Problematic tibial nonunion management by distraction osteogenesis and Ilizarov fixator

Forty-nine tibial nonunions that were associated with different difficult problems were treated by radical resection of necrotic and infected bone, distraction osteogenesis for internal bone transport or lengthening, acute or gradual correction of deformities with the aid of Ilizarov external fixator. The included problems were active infection in 30 patients [61.2%], segmental bone defects in 24 patients [48.9%], shortening in 17 patients [34.7%], deformities in 16 patients [32.7%], unhealthy or soft tissues coverage defects in 22 patients [44.9%] and 3 patients with soft tissue contractures [6.1%]. Forty-five patients were males and the other four were females and the mean age was 36.5 years ranging between 16 years to 75 years. All un- united tibiae were united, except 3 patients [6.1%] and the infection was eradicated, except one patient that still had small sinus discharging serous fluid. Equalization of length was occurred in all patients, except two and all segmental bone defects were filled by new bone formation. The mean period of treatment was 10.1 months and the mean period of follow up was 25.9 months. The functional results were 24 excellent [49%], 17 good [34.7%], 3 fair [6.1%] and 5 poor [10.2%]. This method is proved to be an encouraging method to manage such difficult cases

Experience with 60 total knee arthroplasty

The results of 60 Total knee Arthroplasty [TiCA] in 53 patients followed up for six to twenty four months are analysed. The patients included 40 females [75.5%] and 13 males [24.5%] with 7 of them [13.2%] have bilateral replacement. The indication wasosteoarthritis [OA] in 47 knees [78.3%], Rheumatoid [RA] in 8 knees [13.3%j and posttraumatic arthritis [PTA] in 5 knees [8.3%]. Average Hospital for Special Surgery [H.S.S] score improved from 53.6 points [33-79] preoperatively, to 81.6 points [51-96] after replacement, with 34 knees [56.6%] have excellent scores, 21 [35%] good scores, 4 [6.6%] fair, and 1 knee] 1.6%] have poor score, TKA resulted in marked improvement in pain state, range of knee movement, knee stability and the functional performance of the patients