Results of surgical release of the plantar fascia in the treatment of recalcitrant plantar fasciitis heel pain syndrome: a clinico - pathological study

Plantar fasciitis is one of the most important and recognisable causes of heel pain. Most of cases can be treated conservatively, and surgical treatment will be reserved for resistant cases. Plantar fascia release was advocated and tried as a simple surgical treatment of plantar fasciitis. The purpose of this prospective study is to assess the results of plantar fascia release in patients of recalcitrant plantar fasciitis with follow up for at least one year postoperatively and also to report the histopathological patterns of such condition. Fifty-four patients were diagnosed as plantar fasciitis, which were resistant to conservative treatment for at least 6 months. The average duration of symptoms was 16.9 months. The average age was 41.4 years. There were 50 females [92.6%] and 4 males [7.4%]. The right side was affected in 18 patients [33.33%], the left in 14 patients [25.93%] and 22 patients [40.74%] had bilateral affection. Only two patients were operated upon bilaterally. So [56 feet] were treated by surgical release of the plantar fascia through a medial calcaneal approach. They were followed up for an average of 13.6 months. Thirty-eight patients [70.37%] were obese and 28 feet had local corticosteroid injections. Radiologically, calcaneal spur was detected in 36 feet [64.29%]. Excellent results were encountered in 34 feet [60.71%], good in 14 feet [25%] and poor in only 8 feet [14.29%]. Satisfactory results were obtained in 48 feet [85.71%] and 8 feet [14.29%] were rated as unsatisfactory. More excellent results were encountered among cases with the duration of symptoms one year or less and in those without history of previous local corticosteroid injections. Patients with calcaneal spur had more satisfactory results. Superficial wound infection and delayed healing occurred in 6 feet [10.71%], deep wound infection and sinus formation occurred in 6 feet [10.71%]. All were treated successfully by antibiotics and repeated dressing. Eight feet [14.29%] had persistent numbness at the incision site. The commonest histopathological pattern was hyalinization of the collagen bundles in 44 feet [78.57%] especially in cases with long standing complaint and those who had local steroid injections. Plantar fascia release is a simple and safe procedure with few complications. It is a procedure, which may offer a good chance of cure for the patients with chronic plantar fasciitis refractory to conservative treatment

furlong hydroxyapatite ceramic-coated hip arthroplasty A 6- to 10- years follow-up study

The aim of this study was to describe the clinical and radiographic results of implantation of hydroxyapatite ceramic-coated total hip arthroplasty. Thirty total hip replacements were performed in 28 patients using Furlong hydroxyapatite-coated hips. The right hip was operated upon in 12 patients, the left in 14 patients and both hips were operated upon in 2 patients. The average period of follow up was 7.9 years [range 6-10 years]. The study concluded that the encouraging clinical and radiological results support the continued use of hydroxyapatite ceramic coated components in hip arthroplasty, especially for young patients

Results of surgical release of the first branch of the lateral plantar nerve in the treatment of chronic heel pain

Forty patients [44 feet] were diagnosed as having entrapment neuropathy of the first branch of the lateral plantar nerve and were treated by surgical decompression of that nerve. The mean age of the patients at the time of surgery was 41 years. There were 32 females and 8 males. The right side was affected in 18 patients, the left in 18 patients and 4 patients had bilateral affection. All patients received long courses of non-steroidal anti-inflammatory drugs and local injections of corticosteroids. The mean duration of complaints before implementing surgery was 18.6 months. The mean preoperative start-up pain score was 9.77. This had improved to a mean value of 2.45 at the final follow up. The mean preoperative standing pain score was 9.55. This had improved to a mean value of 2.86 at the final follow up. Postoperatively, the length of time required to develop pain was reduced markedly. Excellent results were encountered in 20 feet, good results in 18 feet and poor results in 6 feet. The shorter was the duration of complaints [less than one and half years], the better were the results. Over-weight was associated with more unsatisfactory results. The presence of calcaneal spur was associated with more satisfactory results. Superficial wound infection and delayed healing occurred in 4 heels, deep wound infection and sinus formation was encountered in 4 heels. All were treated successfully. Eight heels had persistent numbness at the site of the incision that persisted at the end of the follow up period, but did not interfere with their activities. According to the results of this study, surgical release of this nerve is expected to provide excellent relief of pain and facilitate return of normal activity with minimal complications, provided that the clinical diagnosis is surely correct

Treatment of displaced pelvic fractures with external fixator

A total of 38 patients with displaced pelvic fractures, 29 males and 9 females, with average age of 35.8 years, were treated by Hoffmann external fixator devices. Road traffic accidents were the main cause of injury [26 patients]. 15 patients had associated urogenital injuries managed by urosurgeons. Reduction of the fracture was carried out under image intensifier on the orthopaedic traction table. After an average follow-up period of 18.9 months, the results were: 30 patients [78.9%] satisfactory, 8 patients [21.1%] unsatisfactory. The age of the patient, presence of associated injuries whether skeletal or visceral, the time lag before application of the fixator and the duration of follow-up period were found to affect the results significantly

Ulnar nerve entrapment at the elbow: clinical and electrophysiological study

23 patients with 25 nerve compressions at the elbow were operated upon by decompression of the nerve in the cubital tunnel together with proximal and distal neurolysis. Preoperative nerve conduction studies were carried out for all cases. At operation, the nerve was found constricted by the flexor carpi ulnaris aponeurosis in 16 extremities [64%], perineural adhesions in 3 [12%], distal fibrous constricting bands in 4 [16%], and no demonstrable pathology was encountered in 2 cases [8%], Results seemed to be independent of the patient's age. Recovery was greater when the operation was performed early [less than 12 month from the onset of symptoms] and when obvious aponeurotic constriction [Osborne lesion] was found. The results were worse when distal fibrous constricting hands, post condylar perineural adhesions or no demonstrable pathology were found

