Dome-shaped high tibial osteotomy guided by circular wire

The aim of this study was to evaluate the early results of dome-shaped high tibial osteotomy in patients with medial compartment osteoarthritis of the knee with varus deformity. The average preoperative duration of symptoms was 5.1 years. The average age was 50.71 years [range, 42-59 years] at the moment of operation. The mean follow-up was 16.6 months [10 - 22 months]. We assessed the degree of arthrosis according to Ahlb'ack in three-grade scale. The patients with varus deformity had mean preoperative and postoperative tibiofemoral angles of 4.4 WHITE BULLET varus [0 WHITE BULLET 11 WHITE BULLET] and 5.7 WHITE BULLET valgus [4 WHITE BULLET -100], respectively. The patients were assessed according to the system developed by the Knee Society Scoring System. The mean preoperative Knee Score was 52 and the Knee Functional Score was 53,while the mean postoperative Knee Score was 82 and the Knee Functional Score was 84. Although the indications for arthroplasty of the knee are more frequent nowadays, the authors recommend not to forget dome-shaped high tibial osteotomy in the treatment of angular deformity of the knee with osteoarthritis. After a mean duration of follow-up 16.6 months, we found that the dome-shaped high tibial osteotomy of the proximal part of the tibia provided satisfactory clinical results for patients with osteoarthritis of the knee

Open versus arthroscopic acromioplasty with intact rotator cuff

Twenty patients [22 shoulders] were selected for either open acromioplasty or for arthroscopic acromioplasty. All suffered from chronic impingement syndrome in the presence of intact rotator cuff, which conservative treatment had been unsuccessful. The minimum follow-up was 12 months for both groups. There was no statistical difference in mean postoperative shoulder scores between the two operative groups. However, there were more excellent and good results in the open group as compared with arthroscopic group [72.7%, vs 63.6%, respectively]. In addition there was a higher percentage of fair and poor results in arthroscopic group as compared to open group [36.4%, vs 27.3%, respectively]. As regard to the function and pain, postoperatively, there were a satisfactory results in around 80% of cases for either open or arthroscopic acromioplasty. Arthroscopic acromioplasty associated with shorter hospital stays and faster achievement of maximal pain relief as compared with open acromioplasty. Choice of the technique depends on expertise of surgeon

Combined chevron osteotomy and lateral capsuloligamentous release in treatment of hallux valgus

Twenty two patients with 34 bunions were treated surgically by exostectomy, lateral translation of the metatar-sal head after V- shaped osteotomy, a lateral release of the capsuloligamentous structures and reconstruction of the medial metatarsosesamoid ligament. The versatility of the osteotomy allows correction of the hallux valgus [HV] deformity by tilting the metatarsal head medially, dorsally and plantarwardly. Fixation by 2 k-wires added stability to the osteotomy site and allowed early rehabilitation. Tlie mean age of the patients was 41 years at time of operation. Most of our patients were females [91.9%]. The feet were evaluated clinically and radiologicaliy with a mean follow up period of 21 months [range from 10-36 months]. The mean correction of the hallux valgus angle was [13 WHITE BULLET] and of the intermetatarsal angle [6 WHITE BULLET]. Patient satisfaction was 95% as-regard bunion pain, and shoe. fitting. The American orthopedic foot and ankle society [AOFAS] scale [0-100] was used. The average value was 81.2 [ +/- SD 14.7] points according to the AOFAS rating system at the end of the study

comparative study between pateller tendon and four strand semitendinosus tendon grafts in arthroscopic anterior cruciate ligament reconstruction

A prospective study was designed to compare the clinical results after isolated anterior cruciate ligament rupture. 52 patients were randomized to undergoe either Patellar Bone Tendon bone autograft [27 patients [51.9%]] or a four strand semitendinosus tendon graft reconstruction [25 patients [48.1%]] arthroscopically. The results were reviewed at 3,6,12,24 and 36 months. Pain on kneeling, and extension deficits were greater in patellar tendon group at 3 and 6 months but not there after [P<0.05]. In the semitendinosus group, active flexion deficits and anterior knee laxity were greater from 6 to 36 months [P<0.05]. Rates of return to pre injury activity levels and Cincinnati knee scores were not significantly different between the two groups [P<0.01]. Both grafts resulted in excellent functional results but with increased morbidity in the patellar tendon group in early post operative period compared to increased knee laxity in the semitendinosus tendon group detected at 6 up to 36 months after surgery

