Effect of percutaneous and open tenotomy on continuity of tendoachillis in relapsed clubfoot

Background: Tenotomy of tendon Achilles is one of the major components of Ponseti method and necessary to complete correction in about 80 to 90 % of patients, it is safely procedure can be done in outpatient office as percutaneous technique under local anesthesia or in operative room under general anesthesia as mini-open technique. This study was designed to evaluate effect of tendoachillis tenotomy either percutaneous or open on continuity of tendoachillis by open evaluation in relapsed club foot. Patient & method: This study was conducted on 18 individuals. They were divided into 2 equal groups: Group I: containing 9 patients both sex had previously percutaneous tenotomy is done and Group II: 9 patients both sex had previously open tenotomy is done. Results: percutaneous technique found easy dissection in 6 patients (66.7%) and difficult dissection in 3 patients (33.3%) and continuity found central and regular contour in 7 patients (77.8%) and fibrotic mass in 2 patients (22.2%), open technique found easy dissection in 5 patients (55.6%) and difficult dissection in 4 patients (44.4%) and continuity found central and regular contour in 5 patients (55.6%) and fibrotic mass in 4 patients (44.4%), Conclusion: the techniques tenotomy of tendoachillis had no effect on continuity of tendoachillis either open or closed techniques in management of club foot

Primary pyomyositis in children.

BACKGROUND: Pyomyositis (PM) is defined as a primary pyogenic infection of the striated skeletal muscle; although it has many dystrophic musculoskeletal complications, it is always misdiagnosed by many orthopedic surgeons. HYPOTHESIS: PM is rare in temperate climates and usually considered to be a tropical disease, until recent times, after globalization, it is possible to occur in the subtropical climate as in our country. MATERIAL AND METHODS: In the present series, the results of 15 children patients with primary pyomyositis have been reviewed. In five out of them, conservative treatment protocol alone which has been by intravenous and oral antibiotics therapy was effective. The remaining ten patients with confirmed abscess formation needed invasive procedures which have been percutaneous US-guided drainage in two patients and an open surgical drainage in the remaining 8 patients. RESULTS: Conservative treatment was successful in five cases with marked improvement within 3 days, but in the other ten patients who needed surgical treatment, all were effectively treated except three out of them who were complicated as follows; elbow stiffness in one case, hip joint septic arthritis with epiphysitis in the second case and osteomyelitis of the lower femoral end with knee joint septic arthritis in last one. DISCUSSION: Both clinical picture and laboratory investigation of PM are not specific and resembled many other differential diagnoses so the proper imaging study is of valuable importance needs to be accurately identified and treated to avoid its delayed complications. CONCLUSION: In children complaining of joint pain or muscle aches and septic-appearing, pyomyositis should be considered in the differential diagnosis. MRI is the most valuable tool for diagnosis of PM. Early diagnosis, the use of appropriate antibiotic therapy and complete drainage of the purulent material are important factors for successful treatment that leads to complete resolution of PM. LEVEL OF EVIDENCE: IV.

Open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable posterior pelvic ring disruptions.

BACKGROUND: Surgical stabilization of posterior pelvic ring fractures can be achieved by either open or closed methods. They all provide a comparable biomechanical stability. The aim of the present study is to compare the clinical results of both techniques for treating posterior pelvic ring injuries. MATERIAL AND METHODS: Seventy patients operated for unstable posterior pelvic ring disruptions were retrospectively reviewed. We compared 35 patients treated by open reduction internal fixation (ORIF group) versus 35 patients stabilized by using closed reduction and percutaneous iliosacral screw fixation (CRIF group) under fluoroscopic guidance. RESULTS: According to pelvic outcome scoring system of Pohlemann et al., 28 patients out of the ORIF group obtained good or excellent results (20 excellent and 8 good), five fair and two poor. In the CRIF group, 30 patients obtained good or excellent results (25 excellent and 5 good), four fair and one poor (P=0.64). The average intraoperative blood loss in the ORIF group was 500cc with average blood transfusion of 2units (1000cc) compared to blood loss 150cc in the CRIF group, with average blood transfusion of 1unit (500cc) (P=0.002). No intraoperative complications were reported in the ORIF group while operative guide wires were broken in two cases in the CRIF group (P=0.16). There were no neurological complications observed in the ORIF group, but one radiculopathy (L5 root palsy) occurred in the CRIF group (P=0.317). In the ORIF group, three patients had superficial wound infection and one patient had deep infection while in the CRIF group, we noted only one case of deep infection (P=0.083). CONCLUSION: No difference was noticed between ORIF and CRIF. The technical decision is variable according to time of surgery, fracture types, patient general condition, skin condition, presence of ipsilateral fractures of the acetabulum and feasibility of the closed reduction. More studies are needed to identify prognostic factors related to quality of the reduction. We need for creation of decisional algorithm for ORIF versus CRIF. LEVEL OF EVIDENCE: Level 4.