Evaluation of the results of operative treatment of hip dysplasia in children after the walking age

Treatment of neglected developmental dysplasia of the hip [DDH] in children after the walking age has been a challenge to the orthopedic surgeons. It is usually surgical at this age group. The study included 35 patients [42 hips], they had been treated by different combinations of open reduction, femoral [shortening, derotation and varus] and pelvic [Salter or Dega] osteotomy. The age at the time of the operation ranged from 18 to 96 months. At the end of follow-up [a mean of 33.5 months], the overall final clinical result was excellent in 13 [31%] patients, good in 24 [57%] patients, fair in four [9.5%] patients and poor in one [2.5%] patient satisfactory in 37 [88%] patients and unsatisfactory in five [12%] patients. The radiological end result was Class I [excellent] in 26 [62%] patients, Class II [good] in 11 [26%] patients, Class I [fair] in three [7%] patients and Class IV [poor] in two [5%] patients. It was satisfactory in 37 [88%] patients and unsatisfactory in five [12%] patients. We concluded that operative treatment of neglected DDH after the walking age is a technically demanding procedure but when performed properly by an experienced surgeon it gives satisfactory results

Treatment of fracture of the oscalcis: comparative study of two methods

Fifty patients with 54 feet suffered from recent displaced intra-articular fractures of the os calcis. They were managed randomly by either one of two methods: 1] closed reduction and compression bandage with early mobilization, or 2] closed reduction using a pin and plaster [a modified Gissane's method]. The results of the second method were clinically better. The difference however was statistically insignificant. The results were found significantly affected by the age. The degree of displacement, the restoration of tuber joint angle and the period of follow-up showed an insignificant effect on the results. The period of incapacitation was shorter as compared with other previous studies. Closed reduction by Gissane's method helps much to restore the tuber-joint angle

Surgical treatment of club foot long term follow-up

180 patients with 206 feet having congenital talipes equinovarus underwent surgical correction over a period of 12 years and could be followed up for a period of 1 to 12 years. Cases below the age of 3 years were treated by soft tissue release and tenoplasty. 29 neglected cases over 3 years of age were treated by preliminary manipulation and correction casts of kite's type, then soft tissue release and tenoplasty, followed by one of the bone resection operations. Clinical assessment proved 89% excellent and good and 11% bad results

Displaced supracondylar fractures of the humerus: a study on the importance of Baumann angle

Thirty-four children with closed displaced supracondylar fractures of the humerus treated conservatively were studied and followed up to detect the relationship between Baumann angle and the final carrying angle of the elbow. A significant negative correlation between both angles was detected. It changed markedly in the same patient during the course of plaster slab fixation denoting insecure fixation

Femoral neck fractures in children

18 children with fracture of the neck of the femur were the subjects of this study. They were received during the period from 1982 to 1987. According to Ingram classification, there were only Type II and III fractures that are known for a high percentage of complications. Closed reduction and internal fixation by Moore's pins, Kirschner wires or screws was done with additional hip spica for six to ten weeks. Results were, assessed according to Ratliff: eleven were good, five fair and two poor. Complications met with were avascular necrosis, non-union, coxa vara, coxa valga, premature epiphyseal fusion, metal failure and backing of the fixing device. The authors feel that some complications were inevitable while others could be reduced if immediate interference was done, by gentle manipulation, accurate reduction, rigid internal fixation without transfixing the epiphyseal plate and plaster immobilization until radiological evidence of union

Evaluation of the results of treatment of trochanteric fractures of the femur in adults by dynamic hip screw

Thirty cases of trochanteric fractures, 16 stable and the 14 unstable, were fixed surgically by a dynamic hip screw, after closed reduction and using the X-rays television image intensifier, 16 stable and 14 unstable. The mean age was 53 years. 28 cases attended the final follow up. One case died and another could be not followed. Union occurred after 3-6 months. Satisfactory results were obtained in 89.2% of cases and complications occurred in 3 cases

Painful medial aspect of knee above middle age

Out of 100 patients complaining of painful knee and tenderness on the medial aspect of the knee joint investigated clinically, radiologically and arthroscopically, there were 55 degenerative arthritis, 27 torn medial meniscus, 6 degenerated medial meniscus and 21 other different knee affection. The study pointed out to the importance of the preservation of the medial meniscus even when degenerated, and that most of the patients after the age of 30 years complaining of pain on the medical aspect of their knees are suffering from degenerative arthritis

Surgical treatment of club feet by soft tissue release

Soft tissue release operation was applied to 172 feet in 108 patients suffering from talipes equino varus. Only 68 feet in 40 patients could be followed up for at least one year. Of these; five cases were arthrogrypotic and were included for comparison. No tendon transfer was done in the whole series. The results of the operation varied inversily with the preoperative deformity. Also it has been shown that the earlier the operation, the better were the results. Arthrogrypotic cases were all bad

Treatment of residual defects in the shoulder in Erb's palsy

Fifty-three patients suffering from Erb's palsy were treated surgically in order to improve the function of the shoulder. These surgical procedures were sever's release, L'Episcopo's transplant and derotation osteotomy of the upper end of the humerus according to certain indications. Forty-nine cases attended regular follow -up which ranged from 1-4 years. The overall results were satisfactory in 69.4% of cases. Improvement in the functional activity after derotation osteotomy was superior to the other two procedures since the operation did not disturb the muscles acting on the shoulder

Infection and role of antibiotics [Kanamycin] in clean orthopedic operations

To study the effect of kanamycin as a prophylactic antibiotic in clean orthopaedic operations, a prospective study including 394 patients was carried out. On alternating months the cases were either operated upon without antibiotic, cover [group A], or given kanamycin [group B] regardless the patient's age, nature of the operation or the duration of the operative procedure. Accordingly 197 cases did not receive antibiotics while 197 received prophylactic kanamycin. Fifteen infected cases were met with, five in group A [2.5%] and ten in group B [5%]. The younger the patient and the shorter the time of the operation the less he was liable to infection. The commonest offending organism was Staphylococcus aureus and mixed infection was present in one third of the cases. The most effective antibiotic was gentamycin