one stage operation to correct congenital vertical talus deformity

Seven patients diagnosed with rigid congenital vertical talus deformity were treated with a one stage posterior, medial and lateral release operation between June 1983 and August, 1987. Four of the patients had the deformity bilaterally for a total of eleven feet operated upon. The patients were between one and four years of age at the time of operation. The patients were followed-up for a period of three to seven years. A single incision was used to perform the necessary posterior, medial and lateral releases to reduce the talo-navicular joint. The peroneus muscle was transferred to the neck of the talus to maintain its reduced position. The results were that nine feet of the eleven operated upon maintained the reduction and were asymptomatic with normal foot development at follow-up

Treatment of chondromalacia patellae by advancement of the tibial tuberosity

Chondromalacia patellae is a condition that is presented clinically as pain in the retropatellar region. Various factors might contribute in the development of this condition. Malalignment of the patella as well as abnormal mechanical stress might be responsible for the development of its clinical symptom. In this paper is a description of an angle "patella edge tuberosity angle" that help in the diagnosis as well as the advocation of a procedure which help relieving the clinical symptoms

Lateral recess entrapment

The lateral recess is considered as the hidden exit path of the nerve root emerging from the neural canal towards as peripheral destination. One hundred and seven cases in which the root symptoms were attributed to pathiological changes in this exit were studied. The result of the surgical procedure carried out to improve the state of the nerve in this exit were assessed. Seventy three patients had a previous surgery on their backs having their disc removed. In twenty one cases, a full laminectomy was performed. fifteen had a hermilaminectomy, and thirty seven had a simple discectomy. All patients had suffered from persistent pain in the leg, as well as from backache of a variable severity. This fact rendered them almost handicapped to an extent in which they were unable to perform their simplest duties. The clinical features were found helpful to define this condition, along with plane radiological findings which showed many stigmas lightening the hidden path of this recess

need for infant screening in early diagnosis of congenital hip dislocation

Most congenital dislocated hips are in apparent and asymptomatic during neonatal period and infancy, even though at such a time a high percentage can be detected. Treatment during this period can decrease the late sequelae of the congenital dislocation of the hip. This paper reports the clinical feature the presenting symptoms and the reasons of delay in the treatment of 88 patients with congenital dislocation of the hip admitted to the fifth orthopaedic unit, at Saddens Medical City, Baghdad between March 1988 and July 1990. The findings indicate that there is an urgent need for an early diagnosis program and for a screening institution for the congenital dislocation of the hip to minimize disability and the need for surgery

One stage posterior-medial and lateral release to correct a congenital vertical talus

Seven patients with eleven deformed feet aged between one and four years with clearly distinguished congenital vertical talus were treated by this method between June 1983 and August 1987,and followed-up for a period of four to seven years. The Surgery entitle a one stage correction of the deformity; the peroneus longus muscle was used to hold the corrected position of the talus. the result of this procedure was found promising with nine feet showing a full correction and normal development

Treatment of unicameral bone cyst by repeated needling

An evaluation of the results of repeated needling of a unicameral bone cyst in thirteen patients aged between seven and eighteen years with an average follow up of three years was carried out. Their presenting features was feeling of heaviness, pain or pathological fracture. The diagnosis was made on clinical examination, radiographic picture and the examination of the aspirated fluid. Needling was performed and it was noticed that the cyst did show three pattern of response to needling. Healing was assessed radiologically and the average healing time was between five and six months. The procedure was simple when compared to the conventional method of surgical treatment of the unicameral bone cyst, it has low morbidity and can be done under local anesthesia with a minimum blood loss

influence of the mechanical and anatomical changes in the congenital hip dislocation

This paper will demonstrate the effect of the anatomical and the mechanical changes which are the cause or the result of a dislocated hip in influencing the treatment of this condition. The contents of this paper are based on observation and a studies made on two hundred and ten hips treated when the deformity was established and covers the Period between Oct 1982 and the end of 1988. The paper demonstrates that two forms of dislocation were encountered. In one, the hip is basically normal, and the changes seen were the result of the malalignment of the joint, while in the other type the hip is abnormal and so the changes that result are the effect of this abnormality. Based on these findings a treatment guide was made to avoid errors encountered, because of an inadequate correction, or a faulty correction which results in serious failures, that require a second or even a third correction, with all the drawbacks of repeated surgeries in this area

Mechanism and classification of ankle fracture

The ankle joint being an important instrument of walking makes the proper understanding of the mechanism of its fracture and the method for restoring its integrity and function, an important factor in regaining a normal ankle action. In this paper a description of the ankle injuries were made following a cadaveric study and a modification of Ashhurst and Bromer classification will be described. The paper will also review the result of the treatment undertaken in 117 ankle fractures, and review the importance of the restoration of the inferior tibio-fibular syndesmosis. The paper will furthermore re-explore the question of the tibio-talar contact area and the need for the proper placement of the talus in the mortise in order to maintain the contact area to as normal a position as possible

Dual repair for treatment of lateral ankle instability

Lateral instability of the ankle joint is a disabling condition especially when walking on uneven surfaces or participating in a sports activity. Various surgical procedures have been described to correct this disabling condition by using the tendon of the peroneus brevis muscle. In doing so they create a tenodesis effect at the vector direction of the lateral band complex, resulting in some degree of stiffness of both the tibio talar compartment and the talo - calcanal compartment of the ankle, subtalar articulation complex. In the procedure advocated by this paper both the anterior talo - fibular ligament function and the calcaneo - fibular ligament function are corrected restoring stability to the ankle region without inducing stiffness

Compression neuropathy of the medial calcaneal nerve

This paper explains the existence of a compression mechanism, on the medial calcaneal nerve which is the cause of pain frequently encounterd in the heel. This will replace a concept widely accepted that such pain is due to spur formation or planter fasciaitis The work has been based on the anatomical dissection of the nerve, and the response to surgical release. It also refers to the relation of the compression, to venous distension under the tunnel, which was demonstrated by undertaking pressure studies in cadavers before and after the release of the tunnel It also explains a method for the surgical release of the nerve, the aetiology, and the possible complications

correlation between obstructive agent to reduction and the preoperative radiological findings in congenital dislocation of the hip

Ninety two Congenitally dislocated hips in children between the ages of one and six years were all operated by open reduction by the same surgeon [l.M.S]. A retrospective study correlating between the preoperative X-ray findings of their hips and intraoperative obstructive agent to reduction was noted. It was found that the Obstructive agents occurred in any combination in any one patient and the limbus was not found to be an obstructive agent in any of the studied hips and its preservation was found useful to achieve a more stable reduction

Functional cast for the treatment of complicated fractures

Complicated fractures often pose a formidable challenge to the orthopaedic surgeon. This report presents the result of the treatment of these Injuries by a functional brace; it demonstrates that early ambulation following the application of the brace produces an excellent opportunity for rapid bone union while maintaining the joints and muscles at a functional level on completion of the treatment. It also shows that bone healing in the group in which excessive bone formation has been inhibited are faster and less eventful, than those which are not