Congenital spinal anomalies and occult dysraphism

Congenital spinal deformities, particularly congenital scoliosis were reported in the literature to be associated with high incidence of neural axis abnormalities. These abnormalities included tethered cord, syringomyelia, Arnold-Chiari malformation, spinal cord tumours and diastematomyelia. The incidence of occult intraspinal anomalies in patients with congenital scoliosis is still controversial and ranges from about 18% to as high as 58% in different series. As such patients are frequently candidates for corrective surgery, they are theoretically at high risk of neurological deterioration. We reviewed a short series of 30 consecutive patients with congenital spinal deformities, mainly scoliosis, based on clinical presentation, type of spinal deformity and other associated congenital deformities with magnetic resonance imaging [MRI] findings. Based on MRI findings, the incidence of associated spinal cord abnormalities in the current study was much less than that reported in the literature. Magnetic resonance imaging is still the recommended routine investigation and supports in choosing the appropriate surgical procedure

Anterior spinal fusion for management of adolescent idiopathic scoliosis

Segmental instrumentation is the current standard surgical treatment for severe adolescent idiopathic scoliosis [AIS]. Twenty-one patients with AIS operated through anterior release, fusion and instrumentation were reviewed. The preoperative scoliotic curve pattern, severity, and flexibility were assessed and sagittal thoracic kyphosis and lumbar lordosis were measured. The correction gained after operative procedure was evaluated and compared with the literature. Special concern was given to the effect of surgery on spontaneous correction of the secondary curves, trunk decompensation and changes in the sagittal alignment. The reported complications until solid fusion were collected, analysed and discussed. Anterior spinal fusion achieved correction of the main scoliotic curve at latest follow-up by 76% in average and improved spinal decompensation in 6 out of 7 patients. It improved the secondary proximal [PC] and distal curves at the latest follow-up by mean values of 8° and 20° respectively. The reported complications were one case of asymptomatic pseudarthrosis, one residual partial trunk imbalance and one partial pull-out of the proximal vertebral fixation. Anterior spinal fusion is one of the current surgical options. It has certain advantages over the standard posterior approach in short-term studies. However, long-term follow-up studies are still required

dynamic condylar screw for management of fractures of the distal femur

The advantage of the dynamic condylar screw [DCS] over the condylar blade plate [CBP] is to over come the difficulty in adjusting the plate with the femoral shaft, which necessitates strict insertion of the blade portion in the distal femur. A series of 12 patients with type C fracture of the distal femur was reviewed. Technical difficulties were encountered during surgical management of some cases treated with the DCS. The cause of these technical difficulties was analyzed. Intraoperative technical causes, individual variation in the shape of the distal femur and implant/instrumentation factors were suggested and investigated. The first two possibilities were excluded through reviewing intraoperative images and dry cadaveric bone of distal femur. Variation in the shape of two brands of DCS available in the market was found. One design is matching more the original design of CBP and the angle guide of the DCS and subsequently the contour of the distal femur. The other design was not. This point has to be considered to avoid lateralization of the proximal femoral shaft fragment with the less anatomic design. This will ensure anatomic reduction of such difficult fracture and restoration of biomechanics of the distal femur during the process of healing

Femoral neck fractures in children

Femoral neck fracture in children is a rare injury. It is induced by severe trauma and often associated with other injuries. It has high incidence of complication. In a small series of seven cases with displaced transcervical femoral neck fracture, long follow up result was collected. The standard technique was open reduction and internal fixation. The fixation was performed by parallel Knowel's pins or canulated screws and the fixation respected the physis. The patient was allowed to move in bed and ambulating as pain subsided and as he fell comfortable to do so. Although in the literature there is high incidence of disabling complications with such injury, however, in this small series complication was rarely encountered after a long period of follow up. The results obtained were analyzed and discussed

Total knee replacement for osteoarthritic knee

In a prospective non-randomized study, we evaluated the results of 44 primary total knee prosthesis in patients who had knee OA. All of the cases were performed in Hamad General Hospital, Doha, Qatar. Two main implant designs were used. The patella was not resurfaced in any patient. The mean duration of follow up was 4 years and two months. We used knee society scoring system to evaluate the results. We estimated pain, range of motion [ROM] and walking ability as separate entities. We compared our results with that of specialized and general orthopaedic centers. Thought we used standard operation room facilities and the technique was recently introduced to our hospital, the results obtained were superior to that of general orthopaedic center and closed to that of the specialized centers. Pain and walking ability improved by 32 and 30 points respectively. ROM improved by 21 into more flexion and extension, a factor which is desirable in the Arabian community. We consider that the results are quite encouraging, however a longer follow up is required to get the full feed back about the technique

extensive posterior pelvic approach

A modified posterior pelvic approach is described. It can be used for surgical management of complex posterior pelvic ring fractures. Through this approach open reduction can be performed for dislocation of the sacroiliac joint, fractures of posterior iliac wing and sacral fractures particularly for the bilateral injuries. Fixation by iliosacral screws and by transiliac plate is also possible. The authors used this approach in treating ten patients with type [C] vertically unstable posterior pelvic fractures. Manipulation, reduction and fixation of those fractures were relatively easy. Little skin and soft tissue morbidity was encountered. The authors feel that this approach is more extensile than the current approaches that deal with most posterior pelvic ring fractures particularly the complex ones