Use of drain in laparoscopic cholecystectomy

Background: laparoscopic cholecystectomy has become the procedure of choice for treatment of patients with gall stones. The routine placement of drains becomes a part of this operation for a long period of time. However, controversy has surrounded this practice in elective conventional cholecystectomies, with most surgeons departing from this approach

Aim of the Work: this study aimed to assess the value of the drain in uncomplicated laparoscopic cholecystectomy and if the insertion of a drain should be routinely done or not

Patients and Methods: this study was conducted at AL-Azhar University Hospitals in Cairo [Al Hussien and Bab Al Shaaria Hospitals], Kafr Al-Sheikh General Hospital and Biala Central Hospital on 180 patiants presented to general surgery clinic with gall stone disease. Patients were randomized into two groups and both groups underwent laparoscopic cholecystectomy, group A [90 patients] received a drain in gall bladder bed and group B [90 patients] receivd no drain. Postoperative mortalities and morbidities shuch as pain, nausea, vomiting, fever, abdominal collection, wound infection, need for analgesics and time of discharge from hospital were assessed. Statistical analysis was performed. Mean and standard deviation were estimated for each continuous variable

Results: there was no mortality in either groups and no statistically significant difference in postoperative pain, nausea, vomiting, wound infection or abdominal collection between the two groups. However, hospital stay was longer in the drain group than in group without drain

Conclusion: our study suggested that insertion of drain should not be routinely done in elective laproscopic cholecystectomy as it has no significant effect on postoperative morbidity, moreover, it delays hospital discharge

role of advanced techniques of MRI in evaluation of pediatric bone tumors

Background: Functional magnetic resonance imaging [MRI] improves tissue characterization and staging of bone tumors compared to the information usually supplied by structural imaging. Dynamic MRI and diffusion MRI can be performed in everyday practice. Tumour characterization can benefit from perfusion MRI with dynamic gadolinium injection and enhancement time-intensity curve analysis combined with quantitative and qualitative diffusion MRI

Aim of the Work: is to elucidate the role of advanced MRI techniques in diagnosis of pediatric bone tumors and to assess the diagnostic potential of Dynamic contrast enhancement [DCE] in conjunction with Diffusion weighted imaging [DWI] in differentiating benign from malignant bone tumors

Patients and Methods: a prospective study conducted on thirty pediatric patients with clinically suspected and radiologically proven bone tumor or tumor like lesion. The patients were referred from the Department of Orthopedics, Ain Shams University. The patients were investigated using 1.5 Tesla magnetic resonance device. They were subjected to conventional MRI and DCMI

Results: DWI with measurement of Apparent diffusion coefficient [ADC] values helped in the differentiation of benign and malignant bone tumors, and that the best cut-off criterion is ADC of 0.9 is defined as benign results with overall sensitivity 100% and specificity 100%. A type II curve was seen in 23 cases [one malignant and twenty two benign], type IV was seen in 5 cases [all are malignant] and type V curve was seen in two malignant cases [after chemotherapeutic treatment]. ROC analysis for the Dynamic contrast enhancement [DCE] showed a sensitivity of 75 % and specificity of 100%

Conclusion: DWI and DCE-MRI had been proven to be highly useful in the differentiation of benign and malignant bone tumors. Measurement of ADC values improved the accuracy of the diagnosis of bone tumors. Moreover; they could be used in the follow up of tumors and their response to therapy

Magnetic resonance imaging of suspicious ovarian lesions

Background: Characterization of an ovarian lesion represents a diagnostic challenge; the optimal assessment of an adnexal mass requires a multidisciplinary approach, based on physical examination, laboratory tests and imaging techniques. Diagnostic imaging plays a crucial role in detection, characterization and staging of adnexal masses. Magnetic Resonance Imaging [MRI] is an essential problem solving tool to determine the site of origin of a pelvic mass and then to characterize an adnexal mass, especially in patients with indeterminate lesions

Aim of the Work: The aim of the study is to evaluate role of MRI as a powerful and noninvasive technique which may effectively characterize and differentiate between various suspicious ovarian lesions

