Arthroscopic repair of meniscal tears by the inside out technique

Twenty patients having longitudinal meniscal tear in the middle of the meniscal arc were included in the study. The aim was to present our experience and to report the results and follow up. We had used the inside out technique. The follow up evaluation, for a period of two years, of the results was done by a comprehensive examination for the affected knee. The overall results showed that up to 75% is considered satisfactory and that 85% of them were self-satisfied. In conclusion, this study demonstrates that arthroscopic meniscal repair in knees with isolated meniscal tears has a potential clinical successful outcome

Isthmic spondylolisthesis posterolateral fusion with transpedicular fixation in adults

Twenty adult patients with symptomatic isthmic spondylolisthesis under-went in situ posterolaleral fusion with transpedicular Cotrel-Dubousset instrumentation [CD]. Decompression was done in 14 patients [70%] with sciatica. There were 12 women and 8 men. with a mean age of 38 years [range, 20-52 years]. All patients were recommended for surgery after a failed trial of conservative treatment. The degree of olisthesis was: Grade I in 10, Grade II in 8, and Grade III in 2. All patients had low back pain; with leg pain-bilateral in 10 and unilateral in 4. The single level fusion was done at L5 - Sl in 14, and at L4 - L5 in 6 patients. At a mean follow-up of 20 months [range, 12-36 months], successful fusion was achieved in 90% and 85% had excellent or good clinical result. Successful fusion did influence the clinical outcome in terms of pain relief and increased activity. The results justify the use of instrumented posterolateral fusion for treatment of isthmic spondylolisthesis in adults

Displaced articular fractures of the distal radius open reduction and internal fixation with plate and screws

In this study, open reduction and internal fixation with a T-plate were used in a series of 18 displaced intra-articular distal radius fractures in 18 young adult patients [12 males and 6 females] with a mean age of 27 years [range 19-40 years]. Eight fractures were AO type C2 and 10 were type C3. A dorsal plate was used in 7 patients and a volar plate was used in 11 patients, with cancellous bone grafting in 6 and supplemental K-wires in 8 cases. The mean follow-up period was 25.4 months [range 18-34 months]. By the criteria of Gartland and Werley, 15 patients had an excellent or good end-result. The mean grip strength was 70% of the contralateral normal side. Postoperatively, satisfactory open reduction was obtained in 17 cases and an excellent or good articular congruency was achieved in 14 cases. At the end of the follow-up, two wrists had substantial change in position of reduction achieved at surgery and there was a mean of 8.7 mm of radial length, 16.9 degrees of radial inclination, 5.2 degrees of volar tilt and 1.2 mm of radio-ulnar index. Post-traumatic arthritis of grade 2 or 3 developed in 5 cases. Sixteen patients were able to return to pre-injury occupation or level of activities. The study indicated that open reduction and internal fixation with plate and screws can be recommended for displaced articular distal radius fractures, particularly in young adults, after failure of closed reduction in restoring articular congruency

Role of joint molecular markers in assessing physical therapy modalities in traumatic knee effusion

To study the role of joint molecular markers in assessing physical therapy modalities in traumatic knee effusion, 60 athletes, 36 males and 24 females, aged 17-24 y with a mean age of 2l +/- 1.8 y with acute knee injury [ACL and MEN] associated with marked knee effusion. All subjects were subjected to diagnostic arthroscopy, pre- and post physical therapy program knee aspiration. Subjects are classified into three groups, each group consisted of 20 subjects, 8 female athletes and 12 male athletes. All participants are subjected to routine physical therapy [PT] program of post-traumatic knee synovitis, group one received only the routine PT program, group two received beside routine PT program a pulsed ultrasonic treatment, group three received routine PT program and laser treatment. Concentrations of proteoglycan [PGS] cartilage oligomatric protein [COMP], bone sialoprotein [BSP], interlukin-l beta [IL-1 beta], turmor necrosis factor-alpha [TNF-alpha] and interlukin-6 [IL-6] were measured in synovial fluid [SF] of all patient for the pre- and post PT program. Total PGS was measured using a dyebinding method and COMP, BSP, IL-lbeta, TNF-alpha and IL-6 by ELISA. The concentrations of PGS, COMP, BSP, IL-1 beta and TNF-alpha were high in the pre-PT program but that of IL-6 was in the normal level for all the participants [n=60]. Post PT measurement of laser and US groups showed a highly statistical reduction in PGS, COMP, BSP, IL-1 beta and TNF-alpha compared to the control group, IL-6 was significantly elevated in laser and US group compared to the control group. The finding of the present study suggested that PT modalities had a significant roll in controlling cartilage degradation process through inhibition of the catabolic factors and stimulating the inhibitors, suggesting that molecular markers can successfully assess PT rnodalities in various traumatic and rheumatic affections and also PT modalities can act as a prophylaxis against early OA

Results and complications of fracture neck of femur in children and adolescents

Forty-four fractures of the neck of femur in patients below 17 years of age are the subjects of this study, the mean age was 12.3 years [SD +/- 2.9] [range 5 to 16 years]. Twenty-two patients were of type Il fractures, 16 of type Ill, 4 of type IV and only two cases of type I according to Delbet's classification of fracture neck of femur in children. Four fractures were undisplaced and treated by spica cast immobilization. The other 40 fractures were displaced and treated by closed reduction and spica cast without internal fixation in 10 [22.7%] and with closed reduction with internal fixation in 30 [68.2%]. The follow-up ranged from one to five years with average of 2.5 years. The results were good in 54.6% fair in 31.8% and poor in 13.6%. The results were found to be affected by the age of the patient as well as the type of fracture and the degree of displacement. The complications met with in this study were avascular necrosis in 45.5%, coxa vara in 18.2%, non-union in 9.1% and premature physeal closure in 31.8%. Correct classification, stable anatomical reduction, with use of internal fixation for type II and III fractures with any degree of displacement are important, stress points during treatment of these fractures