Management of pathological and impending pathological fractures around the hip

Author reviewed his experience in managing 27 cases of pathological or impending pathological fractures around the hip. The study included 27 hips in 27 patients [no bilateral cases]. There were 17 females and 10 males. The age ranged at time of surgery between 28 years and 61 years [with the mean average of 47 years]. Follow-up ranged between 6 months and 42 months postoperatively with a mean average of 28 months. At the final follow-up, one case necessitated revision due to recurrence of an aneurysmal bone cyst and another case necessitated conversion of a hemiarthroplasty into gridlestone procedure due to deep seated infection. Other than these two cases, the overall final result was considered satisfactory [92.6%]. It was concluded that surgical stabilization for pathological or impending pathological fractures yielded good results regarding the pain and function in the operated group

Two staged reconstruction of flexor tendons of the fingers using ipsilateral pedicled flexor digitorum superficialis tendon graft

Twenty-three patients with flexor tendon injuries were operated upon for flexor tendon reconstruction using a staged technique of Hunter rode replacement, followed by pedicled flexor digitorum superficialis graft. The indication for this technique was excessive scarring of the tendon bed. There were 16 men and 7 women ranging in age from 16 to 48 years. Four patients had 4 fingers involved, 2 patients had 3 and 6 patients had 2 fingers involved, while the rest 11 patients had one finger involved. The number of involved fingers were 45 fingers. The postoperative follow up period ranged from 1 to 3 years. The measurements of active range of motion of the involved finger were taken in the closed fist position. Twenty seven fingers in this series were rated as excellent, 15 as good, 3 as fair and no finger as poor. Two stage flexor tendon reconstruction using this technique proved to be a safe and effective technique with minimal complications

Arthroscopic release of the diabetic persistent frozen shoulder

Sixteen diabetic patients who developed frozen shoulder which failed to respond to conservative treatment were subjected to arthroscopic shoulder release between January 2000 and March 2001. They had persistent pain, stiffness and limited function. They were followed up for an average period of 22 months, ranging between 19 and 24 months and evaluated according to the modified score of UCLAwith an average improvement of 16.25 points; 3 patients scored excellent [18.75%], 12 good [75%] and 1 fair [6.25%] result. In addition, the patients were assessed preoperatively and postoperatively for forward flexion, external rotation, abduction and internal rotation. The study revealed a good measurable increase in the range of motion in all planes. The study also considered arthroscopic release of the diabetic persistent frozen shoulder to be an effective method of treatment

Management of stage 3 Kienbock's disease by scapho-trapezio-trapezoid fusion [STT Fusion]

In this study, 34 patients having unilateral stage 3 Kienbock's disease were followed up after scapho-trapezio arthrodesis [STT fusion] between 1997 and 2002 [24 females and 10 males with an average age at the time of surgery of 23.2 years]. The follow up ranged between 12 and 52 months with an average of 38.7 months. In conclusion, in spite of the decreased postoperative range of motion, STT fusion is effective in reducing the pain and improving the grip strength in cases of Kienbock's disease. STT fusion improves and prevents the collapse of the carpus in stage 3 Kienbock's disease. The decreased postoperative range of motion [ROM] could be improved by adding radial styloidectomy to STT fusion to decrease radioscaphoid impingement. The adjustment of scaphoid orientation intra-operatively is a technical defect which should be taken in consideration to have a better outcome from STT fusion

Periprosthetic fractures around the hip

Authors reviewed their experience with 19 cases of periprosthetic fractures in 19 patients [No bilateral cases]. Follow up period ranged between 18 months and 39 months [mean average of 28 months]. Patients aged between 42 years and 67 years [mean average 58 years]. There were 11 males and 8 females. All patients were classified according to the classification. Two were type A, 13 type B and 4 type C. Treatment was tailored according to stem stability varying from simple wiring or screw fixation for greater trichinae fractures [Ag type] to compete revision using made prosthesis. We had only one case of failed fixation [5.3%]. We concluded that sound and tailored surgical management based on a proper classifications gives good results on the final outcome

Prevalence of celiac disease in Egyptian children and adolescents with insulin dependent diabetes mellitus: a biochemical and histopathologic study

Diagnosis of atypical and silent celiac disease [CD] is important because of its serious complications. The association of insulin dependent diabetes mellitus [DDM] and CD has been reported worldwide. The aim of this study was to determine the prevalence and clinical, biochemical and histopathologic characteristics of CD among Egyptian children and adolescents with IDDM. A total of 116 children and adolescents with IDDM [62 males and 54 females, age rage 2-21 yrs] and 25 age and sex matched healthy children were screened for CD using anti-gliadin [AGA], anti-tissue transglutaminase [t-TG], anti-reticulin [AGA] and anti-endomysial [EmA] antibodies. Clinical data, hemoglobin Air, insulin requirements, hemoglobin concentration, mean red cell volume and serum ferritin levels were evaluated. Twenty six [22.4%] patients were positive for AGA and ITG antibodies, 14 of them were ARA positive. Ten of these patients were EmA positive and four were EmA negative. From the EmA negative patients three sera with IgA deficiency had high lgG class in AGA, anti-t-TG and ARA antibodies. All these 14 patients [EmA positive and negative] underwent intestinal biopsy. Thirteen had histological evidence of CD including the EmA negative patients with IgA deficiency, giving a prevalence of CD in diabetic children of 11.2% [13/116]. Compared with the other diabetic patients, those with CD had a significantly higher height SD scores with no statistical significant changes in any other parameters. The prevalence of CD in Egyptian IDDM children and adolescents was found to the high. Serologic markers for CD are useful for identifying asymptomatic IDDM children who should undergo a small intestinal biopsy

99M technetium bone scanning in orthopedic surgery: report on 93 cases

This paper presents experience of authors with 93 patients investigated for different orthopaedic affections by the use of radioactive bone scanning. The indications and limitations of the procedure were discussed. The importance of bone scanning as a useful tool for investigating bone diseases especially in the early diagnosis of bony tumours is stressed

Treatment of non-union of fractures of shaft of humerus by posterior plate fixation and cancellous bone grafting

A series of twenty-seven ununited fractures of shaft of humerus were treated over ten-years [1972 to 1981]. More than half of these injuries were complicated by severe soft tissue damage, segmental bone loss, infection or multiple previous operative attempts to obtain union. Cancellous iliac bone grafting and internal fixation using plate and screws through a posterior approach was used. Union was achieved in all cases after an average of 3 months. There were few post-operative complications, viz radial nerve palsy in one case and discharging sinus that cleared off without residual osteomyelitis after removal of plate and screws in another two cases