Slide lengthening of the heel cord in cerebral palsy

Equinus is the most common deformity in children with spastic cerebral palsy [CP]. [Z] lengthening has a low rate of recurrence, but a significant rate of calcaneus deformity. Slide techniques have a higher rate of recurrence, but no calcaneus deformity. The aim of this study is to repopularize the White sliding technique and re-emphasize its efficacy in correcting equinus while avoiding calcaneus deformity. Thirty five children with CP and equinus deformity underwent [White] slide lengthening of the heel cord. The average improvement in dorsiflexion was 22.8°. Four children had a recurrence that required revision surgery. No patient developed a calcaneus deformity. White slide lengthening is an efficient [low recurrence] and safe [no calcaneus deformity] technique for correcting fixed equinus in CP. Surgical intervention should be postponed till above the age of 4 years. Long term follow up is required to report the true incidence of recurrence

Double level stand alone cage assisted fusion in cervical radiculopathy [preliminary report]

Interbody fusion following ACD [Anterior cervical discectomy] for treatment of cervical radiculopathy or cervical myelopathy is thought to have several advantages compared with discectomy alone. There is no consensus, however, regarding the optimum indications for cervical fusion. Double level interbody cervical fusion adds more concern regarding fusion rates, maintenance of lordosis and sagittal balance, and clinical outcome. The aim of this study was to assess clinically and radiologically the use of standalone double cervical cage in treatment of double level cervical radiculopathy. A prospective study enrolled 10 patients [6 males and 4 females] who were surgically treated for radiculopathy secondary to double level degenerative cervical disc disease. Radiographic and clinical outcome measures were analyzed prospectively. All patients underwent a standardized clinical, neurological and radiographic examination and completed outcome questionnaires [visual analogue scale for neck and arm pain, and modified Oswestery neck disability index] preoperatively and at each postoperative intervals [6 weeks, 3, 6, 12, and 24 months], with a mean follow up 18 months. X-ray films were reviewed and assessed at the treated levels, preoperatively, 6 weeks, 3, 6, 12, and 24 months postoperatively. After standard anterior discectomy and neural decompression, PEEK stand alone cages were inserted after packing with bone graft taken from iliac crest by special device. Decompression levels were C4/5 and C5/6 in 7 patients and C5/6 and C6/7 in 3 patients. Standard statistical methods were used to compare all outcome measures. Clinical results regarding neck and arm pain was markedly improved [VAS neck 3.4 to 0.8, VAS arm 8.1 to 0.4, both are statistically significant; p < 0.05. functional outcome was improved [NDI 20.4 to 2.8, statistically significant; p < 0.05]. Lordosis was maintained in 2 cases only, and fusion was achieved in all cases without symptomatic pseudarthrosis. The standalone double interbody cages assisted fusion achieves fusion rates similar to single level fusion, but it cannot maintain or correct cervical lordosis without plate supplementation

Tibialis anterior transfer for residual metatarsus adductus in club feet

Adduction and supination are the most common residual deformities after conservative or surgical treatment of clubfoot. These deformities concern the parents as they note a decreased agility of their children due to repeated falling and also because of the problems in shoe fitting and rapid wear of the shoes. Garceau first described tibialis anterior transfer [TAT] in recurrent congenital clubfoot. Since then, the procedure has been widely used with various modifications. Twenty three children with clubfoot underwent thirty one TAT to the cuboid. All children showed an improvement in the range and power of eversion. All parents were extremely satisfied by the result of surgery regarding functional and cosmetic outcome as well as improvement in shoe wear. TAT to the cuboid is recommended for management of residual adduction and supination deformity in treated clubfeet

Surgical correction of infantile coxa vara

Surgical correction of infantile coxa vara can be achieved through valgus osteotomies, but recurrence ranges from 30-70%. Several previous studies have concluded that the single most important factor preventing recurrence of the deformity following surgical correction is to achieve an Epiphyseal-Hilgenreiner angle, [EHA] of 35-40°. This study evaluates the outcome of surgical correction of infantile coxa vara using an intertrochanteric Y-shaped valgus osteotomy. Eight children [nine hips] underwent an intertrochanteric Y-shaped valgus osteotomy for correction of infantile coxa vara. The age at time of surgery ranged from 4-8 years [average 5.4 years]. All hips had improvement of the immediate and final follow up EH A. In eight hips the EH A was corrected to

Management of wrist drop in children with Erb's palsy

There are two main types of obstetric brachial plexus palsy [OBPP]: Erb's and total palsies. Children with total involvement of the brachial plexus [C5-Tl] have poor hand function and are not candidates for limb reconstruction. In children with Erb's type of palsy restoration of active wrist extension is important as an effective hand grip is only possible with the wrist extended. The aim of this study is to evaluate the results of flexor carpi ulnaris [FCU] to extensor carpi radialis brevis [ECRB] transfer to restore active wrist extension and consequently establish an effective hand grip in patients with C5-7 pattern of Erb's palsy. Fifteen children with OBPP and wrist drop [C5-7 pattern of involvement] underwent FCU to ECRB transfer. The wrist drop was reconstructed in all patients who were consequently able to perform an effective hand grip. This study confirms that FCU to ECRB transfer in patients with OBPP and wrist drop is a simple and effective technique provided the selection criteria are respected

Repair of acute patellar tendon rupture without a tension - relieving method

This prospective study was done on 11 patients with complete acute traumatic patellar tendon [PT] rupture treated by direct repair without using any tension-relieving method. Early passive range of motion [ROM] was initially allowed before immobilizing the knee. The average follow up was 18 months. All patients were satisfied with the outcome of surgery. ROM improved continuously in all patients. No patient was left with an extension lag and the average flexion deficit was 9 degree. No patient developed patella infera. The study suggested that the technique used is effective in holding the repair till healing of the tendon to the patella occurs and seems to restore the biomechanics of the extensor mechanism and the patellofemoral joint [PF] to as near normal as possible. Allowing passive ROM in the immediate postoperative [PO] period promotes articular cartilage nourishment and facilitates rehabilitation

comparison between the results of plating and intramedullary nailing for treatment of humeral shaft fractures

The aim of this study was to compare the results of intramedullary nailing [IMN] and plating in the treatment of humeral shaft fractures with a particular emphasis on the type and frequency of complications encountered with each technique. Thirty-seven patients were included in the study. Eighteen fractures were fixed with 4.5 mm, AO design, plates and 19 fractures were fixed with an antegrade humeralinter- locking nail. The main clinical assessment measures were shoulder and elbow functions, radial nerve recovery and presence of infection. The radiological assessment was based on fracture alignment, healing time, delayed and nonunion. It was suggested that both plating and IMN provide a satisfactory fixation for humeral shaft fractures with ultimate fracture healing, however IMN is associated with more complications

Oxford unicompartmental knee arthroplasty for anteromedial osteoarthritis

The aim of this study was to assess the early outcome of the Oxford unicompartmental arthroplasty [UCA] using the phase 3 prosthesis when used in well selected patients with anteromedial osteoarthritis [OA]. Over a period of 12 months, 24 patients with anteromedial OA of the knee were operated upon. UCA using the phase 3 Oxford prosthesis was performed. All patients were available for follow up at a minimum period of 24 months postoperatively [PO]. At 2-year follow up, only two patients complained of mild pain in the knee. All patients had a continuous improvement in the range of flexion. The mean fixed flexion deformity was 4 degree and the mean varus was 1 degree. It may be concluded that this implant is an effective treatment for anteromedial OA of the knee when patients are properly selected