Correction of genu recurvatum in poliomylitis by the ilizarov method

Mild Genu Recurvatum can cause some disability, but when quadriceps is severely weakened as in poliomyelitis, such a deformity is desirable. However severe genu recurvatum is significantly disabling. The Ilizarov apparatus was used to correct genu recurvatum in eight patients suffering from poliomyelitis using our new technique of pate liar block of the proximal tibia. In six cases, the genu recurvatum was entirely due to capsuloligamentous stretching resulting in posterior translation of the tibia whereas in two cases it was associated with osseous deformity. Preoperatively, the angle of recurvatum averaged 33.8° [23 to 42]. The average duration of external fixation was 4.8 month [3 to 7]. At the last follow-up, all patients, except one, had achieved an excellent or good radiological and functional outcome. Three patients suffered complications including, pin-track infection and Knee stiffness. Our results indicate that the Ilizarov apparatus is an effective tool for managing the deformity of Capsuloligamentous Genu recurvatum, with or without shortening

Ankle joint reconstruction in fibular hemimelia in conjunction with the ilizarov Technique

Fibular hemimelia is a congenital disorder characterized by partial or complete absence of the fibula. It ranges from mildfibular shortening to bilateral involvement with associated defects of the femur, tibia, ankle and foot. This article is a prospective study of 14 patients [15 limb segments] with fibular hemimelia treated by limb lengthening and ankle reconstruction either by distal end of the fibula if present, contra lateral head of fibula or remnants of cartilaginous anlagen. Application of Ilizarov frame was done to start lengthening and correction of foot deformity. There were 7 males and 7 females. At the latest follow-up, the 14 patients were functioning well and had few complications. The findings suggest that these approaches are a more effective method of management of fibular hemimelia. The Ilizarov method is an attractive alternative for those patients

Management of fibular hemimelia by the Ilizarov technique

This work was undertaken to evaluate the early functional results of the fibular hemimelia patients. The use of ring fixator together with the llizarov technique has enabled us to correct most of the deformities and limb discrepancies. The average age in this study was 7.1 years ranged from 4-10 years. Right to left side affection was 7:3 and boys to girls ratio was 8:2. The leg length discrepancies [tibial] also ranged from 5-11cm with an average of 7.5 cm. Six feet were associated with absence of the lateral two rays with marked valgus deformity. All cases were subjected to at least one additional operation during the course of treatment. Our average follow up was 10.7 M ranged from 6-16M. Although, there were few complications met with. However, at the latest period of the this review, we achieved satisfactory results in all cases except one

long term results of epiphyseal transplant of more than 25 years

This study included a long term final results of nine cases, ten hips with septic epiphysitis complete loss of the head neck between the year 1962-1972. All cases ranged from 2-3 years, 7 females and 2 males. Surgical technique followed one stage surgery which involved exposure of the hip, free transplant of the upper end of the fibula with its epiphysis in the anatomical position of the head and neck, clinical picture and radiological assessments are studied and analyzed. All hips proved to be stable except 3 hips; average range of motion with flexion ranging from 100° to 130°, abduction from 0° to 20°, adduction from 0° to 18°, external rotation from 0° to 20° and internal rotation from 0° to 15°. Shortening in all cases ranged from 5 to 10 cm. Radiological examination showed union of the graft unless infection occurred leading to absorption. Varus position of the neck noticed in all cases. Harris hip score hip score was 6 good, 3 fair and 1 poor results. Complications included 3 dislocation, 1 sublaxations, varus neck and shortening

Lengthening index in poliomyelitis

This study included 32 cases of Poliomyelitis, all were subjected to tibial bone lengthening with or without correction of deformity. 15 patients were males and 17 were females. The average age was 20.5 years ranged from 17-25 years. Also, the average length achieved was 4.3 cm [2-9 cm]. All cases were followed up for about 18 month [10-30 month]. By statistical analysis of our results we found that, the lengthening index in poliomyelitis was prolonged to about [2.5 +/- 0.5] month/cm. Times the lengthening index in normal bone lengthening which is 1 month/cm. And this should facilitate our expectations and plans in future bone lengthening in poliomyelitis

Management of segmental bone defects by Ilizarov technique

This study included 20 segments in 20 patients with segmental bone defects [16 tibial and 4 femoral] due to non-union, chronic osteomyelitis or pseudoarthrosis. All tibial segments were managed by intercalary bone transport while, in all femoral segments, immediate excision of pathological segments and acute gap reduction were done according to the soft tissues around. Then bone transport with or without lengthening was started. Our average age was 19.2 y [9-42 y]. Male to female ratio was 11: 9. Also, the average length of the regenerated segment was about 6.9 cm [4 - 14.5 cm] with an average fixator time of 10.6 m [5 - 18m]. All cases were followed up after fixator removal for about 13m [6 -22m]. Some complications were met, but satisfactory results were obtained in most cases