Patients and Methods: The current study is a prospective analysis that evaluated 26 female patients with 36 suspicious ovarian lesions. The study was conducted at Radiology Department of El-Demerdash hospital. The patients were previously evaluated by ultrasound examination in the period from November 2017 to April 2018. The patients' age ranged from 12 to 65 years old [mean age 41+/- 15 SD]. 4 patients presented by abdominal swelling [15%], 8 were complaining of chronic pelvic pain [30.7%], 10 came with menstrual irregularities [38%] and 4 [15%] cases were accidentally discovered during US examination

Results: This study included 36 ovarian lesions in 26 patients [8 cases had bilateral masses]. The age in cases with benign lesions ranged from 12 to 65 years [Mean age 37.31 +/- 16.214 SD], While the age in cases with malignant lesions; ranged from 14 to 61 years. [Mean age 44.38+/-14.015 SD]

Conclusion: As an advanced technique, dynamic contrast-enhanced MRI [DCE-MRI] plays an important role in tumor detection and characterization, subtyping, prediction of prognosis, treatment monitoring, and drug development

Sonographic evaluation of synovium of wrist joint in rheumatoid arthritis patients during activity

Background: Rheumatoid arthritis [RA] is an inflammatory rheumatic disease with progressive course affecting articular and extra-articular structures resulting in pain, disability and mortality. Persistent inflammation leads to erosive joint damage and functional impairment in the vast majority of patients. The onset of disease is not similar in all patients but varies in regard to type, number, and the pattern of joint involvement. The course of disease may be also different according to the presence or absence of several variables including genetic background, frequency of swollen joints, autoantibody in the serum and the severity of inflammatory process

Objective: The aim of this study was to demonstrate the role of Ultrasonography and Power Doppler in diagnosis of activity of rheumatoid arthritis in the hands and wrist joints among different aged population, compared with the laboratory investigations

Patients and Methods: This study was carried out in Radiology department of Ain Shams university hospitals. Twenty-five patients known patients with rheumatoid arthritis suspecting activity will underwent assessment by ultrasonography and power Doppler of both wrist and hand joints

Result: US and PD are highly sensitive and specific in detection of activity of the Rheumatoid Arthritis in correlation to laboratory investigations. So, they can be used as non-invasive methods in detection of RA activity changes in wrist and hand joints

Conclusion: Both ultrasonography and power Doppler are good predicators for activity in rheumatoid arthritis patients

Sonomammography versus MRI in evaluation of BI-RADS III breast lesion

Background: Breast cancer is sometimes found after symptoms appear, but many women with breast cancer have no symptoms. This is why regular breast cancer screening is so important, early detection and treatment are the most important strategies to prevent deaths from breast cancer. Breast cancer that's found early, when it's small and has not spread, is easier to treat successfully, regular screening tests are the most reliable way for early detection

Objective: to high light the role of sonomammography versus Magnetic Resonance Imaging [MRI] in evaluation of BI-RADS III [Breast Imaging Reporting and Data System] breast lesion

Patients and Methods: in this retrospective study, 28 patients with BI-RADS III breast lesion were assessed by Digital mammography [DM], Ultrasound [US] and MRI. The resultant images were correlated with reports of the pathology specimens

Results: histopathological analysis was done for each lesion with 13 lesions [46.43%] proved to be benign, 15 lesions [53.57%] proved to be malignant. The sensitivity, specificity, Positive predictive value [PPV] and Negative predictive value [NPV] of mammography [MG], ultrasonography and MRI in BI-RADS III breast lesions were calculated

Conclusion: BI-RADS III lesions group is a very critical group to deal with as it exhibits characters of both malignant and benign lesions. According to our study Dynamic contrast enhanced - Magnetic Resonance Imaging. [DCE-MRI] should go hand by hand with sonomammogaphy especially in BI-RADS III patients group, patients with benign looking lesion six months follow up is recommended and those with malignant looking lesion biopsy should be done

