Surgical management of paralytic valgus ankle

The aim of this work is to determine the. protocol of treatment of paralytic valgus ankle secondary to poliomyelitis in twenty two patients. Hindfoot valgus can occur at subtalar joint, ankle joint or at both sites. Valgus ankle is characterized clinically by prominent medial malleolus and radiologically by a triade of: Fibular shortening, lateral wedging of the distal tibial epiphysis and lateral talar tilt. Sixteen cases were treated by supramalleolar osteotomy, four cases by fibular achilles tenodesis and three cases by internal fixation for fibular pseudarthrosis [one of them was followed by supramalleolar osteotomy]. There was improvement of hind foot valgus and talar tilt in all cases

Treatment of nonunited tibial fractures by Ilizarov Technique

Twenty-two patients aged seven to fifty four years were treated between January 1993 and September 1995, for tibial nonunion [seventeen atrophic and five hypertrophic] by the Ilizarov technique and fixator. Fifteen had chronic osteomyelitis, [septic nonunion], eighteen had a leg-length discrepancy, sixteen had a bony defect [1-10 cm, mean 6 cm]. Five cases had shortening without defect, three with bone defect without shortening and thirteen had both a bone defect and shortening. Nonunion, bone defect, limb shortening, infection and deformity all can be managed simultaneously with the Ilizarov apparatus. Bone defects were filled from within, without bone graft, by the Ilizarov bone transport technique of sliding a bone fragment internally, producing distraction osteogenesis behind it until the defect was bridged [internal lengthening]. Length was reestablished by distraction of a percutaneous corticotomy or osteotomy together with intermittent compression and distraction at the nonunion site [External lengthening]. Distraction osteogenesis resulting from both processes eliminated the need for a bone graft. Deformity was corrected by means of hinges on the apparatus. Infection was treated by radical resection of necrotic bone and internal lengthening to regenerate the excised bone. Union was achieved in twenty cases. The mean time to union was nine months [range 6-30 months]. The bone results were excellent in twelve cases, good in five, fair in three and poor in two cases. The functional results were excellent in eleven cases good in six cases, fair in two and poor in three cases. The commonest complications encountered were pin tract-infection andfixator instability. No serious vascular complications were encountered. Four cases developed paraethesia in the distribution of the common peroneal nerve

Localization of thepoint of entry and morphometric characteristics of the pedicles of the lower dorsal and lumbar spines an experimental work

Human adult cadaveric disarticulated vertebrae from the tenth dorsal to the fifth lumbar were obtained from twenty-five dried cadavers. We localized the point of entry to the pedicles of these vertebrae [50 pedicles] using the intersection technique depending on anatomic landmarks. The transverse pedicle diameters and the transverse pedicle angles were measured by three methods: directly, radiologically and by CT scan of disarticulated vertebrae. The sagittal pedicle diameters and the sagittal pedicle angles were measured by direct measurement and by lateral view x-rays. The transverse pedicle diameters ranged from 6.1 mm at the eleventh dorsal to 17.9 mm at the fifth lumbar and the sagittal pedicle diameters were generally larger than the transverse slant ones, except in fifth lumbar vertebrae. The transverse pedicle angles were less than five degrees in the lower dorsal spines and progressively increase in the lumbar spines to a maximum of almost thirty degrees medial angulation at the fifth lumbar vertebrae. The sagittal pedicle angles were about ten to sixteen degrees cephalad for the majority of the lower dorsal spines and nearly neutral [less than eight degrees] for the majority of the lumbar spines except the fifth lumbar that angles caudally about twelve degrees in eighty-four percent of the pedicles

Assessment of early results of a new technique of high tibial osteotomy in osteoarthritis of the knee joint