Gastroplasty for morbid obesity: effect on morbidity and quality of life

54 patients underwent Mason vertical banded gastroplasty over 3 years. 12 patients were superobese, 32 morbidly obese and 10 with medical significant obesity. Operative treatment results in a reduction of 85.5% of ideal weight [38.5% of their original weight and 70.14% of their excess weight] after 2 years in 53.7% of patients. A typical indication is in a patient above 160% of his ideal weight [body mass index more than 35 kg/m2], aged between 18-60 years, has masculine fat distribution and got an obesity related disease with impairment of life quality. The constricting band and pouch size should not be greater than 5 cm and 20 ml respectively. Double staple line with reinforcement is essential to avoid suture line dehiscence. Post- gastroplasty special diet should be followed. No mortality recorded and all complications treated conservatively except 2 and they entail hypoventilation [2 cases], chest infection [4 cases], wound infection [4 cases], wound seroma [4 cases], stomal stenosis [3 cases], nutritional problem [1 case], reflux esophagitis [3 cases] and weight regain [4 cases]. Co-morbid conditions [obesity related disease] entails arthritis [38 cases], hypertension [19 cases], diabetes [12 cases], hyperlipidemia [11 cases], asthmatic bronchitis [9 cases], angina/CHF [4 cases] and sleep apnea [1 case]. The improvement of co- morbidity with surgically induced weight loss is impressive. The percentage of either resolution or improvement is documented. Finally, the effect on the quality of life has been studied using the sickness impact profile, and total dysfunction score has improved from 22.3% preoperatively to 8.7% postoperatively. To date, surgical methods are the only viable method to achieve weight loss in dangerously obese patients and gastroplasty is a safe and effective procedure to achieve this

Laparoscopic varicocelectomy

We performed laparoscopic varicocele ligation in 24 patients [4 bilaterally] whether clinically evident or detected by doppler. The main indication for surgery was oligo/athenospermia [13]. Other indications were failure of the medical test for joining military service [5], testicular atrophy [4] and scrotal pain [2]. The procedure is of real advantage in bilateral ligation [4 cases]. No morbidity recorded apart from one patient who developed pneumoscrotum which was brought to minimum during the procedure by scrotal compression and disappeared completely within one day. The spermatic artery was identified and preserved in 22 patients and clipped with the spermatic vein in 2 patients with no subsequent morbidity. The mean post-operative hospital stay was 1.9 days [range 1-3 days] and the mean time needed to return to full activity and work was 4.2 days [range 3-6 days]. Preliminary follow-up showed disappearance of varicocele as evidenced clinically and by doppler study, in all patients within 3 months. The wife of one patient treated for infertility conceived and the rest of the patients treated for oligo/athenospermia showed marked improvement. Pain disappeared in those treated for this symptom. We found the procedure safe, effective and offer the potential to diminish post-operative morbidity

Arteriovenous shunting for hemodialysis

Two hundred and forty six shunts were done in the last 5 years as vascular access for haemodialysis in 205 patients with end stage renal failure. These included 203 radio-cephalic fistulae done at the region or just above it [121 end-to-side and 82 side-to-side], 2 saphenous loops, 4 polytetrafluoroethylene [PTFE] Impra grafts, 26 brachio-basilic, 10 external Scribner shunts and in one case a new technique of shunting the brachial artery to accompanying deep vein and 2 mouths later superficializing the vein so it can be used for haemodialyses. Most failures occur in the early post-operative period [within 48 hours] and usually due to inadequate outflow through the venous side which will cause thrombosis of the fistula. Other detected complications include aneurysm [2 cases], infection [11 cases], later graft thrombosis [3 cases], secondary haemorrhage [1 case], oedema and swelling of the hand [2 cases]. Satisfactory patency rates are obtained so long as the fistula is handled well in the early usage by the nephrology staff. The arteriovenous fistulae had been repeated in 39 cases

Evolution of experience in laparoscopic cholecystectomy

A prospective study of 100 consecutive laparoscopic cholecystectomies was initiated with the introduction of the procedure. Patients presented with chronic calcular cholecystitis [81], acute cholecystitis [8], gall stone pancreatitis [4], chronic calcular cholecystitis with common bile duct [CBD] stone [4], mucocele of gall bladder [2] and acalculous cholecystitis [1]. Obesity, cirrhosis, previous abdominal surgery and thick wall gall bladder were not considered contraindication for the procedure. No mortality was reported and major morbidity occurred in only 3 cases: one post-operative bleeding, one CBD injury and one subphrenic abscess. Also mild cellulitis around the umbilicus occurred in 4 patients and gall bladder perforations dealt with during the surgery in 9 cases. Operative cholangiogram was done in 38 cases and was technically impossible in 2 cases. Conversion to open cholecystectomy was necessary in 4 cases: one for CBD injury, one for instrument failure, one for technical difficulites and the fourth one for common hepatic duct stone. The mean operative time was 88.4 minutes [range 20-200 minutes] and the mean post operative hospital stay was 2.23 days [range 1-10 days] and median time to return to normal activity and work was 8.7 days. These results confirm previous reports that laparoscopy has actually revolutionized the procedure of cholecystectomy