Surgical treatment of volarly displaced intra - articular fractures of the distal end of the radius

Intra-articular fractures of the distal end of radius that are characterized by volar displacement of part of the articular surface are uncommon and tend to be associated with high velocity trauma. In this study, the results of operative treatment of 30 volar intra- articular fractures of the distal end of the radius were evaluated. According to the comprehensive classification of fractures of the long bones [Mueller et al., 1990], there were 6 cases type B 3-1, 14 patients type B 3-2 and 10 patients type B3-3. All cases were treated operatively by open reduction and internal fixation by small T plate. In ten comminuted cases of type B 3-3, external fixator and iliac graft were added. In five cases, K-wires were used. After an average follow up period of one year, there were seven excellent cases, nine good, nine fair and five with poor results according to the modified system of Green and O'Brien 1978. Accurate articular surface restoration was the most critical factor in achieving a successful outcome. Fair or poor results mainly occurred in type B 3-3 fractures characterized by comminution of the volar fragment

results of treatment of non-union of the scaphoid with pronator quadratus pedicled bone graft

Forty patients with symptomatic nonunion of the scaphoid had been treated with pronator quadratus pedicled bone graft in the period from 1997 to 2000. The patients were presented and treated at both Army Force Hospitals and Kasr El-Aini Hospital. The patients presented with pain, tenderness in the anatomical snuff box, limited range of motion and weak hand grip strength. The average time before operation was 21.2 months [6 to 60 months]. Fractures with distinct fracture line, sclerotic margins with or without cyst formation were considered as un-united fractures. Two patients had distal third fractures, 28 patients had waist fracture and the remaining 10 patients had proximal third fracture. Eight patients had dense X-ray appearance of the proximal fragment. After an average follow-up of 12 months [range from 6 to 19 months], 28 patients united and 12 patients failed to unite. Four out of eight cases with sclerotic proximal fragment united

Surgical management of infected bone cavities

Thirty patients with chronic bone infection and infected bone cavities in different skeletal sites were treated surgically by radical debridement and obliteration of the dead space either by cancellous bone grafting or by local muscle transposition, together with specific antibiotic therapy after proper identification of the infecting bacteria. These cases were done in the period from 1994 to 1997. Half of the cases [group I] [fifteen cases] were treated surgically by radical debridement and obliteration of the dead space by cancellous bone grafting. The other fifteen cases [group II] were treated by radical debridement and obliteration of the dead space by local muscle transposition. Results were evaluated both clinically and statistically. Clinically local muscle transposition for obliteration of bone cavities gave better results [93% eradication of infection] than cancellous bone grafting [80% eradication of infection]. Statistically there are no significant differences between both methods of treatment

Closed treatment of intra-articular calcaneal fractures with axial pin fixation

Intra-articular fractures of the calcaneus account for approximately 75% of all calcaneal fractures and have been associated with poor functional outcome especially if the posterior subtalar joint is severely disrupted. In the last decade, open reduction and internal fixation of intra-articular calcaneal fractures increased, however, the high rate of skin complications discouraged many surgeons. This paper discussed the results of twenty- four intra-articular calcaneal fractures of the tongue type treated with closed reduction and axial pin fixation. The clinical and radiological results were 79.2%, 83.3% satisfactory results, respectively, after a minimum follow up period of one year

Augmented external fixator for treatment of unstable lower radius fractures

Unstable distal radius fractures are those with severe displacement, comminution or intra-articular involvement. Treatment of unstable fractures with cast immobilization only is not adequate and resulted in more than 30% incidence of complications. The use of external fixator for treatment of these fractures has improved markedly the results of treatment. But it was found that treatment with external fixator alone did not always accomplish reduction of all articular fragments of a complex intra-articular fracture. Also excessive distraction and long period of immobilization [6-8 weeks] may cause stiffness and disuse atrophy [osteopenia of the carpus and distal radius] and increased incidence of pin tract infection. The combination of the external fixator, pinning of the key articular fragments and/or grafting of the dorsal defect through limited exposure has further improved the results and allow early removal of the fixator and restoration of wrist movements. In this paper, the details of treatment of 30 cases of unstable distal radius fractures treated by this method are presented. Ninety percent excellent or good functional and anatomical results were obtained at the end of follow-up period [minimum one year]