In this study we present the early results of a new technique of high tibial osteotomy The main idea of the technique is to resect a predetermined rectangle of bone from the lateral, anterior and posterior four-fifth of the tibia, leaving the medial one-fifth to one-eighth of the bone intact. The created space is closed gradually by a Muller plate tension device after protecting the subchondral area by a long cancellous screw. The osteotomy is securely fixed using an L-shape buttress plate; which allows early postoperative joint mobilization.This technique was applied on twenty-three knees in twenty patients with osteoarthritis and varus deformity of the joint twelve were males and eight were females. The average age at surgery was 56.2 years [Range 41 to 70 years]. The average period of follow up was 17.2 months [Range 6 to 26 months]. Cases were assessed before and after surgery using a definite scoring system of evaluation based on clinical and radiographic findings.The overall results of the technique were satisfactory apart from a few complications met with

Surgical treatment of neglected congenital dislocation of the HIP joint

Sixteen cases of congenital dislocation of hip joint with an age range between 9 months and 6 years at the time of presentation were operatively treated by open reduction combined with Salter pelvic osteotomy in one stage, to be followed 3 - 4 weeks later by varus derotation femoral osteotomy. The patients were followed up to 4 years after surgery and the results were all satisfactory. In all cases the joint was well reduced except in one case in which concentric reduction and perfect containment could not be achieved. No cases of avascular necrosis or head collapse were recorded. The range of movements was almost full in all directions apart from limitation of the last degrees of abduction and external rotation

Treatment of femoral shaft fractures by straight dynamic compression plates

Plating of the femoral shaft fractures is usually indicated for cases not suited for intramedullary nailing. Although the interlocking nail has made the field of plating much narrower, yet the plate is still popularly used. A group of femoral shaft fractures treated by plating is presented, the cases were treated according to the AO principles. The cases were assessed around 4 months and one year post operatively according to a special follow up system depending on a numerical score and formed of eight points namely pain, weight bearing, walking ability, quadriceps function, knee movement, union, alignment and infection. The complications included infection, malalignment, failure of fixation, delayed union and non union

Granulocytic sarcoma in bone preceding diagnosis of acute leukemia a report of two cases

Granulocytic sarcomas may develop during the course of, or as a presenting sign of, myelogenous leukemia. Rarely, however, an extramedullary neoplasm composed of poorly differentiated granulocytic cells occurs in patients without peripheral blood or bone marrow evidence of leukemia. We encountered two cases of granulocytic sarcoma [chloroma] of bone with negative blood and bone marrow finding. Before and after biopsy taking we were confused about the diagnosis and we had to review the literature. The aim of this work is to put this lesion in focus, so that orthopaedic surgeons may not be confused on facing such lesion

Shoulder-forearm functional coupling after forearm diaphyseal fractures

A group of adult patients with forearm diaphyseal fractures were treated by AO plate osteosynthesis. The clinical versus functional recovery of forearm rotation was assessed. It was found that pronation loss is more common than supination loss but since pronation loss can be compensated for by shoulder abduction, the ultimate functional recovery of rotation is good

Cast bracing of tibial shaft fractures

Eighty patients with simple tibial shaft fractures were treated conservatively at Orthopaedic Department Ain Shams University. Forty patients were treated functionally by below knee brace, designed originally by Sarmiento [1970] and modified recently by us and the rest conventionally by above knee plaster cast. The average healing time of the functionally treated cases was eight weeks compared with 13.7 weeks of the control group. The rate of healing was found to be correlated with the time of weight bearing, the earliest was the time of weight bearing, the faster was the union. Comminuted and lower third tibial fractures took longer time to heal in the functional group but still less than the other group. The functionally treated cases showed full range of both knee and ankle joints with no wasting of the thigh or calf muscles. Complications of the functional bracing technique was found to be minimal

Treatment of cysts of long bones in children using fibular strut graft

Fourteen cases of cysts of long bones in children were treated with curettage and fibular strut graft in addition to cancellous iliac bone. Eight cases were in the upper end of the humerus and six in the upper part of the tibia. Nine patients were males and five females with an average age of 10 years. Pathologically six cases were aneurysmal bone cysts and eight cases simple bone cysts. The average period of follow-up was 1.5 years. 71.4% of the cases showed good results