Results of flexible intra-medullary nailing in paediatric femoral fractures

Treatment of fracture femur in children between 6-14 years is still controversial. The aim of this study is to evaluate the results of treatment of fracture femur in children between 6 and 14 years old using elastic stable intramedullary nailing [ESIN]. ESIN was used to treat 20 patients between the age of six and fourteen years old with fracture shaft femur. The main mechanism of trauma was road traffic accidents. One fracture was an open grade II fracture. The most encountered level of the fractures was in the middle third. The mean time lapse before surgery was 6.65 +/- 5.4 days. The final results obtained were excellent in eighteen patients [90%] and good in two patients [10%]. The mean time to clinical union was 5.65 +/- 0.81 weeks, while the mean time to radiological union was 7.55 +/- 1.39 weeks. Final score had no statistically significant relations to age, sex, side affected, time lapse before the operation, minimum canal diameter, nail diameter used, intra-operative image intensifier time, mechanism of trauma, type/level/shape of fractures, the presence of associated injuries, and technique of reduction. Four patients had pain at insertion site, two had 10 external rotation, two had 20 valgus, one had 10 varus deformity and one had 10 anterior angulation. We concluded that flexible intramedullary nailing is an accepted treatment option with the advantage of shorter hospital stay and early recovery

Arthroscopic repair of isolated triangular fibrocartilage complex tears

A prospective study included 22 patients with a symptomatic triangular A. JL Jibrocartilage tear [Palmer's type IB or type 1C]. Pre-operative clinical diagnosis was confirmed by conventional MRI, MRI arthrogram and arthroscopically. All cases were arthroscopically repaired using the two needle technique. The mean follow-up period was 26 [range, 11 to 48] months. Pre-operatively, all patients complained of pain, restricted wrist and forearm motion and weakness of hand grip. According to the used El-Hadra wrist function scoring system, the mean pre-operative score was 9 [range, 4 to 12] points that improved after surgery to a mean of 20 [range, 16 to24] points, with thirteen wrists were graded excellent, eight good and one as fair. Pain was relieved completely in 15 wrists. Eighteen patients gradually returned to their original jobs and sports activities. The mean objective range of wrist movements increased to 91% of that of the normal side and the mean grip strength improved to 83% of the unaffected side. The results are encouraging and the procedure would seem to be an effective treatment for Palmer's types IB and 1C TFCC tears. It is also a less invasive option of management that may have mechanical advantages of stabilizing the ulnocarpal articulation and the distal radioulnar joint, while significantly improving the clinical symptoms

Outcome of anterior cervical decopression and fusion using the atlants anterior cervical plate system

The study was conducted on 45 patients suffering from degenerative disease of the cervical spine that was resistant to conservative treatment. Patients with either single-level or two-level cervical disc affection only were included. Radiculopathy was diagnosed in 41 patients and myelopathy in 10. The mean age was 43.2 years [range 34-66 years]. The patients were randomly divided into two groups: Group I [23 patients] had the Atlantis plate system to stabilize the grafted discs, while, group II [22 patients] had the same procedure without plating. It was concluded that, the Atlantis anterior cervical plate system provides the additional benefits of fixed, variable and hybrid constructs. In addition to being safe and easily implanted, its use appears to yield equal or better results than other established anterior plate systems, particularly with two-level fusion. Further studies and longer follow up should be carried out

Trapeziectomy and flexor carpiradialis tendon interposition arthroplasty for osteoarthritis of the first carpometacarpal joint

Aprospective study aimed at the evaluation of the outcome of complete excision of the trapezium, flexor carpi radialis tendon interposition arthroplasty and ligament reconstruction in treating symptomatic primary osteoarthritis of the trapeziometacarpal joint. Forty-six hands in 38 patients [36 women and 2 men] were studied. The mean age was 57 years. The mean follow-up period was 42 months. Pre and post-operative subjective, objective and radiological evaluation were performed for all patients. All patients reported significant relief of pain. Subjective hand function improved in 43 cases [93.5%]. Mean key pinch and hand grip strength improved from 10.44 and 30.13 pond per square inch [PSI] pre-operatively to 11.37 and 32.05 PSI, respectively, at the end of the follow-up. Better thumb mobility has been achieved, with improved mean first web span from 47 to 63 degrees. The procedure accomplishes its objectives in treating symptomatic trapeziometacarpal arthritis that failed to improve with conservative care

Ulnar shortening osteotomy for the management of ulnar impaction syndrome

Twenty-two patients with symptomatic ulnar impaction syndrome associated with ulnar positive variance were treated by ulnar shortening osteotomy. The mean follow-up period was 62 months. Pre-operatively, all patients complained of pain, restricted wrist and forearm motion, and weakness of handgrip. Osteotomies soundly healed in all patients. Postoperatively, thirteen wrists were graded excellent, seven good, and four fair, using Chun et al's modification of Garteland and Werely scoring system. Two patients with persistent postoperative pain had additional procedures performed. Ulnar shortening was a useful procedure for the treatment of ulnar impaction syndrome associated with ulnar positive variance

Complex distal radius fractures treated by percuta-neous pinning. A prospective comparative study of cast immobilisation versus external fixator

Forty-six patients [37 women and 9 men] with unilateral comminuted intra-articular, unstable supination fractures of the distal radius were studied in a randomized prospective manner. The mean age was 62 years. They were treated by reduction under general anesthesia and percutaneous Kirschner wires fixation, followed by either plaster immobilization [group A] or Pennig external wrist fixator [group B]. The mean follow-up period was 21 months. Assessment protocol consisted of patient's questionnaire, medical record review and physical and radiographic evaluation. The demerit point system of Sarmiento was used to objectively evaluate the functional outcome. The results were good or excellent in 80.4%. Both methods maintained the reduction reasonably. Apart from early stiffness in the fixator group, no major differences were found between treatment groups. No late complications were found at the end of follow-up