Role of Pet/Ct in assessment of post therapeutic hepatocellular carcinoma

Aim of the work: this study aimed to highlight the role of PET/CT in evaluation of post-therapeutic hepatocellular carcinoma, hence guiding the clinician to proper management strategy

Patients and methods: 35 patients [32 male and 3 female] were included in this study. All patients had history of local treatment of HCC; most of the cases were treated with TACE or RFA. They had undergone 18F-FDG PET/CT for evaluation of the therapeutic effect after the end of the therapy

Results: our study demonstrated that 18F-FDG PET/CT is a significant prognostic factor for tumor recurrence in post-therapeutic HCC with a cutoff TSUVmax/LSUVmax value of 1.3

Conclusion: 18F-FDG PET/CT imaging have a prognostic significance in evaluation of patients with posttherapeutic HCC and provide valuable information that can be used in the treatment response evaluation and clinical decision making process

Attempt to improve the diagnostic efficacy of enzyme-linked immunosorbent technique for the serodiagnosis of cystic echinococcosis

ELISA with crude hydatid fluid antigen [CHF] is widely used in the immunodiagnosis of cystic echinococcosis, but cross-reactivity with other helminths, overestimating the true prevalence, represents a great limitation. The present study was carried out to comparatively assess the diagnostic performance of three different ELISA techniques; cystatin capture ELISA, sodium metaperiodate treated antigen ELISA [SMP-ELISA] and conventional ELISA, using CHF antigen to detect lgG antibodies in the serum, aiming to increase the diagnostic efficacy of ELISA technique in detection of hydatid disease. The individuals under study were categorized into 3 groups. Hydatidosis group included 30 hydatidosis patients confirmed by IHAT and abdominal ultrasonograpy, computerized tomography or surgical removal with aspiration and cytological examination. Other parasitic diseases group included 10 sera from patients with; amoebiasis [2], fascioliasis [2], toxoplasmosis [3] and schistosomiasis [3]. Control group included 10 healthy individuals. Sera of all groups under study were examined for the detection of E. granulosus IgG by three different EL1SA techniques; cystatin capture ELISA, SMP-ELISA and conventional ELISA. The diagnostic performance of the three tests was statistically compared. The best diagnostic results were obtained with cystatin capture ELISA. with 96.7% sensitivity. 100% specificity, high positive predictive value [PPV] [100%] and negative predictive value [NPV] [95.2%], 98% diagnostic accuracy [DA], and AUC [0.999] with Cl [95%] [0.99-1.0], followed by SMPELISA, with 90% sensitivity, 95% specificity, PPV [96.4%], NPV [86.4%], DA [92%] and AUC [0.995] with CI [95%] [0.97-0.99], then, the conventional ELISA, with 90% sensitivity, 75% specificity. PPV [84.4%], NPV [83.3%], DA [86%], and AUC [0.962] with Cl [95%] [0.88-0.98]. Both cystatin capture ELISA and SMP-ELISA gave equivalent results for the immunodiagnosis of cystic echinococcosis with AUC1-AUC2 < 0.05. Cystatin capture ELISA and SMP-ELISA are valuable tests for serodiagnosis of human cystic echinococcosis as they improved the diagnostic performance of conventional ELISA