Tumoral calcinosis: report of a case and review of the literature

Review of the literature on tumoral calcinosis as regards its incidence, possible aetiology, clinical and radiological picture, pathological findings, prognosis and management was carried out. A case of tumoral calcinosis in a healthy, girl treated by complete excision of the elbow lesion and incomplete excision of the bilateral shoulder lesions was reported with 10 years follow-up. No recurrence has occurred in the elbow or shoulders, but secondary infection of the bilateral shoulder lesions, which was resistant to all lines of treatment, was the result

Stenosing tenosynovitis of the extensor carpi ulnaris

12 wrists with stenosing tenosynovitis of the extensor carpi ulnaris in 11 patients were studied. The condition is quite uncommon. It affects females more than males, and the right side more frequently. In males, jobs entailing repetitive dorsiflexion, palmar flexion of the wrist and pronation-supination movements are mostly affected. Local injection of corticosteroids was either useless or gave a short term alleviation. Surgical release relieved all cases

Displaced intracapsular femoral neck fractures dynamic hip screw versus Smith-Petersen nail and cancellous lag screw fixation

86 cases of displaced intracapsular femoral neck fractures were treated by either dynamic hip screw or Smith-Petersen nail + cancellous lag screw fixation. Only 80 patients were followed-up an average of 21 months. Their ages ranged between 30 and 60 years. Traffic accidents were the most commonly encountered cause of fracture. Cases classified as Garden type III and IV only were included. Closed reduction under image intensifier was tried first. Two trials were maximally done and if acceptable reduction was not achieved then open reduction was resorted to. Significantly better rate of union and lower rate of avascular necrosis were obtained in the dynamic hip screw treated cases. Type IV fractures showed higher rates of avascular necrosis and lower rates of union. Avascular necrosis was higher in the younger age groups and non-union was higher in the older age groups. Results in cases fixed after open reduction were slightly insignificantly better than those fixed after closed reduction. Only one case of late deep infection was encountered and necessitated removal of the implant

Humeral shaft fractures results of AO plating

Sixty-one patients with fractures of the humeral shaft were treated by open reduction and AO plating. Bone grafting was resorted in cases of comminuted fracture only. In 54 patients, an open fracture was treated after failure of conservative treatment and two after inadequate internal fixation. Four patients refused the idea of plaster immobilization and two were surgically treated after post- reduction radial nerve palsy had occurred. Sixty out of the 61 cases united primarily and one failed to unite necessitating a subsequent procedure. Two superficial and one late postoperative wound infection, seen radial nerve palsy, two median and radial nerve injury were the encountered complications. Functional range of movement was obtained in all but four cases; they had severe soft tissue injury and forearm fracture in the same extremity. AO plating seems to be an attractive method of treatment provided the correct principles of fixation are carefully followed

AO plate fixation of displaced fracture of the radius and ulna in adults

A total of 136 adult patients with 148 acute diaphyseal fractures of the radius, the ulna or both was operated upon for rigid internal fixation using AO plates. Narrow plates were used to fix the radius, selecting DCP if compression was decided. Otherwise round-hole narrow plates were used. No primary bone grafting was resorted to 98.6% union rate was obtained. One case of deep infection, 2 non-unions of the ulnar distal third, one postoperative transient posterior interosseous nerve palsy, one refracture and one cross union were the encountered complications

Treatment of closed tibial shaft fractures operative or conservative?

136 patients with 140 closed fractures of the tibial shaft were classified into 2 groups. One was treated with AO plate [72 patients with 74 fractures] and the other with functional below the knee cast brace [64 patients with 66 fractures]. Comparison of the results of [treatment in both groups showed that the overall results were insignificantly better in the conservative series. No significant difference in the rate of healing was found in both series when the severity of injury and the level of the fracture were considered. Lower third fractures had the shortest duration. On the other h and, no significant difference was found in the conservative series with regards to the type of fracture. Older ages groups [60 years or more] had the longest duration of healing. Six superficial and two late deep infections, one fracture of the plate, one stress fracture after plate removal and 5 non-union were the complications in the operative series. Eight malalignment and two impaired joint motion were the complications of the cast-bracing method. The study recommended cast- bracing at the method of choice for closed tibial shaft fractures, especially comminuted fractures

Intertrochanteric fractures of the femur: dynamic hip screw or Jewett nail plate

46 cases of intertrochanteric fractures of the femur were treated by dynamic hip screw and Jewett nail plate fixation. Postoperative complications were few, sepsis rate was nil and no mechanical failure of fixation has occurred. Unstable fractures were rendered stable either by medialization or lag screw fixation of the lesser trochanter and medical cortical fragments. Little difference was found between the stability of internal fixation using the dynamic hip screw and the Jewett nail-plate; the dynamic hip screw had the advantage of earl mobilization of stable or rendered stable fractures in the presence of adequate bone stock. Delay of post-operative ambulation of osteoporotic cases contributed to the absence of mechanical complications in this series. Intravenous cefoxitin sodium during and 48 hours after operation together with suction drainage and meticulous haemostasis, contributed to the absence of post-operative early or late infection in the serie

Surgical treatment of displaced ankle fractures

Review of 60 cases of displaced ankle fractures has shown that the commonest mechanism of injury was mainly external rotation stress. Accurate reduction and rigid internal fixation of both malleoli and repair of the syndesmotic ligament within 12 hours from the occurrence of trauma is the clue to satisfactory results later. Deep infection was not encountered in this series; only one case of superficial wound sepsis which responded promptly to antibiotics was seen. A new modification was suggested which may help to achieve accurate reduction of both malleoli