Functional results of surgical treatment of congenital superior radio-ulnar synostosis in children by muscle transfer and derotational osteotomy

This study was performed to evaluate the functional results of surgical treatment of congenital superior radio-ulnar synostosis [SRUS] in children by Anconeus muscle transfer and derotational osteotomy. Patients diagnosed as having SRUS presented to the outpatient clinic of the Suez Canal University Hospitals between august 2003 to October 2006. 6 patients were included in the study as 4 males and 2 females, and two male patients had bilateral deformity with the total number of deformed SRU joint of 8. The average age was 4.8 [3-8] years. History taking about the functional deficit caused by this deformity and local examination of the affected elbow joint for evaluation and measurement of the range of motion of flexion and extension, supination and pronation movement. The position of the forearm and if it is a bilateral deformity was also evaluated and measured. Pre-operative plain x-ray was done for every patient for evaluation of the degree of the synostosis and if there is any other consequent deformities such as bowing of the radius. Anconeus muscle transfer and derotational osteotomy of the distal radius was done for all patients and post-operative evaluation through x-rays and clinical evaluation for the range of supination and pronation was done and at one year of follow-up. All patients had fixed pronation deformity of the forearm pre-operatively at 70 degrees [ranged from 60 to 80 degrees] and this position causes functional disability. Post-operatively, they had a range of motion with the degree of supination as 30 degrees [range from 20 to 40 degrees], and the degree of pronation is 60 degrees [range from 40 to 70 degrees] and the range of motion was assessed after one year and all patients had decrease of the range of supination and pronation in different degrees as the supination was 25 degrees [ranged from 10 to 40 degrees] and the pronation was 40 degrees [ranged from 35 to 55 degrees]. Surgical treatment of congenital superior radio-ulnar synostosis in children using the Anconeous muscle as an interpositional material prevented recurrence of the ankylosis and improving rotation of the forearm. Also, derotational osteotomy of the radius will prevent dislocation of the radial head and this will improve rotation of the forearm as well. In addition this technique is more easy than other procedures and has less complications

Evaluation of the functional results of management of traumatic anterior glenohumeral instability by arthroscopic capsular shift using suture anchors

This study aimed to evaluate the functional results of management of traumatic anterior gleno-humeral instability by arthroscopic capsular shift using suture anchors. This prospective study was carried out on 20 patients who attended to the outpatient clinic of Suez Canal University hospital, during the period from 2004 to the end of 2006. Patients [19 male patients and 1 female with range of age from 20-50 years] included in the study had the criteria of chronic traumatic anterior glenohumeral instability. Every patient had complete history taking, complete physical examination of shoulders and cervical spine and range of motion of the shoulder joint, evaluation of the strength of the deltoid and rotators and screening neurological examination and investiagations of the shoulder joint by radiographs as plain x-ray and sometimes MRI. All patients had Bankart lesion managed by capsular shift using Mitek suture anchors. Average follow- up period was 16.5 months. Assessment of the improvement of motion ranges were registered, and satisfaction of each patient as well as in the criteria of the UCLA scale. The UCLA score revealed significant improvement in the status of the shoulder. Preoperatively: none of the patients rated their satisfaction as good or excellent. Postoperatively 16 [80%] rated their satisfaction as good or excellent and 4 [20%] rated it as fair or poor. For range of motion, most of the patients show improvement in range of elevation from 158.25 to 172.25 degrees. The mean external rotation measured 48.75 degrees preoperative and 45.20 postoperative with loss less than 5%. The mean abduction was 173.25 degrees preoperative and 172.25 postoperative with loss less than 5%. Most of the patients show improvement in range of all movements within three months of operations. For the degree of instability, the final mean UCLA score was found to be 34.11 points for the patients with recurrent dislocation, 35 points for the patient with recurrent subluxation after an initial dislocation, and 33 points for the patient with Apprehension [p = 0.519]. After one year of follow up no patient suffered from recurrence of dislocation or apprehension and only one patient [5%] suffered from subluxation. Arthroscopic repair with suture anchors is an effective surgical technique for the treatment of degenerated labrum using capsular shift. Open repair does not offer a significantly better result in terms of stability, and what is more, can negatively affect the recovery of full ROM of the shoulder. Because the arthroscopic procedure has some advantages regarding duration of surgery, morbidity, postoperative pain, time of hospitalization, and risk of complications, also it is more cost-effective

Internal fixation of aseptic non-united fractures of tibia after implant failure by interlocking nail and bone grafting

This study was performed to evaluate the results of internal fixation of non-united fractures of the tibia by interlocking nailing after implant failure. Fourteen patients were included in the study, 10 males and 4 females who were admitted to the Suez Canal university hospital. The average age was 36 years [21-68]. Patients who had non-united fracture tibia after implant failure were the material of this work. Eleven patients had been treated with plate and screws and three by locked intra-medullary nailing. Twelve patients had closed fractures and two had open fractures Gastilo I. The diagnosis of nonunion was made on the absence of progression of the radiological signs of union and the persistence of pain at the fracture site. The mean interval between fracture and secondary surgery was 13 months [6 to 21]. Open technique was used in all patients for removal of tibial plating and Locked intra-medullary nailing and also laying down an iliac bone graft at the non-united fracture Site. Clinical union was proved in all patients with pain-free weight-bearing and this precede radiological union which occurs in all patients after 3 to 9 months with an average of 4 months. Angular and rotational deformities were corrected in all patients and 4 patients had shortening of 1 to 2.5 cm. One patient developed infection but debridement and frequent dressing and antibiotics resulted in relieve of infection after one month and union occurred radiologically after 9 months. Locked nailing, providing stable fixation, with iliac bone graft in patients with aseptic nonunion of the tibia allows physiologic early weight bearing stresses at the fracture site, together with the osteogenic potential of the bone graft, stimulate healing of the nonunion