Dome - shaped osteotomy for correction of malunited Colles' fractures

The aim of this work is to study the effectiveness of the dome- shaped osteotomy in correcting the different components of the deformity of the lower end of the radius after malunited Colles, fractures. Material and methods: the study included 28 patients with malunited Colles, fractures. The age of patients ranged 18-58 years [mean = 40.10 + 11.90].Fourteen were males [50%], the left side was affected in 71.4% [20 patients] and the dominant side was affected in 42.86% [12 patients]. Half of the patients [14] were manual workers, 8 [28.57%] were housewives and 6[21.43%] were employees. The fracture was caused by fall on the outstretched hand in 27 patients [96.43%] and by direct trauma to the wrist in one patient [3.57%]. All patients were treated by dome shaped osteotomy done through a dorsal approach. An iliac graft was put in the osteotomy site. The osteotomy was fixed by 2 Kirschner wires. full correction was achieved in 20patient [71.43%] while 8 patients [28.57%] had residual deformities, 5 of them had residual dorsal tilt of the distal radial articular surface and 3 had residual prominence of the ulnar styloid process. The radial shortening was also corrected from 6.30+ 3.15 mm to 1.13 + 1.48. The range of motion in the wrist region improved significantly after operation except for the range of pronation which showed an insignificant improvement. After correction, 5 patients [17.86%] only had mild pain. dome shaped osteotomy is effective in correcting malunited Colles' fractures with appreciable improvement in the range of motion of the wrist and forearm. Marked improvement of pain also occurred

Single-rod technique for the treatment of scoliosis - 5 years experience

Scliosis is a complex 3-dimensional and segmental deformity of the spine. Surgical treatment is indicated mainly for a growing child with increasing curve or in an already present severe deformity. Multi- segmental 3 dimensional correction gave better correction and fixation than the older systems. But it increased significantly the cost and difficulty of the procedure. To assess the results of using multisegmental fixation with a single rod for the treatment of scoliotic deformities. Subjects: There were 120 patients treated in this study by single rod technique for scoliosis of different aetiologies. There were 120 patients [Age: 5 to 18 years] treated by the single rod technique. The angle of the preoperative curve ranged from 45° to 110° with a mean of 61.4°. The curve flexibility ranged from 21% to 78% with a mean of 47.8%. The postoperative correction ranged from 47.4% to 85.7% with a mean correction of 64.7%, which was maintained until the final follow up [10-60 months, average = 42.6] without implant failure or pseudarthrosis. The use of a single rod for multisegmentalfixation for scolio tic deformities reduced the operative time, blood loss and cost. The implant was less bulky with increased surface area available for grafting which gives better fusion mass. The correction obtained was comparable with double rod technique

Results of surgical treatment of tuberculosis of the dorsolumbar spine

The aim of this work is to study the results of surgical debridement JL ML and posterior instrumentation in treating cases of Pott's disease of the dorso lumbar spine complicated by cold abscess, kyphosis and / or paraplegia . This study included 18 cases of Pott's disease. The age of the patients ranged 29-70 years [mean = 52.1], 12 were males and 6 were females [ratio =2:1]. Twelve patients were immuno-compromised; 8 due to diabetes mellitus and 4 due to chronic renal failure. Patients presented with pain, kyphosis and constitutional manifestations [night fever, sweating, anorexia, loss of weight]. Motor paralysis of the lower limbs was present in 10 patients [2 patients with type B, 3 with type C and 5 with type D according to Frankel grading]. In 17 cases, 2 contiguous vertebrae were affected; 2 in the mid dorsal spine, 11 in the lower dorsal and 4 in the lower lumbar. In only one case, 4 adjacent vertebrae were affected [DV. 7, 8, 9, 10]. MRI examination showed cold abscess formation in all cases. The kyphotic angle ranged 11-38° [mean = 26.9°]. CT guided needle biopsy was done to confirm the diagnosis. It was successful in 14 patients [77.8%] and failed in 4 patients where open biopsy was taken at the time of surgery. All cases were treated surgically through a posterior approach.Costotransversectomy, debridement, grafting and posterior pedicular screw rod fixation using ISO LA system was carried out. Patients were followed up for 20-44 months [mean= 32.6]. The infection was controlled in all cases. The kyphotic angle was partially corrected as it ranged 5-18° [mean = 12.1°] post operatively. Motor paralysis improved completely in 9 patients [90%] and partially in one patient [10%].surgical treatment is effective in controlling infection, kyphosis and improving paralysis

correction of midfoot cavus by release of the plantar fascia and V-osteotomy of the tarsus

Twenty patients [24 feet] suffering from pes cavus were treated by plantar release and V-osteotomy of the mid-tarsus. The age of patients ranged 4-38 years [mean 17.5 years]. There were 12 male and 8 female patients [3:2]. Pes cavus was idiopathic in 8 patients [12 feet], post-poliomyelitic in 8 patients [8 feet] and post-traumatic in 4 patients [4 feet]. The deformity was flexible in 12 feet [4 idiopathic and 8 post-poliomyelitic] and rigid in 12 feet [8 idiopathic and 4 post-traumatic]. In 4 patients with idiopathic pes cavus [8 feet], varus heel was present and this was corrected by lateral wedge resection osteotomy of the calcaneus. In rigid feet, V dorsal wedge resection was done to be able to correct the cavus. The deformity was corrected fully except in 4 patients [8 feet] with idiopathic pes cavus who presented late for treatment [16-20 years]

correction of genu valgum by a reversed dome osteotomy in the supracondylar area of the femur

Twenty-eight knees [in 18 patients] with valgus deformity were treated by a reversed dome osteotomy in the supracondyler area of the femur. The age of the patients was 12-24 years [mean=16.4]. Females [55.6%] and bilateral cases [55.6%] were slightly more common than males and unilateral cases. All cases were physiological and the relatively taller and heavier body built was present in 13 cases [72%]. The valgus angle ranged 15-20° [mean=17°]. A valgus angle of 5-10° [mean=7°] was obtained after surgery and union of the osteotomy ocurred within 2 months in an above knee cast. Delayed recovery of knee motion was met with in patients above 15 years of age