Open medial wedge osteotomy with impacted bicortical iliac bone graft in the treatment of adolescent tibia vara

We treated 14 patients [20 extremities] suffering from adolescent tibia vara. The mean age at the time of the operation was 16.1 [13-20] years. There were 10 [71.4%] males and 4 [28.6%] females. Six [42.9%] had bilateral deformity. Ten patients [71.4%] were either obese or over-weight. The pre-operative tibio-femoral angle was in varus and ranged between 196 to 182 degrees. All the patients were treated by medially opended wedge osteotomy of the upper end of tibia below the tibial tubercle. The osteotomy was kept open by impacted bicortical cancellous bone graft. All the patients were followed up for a period ranged between 9-20 months. The mean post-operative tibio-femoral angle was 176 [172-183] degrees. The patellar tendon height was not changed post-operatively. Only one patient had keloid scaring of her tibial wound. No vascular or neurological complications were reported. Medially opened wedge osteotomy was safe, effective, and stable osteotomy for the treatment of adolescent tibia vara

Heel pad compressibility and plantar tissue elasticity in plantar fasciitis

A study of heel pad thickness and compressibility using lateral radiographs of the foot in loaded and unloaded position over a metal wedge in plaster slipper was carried out on 63 patients with plantar fasciitis and 80 normal subjects. The calcaneometatarsal angle was also measured in loaded and unloaded position to assess the plantar tissue elasticity in both groups. The body mass index and heel pad compressibility index [resistance to compression] were significantly higher for the patients compared to normal subjects. The plantar tissue elasticity index was less for the patients compared to normal [less resilience]. Diminished compressibility of the heel pad and decreased elasticity of the plantar tissue might be a factor in plantar fasciitis and might have a bearing on treatment of resistant cases

surgical treatment of fractures of the clavicle

In this study, 21 displaced fractures of the clavicle inpatients over 14 years were treated. The subjects were 15 men and 6 women and their ages ranged between 23 and 55 years with an average of 37 years. According to Robinson classification of clavicular fractures, 18 fractures occurred in the mid-third [type 2] and 3 fractures occurred in the lateral-third [type 3]. Type 2 fractures were treated by open reduction and internal fixation with one third tubular or reconstruction small set AO plate with at least three fixing screws in both medial and lateral major fragments. Type 3 fractures were treated by open reduction and internal fixation using figure of eight tension band wiring. The mean follow-up period was 11 months. No infection was recorded. Patients' satisfaction was high [95%]. Four patients had residual pain due to either metal protrusion in two cases or due to development of frozen shoulder in two cases. The mean time to return to preoperative level of activity in 20 patients was 32 [21-64] days. The results of the study indicated that surgical treatment of clavicular fractures is a good and safe method for treatment of displaced fractures of the clavicle provided that a good and meticulous surgical technique is applied