Interlocking nail fixation for treatment of pathological fractures of the shaft of the humerus

Fifteen patients 14 with pathological fracture and one with impending pathological fracture of the shaft of the humerus due to bone metastasis were treated by interlocking nail fixation. There were seven male and eight female patients. Their mean age was 58 years [range, 40 to 71 years]. The primary malignant tumor was breast adenocarcinoma in 5, bladder transitional cell carcinoma in 1, multiple myeloma in 5, renal cell carcinoma in 2 and adenocarinoma with unknown origin in 2 patients. The average time from diagnosis of malignancy to pathological fracture was 42 months [range, zero to 85 months]. All interlocking nails were performed in closed antegrade fashion and all except one were statically locked. The mean follow-up period was 18 months [range, 15 to 25 months]. Excellent and good results were obtained in 11 patients [73%] and fair results in 4 patients [27%]. All patients had improvement in the functional use of the upper extremity after fixation. Pain relief was obtained in all patients. Eleven fractures united at an average period of 17 weeks [range, 15 to 22 weeks]. Complications recorded in this series were radial nerve palsy in one patient, superficial wound infection in 2 patients and implant loosening due to tumor progression in one patient. Interlocking nail fixation of pathological fracture of the humerus provides pain relief, immediate stability and early return of function of the upper extremity. Operative time is relatively short and morbidity is low

Ilizarov technique in correction of complex foot deformities

Fifteen feet in 15 patients with complex foot deformities were treated using Ilizarov technique. Simultaneous ipsilateral tibial lengthening was performed to correct shortening in 5 limbs. There were 11 male and 4 female patients. The ages of the patients averaged 14 years [range, 6 to 29 years]. The preoperative diagnosis included relapsed [4 feet], neglected [6 feet] idiopathic club foot, old poliomyelitis with equinocavus in 3 feet, and post-traumatic equinus deformity in 2 feet. After an average follow-up period of 28 months, the overall results were excellent and good in 12 feet [80%] and fair in 3 feet [20%]. Postoperative complications recorded in this study were pin track infection in 10 feet, toe flexion deformities in 5 feet and persistent adduction deformity of the forefoot in 3 feet. Ilizarov technique is a minimally invasive and safe technique for correction of complex foot deformities. This technique is able to solve problems previously more difficult or less safe with conventional technique. Advantages also exist over open technique since bone lengthening is possible with Ilizarov technique and the size of the foot is maintained

Pronator quaratus pedicled bone graft for treatment of scaphoid non-union

Twenty male patients with scaphoid nonunion were treated with the use of a pronator quadratus pedicled bone graft. The ages of the patients ranged from 20 to 48 years [average 33 years]. The average duration of nonunion was 10 months [range 6 to 25 months]. Ten nonunions were in the middle third, 8 in the proximal third and 2 in the distal third of the scaphoid. In 7 patients, there was avascular necrosis of the proximal fragment of the scaphoid, which was confirmed radiographically and clinically. The average duration of follow-up period was 32 months [range 23 to 41 months]. Union was achieved in 19 patients at an average period of 12 weeks [range 8 to 15 weeks] postoperatively. According to the modified Mayo Clinic Wrist Scoring System, 17 patients had excellent and good results, 2 patients had fair results and one patient had poor results. Postoperative complications included pin track infection in 2 patients, superficial wound infection in one patient and persistent nonunion in one patient. Pronator quadratus pedicled bone graft is a simple and effective procedure as primary treatment for scaphoid nonunion with or without avascular necrosis and does not need special equipments and produces union in a shorter time compared to conventional Russe graft

