ABSTRACT
Objective: to study and analyze the surgical results of distal femoral Varus osteotomy in patients with genu-valgum
Material and Methods: between September 2006 to November 2013, 18 distal femoral oste tomies were performed on 14 patients at department of orthopedic surgery Services Hospital Lahore. After taking the history and physical examination, appropriate radiographs were taken. We did Varus femoral osteotomy by standard lateral approach and 95 angled dynamic compression screw [DCS] fixation, then followed the patient clinically and radiographically till sound healing of osteotomy was achieved
Results: this study was done on 18 knees [14 patients] with mean age 17 years [range 16 to 19 years].The mean duration of follow up was 7.9 months [range 6 to 9 months]. The tibiofemoral angle before and after operation was compared. The average tibiofemoral angle before operation was 19.24degree [14degree to 24degree] and follow up was 6.75degree [5degree to 8degree]. Mean lateral distal femoral angle [LDFA] before surgery was 7 4.85degree [67degree to 83degree] and after surgery was 86.90degree [83degree to 90degree]
Conclusions: distal femoral osteotomy wit DCS fixation through lateral approach can be reliable procedure for the treatment of valgus knee deformity. In this procedure tibiofemoral angle correction can be achieved without compromising the function of quadriceps muscle which helps in the early rehabilitation of the patient in terms of restoring the knee movements. Another advantage of lateral approach is, along with genu-valgum correction, the patella can be stabilized simultaneously
ABSTRACT
Objective: to study wide resection and arthrodesis of wrist, utilizing an autologous iliac crest for giant cell tumour of distal radius [Campanacci Grade-I I I]
Material and Methods: between Feb 2004 to Nov 2011 ,fourteen patients with amean age of 31 .5 years [21-42 years] with Campanacci Grade-Ill GCT of distal radius were admitted in orthopaedic ward Services hospital Lahore. Thirteen patients were managed with wide excision of tumour and reconstruction with ipsilateral iliac crest, fixed with small fragment plate to the remnant of radius. Primary autogenous iliac crest grafting was done at iliac crest radial junction in all the patients
Results: all the patients were followed to bony union, and twelve out of 14 patients were available at mean follow up of 24 months [10 to 26].The mean time to union was four months [3.0 to 6.0] at iliac crest-carpal site and 4.5 months [3.0 to 6.60] at iliac crest- radial site. Eleven patients had a reasonably good range of supination and pronation. The mean Musculoskeletal Tumour Society score was 23.21[77.38%, range21 to 25]. Among the complications, two patients developed radioulnar synostosis, one patient had a local recurrence, but with no bony involvement. Local excision was done and no local recurrence took place thereafter and he is disease free. One patient developed stiffness of fingers, which improved with physiotherapy. There was no other complications like nonunion at the graft bone junction, wound infection [superficial or deep], skin necrosis deformity and bony metastasis and refracture at the reconstruction site
Conclusions: iliac crest provides a local corticocancellous bone graft to reconstruct the defect left after excision of the distal radius for giant cell tumour. Iliac crest graft has advantage over the fibular and ulna graft of having the early union and better incorporation to the host bone, with no evidence of nonunion in our studies. It provides good stability at wrist with contouring of DCP over its concave surface, while retaining a good function of hand and forearm rotation
ABSTRACT
To evaluate the results of union in unstable pertrochanteric fracture of femur in nonanatomical reduction and fixation. A descriptive study conducted at Department of Orthopaedic surgery Bahawal Victoria Hospital Bahawalpur. In the present study, we had 30 patients with unstable intertrochanteric fractures of either sex. Patients were treated by nonanatomic reduction, either by Dimon Houghsten or Sarmiento osteotomy depending upon fracture geometry, and fixed by dynamic hip screw. Out of thirty patients, 21[70%] were male and 9 [30%] were female. The average age of male patients was 74.9 years and that of female was 61.2 years. We included patients with Jensen's type IV fractures having osteoporotic grade of four to six according to Singh's index. Patients were followed up for minimum period of 20 weeks and evaluated for radiological union and functional outcome using Sikorski and Barrington's pain and mobility scale. Out of thirty patients, only 25 completed the follow up. Four patients had limb length discrepancy. 88% of the patients had excellent to good functional outcome. Anatomical reduction must be tried in all cases. However, to avoid the complications of implant failure and loss of reduction with varus union in unstable fractures, non anatomical reduction should be considered