Arthroscopic repair of the recurrent anterior shoulder dislocation

Twenty four recurrent anterior traumatic unidirectional shoulder dislocations were stabilized arthroscopically with a muscular capsculo-labral suturing technique. A Bankart lesion was diagnosed and repaired in all cases. Postoperative follow up averaged 26 months [range 24 - 36 months]. All results were rated excellent. All patients achieved full, painless range of motion, and no instances of postoperative instability occurred. There was one complication with stitch sinus. The details of the operative technique were described

new surgical technique for the treatment of talo-navicular pseudo-arthrosis

Talo-navicular pseudo arthrosis represents the higher percentage of non-union after triple fusion than any other joints included in the arthrodesis. It was due to increased shearing movements at the horizontally placed joint following abolition of movements at the subtalar and calcaneo cuboid joints. A trial of changing the direction of the talo-navicular pseudo arthrosis from being horizontally placed to become vertically situated - as hypothesized to enhance bone healing at the non union. Twenty three patients of established non union at the talo-navicular joint were subjected to that method by excising a cubic of bone centered at the T.N. pseudo arthrosis to be replaced into its original bed in a ninety degree rotation, so that the horizontally placed T.N. pseudo arthrosis becomes vertical and abolishing the shearing stresses on the non union. All the pseudo arthosis were showing healing within 6-8 weeks with no need for bone grafting and prolonged immobilization. Excellent results were obtained regarding pain during walking and standing. No case was reported with Suddeck's artrophy

Back to the conventional plaster cast for immobilizing dome-shaped high tibial osteotomy

Proximal tibial osteotomy is commonly performed for osteoarthrosis of the knee with deformity. Dome-shaped osteotomy is the most stable one of all types of the osteotomies and is not in need for internal fixation. Two groups of patients with medial gonarthrosis were subjected to dome-shaped osteotomy of the upper tibia followed up in a randomized fashion. One group [17 patients] immobilized using a cast brace with two hinges at the knee joint, and another group [14 knees] immobilized by a high above knee plaster cast. Initially after osteotomy healing, the range of motion of the cast brace group was much better [90-100 degrees] than the plaster group [10-20 degrees]. Complete knee flexion was gained in the cast brace group within 3-4 weeks while it was reached within 5-6 weeks in the plaster cast group. After one year, there was no difference regarding the knee motion and alignment. On the other hand, delayed bone-healing [more than 6 weeks] at the osteotomy site was reached in the cast brace group, a rate of 64.7%, while it was 7.1% in the plaster cast group. The high rate of delayed union in the cast brace group could be explained due to the screw action movement of the knee that was allowed in the cast brace during flexion extension movement

Z-osteotomy in limb lengthening

Z-osteotomy is a modified technique that involves controlled distraction after subperiosteal, metaphysiocortical osteotomy in a Z- shaped manner. The technique and its advantages over other methods are described. Results of lengthening involving 29 operated bone segments [10 femura and 19 tibiae] in 23 patients are reviewed. All except one are due to limb length inequality as a complication of poliomyelitis. The desired amount of lengthening was achieved verying from 3 to 8 cm for a single bone, with a mean of 6.8 cm. The percentage increase over the initial length varied from 8 to 23% with a mean of 19%. All the lengthened segments healed without the need for bone graft and in a very short period in comparison with any other technique, especially there is no delay period and 1 cm can be gained at the first postoperative day. The complications were mentioned and no care of early or delayed bone consolidation was recorded