Buttress-condylar plating in treatment of intercondylar supracondylar fractures of distal femur

Fractures of the distal third of the femur are some of the most difficult fractures to treat. They present a considerable challenge in treatment as there is soft tissue damage, extension of the fracture into the knee joint with comminution which usually leads to unsatisfactory results in many cases.Is to evaluate the use of buttress condylar plate in treatment of comminuted supracondylar inter-condylar [type C] fractures of the distal femur. During the period from February 1999 until December 2003, twenty three cases of comminuted intercondylar supracondylar [type C] fractures of the distal femur were treated using the buttress- condylar plate and completed their follow up. Thirteen were males and ten were females. Age ranged between 28 and 76 years with an average of 48 years. Bone graft was needed in 7 cases. Follow up period ranged from [8] months to [66] months with an average of 32 months. Satisfactory results were obtained in [78.26%] and unsatisfactory results in [21.74%].When correctly inserted the condylar buttress plate provides excellent alignment and stability and is very helpful in reducing the comminuted intra-articular supracondylar [type C] fractures of the distal femur

Fractures of the clavicle, when to fix?

The incidence of clavicular injuries in adults appears to be increasing as a result of several factors, including the high-velocity vehicular injuries, and the increased popularity of contact sports for adults. The classic conservative treatment rarely obtained anatomic reduction. It involves immobilization -Which is always relative- with bandages and uncomfortable postures that are not well accepted. Although it is the role for this fracture to heal with voluminous calluses, their subcutaneous location may make them unsightly. Delayed unions in adults in not unusual with non-union rate ranged from 0.9% to 4%. Was to evaluate indications and results of plate fixation of the fracture clavicle. From August 2001 till February 2004, nine clavicular fractures needed to be fixed internally. They were [2] females and [7] males., [6] were right and [3] were left sided. All patients were right handed. Indications for internal fixation for them were as follows: one was non-union, five were marked displacement of the fragments, two of them were associated with tenting of the skin, two because of associated ipsilateral chest wall injuries and one with neurological manifestation. Internal fixation device were; six one-third tubular plates and three reconstruction plates. All fractures were united with healing time ranging from [6] to [14] weeks postoperatively with an average of [10] weeks. Using Constant and Murley scoring system for evaluation, 3 cases [33.33%] were rated excellent, and 5 [55.56%] good with satisfactory results 8 cases [88.89%] and one case [11.11%] rated fair and was unsatisfactory. One case was complicated by superficial infection, 2 cases with painful scar and one case showed delayed union [united after 14 weeks]. Internal fixation of clavicular fractures by plates in cases of non-union, marked displacement, Ipsilateral fracture ribs and neurological compression is a reliable method with satisfactory results in 88.89% of cases

Clinical and radiological results of two different arthroscopic techniques using quadrupled hamstring tendon grafts in ACL-reconstruction

Purpose: The purpose of the study was to evaluate the clinical and radiological outcome of two different methods of primary anterior cruciate ligament [ACL] reconstruction using quadrupled hamstring tendons with a minimum follow-up of two years. Type of study: Retrospective study. 45 patients were evaluated 2 years after endoscopic ACL-reconstruction. Two methods of graft fixation were compared: In group 1 [20 patients, EB-group] an indirect graft fixation was achieved utilizing the Endobutton [Acufex, Mansfield, MA] with manually knotted polyester tape for proximal femoral fixation combined with bicortical suture and post tibial fixation. In group 2 [25 patients, TF-group] a direct graft fixation was achieved utilizing cross pin femoral fixation [Arthrex Trans Fix II Pin, Naples, FL.] with an additional autograft bone plug inserted into the femoral tunnel. Tibial fixation of the graft was performed with a bioabsorbable interference screw and an additional staple on the graft. All cases were operated using a transtibial technique. According to the IKDC-evaluation patients of the TF group performed clinically better compared to the EB-group. Radio- graphs of the EB-group demonstrated a higher degree of divergence of the osteoscierotic lines indicating the bone tunnels in comparison to the TF-group. The entrance diameter of the drilled femoral bone tunnels were 12.5 mm and 10.5 mm in the EB-group and TF-group, respectively [p0.05]. Avoiding tapes and sutures and using a surgical technique with direct graft fixation minimizes movement of the tendon graft for ACL-reconstruction and improves clinical results

Ostechondral autograft transplantation in treatment of focal articular cartilage defects of the knee

Articular cartilage defects of the knee can be very annoying, and diagnosis can be difficult because the symptoms are often non-specific. It is well known that the capacity of articular cartilage for repair is limited, and treatment of these injuries is still evolving. Treatment options are few and the long term outcome is uncertain. Osteochondral Autograft Transplantation is currently considered one of the best treatment options that provides and retains proper hyaline articular cartilage and has been associated with a good rate of success. Aim of the work: The aim of this study was to evaluate the results of Osteochondral Autograft Transplantation in treatment of focal articular cartilage defects of the knee. Patients and Fourteen patients with focal articular cartilage full thickness defects were treated in the period from September 2000 till December 2003, by this method. They were 6 females and 8 males, age ranged from 22 to 46 years old with an average of 30.8 years. The average duration of symptoms prior to surgery was 10 months [ranged from 6 to 28 months]. Twelve patients had prior surgery to their knees. Follow up period ranged from 12 to 51 months with an average of 21.4 months. Results were satisfactory in 10 cases [71.42%] and unsatisfactory in 4 cases [28.58%]. In all cases grafts were taken except in one case [7.14%] Optimally fitted Autograft that correctly restores the contour of the articular surface provides a promising chance for treatment of an osteochondral defect

Redistribution of muscle power around the shoulder to improve the daily activities for brachial plexus birth palsies

This study included 19 children had adduction internal rotation contracture with internal rotation deformity of the shoulder and disability in their daily activities following obstetric brachial plexus palsy that involved the fifth and sixth cervical roots. These children were treated by courses of physiotherapy for different durations before and after surgery. At operation tenotomy of the pectoralis major muscle was done through anterior axillary incision. The insertions of latissimus dorsi and teres major muscles were identified and released through a second posterior axillary incision, then tranplanted to the rotator cuff as high as possible. The mean age at operation was four years, eleven month. The deformity was fully corrected in 17 cases and partially corrected in two cases. At an average of follow up two years, two months the mean increase in active shoulder abduction was 54 degrees and the mean gain of active external rotation was 43 degrees. The postoperative use of the affected limb in all daily activites was achieved in 16 cases. No neurovascular injury or post operative infection occurred

Treatment of complete acromio-clavicular joint dislocation by modified Boswarth method

Acromioclavicular dislocation represents 3-5% of shoulder girdle injuries and about 40% of athletic injuries around the shoulder. Acromioclavicular dislocation may be incomplete [types II and I] or complete [types III, IV, V and VI]. Treatment of acromioclavicular dislocation remains controversial. Complete AC dislocation is better treated by operative method especially in young active persons. Modified Bosworth technique o f coracoclavicular lag screw fixation was used in treatment of 13 cases of complete AC dislocation. The results were very satisfactory in 92.31%. One complication occurred in a manual worker with bending of the screw one year postoperatively as he was lost for follow-up. The screw was removed with no effect on the final functional outcome