Tendon transfer around shoulder and rehabilitation in obstetric brachial plexus paralysis: clinical and computed tomographic study

109 obstetrical palsy patients with defective shoulder abduction and external rotation had subscapularis release and transfer of teres major to infraspinatus with or without pedicle transfer of the clavicular head of pectoralis major to deltoid The age at surgery averaged 67 [11-1 92] months and Follow-up averaged 36 [12-80] months. 39 cases had follow-up CT scan of both shoulders. Improvement of abduction averaged 64 0 and that of external rotation 50 0, 100% and 290% gain, respectively. Both negatively correlated with the age at surgery [p<0.001], and were significantly higher in patients operated < 4 years old. On CT scans, the degree of glenoid retroversion positively correlated [p<0. 001] with the age at surgery, and was significantly higher in patients operated >4 years old The degree of posterior subluxation showed no significant difference between different ages. There was no significant difference between the operated and normal sides in patients operated < 4 years old as regards glenoid retroversion and in those operated <2 years old as regards posterior subluxation. The operation is useful for correction of defective shoulder abduction and external rotation in obstetric palsy. It is best performed before the age of two to get maximal improvement in motion and prevent secondary bone changes. Between the ages of 2-4, it also resulted in significant improvement in motion and prevented glenoid retroversion, but not posterior subluxation. After the age of 4, the improvement in motion was not significant and secondary bone changes were not prevented

Modified Scott's operation for management of lumbar spondylolysis and minimal degree spondylolithesis

Thirty-two patients complaining of low back pain and diagnosed as spondylolysis were included in this study. All of them had spondylolysis of the lumbar spine at different levels. The affected level was L5 [n = 16], L4 [n = 10] and multiple-levels lysis [n = 6]. Twenty-two patients had associated grade I spondylolithesis in association with the lysis. The other 11 patients had spondylolysis only. These patients were managed surgically in this study by the modified Scotts technique using pedicular screws and washers as anchorage point instead of wiring around the transverse process. The defect was filled by iliac grafts either paste or tricortical one. Minimal decompression through limited fenestration was done in three patients. The patients were followed up for one year at least. The follow up duration ranged between 12 and 30 months with an average 18 months. The study concluded that this modified technique is a safe and easy technique, avoiding the complications of wire breakage and transverse process fracture of the traditional Scotts technique. It can be applied to multiple level lysis with the preservation of a good back motion

Radial shortening for Kienbock disease: long term follow-up

Fifteen patients who had radial shortening for the treatment of Kienbock disease were reviewed to assess the results of these procedures. All wrists were reexamined at an average follow-up of 5.5 years [range 3.5-8.0 years]. The age ranged between 20 and 40 years, with an average of 30 years. We noticed improvement in pain severity, range of motion of the wrist and functional capacity of all patients. Radiographic assessment at latest follow-up did not show degenerative changes in the studied wrists. Radial shortening is an effective treatment for Kienbock disease provided absence of arthritic changes in the wrist joint and adjacent carpal bones

Open versus arthroscopic assessed technique in ankle arthrodesis

Ankle arthrodesis was done for 17 patients divided into two groups. The first group consisted of ten patients treated by an open technique, and the second group included seven patients managed by arthroscopic assessed ankle fusion. The details of the patients, surgical techniques and the results were described in this study. In the second group, postoperative pain was much less and healing time was shorter than the first group. The arthroscopic technique is less invasive but there is a learning curve associated with the maneuver, where severe joint deformity is considered a contraindication for arthroscopic fusion

Condylar buttress plating for distal femoral fractures: indications and outcome

Fourteen patients with distal femoral fractures had been treated by condylar buttress plating [CBP] between May 1997 and February 2001 at Assiut University Hospital. There were eight males and six females with an average age of 45 years. Eleven fractures were closed and three were open. The indications for CBP were fractures with articular comminution and fractures with coronal plane element in addition to the sagittal plane element [AO-type C3], fractures extending to less than 3 cm from the joint line with short distal fragment for angled blade-plate fixation, and the presence of comminution of the site of entry for condylar plate. The surgical technique had respected the biological principles in all cases with modification of the approach to be transarticular-minimally invasive in four cases. No bone graft was done in any case even in the presence of medial comminution. All cases united with time to union ranging from 12 to 24 weeks [average 16 weeks]. According to Neer's score, the results were excellent in seven cases, satisfactory in five cases and unsatisfactory in two cases

Surgical treatment of neglected ankle fracture dislocation: mid term follow-up

Sixteen patients with neglected ankle fractures were treated by osteosynthesis following AO principles. The average delay between injury and reconstruction was 2.2 months. The average follow-up period was 5.5 years. Excellent and good results were obtained in 10 patients [62.5%], a fair result in 5 patients and a poor result was reported in only one patient. The quality of reduction obtained and state of articular cartilage before surgery were factors influencing the end results

Operative treatment of intra-articular fractures of the calcaneum

Fifteen patients with intra-articular fractures of the calcaneum were reviewed after operative management. There were 4 females and 11 males. All fractures were due to falling from a height. Fracture fixation was performed between 3 and 11 days after trauma with an average of 6.5 days. Single lateral exposure was used in all cases except two where an additional medial incision was needed. Only one case developed deep infection and needed subtalar fusion. Two other patients suffered from mild pain, apart from this, overall results based on clinical and radiological assessment were satisfactory for all patients

Internal Compression arthrodesis of ankle and foot

During a four-year period, three groups of patients were treated by arthrodesis using internal compression by 6.5 mm cancellous screws and supplementary bone grafting. The first group included fourteen patients where ankle fusion was performed. The second group included six patients who had pantalar fusion and in the last group subtalar fusion was done in five patients. The over all fusion rate was 92.1% in the ankle fusion group and 100% in the other two groups. In all patients, the procedure invariably produced union with excellent cosmesis, few complications and good function

Management of malunited Colles' fracture

Twenty malunited Colles' fractures [nineteen patients] were treated by corrective osteotomy bone grafting and K-wire fixation. The indications for surgery were based on the degree of the deformity radiologically, the functional limitation, the appearance of the wrist and the age of the patients. Excision of the lower end of ulna was performed in six patients. Average follow up period was 20 months. The procedure gave excellent and good results in eighteen wrists and fair in two wrists with no poor results

Results of Malti Russe procedure for non union of scaphoid

15 symptomatic patients with ununited scaphoid fractures were treated by volar cortico cancellous bone grafting. Duration of nonunion before surgery ranged between 3 months and 1.5 years. All patients were treated by the same technique except one patient who had the addition of limited carpal fusion. Overall assessment revealed excellent satisfaction with this line of treatment regarding wrist motion, grip strength and return to work

Results of high tibial osteotomy for varus gonarthrosis of the knee joint

31 high tibial osteotomies [in 30 patients] for varus gonarthrosis performed between 1985 - 1990 were evaluated to determine correction of deformity, functional results and subjective impression. 25 patients had satisfactory follow up evaluations. Factors contributing to success included careful patient selection, over-correction of the limb deformity and precise surgical technique