treatment of infected non union of the tibia by compression-distraction-technique using Ilizarov external fixator

The application of Ilizarov techniques to diaphyseal infected non unions is very encouraging. It may prove to be an excellent technique for future management of resistant diaphyseal infections of bone. Circular external fixation using the Ilizarov apparatus combined with compression- distraction technique were used to treat 11 patients with infected non- union. There were 8 males and 3 females with an average age of 27 years [range 17-51 years]. The average number of previous failed surgical attempts at union was 2 per patients [range 1-4]. Of the 11 patients there were 8 with chronic tibial defects; one with normal extremity length; 5 with shortening associated with bone fragment contact and two with bone loss in excess of the amount of shortening. There were 3 infected non- unions without shortening treated with complete resection of the non- union site and conversion of the diaphysis into a segmental defect. In 11 patients, the infected extremities healed without the addition of a cancellous graft, microvascular fibular or soft tissue grafting. The average length of regenerate gain was 3.7 cm [range 1.5 to 4.9 cm]. Postoperative antibiotics were administered in 3 out of the 11 patients for 10 days after en block resection of the diaphyseal sequestrae. Functional results were excellent in 5, good in 3, fair in 2 and poor in only one patient. There were no additional bone grafting procedures, microvascular bone transplants, or other grafting techniques used in any patient

Clinical diagnosis versus arthroscopic and / or arthrotomy diagnosis in cases of internal, derangement of the knee joint

We studied the validity of clinical diagnosis for internal derangement of the knee joint in 130 patients. The clinical test results were compared with arthroscopic and / or arthrotomy finding as reference. The overall clinical accuracy was 75.21% and the clinical test has a sensitivity 53.64%, a specificity of 3.26%. The arthroscopic diagnosis has overall accuracy of 94.12% and overal sensitivity of 92.38%, a specificity of 72.15%. The clinical test in internal derangement of the knee joint therefore seems to be of limited value in current clinical practice

Immediate internal fixation of open fracture of diaphysis of the forearm bones

Thirteen patients with open diaphyseal fracture of the forearm received in "Traumatology Department" of Banha University Hospital were treated with immediate internal fixation. These patients were operated on within 24 hours. The injuries were classified on the basis of the extent of soft tissue injury as defined by Gustilo and Anderson [1976] and consisted of five "Type I" injuries and eight "Type II" injuries. Eleven cases were fixed by Ao plates for radius and ulna two cases by rush pins for both bones also. The functional results were satisfactory in eleven patients [84.6 percent] and unsatisfactory in two patients only [15.4 percent]. No deep infection or non union were obtained. This study demonstrates that immediate stable fixation is a beneficial method of treatment of open fracture of the forearm. The results are related to the severity of the initial soft tissue injury and the surgical technique. Autogenous cancellous bone grafling at the time of closure of the wound is recommended