Tubercular epidural abscess in children Report of two cases.

Tubercular spinal epidural abscess (SEA) is an uncommon infectious occurrence. SEA was first described in 1761. Clinical prospects of tubercular SEA are graver, if not promptly diagnosed and treated appropriately. We present two cases of spinal epidural abscess of tubercular etiology who progressed to paraplegia over the course of disease. MRI pointed towards an epidural abscess in the dorsal spine. Histopathological analysis revealed SEA, tubercular in nature in both cases. Patients responded to surgical decompression and anti-tubercular therapy (ATT). Such type of clinical entities has least been documented.

Interlaminar decompression in lumbar canal stenosis.

Opinion is still divided over a standard surgical procedure to decompress lumbar canal stenosis. Both, laminectomy with or without facetectomy and foraminotomy and interlaminar fenestration have been advocated. In the present communication interlaminar decompression in lumbar canal stenosis has been discussed. Sixteen consecutive patients (7 males and 9 females) with clinical, neurological and radiological features of lumbar canal stenosis were treated by interlaminar (fenestration) decompression. The age of onset of symptoms ranged between 22-57 years. Adjoining lamina around interlaminar space of involved segment along with ligamentum flavum and part of facet joint (undercutting facetectomy), extending laterally (foraminotomy) were removed at single or multiple levels. Follow-up response (93.7%) over a period of two and half years showed the results as good in 73.3% and fair in 26.7% of cases, with uniformly uneventful post-operative period.

Results of thumb correction in leprosy using different techniques.

Forty-four hands of 42 leprosy patients with paralysis of intrinsic muscles of the hand were treated by opponensplasty using ring finger superficialis (FDS4) or extensor indicis proprius (EIP). Superficialis tendon of middle finger was also used in these hands for lumbrical replacement by "direct lasso" operation. Low ulnar paralysis with Froment's sign was corrected by transfer of radial half of flexor pollicis longus (FPL) to extensor pollicis longus (EPL). Results of thumb correction were assessed and analysed in 37 hands of 35 patients. The mean follow-up period was 19 months. Best results were found with transfer of half FPL to EPL. Results of FDS transfer was good in 12 out of 16 manual workers. EIP transfer worked well, but the power of the thumb and patients' satisfaction was less.

Surgical correction of claw fingers in leprosy using flexor superficialis direct lasso procedure.

One tendon of Flexor digitorum superficialis split into two or four tails and each tail looped around the A1 pulley of one affected finger, was used for correcting intrinsic minus deformity of fingers in 144 patients. This operation has the advantage of retaining superficialis tendons of the other fingers for better power grip and avoiding swan-neck deformity. Satisfactory results were noticed in 81 of the 99 patients (82%) followed up. The remaining 18 patients showed a variety of problems such as swan neck/check rein deformity in the donor finger, skin contracture and recurrence of clawing.

Fibular shortening in poliomyelitis.

This study arose from observation that in children will leg shortening from paralysis, the relationship between the tibia and fibula is disturbed. This article analyses 76 patients of post polio residual paralysis involving only one lower limb. Sixteen patients had fibular shortening. Several factors that interfere with fibular growth, i.e. anatomical continuity, soleus strength, abnormal forces at distal fibular physis, result in fibular shortening. Early the age at onset of paralysis, more is the fibular shortening which is associated with lateral wedging of distal tibial epiphysis, valgus at ankle, external torsion of tibia and genu valgus.

Medial open wedge high tibial osteotomy in medial compartment osteoarthrosis of the knee.

BACKGROUND. For osteoarthrosis of the knee unresponsive to medical treatment, the standard operative technique is to remove a wedge of the knee from the lateral aspect of the tibia. We describe a simple and precise procedure--medial open wedge high tibial osteotomy. METHODS. Between 1988 and 1991, we performed 25 medial open wedge high tibial osteotomies for osteoarthrosis of the medial compartment of the knee with varus deformity. Anterior tibial tubercle elevation (ventralization) was combined with the index procedure in 6 cases which were associated with patellofemoral arthrosis. To keep the osteotomy open a bicortical wedge-shaped graft from the iliac crest was used in 14 cases and from the tibia in 8 cases. Osteotomy was performed 2 cm distal to the articular surface of the tibia above the tibial tuberosity. Fixation of the osteotomy was not required. RESULTS. Twenty-two patients were available for follow up examination and were assessed clinically and radiologically over a period ranging from 6 to 48 months (mean 22 months). Fourteen of them did well and 8 had fair results. No major complications were encountered. CONCLUSION. Medial open wedge high tibial osteotomy not only has results comparable to other techniques but has several advantages of being a simple and accurate procedure with a low morbidity.