuted fractures of lower tibia and fibula [Gustilo grade II, III] all of them had different degrees of bone loss [more than 5 cm] and all of them had complete tibial nerve injury and 10 of them had associated posterior tibial artery injury which is irreparable. We divided our patients in to two groups the first one [9 patients four of them had also associated vascular injury] we did primary below knee amputation, while the second group [16 patients six of them had vascular injury] who refused amputation we did wound exsion and application of external fixation. Both groups followed up clinically and radiologically for one year. Group I the patients rehabilitated early and a prosthesis were used after one and a half month and the patients return to their original work or changing their work and have almost normal life, group II all of them had prolonged course of treatment with economic and social problems. Primary below knee amputation is a very good option for patients with history of compound comminuted fractures of lower tibia and fibula [grade II and III] associated with bone loss and tibial nerve injury. Decreasing rehabilitation time and early return back to work also less cost and less social problems

Management of compound comminuted fractures in and around elbow joint using across elbow external fixation followed by eearly active movement

Compound comminuted fractures around elbow are one of the most common injuries in our country today due to high velocity missile injuries they present a great challenge to the orthopaedic surgeon and severe suffering to the patients as comminution makes anatomical reduction impossible and stiffness is a well known associate .This study was designed to evaluate the functional outcome for such injuries. To evaluate the functional results of management of compound fractures in and around elbow joint using across elbow external fixation and early physiotherapy. A case series study was designed, a [20] patients presented to the orthopaedic and trauma department in the Medical City / Surgical Specialties teaching Hospital / Baghdad/ during the last two years 2006-2007, with history of high velocity missile injury to their elbow or around it, all of them treated by early wound excision and application of across elbow external fixation followed up for 6 weeks till healing of their wounds then the external fixation was removed and active assisted movement were started, patients followed up for 6 months and assessed both clinically and radiograph ically. Good range of elbow movement and return to the original work of the patients were noted in 100% of the patients, and follow up for the first 6 weeks after removal of the external fixation shows that most of the patients [15] got functional range of elbow movement, According to Mayo elbow performance score nine patient got 95 points and eleven got 85 points. Functional range of elbow movement can be achieved in compound comminuted fractures in and around elbow by using external fixation across the joint then physiotherapy