Pemberton acetabuloplasty for residual developmental acetabular dysplasia

The objective of this work is to study the effect of Pemberton lateral acetabular osteotomy on acetabular development. The osteotomy was done for fifty- nine hips in 48 [11 bilateral and 37 unilateral] patients. The average age at the time of surgery was 1.9 years. The osteotomy was preceded by closed reduction in 18 hips, open reduction with varus derotation femoral osteotomy in 32 hips, and no treatment in 9 hips. The radiologic outcome according to the criteria of Sever in was the corner stone in assessment of the results. At the final follow up period [average 4 years] for all the cases [59], there were: 46 hips with Severin class I [excellent], 10 hips with Severin class II [good], and 3 hips with Severin class III [fair]. The final follow up values of acetabular index and centre edge angle were nearly the same for the normal and the operated abnormal hips in the unilateral cases. There was limited range of motion in one case but did not affect the daily activities. Our conclusion is that Pemberton acetabuloplsty can positively affect the growth and maturation of the acetabulum with residual developmental dysplasia

Flexible intramedullary nailing of displaced forearm fractures in children

Background and Purpose: a reasonable number of fractures of both bones forearm, especially in the age group 7 - 13 years, falls to reduce or loss reduction soon after manipulation and casting. This study evaluates the use of closed flexible titanium nailing of such unstable fractures

Patients and Methods: 48 unreduced or unstable both bones forearm fractures in children with a mean age of 9 years were pinned by flexible titanium nails. The fixation was done closed under image intensifier and followed both clinically and radiologically for a mean period of 14 months

Results: All the fractures healed eventually with no refracture. Transient superficial radial nerve numbness occurred in 5 cases and delayed union of the ulna occurred in 2 cases. Variable degrees of limitation of forearm pronation and supination were encountered in 12 cases but the ultimate forearm function and power grip was not affected

Conclusion: Intramedullary fixation of an unstable forearm fracture in skeletally immature patients is a safe, child-friendly, minimally invasive technique that allows early treatment with an excellent functional and cosmetic outcome

Miniplate arthrodesis of the first metatarsophalangeal joint in hallux rigidus

Hallux rigidus refers to limitation of motion of the metatarsophalangeal joint of the great toe. For patient who had diffuse osteoarthrosis of the first metatarso-phalangeal joint, arthrodesis is a reasonable alternative if non-operative measures fail. In the current series, 25 feet grade III and IV hallux rigidus were treated by arthrodesis of the first metatarso-phalangeal joint using a low profile miniplate and screws. After an average follow up period of 22 months, clinical examination showed good cosmetic and functional results in most of cases. Of the 25 feet, 23 [92%] had less or no pain postoperatively. Good radiological union was observed in 23 feet at a mean of 7 weeks. The complications were infrequent; mainly non- union in 2 feet [8%]. This study concludes that patients of advanced grades of hallux rigid- us with significant pain, limitation of joint motion, marked loss of articular cartilage, and osteophytes formation are best treated by arthrodesis of the metatarsophalangeal joint using rniniplate for fixation