Cementless acetabular component after acetabular fracture

Acetabular fractures are serious and uncommon orthopedic injuries. Many of these fractures may potentially result in late complications such as post-traumatic arthritis, osteonecrosis of the femoral head and chondrolysis. These complications can occur with and without initial surgical treatment. Total hip replacement for these patients has produced results inferior to those in patients with nontraumatic arthritis. The purpose of this study is to evaluate the results of total hip arthroplasty with a cementless acetabular component in patients with posttraumatic arthritis. In this study, twenty one hips [in twenty one patients] with posttraumatic arthritis due to fracture of the acetabulum were treated with delayed primary total hip arthroplasty with a cementless acetabular component. The average age at the time of hip replacement was 50.5 years [range, 37 to 62 years]. The interval between the initial acetabular fractures and the hip replacement was 30 months [range, 14 to 52 months]. Nine patients [42.8%] had previous open reduction and internal fixation of their acetabular fracture while twelve patients [57.2%] were treated nonoperatively. Eleven hips [52.4%] required bone grafting of the acetabular defects. Three of the nine hips [33.3%] with a previous open reduction and internal fixation required bone-grafting of the acetabular defects compared with eight of the twelve hips [66.7%] treated by closed means. The average duration of follow-up was 42 months [range, 24 to 60 months]. Evaluation of our patients included the clinical and the radiological assessment. The Harris hip score was used for clinical assessment. The average clinical results of our patients were considered good [87.6 points]. Nine patients [42.8%] had excellent results, eleven patients [52.4%] had good results, and one patient [4.8%] had a poor result. Radiographic analysis revealed that eighteen components [85.7%] met the criteria for stable fixation. A complete radiolucency, <1 mm wide [possibly unstable], was seen around two reconstructions [9.5%]. One acetabular component [4.8%] was surrounded by a complete radiolucency of >2 mm in width. This component was classified as unstable. Total hip arthroplasty with cementless acetabular component after old acetabular fractures is usually difficult because of bone defects, extensive scarring, heterotropic ossification, and retained implants in patients with previous internal fixation. Despite these difficulties, the clinical results are encouraging

Arthroscopic biodegradable meniscal arrow repair

The importance of the meniscus in both the function and longevity of the knee has been well established. Consequently, preservation of the meniscus is a worthwhile surgical goal. Arthroscopic all-inside meniscal repair techniques have become popular to avoid the potential complications of other techniques and decrease the operative time. The arrow is a bioabsorbable device with barbs that are placed across a meniscal tear. In this study, 23 patients with 23 isolated meniscal tears underwent arthroscopic repair with the Meniscus Arrow system. The average patient age was 30.5 years [range, 19 to 38.5]. Eighteen meniscal tears [78%] were in the medial meniscus, and 5 tears [22%] in the lateral meniscus. Nineteen meniscal tears [82.6%] were repaired within 8 weeks of injury [acute tears]. The remaining 4 tears [17.4%] were repaired after 8 weeks from the injury [chronic tears]. There were 15 [65%] vertical [longitudinal] tears, and 8 [35%] bucket handle tears. Five tears [21.7%] were at the menisco-capsular junction, 12 tears [52.2%] in the red/red zone, and 6 tears [26%] in the red/white zone. The average follow-up was 15.5 months [range, 12-24 months]. Evaluation by Lysholm knee score showed that 11 patients [47.8%] had excellent result, 8 patients [34.8%] good result, 1 patient [4.3%] fair result, and 3 patients [13%] poor result. No infection or neurovascular complications occurred in any patient. The use of biodegradable Arrows for meniscal repairs has many advantages as regard the all-inside technique, pull-out strength equal to horizontal suture method, short operative time, easy surgical technique, good clinical results, and low risk of neurovascular complications

Anterior cervical interbody fusion using carbon fiber cages

Anterior decompression and inter body fusion is a widely accepted surgical treatment for patients with cervical disc herniations and cervical spondylosis. Tricorticaf iliac crest autograft has been considered the classic method but problems such as graft collapse, and extrusion still persist. Cages were introduced because of their theoretical ability to prevent graft collapse. Carbon fiber cages for anterior cervical fusion will be evaluated in this study. Thirty two patients with symptomatic cervical disc disease were treated by anterior cervical discectomy and fusion using carbon fiber cages packed with autogenous bone graft. The average duration of symptoms was 9.3 months [range, 2-15 months]. The average follow-up was 28 months [range, 12-36 months]. All patients had neck pain. Twenty one patients [65.6%] had a single level affection, and eleven patients [34.4%] had double level affection with a total of 43 disc lesions. Fifteen patients [46.9%] had radiculopathy without myelopathy, ten patients [31.2%] had myelopathy without radiculopathy and seven patients [21.9%] had myeloradiculopathy. Four patients [12.5%] had sphinctric disturbances. Twenty seven patients [84.4%] had complete relief of neck pain. All patients improved neurologically postoperatively, except 2 patients [6.2%] with myelopathy although their symptoms stopped to progress. Maintenance of cervical lordosis or correction of kyphosis occurred in 29 patients [90.6%]. Fusion occurred in 40 disc lesions [93%]. Subsidence [< 5mm] occurred in 6 disc spaces [14%]. There were no implantrelated complications. Carbon fiber cages represent a good option to restore the intervertebral disc space and promote fusion in cervical disc surgery. Furthermore, the bone fusion can be easily assessed because of radiolucency of these cages

