Correction of tibia vara using Ilizarov technique

Fifty-two lower limbs of 44 patients with tibia vara were treated with the Ilizarov external fixator. Eight patients were bilaterally affected. Their mean age was 12 years and 6 months. Their main complaint was pain on walking and cosmoses. They were assessed clinically and radiologically. CT scanogram was done for lower limb discrepancy. llizarov external fixator was applied and gradual correction was performed. Varus tibiofemoral angle, procurvatum, recurvatum, lower limb discrepancy, and knee range of motion were measured preoperatively; postoperatively and at last follow up. Three patients showed residual deformity. There were no neurovascular complications, delayed union, or nonunions. The llizarov method provides deformity correction and secure early weight bearing with no serious complications

Transpedicular screws for fusion of the Lumbosacral spine in treatment of spondylolithesis

In this study, 62 adult patients presented with spondylolithesis received surgical treatment in the form of laminectomy, discectomy and removal of pars interarticularis with decompression of the nerve root on the symptomatic side and posterolateral fixation by transpedicular screws, in the period between July 1995 and January 2003. The patients were evaluated at an average follow-up period of 21 months. In this study females were 38 cases and males were 24 cases with the average age of both 42 years. The results were excellent in 34 cases, good in 15 cases, fair in 9 cases and 3 patients with poor results, still complaining of low back pain and sciatica

Interlocking nailing versus plating of humeral shaft fractures

Forty cases with humeral shaft fractures underwent surgical stabilization, 22 patients using a dynamic compression plate [DCP] and 18 patients using humeral antegrade interlocking intermedullary nailing [IMN]. There were 9 women and 31 men. Their ages ranged between 23 and 56 years with a mean of 30.4 years. The study was performed at the Saudi German Hospital, Jeddah, Saudi Arabia and King Fahad Hospital, Madina, Saudi Arabia, between October 1998 and May 2000. The range of follow up was 6 to 16 months with a mean of 9.1 months. The aim of the work was to compare the results of surgical stabilization of humeral shaft fractures using these two modalities of treatment as for the rate of fracture union, the incidence of complication and effect on shoulder and elbow function. Cases treated by DCP showed a higher rate of primary union than those treated by IMN, 90.9% and 83.3% respectively. The average duration to union was shorter in the DCP group of patient than the IMN group 18.5 weeks and 21 weeks respectively. The DCP plate group showed fewer complications, the most common being iatrogenic radial nerve palsy which resolved spontaneously in all patients. In the IMN group of patients, the most common complications were distraction of the fracture contributing to nonunion [22%] and impingement at the shoulder due to proximal nail protrusion a rotator cuff injury [16.7%]. It was concluded that dynamic compression plating of humeral shaft fractures resulted in a higher rate of union in a shorter duration of time with less complications than antegrade intramedullary interlocking nailing

Varus gonarthrosis. Combined arthroscopy and high tibial osteotomy with internal fixation using the fork plate

The aim of this study was to report the arthroscopic findings in cases of varus gonarthrosis and the results of treatment of such cases by combined arthroscopy and high tibial osteotomy with internal fixation using the fork plate. The subjects of this study were 87 cases [71 females and 16 males]. The mean age was 53.6 years with range of 42 to 61 years. The study was performed during the period from January 1995 to June 1997. History was obtained for the presence of knee pain and its response to medical treatment. All cases were examined for tenderness over the joint line, knee deformity, range of knee movement and knee instability. Standing anteroposterior radiographs of both knees were examined for medial compartment arthrosis, presence of metaphyseal varus with determination of the tibiofemoral angle. Lateral views are examined for signs of patellofemoral involvement. All patients underwent combined arthroscopy and high tibial lateral closed wedge osteotomy with internal fixation by the fork plate. The results showed that at arthroscopy, 27 cases suffered a tear of the medial meniscus and 5 cases suffered a tear of the lateral meniscus, 8 cases showed grade II and III degenerative changes of the lateral tibiofemoral compartment and 19 cases showed patellofemoral degeneration grade II, III and IV. At four weeks postoperatively, 80 patients regained their preoperative range of knee movement. The overall results were graded according to the hospital special surgery knee score. In the present study, 78 patients showed satisfactory results and 9 cases showed unsatisfactory results. The results were satisfactory in 87.5% of patients with lateral tibiofemoral compartment degeneration and in 84.2% of patients with patellofemoral degeneration. The study showed that fork plate provides rigid internal fixation allowing early rehabilitation and rapid return of joint function. Mild or moderate affection of the lateral tibiofemoral and the patellofemoral compartments did not affect the clinical result. Over one third of the patients suffered a meniscal tear manageable by arthroscopy

treatment of infected non union of the tibia by compression-distraction-technique using Ilizarov external fixator

The application of Ilizarov techniques to diaphyseal infected non unions is very encouraging. It may prove to be an excellent technique for future management of resistant diaphyseal infections of bone. Circular external fixation using the Ilizarov apparatus combined with compression- distraction technique were used to treat 11 patients with infected non- union. There were 8 males and 3 females with an average age of 27 years [range 17-51 years]. The average number of previous failed surgical attempts at union was 2 per patients [range 1-4]. Of the 11 patients there were 8 with chronic tibial defects; one with normal extremity length; 5 with shortening associated with bone fragment contact and two with bone loss in excess of the amount of shortening. There were 3 infected non- unions without shortening treated with complete resection of the non- union site and conversion of the diaphysis into a segmental defect. In 11 patients, the infected extremities healed without the addition of a cancellous graft, microvascular fibular or soft tissue grafting. The average length of regenerate gain was 3.7 cm [range 1.5 to 4.9 cm]. Postoperative antibiotics were administered in 3 out of the 11 patients for 10 days after en block resection of the diaphyseal sequestrae. Functional results were excellent in 5, good in 3, fair in 2 and poor in only one patient. There were no additional bone grafting procedures, microvascular bone transplants, or other grafting techniques used in any patient