effective method for hip arthrodesis

Twenty young patients [mean age 19 years] underwent hip arthrodesis for severe unilateral disabling hip disease resulting primarily from tuberculosis with fibrous union in eight cases, pyogenic infection in six, fracture dislocation of the hip in three, slipped capital epiphysis with chondrolysis in two and congenital coxa vara in one case. Arthrodesis was completed in a position of 25 to 30C flexion, 0 to 7C adduction and 0 to 5C external rotation. To avoid the need for external fixation, an intramedullary nail fixation from the ilium to the upper end of the femur was used supplemented by a muscle pedicle iliac bone graft. The iliac bone graft not only improved hip fusion but also facilitated the insertion of a straight intramedullary nail. The mean follow up time was 4.1 years. All patients had a radiographic evidence of union by two months except one patient who had a delayed union because of the failure to use the proper intramedullary nail. Five patients complained of symptomatic low back pain and one patient complained of pain in the region of iliac crest because of a slightly protruded intramedullary nail

Neonatal treatment of congenital idiopathic clubfoot: a two stages method of surgical treatment

Two basic stages of surgical management for idiopathic talipes equinovarus [TEV] were described. In the first stage, all components of the club foot deformity was early corrected in 50 feet. The deformed feet were corrected initially by manipulation and serial plaster casts at weekly intervals for six weeks. The operative release of tight soft tissue was indicated when the deformity was not completely resolved by this specified period of time of conservative treatment. In the second stage, the corrected foot was maintained surgically by shortening of the peronei and anterior translocation of the peroneus brevis to correct muscular imbalance of the foot and ankle. All cases were evaluated clinically and radiologically and the mean follow-up time was 3.3 years. In 88% of the cases, the corrected muscle imbalance was successful in improving and maintaining the correction. The failure was in patients who had primary weakness in the peronei and who had removed their own casts prematurely. The best results were achieved with postural deformity. The procedure of retentive treatment has the advantages of retaining the correction of all components of deformity of corrected club foot, do not disturb the normal anatomy of the foot and avoiding the complications of prolonged cast and splint retention

Surgical treatment of congenital vertical talus by posterolateral release operation

A posterolateral soft tissue release operation with reduction of sublaxation at the talonavicular and subtalar joints was done on 8 feet with congenital vertical talus in five patients at El-Minia University Hospital. The youngest patient aged one year; the oldest was 7 years, follow up period was 2.5 years on the average. Five feet were satisfactory results while 3 were unsatisfactory. The unsatisfactory results were obtained in old and arthrogrypotic patients

Surgical management of foot disorders in stroke patient

Nineteen stroke patients suffering from foot deformity were treated in El-Minia University Hospital in the period from January: 1990 to August 1992. Six patients required tendo-Achilles lengthening for equines deformities, 8 required combined split anterior tibial tendon transfer and intramuscular lengthening of posterior tibial tendon for equinovarus deformities, and 5 required long toe flexors release for toe curling deformities. The end results were excellent in 63.2 percent, good in 26.3 percent, poor in 10.5 percent. The poor results were of those who presented late and in those who had fixed severe deformity. The operation improves the walking capacity of the patients

Treatment of kienboeck's disease by radial shortening

8 patients [8 wrists] who had Kienbock disease without degenerative changes in the joints were treated in the period from 1989 to 1992 in El-Minia University Hospital by radial shortening. Small DCP 6 holes was used in all cases through anterior approach of the lower third of radius. The segment of the bone removed was equal to the amount of negative ulnar varience that was measured radiologically pre-operatively. Average follow up period was 9.8 months. There was marked improvement of pain in all cases Range of movement of the wrist was improved in all directions and in all cases. Radiologcal improvement was reported in 2 cases by decreased sclerosis, increased trabecular pattern and increased size of the lunate

Treatment of persistent plantar heel pain by calcaneal osteotomy

Twenty-five patients with 28 feet suffering from persistent plantar heel pain [plantar fasciitis calcaneal spur syndrome], with average age of 39.5 years, were treated by calcaneal osteotomy, and approached the medial side of the heel. The late results, after a follow up period of 2 years in average, were satisfactory in 25 feet [89.3%] and unsatisfactory in 3 feet [10.7%]