Relationship of arterial compliance and glycosylated haemoglobin as a predictor of vascular damage in diabetic patients

Accelerated arterial stiffness has been linked in diabetes to hyperglycaemia, hyperinsulinaemia, and impaired glucose tolerance. In this work, we studied two groups: Normotensive diabetic patients Group [A] and non diabetic age and gender matched controls group Group [B]. We excluded those with hypertension, hypercholesterolemia, smokers or ex-smokers and patients with history of or complaining of peripheral vascular disease or coronary artery disease. The aim of work was to study the relationship between arterial compliance and diabetic status in normotensive diabetic patients. The two groups [A and B] were compared as regards the clinical data, laboratory investigations, echocardiographic studies, carotid duplex evaluation [intima-media thickness and incidence of atherosclerotic plaques], pulse wave velocity measurements. On comparing both groups we found that diabetic patients had average pulse wave velocity, higher incidence of diastolic dysfunction and had lower fractional shortening values and E/A ratio on echocardiographic evaluation. Correlation of glycosylated haemoglobin with the other study parameters showed a significantly positive correlation with pulse wave velocity [PWV] among the whole population and with mean intima-media thickness [Mean IMT] among the whole population and in diabetics. Correlation of pulse wave velocity with the study parameters revealed a statistically significant positive correlation with mean-intima media thickness among the total population as well as in diabetics. In this study we concluded that early vascular damage and arterial stiffness is independently related to glycaemic status in diabetic patients even before evident clinical manifestations of macrovascular affection such as hypertension, increase in intima-media thickness, development of atherosclerotic plaques, symptoms or signs of peripheral vascular disease or coronary artery disease. We don't know if tight glycaemic control could reverse these early changes of vascular compliance or not and that needs further investigation. Pulse wave velocity is a non invasive, inexpensive and feasible method for early detection of vascular damage and impaired arterial function, so that therapeutic interventions can be evaluated, in order to reduce future cardiovascular complications and thereby increase both duration and quality of life.

Management of tibial plafond fractures with ilizarov external fixator

Eighteen tibial plafond fractures in eighteen patients were treated with the Ilizarov external fixator. Twelve patients [66.7%] were males and six [33.3%] were females, and the average age was 36.5 years [range, 23 to 52 years]. The mechanism of injury included thirteen motor-vehicle accidents [72.2%] and five falls from a height [27.8%]. Eleven fractures [61%] were closed and seven [39%] were open [five grade, and two grade]. The fractures were classified according to AO classification system. There were four type Al, three type A2, three type B2, four type C2, and four type C3 fractures. Associated injuries occurred in 6 patients [33.3%] and included an abdominal injury [2 patient], a second long bone fracture [3 patients], and a proximal fracture in the same tibia [one patient]. Open reduction and internal fixation of the fibula fracture was performed in 8 patients [44.5%] using a tubular plate. The ankle joint was crossed with a hindfoot half ring in the type C fractures [44.5%]. Minimal internal fixation with interfragmentary screws was performed in 6 fractures [33.3%]. The average follow-up was 30.5 months [range 24 to 36 months]. All fractures united. The average time of healing was 4.5 months [range, 2.5-6 months]. Seven fractures [39%] were excellent, five [27.8%] good, three [16.6%] fair, and three [16.6%] poor according to the functional ankle score. Pin track infection occurred in four patients [22.2%]. Minimal skin necrosis around the wound was observed in two patients [11%]. Malunion in the form of 15° valgus occurred in one fracture [5.5%].Two patients [11%] had shortening of their legs ranging between 1 to 2 cm

