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

Surgical correction of congenital vertical talus by one-stage peritalar reduction and tibialis anterior transfer

Twenty-eight feet of 16 children with true congenital vertical talus [CVT] were treated surgically by one-stage peritalar reduction and tibialis anterior transfer to the neck of the talus. The male to female ratio was 3:1. Fifty percent [8 patients with 15 feet] were isolated CVT and the remaining [8 patients with 13 feet] were CVT associated with other congenital anomalies mostly arthrogryposis. Patients with the neurological disorders were not included. Familial occurrence was encountered in 4 children [7 feet] of the same family. The mean age at operation was 19.1 +/- 7.1 months [range 6-36]. All patients were operated by the author and were available for clinical and radiological follow-up for a mean of 9 +/- 5.3 years [range 2-16]. A modified scoring system with 32 points for clinical and 8 points for radiological parameters was utilized for assessment of the final outcome. Nine feet [32.1%] had excellent results, 15 [53.6%] good, 3 [10.7%] fair and one [3.6%] poor. The mean score for all patients was 31.9 +/- 2.8 points. All patients and their parents, except one, were satisfied by their functional results and appearance of the feet. Radiologically there was a statistically significant improvement of the measured angles at the final follow-up compared to the preoperative angles. Unsatisfactory results occurred in 4 feet [14.3%]; in 3 due to partial recurrence of the deformity; these were associated with arthrogryposis. The fourth had overcorrection. No talar avascular necrosis was encountered in this study. Early treatment of CVT by simultaneous correction of all the anomalies during the same sitting led to very satisfactory medium term results

Subacromial decompression using modified acromioplasty

The aim of this work was to study the clinical results of subacromial decompression using modified acromioplasty in cases of shoulder impingement syndrome. Thirty two patients who had shoulder impingement syndrome were included in this study. Twenty patients were females and 12 were males. The average age at the time of operation was 43.2 years; 40.6 years for females and 47.6 for males. There were two indications for operation. One was the persistence of pain in the anterior aspect of the shoulder when the arm was elevated and the second was progression of symptoms despite the use of anti-inflammatory medications and rehabilitation program. All cases were managed operatively with a modified Neer acromioplasty. In the classic anterior acromioplasty as described by Neer emphasis was placed on resection of the inferior prominence of the acromion. Modified acromioplasty was done in two steps; the portion of the acromion that projects anteriorly beyond the anterior border of the clavicle was resected vertically and then an anteroinferior acromioplasty was performed. The follow up period ranged between 6-24 months, average 13 months. Nineteen patients had excellent result, 7 had good result and 6 had no improvement