Treatment of GAP non-union in the upper extremity by a full thickness cortico-cancellous bone graft with fixation by compression plates

Seventeen gap non-union [seven in the radius, six in the ulna, and four in the humerus] in fifteen patients were treated with a full-thickness cortico-cancellous iliac-crest graft, 1.0 to 2.5 centimeters in length, to replace the bone loss, and with a compression plate to provide stability. Thirteen of the fifteen fractures with adequate follow-up united and the grafts were incorporated in an average of 14 weeks, an 81 per cent success rate. The stability achieved by the compression plate allowed early removal of the plaster cast and institution of active exercises. In the two failures, the graft was not resorbed, and it filled the gap in the bone but failed to unite at one end

Comparative study between partial resection and total meniscectomy of the discoid meniscus

Thirteen knees underwent partial meniscectomy for symptomatic discoid lateral meniscus. This procedure, modifying the discoid meniscus to the normal semilunar shape, was indicated only when degeneration or tear was minimal, when the meniscus was not abnormally thickened nor of Wrisberg type, when it was not hypermobile, when the capsular attachment was intact, and when the residual meniscus was free from abnormality. Nine total lateral meniscectomy were performed to discoid lateral meniscus with multiple tears and degeneration. The results were excellent clinically, radiologicaly and arthroscopically, rehabilitation was shortened to half that required for total meniscectomy and the residual meniscus functioned entirely normally

Evaluation of microsurgical replantation after traumatic finger amputation

Twenty-one replantations of fingers in thirteen patients who had traumatic amputations were reviewed excluding the thumb and finger revascularizations. The average length of follow-up was twenty eight month. [Range, ten to fourty six months]. Seventy-one [71.4 percent] of the replanted fingers survived. Survival was found to be affected by the age of patient the number of vessel, that were anastomosed, and the replantation experience of the surgeons. The survival rate was not affected by the mechanism of injury, or which finger was amputated. As compared with survival only the functional results were most dependent on the level of amputation. The proximal interphalangeal joint in amputated fingers gave a more better results than those of the distal one

Treatment of supra condylar fractures of the humerus in children by straight lateral traction

Thirty-two children with severely displaced supracondylar fractures of the humerus were collected from 1983 to 1986 and treated by lateral traction. The follow up period was ranged from [1983-1987]. There were twenty-nine [90.6 percent] satisfactory and three [9.4 percent] unsatisfactory results. Cubitus varus was present in only two children [6.3 percent].Straight lateral traction has three advantages; it is simple and requires no special equipment; it is safe in that Volkmann's ischaemia permanent nerve lesions and stiffness are avoided; and finally, control of the carrying angle compares well with the best results of other methods. The chief dissadvantage of traction is the duration of inpatient treatment

Long-term evaluation of high tibial osteotomy for varus gonarthrosis

The results in thirty-eight patients [fifty knees who had a high tibial osteotomy [of any kind] were evaluated for varus gonarthrosis [ostcoarthritis or osteonecrosis]. The operations were performed between January 1982 and June 1984. The mean length of follow was 6.7 years [range, five to seven and half years]. The early results were promising: at two years 89.56% of the knees had either an excellent or a good result. At subsequent follow-up at five year, the percentage of excellent and good results was deteriorated to [65%]. However at the end of follow-up, at five year the percentage of excellent and good results was deteriorated to [65%].However at the end of follow-up period only 25 knees [52%] had an excellent or good results and in the remainder recurrent pain had developed. The alignment obtained by the osteotomy was not as important in determining the long term results as it was previously believed. Although recurrent varus deformity was observed in more than one-quarter of the knees. It was not necessarily associated with all unsatisfactory result

value of the caudal epidural steroids in the treatment of lumbar neural compression syndromes

Sixty-three patients with lumbar radicular pain syndromes were treated in a randomised double blind fashion with either five milliliter containing one hundred and twenty five milligrams of hydrocortison acetate and carbocain 4% in thirty milliliter sterile distilled water or the same volume of sterile physiological saline and carbocain 4%. All patients had radiographic confirmation of lumbar nerve-root compression, consistent with the clinical diagnosis of either an acute herniated nucleus palposus or spinal stenosis. No satisfactory significant differences were observed between the control and the experimental patients with either acute disc herniation or spinal stenosis. Long-term follow-up, averaging twenty months, failed to demonstrate the efficacy of epidural steroids injections in any of both clinical types of lumbar neural compression syndromes. Therefore, a decision to use epidural steroids must be made to demonstrate its clinical efficacy in this study and that reports of serious complications of this procedure have been published