One-stage treatment of neglected congenital dislocation of the hip

One-stage operative procedure for neglected congenital dislocation of the hip in 16 children [18 hips] was evaluated in this study. Nine patients had dislocation of the left hip, five had dislocation of the right and two had bilateral dislocation. None of the patients had a previous treatment of the dislocation. The average duration of follow up was 2 years and 11 months. Open reduction with shortening and derotation of the femur was done for all hips. In nine hips, varus angulation, for excessive valgus, was added to the osteotomy. Salter innominate osteotomy was performed in ten hips. According to Severin's system for radiographic evaluation, 14 hips had excellent or good results. The range of motion was assessed using the rating system of Ferguson and Howorth. Ten hips were excellent, five were good, two were fair and one was poor. Avascular necrosis was developed in one hip which gave a fair clinical result. A limb- length discrepancy of more than 1 cm [2.2 cm] occurred in one patient at the latest follow up. In one hip, instability, which led to subluxation, developed postoperatively which needed operative revision and the capsulorrhaphy was tightened

Management of relapsed clubfeet by soft tissue distraction using the ilizarov method

Nineteen feet with relapsed clubfeet in 14 patients were treated by soft tissue distraction using the Ilizarov method. There were nine unilateral and five bilateral deformities in ten boys and four girls. They had an average of three [range of 2-5] previous surgical interventions; all were in the form of soft tissue release. The average time taken for the correction of the deformity till frame removal was 10.5 weeks [range of 9-12 weeks] and the average follow up period was 2.4 years [range of 1-4 years]. Twelve feet were graded as excellent, 5 as good and 2 as fair results. The frame was well tolerated by all children and their parents until a full correction of the deformity occurred

Mobile - bearing knee arthroplasty: clinical results

Twenty three primary cemented mobile-bearing total knee arthroplasties were implanted in nineteen patients. All implants were of a posterior cruciate-retaining design and allow translation of the polyethylene in the anteroposterior plane and its rotation about the longitudinal axis of the limb. Fifteen patients [17 knees] had osteoarthritis and four patients [6 knees] had rheumatoid arthritis. The average follow-up was 30 months. Preoperatively, the average flexion contracture was 11.5° [range, 0°-25°] and the range of motion 100° [range, 50°-130°] At final follow-up, no knee had a flexion contracture. The average postoperative range of motion was 120° [range, 80°-140°]. Preoperatively the average knee score was 38 points, the average function score was 42 points and the average pain score was 16 points according to the scoring system of the Knee Society. At the time of most recent follow-up, the average knee score was 90 points, the average function score was 82 points and the average pain score was 43 points. Nineteen knees [82.6%] in this study had no evidence of radiolucent lines around any component. Superficial infection was detected in one knee. Patellar dislocation occurred in two knees [3-4 weeks postoperatively] which needed lateral retinacular release

Arthroscopic anterior cruciate ligament reconstruction with quadruple hamstring grafts

Arthroscopic anterior cruciate ligament reconstruction with quadruple hamstring grafts was performed for 26 patients with an average age of 27.5 years [range, 19 to 42]. Eighteen patients were male [69%] and eight patients [31%] were female. Fourteen left knees [54%] and twelve right knees [46%] were injured. All the patients had unilateral ACL insufficiency without other ligamentous injuries, and no patient had a history of previous knee surgery. The medial meniscus was injured in 5 knees, and the lateral meniscus in 3 knees. Average follow-up was 20 months [range; 15-30 months]. At 12 months after surgery, two patients had ruptured their graft. These two patients were excluded from further analysis and from the final results. According to Lysholm Knee Score, twenty one patients [87.5%] had good or excellent results. Overall IKDC assessment revealed that twenty two patients [91.7%] were assessed as normal or nearly normal. A grade 0 Lachman test [A] was demonstrated in 16 patients [67%]. Six patients [25%] had grade one laxity [B] and two patients [8%] had grade two laxity [C]. A grade 0 pivot shift testing [A] was demonstrated in 18 patients [75%]. The remaining 6 patients [25%] had a grade 1 pivot shift [B]. Anterior kneeling pain was present in 3 patients [12.5%] at the most recent follow-up. Hamstring pain was felt in 4 patients [16.7%]. Three patients had pain in the lower third of the hamstring muscles and one patient had pain in the middle third

