Arthroscopic treatment of recurrent traumatic anterior instability of the shoulder using suture anchors

This study for arthroscopic treatment of recurrent post-traumatic anterior dislocation included 18 patients [17 males and 1 female] ranging between 18 years old and 31 years old [average 23 years]. Fifteen patients had history of recurrent post traumatic shoulder dislocations [range is 2 to 5 dislocations], while 3 patients had history of recurrent subluxation after single dislocation. Patients included are patients with recurrent posttraumatic anterior dislocation and no more than five dislocations, with arthroscopic ally confirmed anterior detachment of the glenoid labrum, and good quality and competence of the inferior glenohumeral ligament and symptomatic subluxation. Beach - chair position and posterior and anterior working portals were used. At least 3 suture anchors [G II Mitek] at 5, 3 and 1 o'clock positions were used to fix the labrum - ligament complex to the glenoid using sliding arthroscopic knots. Using the modified Rowe scoring system for preoperative and postoperative patient evaluation, there was marked improvement in postoperative Rowe score regarding stability, motion, pain and function. The score improved to 35 - 100 points [average 85.8] compared to score range 25 - 45 points [average 32.7 points] preoperatively. This technique is thus effective with results that mimic open repair with less operative morbidity

Multivessel coronary stenting versus bypass surgery in patients with multivessel coronary artery disease and normal left ventricular function immediate and six months follow up

The usual goal for CABG is complete revascularization, which may be associated with greater freedom from recurrent angina and better long-term survival. In selected patients with multivessel coronary artery disease and normal left ventricular function, intracoronary stenting may offer an effective alternative to coronary bypass surgery. was to compare the immediate and six months follow up of the results of percutaneous coronary intervention [PCI] and the conventional coronary bypass surgery [CABG] in symptomatic patients with multivessel coronary artery disease and normal left ventricular function. The study included 61 patients who were randomly selected and divided into two groups: group [1]: 33 patients who underwent CABG and group [2]: 28 patients who underwent percutaneous coronary intervention. Both groups were followed up immediately post procedures and for a period of six months after. Stress ECG was done for returning patients during the 6 months follow up. During the immediate post operative follow up, only one patient in group 1 [3%] and 19 patients in group 2 [67.6%] were free of complications [P<0.001] Postoperative angina, acute renal failure, need for inotropic support, blood transfusion and lung atelectasis were significantly higher in group [1] than group [2]. Coronary dissection was found only in the PCI group. Other complications found in both groups were of no statistical significance. Regarding the cost and hospitals stay, it was significantly higher and more in group [1] than group [2]. During the 6 months follow up of the symptoms and the level of activity, there was no statistically significant difference regarding the angina and positive stress test between both groups. There was no statistical difference between the two groups in the composite end points [exercise tolevance, incidence of angina and mortality] during the 6 months follow up after the operation. PCI is relatively safer procedure, less costly and with lower hospital stay than CAVG, but it should be done in the presence of surgical back up because it is not completely free of risk and disadvantages. CABG still will have its role in managing patients with complex lesions not amenable to catheter interventions

Upper Limb lengthening in children and adolescents using monoiaterai fixators

Upper limb lengthening is indicated in large length discrepancies, severe angular deformities due to exostosis, trauma to the epiphyseal plate or congenital deficiency, which may result in functional and cosmetic problems. In our work, 8 upper limb segments in 8 patients were lengthened, which included 6 ulnae, 1 radius and 1 humerus. The cases included 3 patients with multiple hereditary osteochondromatosis, 2 patients with congenital short ulna and dislocated head radius and 2 post-traumatic patients with [pbyseal injuries and old fractures] and one patient with Ollier's disease. The average age at the time of surgery was 11.5 years [range 5-19]. In all cases the Orthofix Limb reconstruction system LRS [pediatric size] was used. Callotasis method was applied. The average follow up period was 19.5 months [range 6- 44]. The average lengthening achieved was 3 cm [range 2.3-5]. The percentage increase over initial length averaged 20% [range 15-31%]. The healing index [HI] averaged 45.7 days/cm. In one case callus deformity occurred and temporary decrease of the radio-carpal joint mobility occurred in another case. In conclusion, the results of our work on upper limb lengthening as regards the functional and aesthetic out come, the complication rate and the healing [HI] index were satisfactory