Compression arthrodesis of the subtalar joint using two parallel lag screws

Thirteen subtalar fusions in 12 patients were included in this study. In situ arthrodesis was done in 11 fusions and distraction arthrodesis with bone block graft was done in two cases. Stabilization of the fusion was done by two parallel lag screws, one from the talar neck down to the calcaneus and the second from the tuberosity of the calcaneus to the talar body. They exert maximum compression on the subtalar joint, hence postoperative plaster cast was not needed. All cases reached union within 12 weeks. The results of the study showed that the use of two parallel lag screws fixation is a reliable technique for compression arthrodesis of the subtalar joint

Radical excision and grafting with pedicular fixation for the treatment of tuberculous kyphosis

In the last four years, twenty-five cases of tuberculous spondylitis with kyphotic deformity were treated by radical excision operation and transpedicular screw fixation [TPSF]. In eighteen cases, one stage approach, lateral rachotomy, radical excision of the lesion, strut iliac bone graft and TPSF were done. In the remaining seven cases, two stages produced was done. In the first stage, left thoracotomy, anterior radical excision and iliac bone graft were carried out, followed by posterior TPSF as a second stage two weeks later. Before surgery, nine cases were paraplegic, while the remaining sixteen cases were neurologically free. The maximum preoperative angle of kyphosis was 70 degrees, while the minimum was 30 with a mean of 52 degrees. An average correction of 28 degrees of the kyphotic angle was achieved immediately after surgery. A mean loss of 14 degrees of the obtained correction was noticed after an average of 31 months follow up with solid bony fusion of the spinal lesions. All but one of the paraplegic patients showed full neurological recovery. This approach combining internal fixation with debridement-fusion of the spine proved to be effective in correction of tuberculous kyphosis, avoiding increase of the kyphotic deformity and providing sufficient rest and protection during healing of the tuberculous spinal lesion

Transpedicular screw fixation in injuries of the dorsolumbar spine

80 cases of dorsolumbar spinal fractures were treated during the period from August 1989 to December 1991. All fractures were fixed by pedicular screws and plates after reduction of the fracture. The parameters of follow up were: Back pain and tenderness, union, rang of motion, radiological deformities and neurological improvement. Accordingly, the study achieved overall 85% excellent and good results. The recorded complications included dural tear, difficult reduction, screw failure and superficial infection

Early versus delayed skin coverage for traumatic skin defects

The aim of this study is to evaluate the results of early and delayed skin coverage in traumatic skin loss. The study included 77 patients with age ranged from 3 to 65 years. Skin loss was associated with fracture in 54 cases [70%]. The majority of cases had skin loss of 10-50 cm2. Skin coverage by split thickness skin graft or flap was performed early in 40 cases and delayed in 37 cases. The success rate was almost the same in the two groups [80% in the early covered cases and 76% in the delayed covered cases]. However, the rate of complications was higher in the delayed covered group [31%] than in the early covered group [18%]. The rates of infection, osteomyelitis and delayed union were also higher in the delayed covered group

Treatment of lower cervical spine injuries by anterior fusion and plating

This study analyzed 39 patients with lower cervical spine injuries treated by anterior fusion and plating. The average age of patient was 38.5 years,23 patients had predominantly discoligamentous injuries and were treated by unisegmental fusion and plating. 15 patients had predominantly crushed bodies and were treated by bisegmental anterior fusion and plating. 6 patients were neurologically free while 18 were completely quadriplegics and 15 patients were incompletely quadriplegics. There are no relevant complications except screw loosening in two patients with no clinical significance

New salvage procedure for the management of malignant bone tumors: preliminary report on 3 cases

Two cases of osteosarcoma and another of malignant fibrous histiocytoma of the lower end of the femur proved by biopsy were treated by wide resection of the tumor and knee joint. The resulting gap was closed primary bringing the end of the remaining femur and tibia into contact application of external fixator frame and compressing the bones together. In one of the osteosarcoma cases the bones were allowed to unite, followed by cortectomy and gradual lengthening. Chemotherapy was given to the osteosarcoma cases in courses starting preoperatively. In the malignant fibrous histiocytoma cases and in the other case of osteosarcoma distraction osteogenesis was started 3 weeks following resection. Adjuvant chemotherapy was also started at the same time in the malignant fibrous histiocytoma case

Anterior stabilisation by bone graft and plate for fracture dislocation of cervical spine

In fracture-dislocation of the cervical spine, there is associated injury of the stabilizing posterior elements. Anterior inter-body bone block as suggested by Robinson and Cloward did not provide stability of the injured segment. Additional fixation by H-plate was employed over the past year in ten cases. Cervical collar fixation was enforced for two months. All cases had neurological involvement before surgery. In none, the neurological deficit increased, while in seven cases partial or marked improvement occurred. Satisfactory radiological appearance with restoration of the spinal canal was achieved in all cases

