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

Modification of plating in fractures of proximal shaft femur in adolescents

17 patients with fracture upper third femur in adolescents treated surgically by cloverleaf plate in King Fahad Hospital madina and Ain Shams University Hospitals between 1992 and 1995. Their age was 12.3 to 17.8 years old, mean age was 15.4, 11 patients were males while 6 patients were females. The patients were treated with open reduction and internal fixation by cloverleaf plate. The wings of the plate bent to hold the proximal fragment and the greater trochanter. Ten patients were operated within 6 hours while the rest operated upon within 5 to 11 days after trauma. The follow up range between 9 to 14 months, average 12.5 months. Healing takes 12 weeks average, ranges between 9 to 18 weeks. Final follow up, all patients united with full range of motion at the hip and knee, with only one patient with leg discrepancies above 1 cm [1.8 cm]. One patient suffer from superficial wound infection that resolved after I.V. antibiotics