Radial tunnel syndrome results of surgical treatment

To evaluate the clinical results of decompression of posterior interosseous nerve in radial tunnel syndrome. A prospective clinical and operative study. Orthopaedic surgery department, Zagazig University Hospitals. Radial tunnel syndrome was diagnosed clinically in 18 patients and treated by surgical decompression of the posterior interosseous nerve. There were 16 male and 2 female patients. The mean age of the patients was 37 years. The dominant extremity was involved in 15 patients. The mean duration of symptom before definitive clinical diagnosis of radial tunnel syndrome was 32 months. The mean follow-up period was 18 months. The main clinical symptoms and signs of radial tunnel syndrome were: deep aching pain in the proximal radial part of the forearm. local tenderness 5 cm distal to the lateral epicondyle on the extensor wad, pain caused by supination against resistance, positive middle finger test and positive xylocaine local injection test. Anterior transbrachioradialis approach was used in all patients for decompression of the posterior interosseous nerve. Using our suggested rating scale, excellent and good results were 72%, fair results were 11% and poor results were 17%. Post-operative complications included recurrence of symptoms in one patient and hypertrophic tender scar in two patients. The diagnosis of radial tunnel syndrome is mainly clinical and surgical decompression of the posterior interosseous nerve gives relief in most cases

Posterolateral fusion of lumbar and lumbosacral spine with and without internal fixation

This is a prospective [38 patients] and retrospective [30 patients] study of 68 patients with sever mechanical low back pain treated by posterolateral fusion [PLF] of lumbar and lumbosacral spine with and without internal fixation. In 38 patients, internal fixation was used to supplement the fusion [Boucher technique in 10 patients [group A] and Magerl technique in 28 patients [group B]]. No internal fixation was used in 30 patients [group C]. There were 50 male and female patients. Their mean age was 47 years. The mean follow-up period was 32.4 months. The overall clinical results in groups [A and B], were excellent and good in 35 patients [92%], fair in one patient [3%] and poor in 2 patients [5%]. The overall clinical results in group C, were excellent and good in 21 patients [70%], fair in 5 patients [17%] and poor in 4 patients [13%]. Fusion rate was 92% in groups [A and B] and the mean time to fusion was 6.6 months. In group C, fusion rate was 73% and the mean time to fusion was 10.5 months. Enhancement of PLF of lumbar and lumbosacral spine by internal fixation significantly improved the clinical results [P < 0.05], the fusion rate and the fusion time [P < 0.001], thus allowed early return to productive life

Results of high tibial osteotomy in treatment of osteoarthritis of the knee

Thirty two high tibial osteotomies [HTOs] were performed in 26 patients for osteoarthritis [OA] of the medial compartment of the knee joint. There were 20 male and 6 female patients. The mean age of the patients was 45.4 years. Their mean weight was 77 kg. The osteotomy was fixed with staples in 20 knees and T-buttress plate in 12 knees. The mean follow-up peroid was 40 months. Results were excellent and good in 72%, fair in 19% and poor in 9% of cases. The age of the patients, their weights, and the postoperative valgus alignment significantly affected the results [P<0.001]. The method of fixation of the osteotomy and the pre-operative varus deformity did not significantly affect the results [P>0.05]. Postoperatively, most of heavy manual workers [83%] could return to their original job and other patients could participate in sport activities. Post-operative complications included infection in 4 cases, non-union at the osteotomy site in one case, and lateral popliteal nerve palsy in one case. High tibial osteotomy is an appropriate procedure/or medial monocompartmental osteoarthritis of the knee in patients younger than 50 years old with varus angulation and within the average weight. Post-operative valgus alignment of 8 degrees and probably not more than 13 degrees is the goal

Treatment of post-traumatic disorders of the distal radio-ulnar joint by sauve-kapandji procedure

Twenty patients with post traumatic discorders of the distal radio ulnar joint [DRUJ] were treated by excision of a portion of the ulnar neck and arthrodesis of the DRUJ. The average age of the patients was 30.2 years. The mean of floow up period was 18.5 month. Pain was completely relieved in 60% of patients and declined in 40% of patients. Grip strength was improved in all patients and their ability to pronate, supinate the forearm flex and extend the wrist were also enhanced 85% of patients were able resume their original work. The shape of the wrist was nearly normal