Management of postburn stiff elbow

The activities of daily living using the elbow joint are possible with a functional arc of 100 degrees . Loss of motion of the elbow joint sufficient to produce moderate to severe functional impairment in activity of daily living or occupational and recreational activities is common after various elbow insults. Following burns it is not uncommon to have stiffness of the elbow due to heterotopic bone formation and ankylosis. To evaluate the efficacy of using surgical techniques, continuous passive motion [CPM] and intermittent passive and active assisted exercises in increasing the range of motion of the elbow joint after postburn stiffness. Between April 2001 and January 2005 twelve elbows of postburn stiff elbow in ten patients were surgically treated in Assuit burn center with an average age of thirty-two years; female to male ratio [9 to 1]; two cases were bilateral; humero-ulnar bony ankylosis was found in eight elbows while the other four elbows had a preserved minimal range of motion. Excisional arthroplasty was done in eight elbows while soft tissue procedures were done in the other four elbows . CPM and different types of exercises were used to regain the range of motion. All patients were evaluated with an average follow up of 22 months, with revision surgery done in two cases. The average range of gained flexion was 70 degrees [ranged 35-110 degrees]. All patients were satisfied with the gained functioning painless range of flexion at the end of the follow up. The use of surgical procedures in combination with [CPM] and intermittent passive and active assisted exercises has been found to be an effective procedure to regain functioning painless range of flexion after postburn stiffness of the elbow

Ten years' experience in arthroscopic treatment of discoid lateral meniscus

Between March 1991 and April 2001, over 1800 arthroscopic meniscus surgeries were performed at our unit of arthroscopy. Seventy-three of these procedures were for the treatment of discoid lateral meniscus in seventy patients, three were bilateral. The age of the patients was nine to thirty two at the time of operation [average 22 years]. The patients were categorized according to Watanabe's classification into: complete [58 Knees], incomplete [14 Knees] and Wrisberg type [1 Knee]

The aim of this retrospective study was to analyze the relationship of the type of the discoid meniscus to the tear pattern, and to reach the optimum arthroscopic technique in resection dynamics of the discoid lateral meniscus. The mean follow up was 5.7 years [ranging 10 months to 10 years]

According to the scale of lkeuchi, the results were excellent in 45 knees, good in 12 knees, fair in 12 and poor for 4 knees

The 4 poor cases included two cases that lost some range of flexion [limited to 115[degree]-120[degree]] at their last follow up. The other two cases were from the earlier surgeries, both had intraarticular infection, one responded to long duration of parental antibiotics, and the second necessitated arthroscopic drainage, lavage and suction drain, both cases resolved with some residual pain

Arthroscopy is very helpful in diagnosis of discoid lateral meniscus and its tear pattern; it is the most effective for its resection with lowest morbidity

Surgical tips and tricks for open reduction and internal fixation of intra-articular calcaneal fractures

Twenty-four intra-articular calcaneal fractures in twenty-three patients have been treated by open reduction and internal fixation. Ten were women and thirteen were men. Age ranged from 18 to 45 years. Fracture classification was based on Sanders computed tomographic classification. There were 5 type II, 15 type III, and 4 type IV fractures. All operations were performed using a standard surgical technique with an extended lateral approach, and the fractures were fixed with plates and screws with bone grafting if needed. Average follow-up was 14 months [range, 10-22 months]. The Creighton-Nebraska assessment score was used for clinical evaluation. Radiological and functional assessments were done for all patients at the latest follow-up. Excellent results were achieved in nine fractures, good in twelve, and fair in three. The average score was 93 for type II, 89.2 for type III, and 73.75 for type IV fractures. There was a clear statistically significant superiority with type II and type III fractures treated with open reduction when compared with type IV fractures [p 0.0001]. Open reduction and internal fixation is recommended for all displaced intra-articular fractures of the calcaneus. It restores hindfoot and subtalar joint anatomy so that sub talar arthritis may be avoided

