Treatment of recalcitrant lateral epicondylitis of the elbow by surgical release of the common extensor origin

A prospective non-randomized study of 21 patients with recalcitrant lateral epicondylitis of the elbow was carried out to evaluate the results of the surgical release of the common extensor origin. The dominant arm was involved in 76.2% of the patients. The average duration of symptoms before the operation was 19 months [range, 9-38 months]. The average duration of follow up was 24 months [range of 10-42 months]. The results of the current study suggested that the release of the common extensor origin is an acceptable surgical modality to provide an effective treatment for the resistant lateral epicondylitis when nonoperative management fails

Percutaneous pinning of open or unstable diaphyseal forearm fractures in children

This is a retrospective review 58 children with both-bone forearm fractures who were treated by percutaneous intramedullary K-wire fixation after closed reduction in 43 cases and open reduction in 15 cases. All fractures were diaphyseal, displaced, and unstable. The factures were closed in 51 cases and open in 7 cases. The mean age was 12.3 years [range, 7-15 years]. There were 44 boys and 14 girls. The average follow-up was 18.4 months [range, 8-29 months]. At the last follow-up, the results were graded according to the system described by Price et al. Fifty-two cases showed excellent results, 5 cases showed good results, while only one case showed fair result. There were no poor results. Of the 51 closed fractures, closed reduction failed in 8 cases; and at open reduction soft tissue interposition was always the cause of failure of closed reduction in these cases. Forty-nine fractures united within 2 months, 7 fractures united within 3 months, while union was delayed for more than 3 months in 2 cases. Complications were encountered in 11 cases [5 cases of transient radial nerve affection, 3 cases of superficial pin site infection, and 3 cases of refracture after K-wires removal]. No cases were complicated by deep infection, physeal growth arrest, cross-union or non union. Six patients lacked full pronation and supination. Statistical correlation between the overall results and each of the type of fracture, level of fracture and type of reduction was found to be significant only for the type of fracture. The results of the current study suggest that intramedullary fixation by using standard K-wires plus cast immobilization provides effective treatment for the problematic open or unstable diaphyseal forearm fractures in children when closed management has failed

ACL reconstruction using mid-third patellar tendon autograft: modified technique, subjective and objective evaluation

Between February 1998 and January 2002, 119 patients suffering from chronic knee instability due to ACL injury were operated upon. The average follow up period was 28 months [range 14-47 months]. At the final follow up, the overall International Knee Documentation Committee [IKDC] evaluation results showed that 93.3% of the patients were graded as normal or nearly normal [grade A or B], 5% as abnormal [grade C], whereas 1.7% as severely abnormal [grade D]. According to Tegner activity level, the median score was 7. Applying the Lysholm score, 44.5% of the patients were scored as excellent, 51.3% were scored as good, 4.2% were scored as fair, while no patients were scored as poor. 96% of the patients showed a full range of knee motion. 18.5% of the patients complained of mild donor site morbidity, which was not significantly disabling. The rate of associated meniscal injury was 46.3%

Lisfranc joint injuries: surgical treatment, outcome and complications

In this study, 31 adult patients with a Lisfranc joint injury treated surgically between 1998 and 2002 were reviewed, where both closed reduction with percutaneous pinning and open reduction and internal fixation with screws were adopted. The study detected 26 closed injuries and 5 open injuries. Nineteen patients had combined ligamentous and osseous injuries and 12 patients had ligamentous injury only. The average duration of follow up was 28 months [range 14-54 months]. At the final follow up, the results were graded using the American Orthopedic Foot and Ankle Society [AOFAS] midfoot Score and the grading system suggested by Arntz et al. Closed reduction was successful in 61.5% of the closed injuries, followed by stable fixation by percutaneous pinning. Open reduction and internal fixation with 3.5 mm cortical injuries were needed for the remaining closed injuries, in addition to the open injuries. The average AOFAS midfoot score was 79 points [range 45-100 points]. As regards the Arntz et al. grading system, 32.2% showed excellent results, 45.2% showed good results, 16.1% showed fair results and 6.5% showed poor results. 29% of the patients showed an evidence of tarsometatarsal osteoarthritis. Complications were encountered in 29% of the patients. A secondary tarsometatarsal arthrodesis was performed in three patients, due to persistent pain. No primary arthrodesis was undertaken