Evaluation of the normal calcaneal angles in Egyptian population

The calcaneus is the largest and strongest tarsal bone. It is the most commonly fractured tarsal bone and accounts for about 2% of all fractures. The importance of the calcaneal angles in assessing the fractures of calcaneus and planning treatment has been highlighted. The purpose of this study was to evaluate the normal calcaneal angles in the Egyptian populations who live in Alexandria and nearby governorates and compare their values to the published data. Lateral plain radiographs of 220 normal feet and ankles of 103 males and 97 females with age ranged from 20 to 40 years, were studied retrospectively at El Hadra University Hospital, Alexandria, Arabrepublic of Egypt between June and December 2010. Three of the normal calcaneal angles [Bohler angle-Gissane's angle-calcaneal compression angle] were measured and the mean and standard deviation of each angle were calculated. The relationships between each angle and age, sex, side of the body, occupation, weight, height, and residence of examined persons was tested and compared to previous researches and international figures. The mean of Bohler angle in the Egyptian population was 30.14 +/- 4.182 ranged from 22° to 40°. The mean of Gissane's angle was 122.92 +/- 6.952 ranged from 108° to 138°, while the mean of calcaneal compression angle was 31.03 +/- 3.82 ranged from 24° to 44°. The measured calcaneal angles are not significantly related to age, sex, and side of the body, residence and occupation of the examined persons except there is significant negative correlation between the Bohler angle and the age which not reported in the previous researches and studies. The study showed that difference in the mean of the calcaneal angles from other previous studies that reinforce the importance of establishing the normal range of the calcaneal angles in a given population

Management of giant cell tumour of the distal end of the radius by en-block excision and reconstruction by free-autogenous graft using the upper end of the fibula

This study included 17 patients [6 women and 11 men with a mean age 36.5 years] with giant cell tumor [GCT] of the distal end of the radius treated by en-block resection and reconstruction by autogenous massive graft using the upper end of the fibula. The main presentation was pain; 13 patients complained of swelling as well 3 had undisplaced pathological fractures. In all patients, en-block excision of the lower end of the radius with a safety margin and removing the tumor with its pseudo capsule was carried out. The excised segment was replaced by a massive autograft from the upper end of the fibula. The graft was fixed to the remaining radius by a plate and screws and temporarily to the carpus or distal end of ulna by K wire or screw. The results showed that three patients developed a local recurrence, two had distant metastases and one patient was lost for follow up. Recurrent cases turned malignant. A functional study was done for the remaining 11 patients, which showed a good hand function and a slight limitation of wrist movement and almost normal pronation/supination. There was a widening of the wrist and no recurrence for an average of 18.1 years was detected

Surgical repair of complete acromioclavicular dislocation augmented with PDS bands. Technique and results

In this study, 23 patients presenting with complete acromioclavicular [AC] joint dislocations were managed by surgical reconstruction. According to Rockwood and Matsen classification, 16 patients had type III lesion, 4 had type IV and 3 patients had type V lesion. The AC as well as the coracoclavicular [CC] ligaments were reconstructed. Augmentation of the reconstruction was done using resorbable 5- and 10-mm PDS bands. The results were assessed postoperatively using the University of California at Los Angeles [UCLA] end-result score. Twenty patients had excellent and good results, while three patients were rated as poor. No calcification of the ligaments was found postoperatively. Two patients had AC joint arthrosis

