Percutaneous fixation of recent scaphoid fracture

Conservative treatment of fractures of the scaphoid often leads to an important physical and economic morbidity, especially in young active population. Acute percutaneous scaphoid fixation is a fast technique with minimal soft tissue damage, which allows immediate mobilization without prolonged casting. The study and the results are carried on 15 patients, presented with undisplaced B 1 or B 2 scaphoid fractures with minimally displaced fractures. Nine cases were treated by percutaneous pinning using K-wires and six cases were treated with cannulated screw. There was a short period ofimmobilization in below elbow cast. Union was obtained in all at a mean of 57 days [58 to 71]. The range of movement after union was equal to that of the contralateral limb. Grip strength was 95% of the contralateral side at three months. Patients were able to return to sedentary work within 6 weeks, and to manual work within 10 weeks. The results show that percutaneous fixation for recent scaphoid fractures is satisfactory and gives rapid functional recovery

Dome-shaped high tibial osteotomy guided by circular wire

The aim of this study was to evaluate the early results of dome-shaped high tibial osteotomy in patients with medial compartment osteoarthritis of the knee with varus deformity. The average preoperative duration of symptoms was 5.1 years. The average age was 50.71 years [range, 42-59 years] at the moment of operation. The mean follow-up was 16.6 months [10 - 22 months]. We assessed the degree of arthrosis according to Ahlb'ack in three-grade scale. The patients with varus deformity had mean preoperative and postoperative tibiofemoral angles of 4.4 WHITE BULLET varus [0 WHITE BULLET 11 WHITE BULLET] and 5.7 WHITE BULLET valgus [4 WHITE BULLET -100], respectively. The patients were assessed according to the system developed by the Knee Society Scoring System. The mean preoperative Knee Score was 52 and the Knee Functional Score was 53,while the mean postoperative Knee Score was 82 and the Knee Functional Score was 84. Although the indications for arthroplasty of the knee are more frequent nowadays, the authors recommend not to forget dome-shaped high tibial osteotomy in the treatment of angular deformity of the knee with osteoarthritis. After a mean duration of follow-up 16.6 months, we found that the dome-shaped high tibial osteotomy of the proximal part of the tibia provided satisfactory clinical results for patients with osteoarthritis of the knee

Open versus arthroscopic acromioplasty with intact rotator cuff

Twenty patients [22 shoulders] were selected for either open acromioplasty or for arthroscopic acromioplasty. All suffered from chronic impingement syndrome in the presence of intact rotator cuff, which conservative treatment had been unsuccessful. The minimum follow-up was 12 months for both groups. There was no statistical difference in mean postoperative shoulder scores between the two operative groups. However, there were more excellent and good results in the open group as compared with arthroscopic group [72.7%, vs 63.6%, respectively]. In addition there was a higher percentage of fair and poor results in arthroscopic group as compared to open group [36.4%, vs 27.3%, respectively]. As regard to the function and pain, postoperatively, there were a satisfactory results in around 80% of cases for either open or arthroscopic acromioplasty. Arthroscopic acromioplasty associated with shorter hospital stays and faster achievement of maximal pain relief as compared with open acromioplasty. Choice of the technique depends on expertise of surgeon

Alignment and soft tissue balance of severe varus knee in total knee replacement

Twenty-nine cases of severe arthritic knee with various degrees of varus deformity [15°-20°] were treated by total knee replacement. Twenty-one [72.4%] of cases were due to osteo-arthritis of knee while the rest [27.6%] were due to rheumatoid arthritis; bilateral affection was reported in 2 patients. There were 20 males and 7 females whose age ranged from 60 to 74 years. The deformity was partially correctable in nine [31%] cases and fixed in twenty [69%] cases. The aim of surgery was to achieve normal alignment of the limb and joint line and to balance the soft tissue structures on both sides of the joint. This required augmentation of medial compartment in 3 [10.3%] cases by bone graft and fixation by cancellous screws. Normal limb alignment was achieved in twenty-five [86.2%] cases. Four [13.8%] cases had residual varus deformity that ranged from [3°- 5° varus]. In three [10.3%] cases lateral laxity was sill present despite the soft tissue surgery