Biological plate fixation for comminuted subtrochanteric femoral fractures

Twenty patients with comminuted subtrochanteric femoral fractures were treated with indirect reduction and bridge plating in the period from 1997-1999 in Kasr El Eini Hospitals. The average age was 44.4 years. Using Seinsheimer classification fourteen cases were type V [70%] three cases were type IV [15%] and three cases were type IIIB [15%]. Associated injuries were present in ten patients [50%] and the delay before operation was average 4.7 days. The technique adopted was by indirect reduction by traction, insertion of DCS or DHS screw and plate through two incisions proximal and distal with the plate slided under the vastus lateralis, the fracture site was never exposed. Union was obtained in eighteen patients [90%] uneventfully in an average 13.7 weeks and with average shortening 0.3 cm and all these patients returned to their previouss jobs or activities. One insulin dependant patient developed deep infection that forced the removal of the implant at 3 months. Another patient 78 years old developed nonunion and metal failure and required another operation for bone grafting and revision of fixation

role of ligamentotazxis in the treatment of fractures of the scaphoid

Ligamentotaxis is an established method for the treatment of unstable Colle's fractures with marked comminution, displacement, angulation and intraarticular involvement. During treatment of more than 60 cases of unstable Colle's fractures with ligamentotaxis, six cases were accompanied with scaphoid fractures, four recent fractures and two with established pseudarthrosis of the scaphoid. All the six cases went to union by the end of 6-7 weeks treatment with this method. This emphasized the idea that external fixator with ligamentotaxis may provide, in addition to stability, stimulation of osteogenesis. This work discussed the results of the use of external fixator with ligamentotaxis in the treatment of 22 cases of scaphoid fractures, ten recent unstable fractures and twelve with delayed union and nonunion. In the first group, the union rate was 90% and in the second group, the union rate was nearly 84%. The advantages, disadvantages and complications of this method were discussed

treatment of lateral tibial plateau fractures under arthroscopic control

Twelve selected fractures of the lateral tibial plateau were reduced and fixed under arthroscopic visualization. In five cases the fracture was grafted as well and in three cases intraoperative X- ray control was used to assess the reduction. Postoperatively, range of motion exercises were allowed as soon as tolerated. The patients were assessed clinically and radiologicly for an average follow-up period of 158 months. All the fractures have united with full restoration of the knee range of motion. The final results were excellent in 10 patients, good in one patient and fair in one patient

Evaluation of the results of radial shortening in the treatment of Keinbock's disease

Peste in 1843 before the advent of roentgenogram first described collapse of the carpal lunate. He believed the lesion to be a fracture with a traumatic etiology. Keinbock's in 1910 also thought the lesion to be the result of trauma. In 1928, Hulten noted that a short ulna was present in 78% of this patients with keinbock's diseases whereas only 23% of normal patients had a short ulna. No universally acceptable treatment is available for this disease. Treatment choice must be based on a number of variables including the experience of the swgeon, the desires and activity level of the patients, the anatomic variant of the ulna and most importantly on the stage of the disease. Twelve cases of keinbock's disease were treated in Kasr El Eini Hospital in the period from 1991-1995 by radial shortening. The indication, technique, results and complications of the procedure arepresenteed. The average follow up period was 2 years. The results were good in 83.3% [10 cases]

Surgical treatment of proximal humeral fractures in late adolescence and young adults

Open reduction and internal fixation for 30 cases of displaced proximal humeral fractures and fracture dislocation was done from the period of 1991to 1994. Two cases were lost for follow up and 28 cases were included in the study. We chose certain age group which is late adolescence and young adults because we felt that this is the most active age in which the person needs free mobility and power from his shoulder. Most of the cases were displaced surgical neck freactures [26 cases]. An AO T buttress plate was used in [26 cases] the mean follow up period is one year [range from 6 months and 2 years]. The results were evaluated subjectively using the scorin system of Neer [6]. Overall results were excellent or satisfactory in 85% of cases. The complications encountered was malunion in one case [3.6%], deep infection one case [3.6%], bicipital tendonitis, two cases [7.1%], pain and limitation of movements in various degrees in 20 cases [71.4%] which were included in the satisfactory and the unsatisfactory group. There were no cases of non-union or avascular necrosis