Accuracy of transpedicular screws placement in scoliosis

Transpedicular screw fixation of the spine in scoliosis is still not very popular. Although biomechanically superior, it carries the risk of wrong placement which may lead to serious complications. A modified method of screw insertion was suggested where the screw was put under vision and feeling. The aim of this study is to assess the accuracy of placement of transpedicular screws in scoliosis. Comparison between the traditional method of screw insertion [depending on anatomical landmarks] and the modified method will be conducted. Also the safest sites of screw placement will be studied trying to find the best sites of screw placement in adolescent idiopathic scoliosis for King I and II types. 248 screws were inserted in 45 patients of King I and II adolescent idiopathic scoliosis. Postoperatively, patients were evaluated clinically and radiologically for curve correction and neurological condition. Each vertebra instrumented was examined for degree of rotation, its location and its position in the curve. Also method of screw insertion was reported. Each screw was examined for its point of entry, direction, length and its containment inside the pedicle. Results were statistically analyzed. Percent correction of thoracic curve was 55.6%, while that of lumbar was 50%. Only two factors significantly affected correction: number of vertebrae included and number of sublaminar wires used. One patient developed irritation of L3 root that improved after removal of offending screw. The average number of screws used was 5.51 screws. Modified method was used to insert 67 thoracic screws out of 248 screws. Twenty three [9.7%] screws were misplaced while wrong point of entry was encountered in 31 occasions [12.5%] and inappropriate direction of the screws in 27 times [10.9%]. Most of these wrong screw applications were in the lower end of the curve. Inadequate screw length was encountered in 16 cases [6.5%]. The factors that affect accurate placement of screws were analyzed. The factors that significantly affect it include: level of instrumentation [higher incidence in lower lumbar], method of screw insertion [modified method gave significantly better results], type of the curve [King II gave better results] and number of screws inserted [the more the number of screws inserted in the patient, the more is the incidence of misplaced screws]

Total HIP arthroplasty following hemiarhroplasty expectation of surgical problems and three years follow up

Recently, cases of hemiarthroplasty that need revision to total hip replacement are increasing. Was to find a classification for expectation of surgical difficulties; moreover the results of follow up of at least 36 months for 32 cases were evaluated. Six males and 26 females of painful aseptic failure of hemiarthroplasties were included. Patients were evaluated both clinically and radiologically. Operative data were recorded and analyzed. Patients were re-evaluated during and after the period of the follow up [with a mean of 49 +/- 8.3 months]. The failed cases of hemiarthroplasty were classified into: Type I: This type includes cases of loose endo-prothesis with a normal or nearly normal acetabulum. It is subclssified into 3 subtypes: I-a: with thin eroded but intact calcar; this was represented by 2 cases. Subtype I-b: calcar eroded till the level of lesser trochanter [18 cases] I-c: lesser trochanter also eroded [5 cases] Type II: Well fixed endoprothesis but eroded acetabulum. This type include 4 cases, mostly of Thompson type [3 cases] Type III: Dislocated hemiarthroplasty. This was subdivided into 2 subtypes. Three cases were included. Type IV: fractures of the femur around the prosthesis. No cases were included in this study. By the end of follow up Harris hip score had increased from a mean of 30.31 preoperatively to 73,59. Only 4 patients were not satisfied. Main complications include: dislocation, wound complication, non union of trochanteric osteotomy, osteolysis and fracture of the femur, thromboembolic complications. Main conclusions: Total hip replacement following aseptic failure of hemiarthroplasty gives commonly high percent of good results and patient's satisfaction. Difficulties during surgery are many. A classification was put to expect these difficulties and for better preoperative planning

Patterns of implant failure in idiopathic scoliosis fixed with transpedicular screws

Transpedicular screw failure with new segmental fixation was described in the literature with a varying incidences in degenerative lumbar conditions, spondylolisthesis and fractures of dorsal and lumbar spine,3'4'5'6'7 but little, if any, was written on this subject regarding scoliosis. May be because till recently FDA did not yet approve its use in scoliosis. The aim of this study was to detect the patterns of implant failure in idiopathic adolescent scoliosis with different types of transpedicular screw fixation and the possible factors that may be responsible for such pattern of failure. Material and methods: 69 cases of idiopathic scoliosis of more than 3 years follow up were examined. Sixteen cases had shown 21 screws failure. The patients included 15 girls and one boy. The average age was 13.06 years The systems used for fixation in those cases of implant failure were TSRH in 7 cases, Claris in 8 cases and Isola in one case. Main results Claris system had the highest incidence of implant failure [38.1%] followed by TSRH [28%] and the least was Isola system [4.3%]. The average number of screws and number of vertebrae fixed with the three system were nearly equal. The main mode of failure with Claris system was due to looseness of the connector screw interface that occurred in 70% of cases. This mode of failure represented 50% of cases with TSRH while the other modes were pulling out of the screw [30%] and screw breakage [20%]. The failed case in Isola system was due to looseness of the screw connector interface. The Lower end of the curve contains two thirds of the cases of failure and the main mode of failure in this area was due to looseness of the connector screw interface [71.4%]. In the upper end of curve failure occurs mainly due to pulling out of the screws. The main modes of failure, however, in the intermediate portion of the curve were both pulling out and looseness of the connector. The mode of failure did not show evident change with the two methods of curve correction [Cephalo-caudal compression-distraction and derotation]. Also the mean percent of correction of the curve was not different in the different mode of failures