Plating of femoral shaft fractures

67 femoral shaft fractures were treated by AO plating at Assiut University Hospital, Orthopaedic Department in the period from 1984 to 1987, 63 patients could be followed. There were 61 males and 6 females. Age ranged from15 to 70 years, Average of 33.8 years, twenty nine patients [43.2%] were between 15-30 years. There were 3 open fractures grade 1. 19 patients sustained other injuries with the femoral shaft and 7 cases required operations other than the femoral plating. Five types of fractures could be identified. 51 fractures [76.1%] were fixed within 3 weeks of injury. 16 fractures [23.8%] were fixed more than 3 weeks after injury. Primary cancellous graft was added in 26 fractures [38.9%]. The fixation was done with an AO broad DC in every case. The smallest one had 8 holes and the longest 18 holes obtaining at least a hold on 8 cortices on either side of the fracture. Additional interfragmentary screws were employed when ever necessary. One graft was used liberally mainly in cases with comminution of medial cortical deficiency. The shortest period for union was 2 months and the longest was 22 months [an average of 5.79 months], and 48 patients [85%] achieved union within the first 6 months. Healing time was found to be longer in comminuted fractures than in two fragment fractures and it was found to be earlier when the reduction was perfect than when it was approximate. The complications, were only one patient died on the tenth post operative day because of pulmonary embolism and 7 patients developed local complications [11.11%]. The infection was in one case [1.58%]. The overall results were graded; excellent in 59 patients [93.6%] and good in 4 patients [6.3%] fair and poor results in none of patients

Treatment of tibial shaft fractures with Kuntscher intramedullary nailing

This study had been carried out at Assiut University Hospital, Assiut, Egypt and El-Razi Hospital Kuwait, between the year 1987 and 1989. 60 tibial shaft fractures were included in 56 patients who were treated with Kuntscher intramedullary nailing. There were 14 females and 42 males [75%]. Their ages ranged from 17 years to 65 years, average [38 year]. The majority of the patients were between 21 and 40 years [average 36.2 years]. The patients were followed-up until months]. The majority of these tibial fractures [70%] were caused by motor car accidents. There were 43 closed and 17 open fractures. The majority of open fractures were Grade 1 in 8 cases [13.3%]. In the 60 tibial fractures there were 10 with double fracture making a total of 70 fracture level. Primary railing i.o on some day in [16], early nailing i.e within the 1st week [21], and delayed nailing i.e after 1st week [18]. The average time for radiological union was 18.25 weeks for fractures of junction of upper 1/3rd and middle 1/3rd, but was 18.77 weeks for middle 1/3rd and 21 weeks for junction of middle and lowest 1/3rd and was 17.78 weeks in lower 1/3rd. Closed fractures healed in 17.45 weeks, 15 patients healed within 24.2 weeks. Cases without reaming of medullary canal took longer time to heal [20.7 w] than nails fixed after reaming [17.2 w]. The bigger the diameter of the nail the rapid healing time i.e less than 11 mm the healing time [21 w], more than [11 to 13] the healing time [16.7 w]. The complication were: infection of open fracture [17.6%] and 2.3% infection in closed fractures, delayed union in 18 cases [30.3%].There was no non-union, 20% of cases healed with shortening varying between less than 1 cm and 3 cm. 16.4% patients showed mild to moderate limitation of movements of knee joint. 53% of patients complained of knee irritation and pain in kneeling. The final assessment in reaming group were excellent in 63.6%, fair 27.3% and poor 9.1% but in group without reaming showed excellent in 48.5%, fair in 48.5% and poor in 3%

Resection of lateral calcaneal prominences and subtalar fusion in old fractures of calcaneum

In Orthopaedic Department Assiut University hospital, twenty patients with average age fractures of calcaneum. Subtalar degenerative arthritis and peroneal tendinitis due to compression by the lateral bulge formation of the calcaneum were found in all cases. Tarsal tunnel syndrome was significant in 2 cases of them and planar calcaneal prominences was also observed in another 2 cases. All cases were managed by conservative measures which failed to relieve their complaint due to persistence of pain on weight bearing. Diagnosis was based on the location of the ender point, radiological views and conduction velocity studies were helpful in cases of tarsal tunnel syndrome. Resection of the lateral bulge and subtalar fusion. Below knee plaster cast was kept for 3 months and we got fusion in all cases, except one at time of cast removal. In all except two patients the pain on weight bearing is markedly reduced. In he first of these two, the lateral bulge was incompletely removed, and the second developed non-union