Treatment of congeintal pseudarthrosis of the tibia using Iilizarov external fixator

Congenital pseudarthrosis of the tibia [CPT] is a difficult orthopaedic problem. In this study, eight cases [5 males and 3 females] with CPT were treated with Ilizarov technique. Their average age at surgery was 4.7 years [ranged from 2.5 to 15 years]. Leg length discrepancies existed in all patients ranged from 1.5 to 6.5 cm [average 3.2 cm]. All cases were followed up from 1.2 to 4 years [average 2.3 years]. Solid union was achieved with initial treatment in 6 cases [75%].Tibial lengthening ranged from 1.5 to 6 cm [average 3.6 cm]. Angular deformity was fully corrected in 7 cases [87.5%]. A total of 9 complications were encountered in 5 cases [62.5%]. All these complications were manageable. Six patients [75%] were satisfied with the results. In general, the Ilizarov technique addresses several problems associated with CPT with promising results

Treatment of unstable femoral shaft fractures with locked intramedullary nailing

Twenty two unstable femoral shaft fractures were treated by Russel Taylor interlocking nail. 63.6% were male and 36.4% were females. Their average age was 36.8 years [ +/- SD 10.33]. The lower 1/3 rd of the femur was fractured in 40.9%, the upper in 31.8% and the middle 1/3 rd in 27.3% of the cases. The fracture was comminuted in 50%, transverse in 22.8%, spiral in 13.6% and double level in 13.6. The fractures were closed in 81.9% and grade 1 open in 18.1% of the cases. Closed technique was used in 36.4% and open in 13.6%. All patients were followed up for an average of 14 months. After one year follow up 90.9% of the fractures had solid complete consolidation and 9.1% had non-union. Full weight bearing was permitted after a period ranged from 2 to 10 months [average 6.5] and occurred in 90.9% of patients. Infection occurred in 4.5% of cases and subsided with antibiotic treatment, shortening in 13.6%, non-union in 9.1%, foot drop in 4.5% and the distal screw was broken in 9.1%. The results were satisfactory [excellent and good] in 81.8% and unsatisfactory in 18.2%. Based on this study, treatment of unstable femoral shaft fracture with interlocking nail has many advantages. The risk of infection and non-union is low, incidence and severity of malunion are reduced, the hospital stay is short and early mobilization of the patient is possible

Gradual femoral lengthening using Wagner technique

Eight patients with leg length inequality underwent femoral lengthening using the Wagner technique. Their ages ranged from 15 to 20 years with an average of 17.5 +/- 2.07. Limb length inequality was due poliomyelitis in 75% of cases and femoral shaft fractures in 25% of cases. Femoral length discrepancy varied from 4.5 to 8 cm. with an average of 5.9 cm. The femoral length gained after the operation varied from 4.5 to 7 cm. with an average of 5.8 cm. Full correction was obtained in 3 cases. Three cases had remaining discrepancy from 1 to 2.5 cm. Complications included post-operative wound infection in 12.5% pin tract infection in 25%, partial peroneal nerve palsy in 12.5% and severe angulations in 12.5%. This study revealed that Wagner method of gradual bone lengtherning allows distraction while holding the bony components rigidly fixed. This allows continued hip and knee motion while protecting the neurovascular structure from rapid stretching