Tension band as a surgical fixation of displaced olecranon fractures

Twenty-six displaced fractures of the olecranon were treated by tension band-wire fixation within February 1982 to March 1989. All had been treated with primary open reduction using the A.O. technique of tension band wiring. All the patients were followed at least to bone union as determined radiographically A high incidence of complications related to the technique of tension band wiring were encountered. The most frequent complication was bending of the Kirschner wire in eight patients. There was symptomatic prominence of the Kirschner wire in five patients, avulsion of the wire loop in five patients, broken Kirschner wire in four patients 1st reduction in two and infection in one. Most complications that are related to this method of fixation may be avoided by careful attention to surgical technique. Also, these complications did not interfere with fracture union except broken Kirschner wires that required change by another stronger and thicker one

Repair of recent peripheral meniscus tears by open technique as alternative to meniscectomy: a preliminary report

This study represents the results of repaired recent vertical peripheral tears of the meniscus in 15 patients [three females '20%' and twelve males '80%'], the mean age was 23.5 years [16-31 years] which was carried out from January 1985 to June 1987. All tears were confirmed preoperatively by arthroscopy. Eleven medial [73.3%] and four lateral [26.7%] menisci were repaired. The fifteen tears were sutured within two weeks after injury. Nine patients [60%] had isolated meniscal tears while 7 menisci were accompanied by injuries of either the anterior cruciate [3 cases: 20%] or the collateral ligaments [2 cases '13.3%] or both [one case]. At a mean follow-up of eighteen months [range 12-39 months] twelve patients had clinically healed meniscal tear. The augmented suturing facilitated the healing process by providing stability and possibly by supplying bridges for synovial cells to migrate in to meniscal tear. Repeated arthroscopy was done for 13 patients [86.7%] every 6 months during the follow up period. The arthroscopy proved that twelve of these repaired tears had healed. Healing took place via the highly cellular but relatively avascular fibrous tissue stroma which proliferated from the synovial margin and invaded along the tear of the meniscus as was observed arthroscopically. Incomplete healing was present in 3 cases [20%] which showed scarred healing while no case showed failure of healing. 86.7% of the repaired menisci [13 cases] were categorized as clinically stable and 80% of the patients [12 cases] returned to full normal daily activity within 6 months.Positive correlations with healing was found in patients who had a narrow peripheral meniscal rim [zero to 3 mm] [11 menisci '73.3%']. There was also positive correlation in patients who had meniscal repair that was associated with reconstruction of the anterior cruciate [3 cases 20%] or medial ligament [2 cases '13.3%] or combined [one case '6.7%']. Arthroscopic suture was not done in repair of longitudinal peripheral meniscal tear because of the significant potential risk which include damage to the perineal nerve and popliteal vascular structures, soft tissue suture interposition failure of meniscal approximation condylar abrasion in addition to the usual complication of arthroscopy and above all the lack of arthroscopic operative skill. The width of the rim had a definite relationship with the capability of the meniscus to heal. Dissection and stimulation of the perimeniscal synovial membrane also appear to influence rates of healing. Four patients had a second tear after the initial repair, three were reruptures at the sutured area [initial 4-5mm gap after 6 months] and one has a new rupture in another area of the meniscus and was associated with fresh trauma 14 months after the initial repair. All of these patients subsequently had an open meniscectomy after failed trial of resuture. The procedure is technically demanding. Short term study indicate the protective effect of the repaired meniscus and this should be the procedure of choice for meniscal tear. A long term follow up study will answer the question of the durability of the repaired meniscus and joint protection

Posterior muscle-pedicle bone grafting and multiple drilling in treatment of post traumatic aseptic necrosis of the femoral head "A preliminary report"

Out of nineteen patients with a vascular necrosis of the femoral head treated surgically, only 14 cases were available for the study. Multiple drilling of the femoral head was performed, necrotic bone was removed and the defect was filled with vascular muscle-pedicle bone graft and cancellous bone which was implanted into the head and neck of the femur followed by insertion of a five inches Steinmann pins or Moore's pins. The viable graft induced rapid healing of the bone. In 7 patients, the necrosis was associated with ununited femoral neck fractures, in four it occurred after the fracture had united and in 3 cases it followed reduction of traumatic dislocated hip. This method of bony replacement encourages adequate removal of the necrotic bone of the head and provide sufficient mechanical support. The hips had the pain improved after operation, nearly 30% had still some degree of pain but it is mostly mild. Further collapse occurred in 3 patients. The patients were young [average age 35 years] and full weight-bearing was not allowed for several months. The follow-up period ranged from 24 to 59 months [average 38.2 months]. The results were excellent in five patients, good in four, fair in three and poor in two. There had been no donor site morbidity. It is concluded that the advantage of the technique is dead bone replacement by both free and vascularised graft in addition to femoral head decompression. There was prolonged restriction of walking after operation. However, in view of the age group involved, it is felt that the results are encouraging and treatment should start before femoral head collapse. Still longer follow-up is necessary to determine the durability of the replacement