Giant cell tumors of long bones: a preliminary report of treatment and outcome

The present study was performed to determine whether there is a difference in the functional outcome and recurrence rate after different methods of treatment of giant-cell tumor of long bones. Thirty-four patients, 23 females and 11 males with a mean age of 26 years were treated. According to the grading system developed by Campanacci et al., three lesions were grade I, 20 lesions were grade II and 11 lesions were grade III. The follow up ranged from 12-40 months with an average of 15 months. The patients were evaluated with regard to pain, postoperative function and local recurrence. Twenty- two patients were treated by curettage, while 12 by resection. After curettage, liquid nitrogen was used in 14 patients and high speed burr only was used in 8 patients. After curettage, the cavity was filled with autograft [iliac bone chips] in 15 patients and cement in 7 patients. After wide resection, arthrodesis was performed in five patients, endoprostheses were inserted in five patients and replacement of the distal radius by an ipsilateral fibular graft for two patients. Four of the 34 patients had a local recurrence during a mean follow up period of 15 months, including three patients having recurrence after curettage and one after resection. The functional result according to Mankin's classification was excellent in 19 patients, good in seven patients, fair in four patients and failed in four patients

Total hip arthroplasty for ankylosed hips

Sixteen spontaneously ankylosed hips were converted to total hip arthroplasties in 12 patients. The average length of follow up was three years. The predominant indications for conversion were progressively disabling pain in the low back, contralateral hip pain, loss of function due to immobility or malposition of the hip, processive pain and instability of the ipsilateral knee. Many problems were faced in this kind of hip arthroplasty including difficult exposure, tissue contracture, atrophy of hip abductors and distortion of anatomy, especially in patients who developed this ankylosis after infection. Long rehabilitation period should be expected in such cases. The postoperative range of motion was markedly improved. The average arc of flexion for all hips was 85 degrees. The average arc of abduction-adduction was 47 degrees [32 of abduction to 15 degrees of adduction] and the rotational arc averaged 42 degrees [18 degrees of internal rotation to 24 degrees of external rotation]. Three hips in this study were rated as failures

Shoulder hemiarthroplasty for malunited proximal hurmeral fractures

In this study, hemiarthroplasty [Neer II prosthesis] was used for the treatment of malunited fractures of the proximal humerus in eight patients [five men and three women with an average age of 57 years, range of 45-68 years]. The average time from initial injury to operative intervention was 13.5 months [range 4-23 months]. The patients were followed up for an average of 18 months [range 12-24 months]. Six patients had a complete painless shoulder. Active total elevation improved from an average of 25 degrees [range 15-35 degrees] preoperatively to 90 degrees [range 70-100 degrees] postoperatively. The external rotation improved from 15 degrees [range 10-20 degrees] preoperatively to 35 degrees [range 25-45 degrees] postoperatively and internal rotation improved from an average of S1 preoperatively to L1 postoperatively

Anterior decompression and stabilization of thoracolumbar burst fractures

Twelve patients with thoracolumbar burst fractures were managed with one-stage anterior decompression, fusion and instrumentation with Kaneda system. The indications for surgery were neurologic deficit secondary to canal compromising 50% or more, kyphotic deformities greater than 20 degrees, 50% or more loss of the vertebral body height and progressive neurologic deficit. The average follow up was 14 months [range 10-18 months]. After the anterior decompression, the neurologic function improved by at least one grade, except in one patient with complete paralysis. The postoperative kyphotic angle ranged from -5 to 15 degrees [average 5 degrees] and it ranged from -3 to 18 degrees [average 6.7 degrees] at the most recent follow up. No serious complications were developed during all surgeries. During the follow up, implant failure occurred in two patients