Surgical treatment of thoracolumbar Kyphosis using combined anterior and posterior approaches

Between May 2002 and June 2005,27 patients with thoracolumbar kyphosis were selected for surgical treatment by both anterior approach that facilitated debridement,release,correction of the deformity and bone grafting followed by posterior transpedecular fixation and posterolateral fusion in the same sitting.In the current study,15 [56%] patients were suffering from post-traumatic kyphosis [Gl] while 12 [44%] patients were affected by postinfection kyphosis [G2].The kyphosis angle ranged from [30°-80°] with a mean of 42.2°.Follow up and evaluation by clinical and radiographic methods continued for a maximum of 36 months.Evaluation was based on the Denis pain and Work scale [PW] and on the new Frankel grading system. In group [l],the mean correction of the kyphosis angle was 33.9.This means that the correction was 76.2% of the deformity which is highly significant [p=0.01]. In group [2] the mean correction was 31.2 which is 74.2% of the deformity [p=0.01]. Marked neurological improvement was obtained postoperatively based on the modified Frankel grading system. In group [l], 67% of the patients were less than grade [Dl] and 33% were grade [E].In group [2],42% of the patients were grade [A] and [B] while 58% were grade [C]. All patients has improved to grade [E],with full motor and sensory functions

Prediction of outcome of anterior decompression and fusion for cervical disc disease

In a prospective study with a two year follow-up, 27 patients with cervical disc disease were randomized to anterior cervical decompression and fusion [ACDF]. Fixation by plate was done in 14 [51.8%] patients, in another group 13 patients [48.2%], no fixation has been done. The purpose of the present study was to report predictors for fusion and also to investigate the importance of radiographic variables for the clinical outcome. Gender, age, segmental kyphosis, disc hight and type of surgical procedure were used as independent variables. Male Gender, one level surgery, and fusion plus fixation by anterior cervical plate were significant predictors of healed fusion [P< 0.05]. Number of levels operated on, however did not influence the clinical outcome [P= 0.006]. Seventeen percent of the women and 12% of men in the first group [fusion plus plate fixation] and 18% of the women and 12% of the men in the second group [fusion without fixation], had pseudarthrosis. Patients with healed fusion had significantly less pain intensity than patients with pseudarthrosis. Neither degree of segmental kyphosis nor disc hight was different between patients with healed fusion and pseudarthrosis [P=01]. According to Odom's criteria [Bertalanffy and Eggert, 1988] the current study yielded excellent and good result in 90% in men and in 80% of women and resulted in excellent and good results in 92.8% in the first group [with plate fixation] compared to 84.5% in the second group [No plate fixation]. One can conclude that gender and type of surgery were significant predictors for a healed fusion and that pseudarthrosis affected the clinical outcome. On the other hand no effect on clinical outcome could be demonstrated for degree of segmental kyphosis and disc hight at follow-up. Overall, the study shows that the importance of radiological factors as predictors for fusion as well as clinical outcome is limited

Eyolution of living doner liver transplantation in Egypt

To date, cadaveric organ donation is illegal in Egypt. Therefore, Egypt recently introduced living donor liver transplantation [LDLT], aiming to save those who are suffering from end stage liver disease. Herein, we study the evolution of LDLT in Egypt. In Egypt, between August 2001 and February 2004, we approached all centers performing LDLT through personal communication and sent a questionnaire to each center asking for limited information regarding their LDLT experience. We identified and approached 7 LDLT centers, which collectively performed a total of 130 LDLT procedures, however, 3 major centers performed most of the cases [91%]. Overseas surgical teams, mainly from Japan, France, Korea, and Germany, either performed or supervised almost all procedures. Out of those 7 LDLT centers, 5 centers agreed to provide complete data on their patients including a total of 73 LDLT procedures. Out of those 73 recipients, 50 [68.5%] survived after a median follow-up period of 305 days [range 15-826 days]. They reported single donor mortality. Hepatitis C virus cirrhosis, whether alone or mixed with schistosomiasis, was the main indication for LDLT. Egypt recently introduced LDLT with reasonable outcomes; yet, it carries considerable risks to healthy donors, it lacks cadaveric back up, and is not feasible for all patients. We hope that the initial success in LDLT will not deter the efforts to legalize cadaveric organ donation in Egypt