Primary hyperparathyroidism: clinical presentation and management

Nineteen patients with primary hyperparathyroidism were operated upon in the period from January 1994 till December 1998. Thirteen patients were females and six were males. The maximum age incidence occurred in the fourth decade. Bony lesions were the frequent presentation. They were in the form of localized pain and bone swelling [38.8%], pathological fracture [26.3%] and generalized bone ache [10.5%]. The diagnosis of primary hyperparathyroidism was established on basis of elevated levels of ionized calcium, 24-hours urinary caclium and PTH together with decreased levelof serum phosphorus. Preoperative ultrasonography correctly localized the parathyroid pathology in 73.7%. Bilateral exporation of the neck revealed a sizable solitary parathyroid adenoma in 18 patients. In a single case the adenoma was intra thyroid in location. A concomitant partial throidectomy was performed in 7 patients. The postoperative complications were trivial; 11 patients suffered from transient hypercalcaemia. The determined postoperative serum calcium and PTH were normalized although both attained a different pattern to do this after operation. Among the 15 patients presenting with bone cysts, only two were treated surgically. The majority responded to conservative treatment adopting rest and immobilization after parathyroid adenectomy. Moreover, the pathological fractures healed well conservatively after the adenectomy. Internal fixation was resorted to in only 2 cases having pathological fractures of the femur

Arthrodesis of the HIP with muscle pedicle graft

Long term patient's slatisfaction, up to 30 years, following hip fusion was reported [2,3]. The aim of this work is to evaluate the results of a modified method of hip fusion. Patients and methods: 14 adults patients with unilateral hip destruction following septic arthritis [7 cases], tuberculous arthritis [4 cases] and trauma form the material of this study. The method of fusion entails using the greater trochanter with the gluteus medius attached as a muscle pedicle bone graft to be put between the superior surface of the neck femur and the outer edge of the acetabulum. Moreover, tricortical iliac graft is put between the roof of the acetabulum and upper part of the head after removing any remanant of their cartilage. The bones are then hold together by Cobra plate. Reusults: one cases of non-union, one case of clinical union and 12 cases [85.7%] of bonny healing. Complications include: one case of flaring of infection, one case of breakage femoral screws, one case of increased shortening and one case of iaetrogenic fracture neck of the femur

Augmentation of single rod with sublaminar wiring in treating adolescent idiopathic scoliosis

To evaluate the effects of single rod augmented with sublaminar wiring in correcting scoliosis. Special attention was. 25 adolescent patients with mean age of 12.9 years. These included 9 boys and 16 girls. All cases were examined clinically and radiologically before and after surgery. Surgery in all cases included the use of single rod fixed with transpedicular screws [except one case where kooks were used in the upper part of the curve]. Sublaminar wires were used to supplement the fixation. Moreover at the sites intended for screw fixation these openings were extended a bit laterally to facilitate screw fixation. The mean thoracic curve preoperatively was: 54.7 degrees, while that of the lumber was 37.3 degrees. Flexibility of the thoracic curve had a mean of 48.1% while that of the lumbar was 46.7%. The mean number of vertebrae included was 10.7 vertebrae. The mean number of screws was 5.1 screws and a mean of 4.4 sublaminar wires was used. The mean correction of thoracic curve was 59.9% that of lumbar was 55.5%. The factors that was significantly affecting the correction were the flexibility of the thoracic curves, the number of vertebrae included in instrumentation, number of screws used. The number of sublaminar wires used were positively but insignificantly correlated to the degree of correction