Anterior cervical fixation following verteberctomy; experience with various bone grafts and locking plates

This work presented an experience in using various bone grafts [iliac crest, BOP graft and banked fibula] following anterior cervical vertebrectomy and fixation with plate. Fifty-two patients with different pathological problems that necessitated anterior cervical decompression, bone grafting and anterior plating were reported. Surgery involved 1 level in 35 patients and 2 levels in 10 patients, while 7 patients necessitated more than 2-level vertebrectomy. Iliac bone graft was used in 22 patients, BOP graft in 20 patients, while banked fibula was used in 10 patients. The technique and results were discussed in details with a review of the literature comparing the three types of grafts with plating. There were no failures in the iliac bone graft group, 3 failures in the BOP graft group and 1 failure in the banked fibula group

Arthroscopic stabilization for first time anterior dislocation of the shoulder using a biodegradable transfixing implants

Sixteen young male manual workers [mean age 30.6 years] with high physical demands who sustained first time dislocation of the shoulder were treated with arthroscopic Bankart repair using the Contour Labral nail [Bionx/Biofix, Bioscience, Tampere, Finland] which is an absorbable transfixing implant. The follow-up period ranged between 5-18 months [mean 13.7 months]. There were no re-dislocations during the follow-up period. All patients, but one had excellent results on Rowe and Zarins scoring system [average score 91.25]. All patients, but one had no or little pain and regained full range of movement within 3-4 months. One patient developed postoperative DVT with poor outcome. This study showed that arthroscopic stabilization of first time dislocation using this technique gives satisfactory results compared favorably with conservative treatment of first time dislocation and with surgical treatment of recurrent dislocation of the shoulder

Congenital anomalies of the lateral meniscus. Results of arthroscopic findings and treatment

Seventeen patients with 19 symptomatic anomalous lateral menisci were treated with arthroscopic partial menisectomy, 13 patients were children or adolescent and 4 were adults. The average length of follow up was 4.4 years. Arthroscopic findings of the anomalies and the type of tears are described, and the classification of discoid lateral meniscus is discussed. Fifteen knees had excellent results after partial menisectomy, while two knees showed good results and two knees fair results. There were no poor results

Correction of axial mal-alignment of lower limb in adolescents

Twenty-one patients aged between eleven and seventeen years old, having knee deformities were treated by corrective osteotomies. Surgery was done for eighteen varus limbs in thirteen patients and ten valgus limbs in eight patients. Pre-operatively, a whole limb view was needed to evaluate the tibial and femoral proportions of the deformity as well as location of the apex of the deformity. Accordingly, seven patients had combined tibial and femoral osteotomies, two had bilateral procedures done for varus deformity, two had unilateral osteotomies for varus and three for valgus deformity. Nine patients had upper tibial metaphyseal osteotomies for varus deformity [three bilateral, six unilateral]. The remaining five patients had valgus deformity [two had bilateral correction and three were unilateral]. Thus a total of thirty-seven corrective osteotomies in twenty-eight limbs were done. All osteotomies were preplanned to determine the appropriate size and site. Correction was controlled intra-operatively by aiding devices under fluoroscopy control, T plate was the common implant used and correction was achieved by the help of plate tension device. Our objectives for correction were restoration of normal limb alignment as indicated by the relation between mechanical axis and joint line and normal co-linear relation between the joint centers of the hip, knee and ankle joints as indicated by the hip, knee, ankle angle. The final results showed correction of the deformity among the varus limbs from an average of -14.4 degrees preoperatively to -2.4 degrees post-operatively. While in the valgus limbs the average pre-operative valgus deformity was +12.9 degrees and +1.2 degrees post-operatively. The average estimated preoperative mechanical axis deviation was 111% and this was reduced to an average of 8.6% post-operatively. There were six cases of mal-correction [four tibial and two femoral], and the success rate according to our criteria was 79%

Evaluation of hemiarthroplasty as a treatment modality for glenohumeral arthritis

Prosthetic shouder arthroplasty [PSA] is no longer an experimental procedure, it is in fact a successful operation. In this study 28 patients underwent a Neer shoulder hemiarthroplasty [16 were evaluated on a prospective basis and 12 on a retrospective basis]. The underlying pathology was RA in 23 patients and OA in 5 patients. There were 21 females and 7 males, ranging in age from 40 to 83 years [mean 65]. The follow up period ranged between 12 and 64 months [mean 33]. All the prostheses used were of the Neer Mark II design, where a 23mm head was used in all patients with OA and a 15mm head was used in all patients with RA. Our procedure was done with the patients in beach-chair position, through a delto-pectoral approach and using a freehand technique for the humeral osteotomy. All our patients received an extensive postoperative rehabilitation program that continued for at least 6 months. We used the Constant scoring system for evaluating our procedures and Wilcoxon signed rank test for statistical analysis of our results. The resultes of 23 shoulder of RA had an improvement in all cases [100%] in their total Constant score-power excluded-with a mean improvement of 34.61 points which was statistically highly significant and also for the 5 shoulders of OA [100%] with a mean improvement of 53 points. Radiographically, none of the shoulders in our series developed subluxation or dislocation apart from transitory inferior subluxation, no heterotopic bone formation, no change in implant position, and incomplete lucencies less than 1mm in 6 of our 28 prostheses which did not progress. We concluded that improvement in pain and sleep is a universal achievement of this procedure regardless of the type of prosthesis and underlying pathology, for these reasons patient satisfaction is extremely high, however better results were achieved when the underlying pathology is OA as the rotator cuff is intact