Open medial wedge osteotomy with impacted bicortical iliac bone graft in the treatment of adolescent tibia vara

We treated 14 patients [20 extremities] suffering from adolescent tibia vara. The mean age at the time of the operation was 16.1 [13-20] years. There were 10 [71.4%] males and 4 [28.6%] females. Six [42.9%] had bilateral deformity. Ten patients [71.4%] were either obese or over-weight. The pre-operative tibio-femoral angle was in varus and ranged between 196 to 182 degrees. All the patients were treated by medially opended wedge osteotomy of the upper end of tibia below the tibial tubercle. The osteotomy was kept open by impacted bicortical cancellous bone graft. All the patients were followed up for a period ranged between 9-20 months. The mean post-operative tibio-femoral angle was 176 [172-183] degrees. The patellar tendon height was not changed post-operatively. Only one patient had keloid scaring of her tibial wound. No vascular or neurological complications were reported. Medially opened wedge osteotomy was safe, effective, and stable osteotomy for the treatment of adolescent tibia vara

clinical study on hamstring transfer for quadriceps paralysis in poliomyelitis

Hamstring transfer is a satisfactory procedure in the treatment of weak paralyzed quadriceps. This restores the stability of the knee by improving the extensor nower and removing some of the deforming flexor muscles. Many patients can discard their braces after the operation. Even with poor function of the transferred muscles, there is some gain of stability and better gait

Acute anterior cruciate ligament injuries, clinical versus arthroscopic diagnosis

Twenty-seven cases of acute anterior cruciate ligament injuries were examined clinically, then radiologically re-examined under general anesthesia and arthroscopically. The findings of these various methods of examination were analyzed to correlate the clinical versus arthroscopic findings. Hemarthrosis was found in all cases. Seven out of 27 cases of acute anterior cruciate ligament were associated with other injuries as follows: Four with lateral meniscus, two with medial meniscus, one case with chondral fracture of the lateral femoral condyle. There were 20 cases [74.1%] considered arthroscopically as isolated lesions. Fourteen cases [51.8%] had complete tear, whilst 13 cases [48.2%] had partial tear. In the 13 cases of partial tear the anteromedial part was involved in 9 cases [69%] and the posterolateral part in 4 cases [31%]. The commonest mechanism of injury in cases of total rupture was valgus external rotation; while in partial tear, it was hyperextension. Lachman's test, when performed under general anesthesia, was 100% accurate in complete area, so it was considered the most reliable test in diagnosing total rupture of the anterior cruciate ligament. In cases with partial tear, the anterior drawer test was positive in cases where the anteromedial portion was involved, whilst Lachman's test was positive in cases with posterolateral tear of the anterior cruciate ligament. The clinical accuracy in this study was found 86% total rupture, 31% partial rupture. Overall accuracy of the clinical tests was 59%

role of arthroscopic examination in diagnosis of acute knee injuries

This study presents 50 patients with acute knee injuries. There was no gross collateral ligamentous injury or radiological abnormality, only joint swelling. Cases were clinically examined without and with anesthesia and arthroscopic examination was carried out. Anatomical lesions were detected in 45 cases [90%] which included anterior cruciate ligament [ACL] tear in 27 cases [34%], of these 6 cases [22%] proved arthroscopically to be associated with meniscal tears and one case [4%] with chondral fracture of the lateral femoral condyle. Isolated meniscal tears were found in 17 cases and 1 had posterior cruciate ligament tear. Arthroscopy increases the chance for reaching correct diagnosis added to the clinical means, helps in detecting combined injuries of knee structures and lastly clarifies the exact meniscal lesion

Bow legs in Egyptian children

Bow legs is one of the frequently encountered deformity in clinical practice among children. Sixty-four children presented with bilateral bow leg deformity were seen in the Outpatients Pediatric Orthopedic Clinic, El-Shatby University Hospital within six months period. All were rackitic, except one which was tibia vara. Three doses of vitamin D 600,000 units were given at four weeks interval to all cases. Mild cases were followed up while for severe cases osteoclasis was performed to correct the deformity. Cases were assessed clinically, biochemically and radiologically before treatment and six months after. Rickets was found to be the commonest cause of bow legs. Serum alkaline phosphatase was found to be the most reliable criterion for the diagnosis of the activity. Medical treatment is sufficient in treating mild cases while osteoclasis yielded satisfactory results in correction of severe cases

Surgical treatment of the displaced supracondylar fracture of the humerus in children using the medial approach

38 displaced supracondylar fractures of the humerus were treated by open reduction and internal fixation with two Kirschner wires using the medial approach. After an average follow up period of 6 months 90% of the cases had satisfactory results. The result was found to be significantly affected by the preoperative trials of manipulations to achieve closed reduction, the time delay before operation and the accuracy of reduction achieved during surgery. Among the complications met with were limitation of elbow movement in 26% and cubitus varus in 23.3% of cases

Intra-articular rheumatoid nodules

Out of 44 patients with rheumatoid arthritis of the knee; rheumatoid nodules were discovered in 8 patients. These nodules were found deep in the subsynovial layer consisting of a central necrotic zone, swelling and fragmentation of collagen fibres which were surrounded by a highly cellular zone formed of lymphocytes, histiocytes and fibroblasts arranged in a radial manner. The preoperative complaints improved dramatically in all patients with no evidence of recurrence after forty months. Post operatively, complete range of knee joint movements was regained in seven patients. Early arthroscopy is of value for early diagnosis of rheumatoid nodules. Total synovectomy is better than local excision of the nodule to avoid recurrence