Ligament reconstruction and tendon interposition in the treatment of thumb basal joint arthritis

Osteoarthritis of the thumb basal joint is a relatively common condition and could be quite disabling. Surgical procedures which restore a painless and mobile joint result in a gratifying outcome both to the patient and surgeon. Fourteen patients with 16 thumbs suffering from thumb basal joint arthritis underwent ligament reconstruction and tendon interposition during the period from September 2002 to March 2005. Eleven patients were females and 3 were males. Their ages ranged from 46 to 68 years [average 52 years]. The patients were selected to perform that procedure after failure of the non-surgical treatment to relieve their symptoms and after careful clinical and radiological evaluation. The lateral half of the flexor carpi radials tendon was used for volar ligament reconstruction and interposition arthroplasty. The follow up period ranged from 12 to 34 months [average 17 months]. The average total Buck-Gramcko score was 49 points [excellent outcome]. In eleven cases the scores were above 48 points [good results], and in one case the score was 36 points [fair results]. One patient had temporary paresthesias in the distribution of the superficial sensory ranch of radial nerve. Reflex sympathetic dystrophy occurred in another patient. Ligament reconstruction with tendon interposition has the advantage of relieving the pain, restoring thumb motion and strength with relatively few complications

Kuntscher nail plus lnterfragmentary screws fixation for comminuted mid-shaft femoral fractures

Twenty-nine patients with unilateral mid-shaft femoral fractures with single butterfly fragments were treated by intramedullary Kuntscher nail and lnterfragmentary screws fixation at Tanta University Hospitalfrom July 1999 to July 2003. Eighteen [62%] were males and 11 [38%] were females. Their age ranged between 19 to 53 years with a mean of 34 years. One lnterfragmentary screw was used in 13 cases [45%] while two were used in 16 cases [55%]. Twenty-seven fractures [93.1%] united within 12 to 24 weeks with an average of 16 weeks. Satisfactory functional results were obtained in 26 patients [90%], and unsatisfactory in 3 patients [10%]. Complications met with this method of fixation were infected nonunion in 1 patient [3.4%], aseptic nonunion with nail breakage in 1 patient [3 .4%], nail bending plus gluteal bursitis in one patient [3.4%], and bursitis alone in 2 patients [6.9%]. This method of fixation is reliable for mid-shaft femoral fracture with a single butterfly fragment. It is- less costly with no need for special equipment's and no X-ray exposure