Arthrodesis hip using broad DCP

In this study, 34 patients were assessed. The mean age was 22 with a range from 16-36 years. All of them were not candidates for total hip replacement. In all patients, the other entire hip was normal. All of them were complaining of stiff arthritic hip for different causes. All of them were operated upon using the direct lateral approach exposing the hip joint and the iliac bone. Internal fixation was achieved using contoured broad DCP instead of the traditional cobra plate, to put the limp in the ideal position of arthrodesis. The greater trochanter was osteotomized with the preservation of abductor muscle attachment for easier THR. The plate was fixed to iliac bone with cancellous screws 6.5 mm and to the femur using cortical screws 4.5 mm. The mean operative time was 90 minutes. Each patient needed one unit of blood transfusion intraoperatively. A good bony union was reported in all patients. One patient of minimal infection was reported due to a general poor condition. A good postoperative lower limp function was reported in all patients. The pain completely disappeared after good bony union, except in one patient with minimal infection

Compression arthrodesis of the subtalar joint using two parallel lag screws

Thirteen subtalar fusions in 12 patients were included in this study. In situ arthrodesis was done in 11 fusions and distraction arthrodesis with bone block graft was done in two cases. Stabilization of the fusion was done by two parallel lag screws, one from the talar neck down to the calcaneus and the second from the tuberosity of the calcaneus to the talar body. They exert maximum compression on the subtalar joint, hence postoperative plaster cast was not needed. All cases reached union within 12 weeks. The results of the study showed that the use of two parallel lag screws fixation is a reliable technique for compression arthrodesis of the subtalar joint

Results of arthroscopic treatment of torn anterior cruciate ligament using patellar tendon autograft

The operative technique for ACL reconstruction has evolved from the traditional arthrotomy to the arthroscopic-assisted reconstruction and to the latest technique, which is the totally arthroscopic reconstruction. The aim of this work was to analyze the results of a totally arthroscopic ACL technique by patellar tendon autograft with an accelerated postoperative rehabilitation program. Between March 1997 and October 2000, a prospective study of 54 patients suffering from knee instability due to anterior cruciate injury was done in Assiut University Hospital. The patients were 53 males und one female with the age range of 18 years [average 30 years]. Four patients had a previous arthroscopic partial meniscectomy and three patients had a previous failed reconstruction of the ACL. The follow up continued until October 2000 with an average of 24 months period [range 9-42 months]. Out of the 54 patients included in the study, the results of 9 patients were deducted because they were lost to follow up. The overall results were satisfactory in 39 knees and unsatisfactory in 6 knees with 34 patients returned to their pre-injury level of activity. The Lysholm score improved from a preoperative mean of 59 to a postoperative mean of 91. Radiological assessment of tunnels placement revealed the tibial tunnel was 43.11 +/- 4.98%. The tibial tunnel position was found to be posterior in 27 patients, central in 12 patients and anterior in 6 patients. Tibia1 tunnel widening [0.5 - 2 mm] occurred in 7 patients, 3-6 months postoperatively. Arthroscopic ACL reconstruction with bone-patellar tendon-bone autograft with an accelerated postoperative rehabilitation program in young adults leads to reasonable stability and good overall function of the knee joint

Arthroscopic arthrolysis of knee arthrofibrosis

There are three different means for treatment of knee joint stiffness; manual mobilization under anaesthesia, arthroscopic arthrolysis or open arthrolysis. The totally atraumatic nature of arthroscopy and the more accurate lysis of adhesions permits passive and active kinesitherapy from the moment the patient recovers from anaesthesia without much pain. This work represented the arthroscopic technique, the postoperative programme and the results in 25 patients with average age 29 years [ranged 5-54]. All cases had previous intra-articular knee surgery and the average period of arthrolysis since the original surgery was 7 months [ranged 2-18]. The average follow up period was 9.5 months [ranged 4-28]. Postoperatively, a special programme of passive and active assisted exercises was followed to reach the maximum gained flexion and extension. According to the criteria of Parisien [1988], the results were 13 excellent, 9 good, 2 fair and one poor. The average preoperative flexion range was 70, while the average final postoperative flexion range was 123C