Purpose This study aimed at determining the effectiveness of medial meniscus posterior root repair by transosseous pull-out sutures, relying on readily available tools. Patients and methods Thirty-four patients, aged between 18 and 49 years old of both sexes, with isolated post-traumatic meniscal root tear, operated between September 2013 and September 2015, were prospectively evaluated clinically in terms of Lysholm and Tegner scoring systems. Successful repair was measured by improvement of gap sign, ghost sign, and meniscal extrusion. Results The study group had 18 females and 16 males, mean age was 40.8±6.9 years, mean BMI was 30.5±4.9 kg/m2. The mean follow-up duration was 24.5 months. Lysholm and Tegner scores improved significantly (P=0.000). Complete healing occurred in 20 cases (P=0.000), and partial healing in 10 cases (P=0.000), failure occurred in four cases. Both absolute and relative meniscal extrusion decreased by −1.2±1.5 mm (P=0.01) and −0.12±0.15 (P=0.007), respectively. Conclusions Meniscal root repair by transosseous pull-out suture is a cost-effective and reproducible technique that yields good structural and functional results. This was objectively confirmed both functionally and radiologically in 88% of cases fixed by this technique.
目的本研究旨在确定经骨拔出缝合线修复内侧半月板后根的有效性，依赖于现成的工具。患者与方法采用Lysholm和Tegner评分系统对2013年9月至2015年9月手术的34例孤立性创伤后半月板根撕裂患者进行前瞻性临床评价，患者年龄18 ~ 49岁，男女均可。通过间隙征、鬼影征和半月板挤压的改善来衡量修复是否成功。结果研究组女性18例，男性16例，平均年龄40.8±6.9岁，平均BMI为30.5±4.9 kg/m2。平均随访时间为24.5个月。Lysholm和Tegner评分显著提高(P=0.000)。完全愈合20例(P=0.000)，部分愈合10例(P=0.000)，失败4例。绝对半月板挤压和相对半月板挤压分别减少- 1.2±1.5 mm (P=0.01)和- 0.12±0.15 mm (P=0.007)。结论经骨拔出缝合线修复半月板根是一种成本低、可重复性好的技术，具有良好的结构和功能效果。88%采用该技术固定的病例在功能和放射学上都客观证实了这一点。
{"title":"Cost-effective technique for medial meniscus posterior root tear repair","authors":"Z. Zakaria, Ahmed Ghazi","doi":"10.4103/eoj.eoj_99_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_99_21","url":null,"abstract":"Purpose This study aimed at determining the effectiveness of medial meniscus posterior root repair by transosseous pull-out sutures, relying on readily available tools. Patients and methods Thirty-four patients, aged between 18 and 49 years old of both sexes, with isolated post-traumatic meniscal root tear, operated between September 2013 and September 2015, were prospectively evaluated clinically in terms of Lysholm and Tegner scoring systems. Successful repair was measured by improvement of gap sign, ghost sign, and meniscal extrusion. Results The study group had 18 females and 16 males, mean age was 40.8±6.9 years, mean BMI was 30.5±4.9 kg/m2. The mean follow-up duration was 24.5 months. Lysholm and Tegner scores improved significantly (P=0.000). Complete healing occurred in 20 cases (P=0.000), and partial healing in 10 cases (P=0.000), failure occurred in four cases. Both absolute and relative meniscal extrusion decreased by −1.2±1.5 mm (P=0.01) and −0.12±0.15 (P=0.007), respectively. Conclusions Meniscal root repair by transosseous pull-out suture is a cost-effective and reproducible technique that yields good structural and functional results. This was objectively confirmed both functionally and radiologically in 88% of cases fixed by this technique.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122204437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Arthroscopic Bankart repair is a common procedure for treatment of recurrent traumatic anterior shoulder dislocation all over the world. Different studies compared the outcome of transglenoid sutures after different modifications with the outcome of suture anchors and they found no significant difference between the two procedures. Objective The aim of this study was to compare the long-term results of the modified transglenoid sutures through two holes and the use of suture anchors . Patients and methods Seventy patients were included in this study (42 for the transglenoid group and 28 for the second group). The mean follow-up period for the first (transglenoid) group was 7.19 years (range 5–11) and for the second (anchor) group 6.93 years (range 5–12). Results There is a significant difference in both groups between the preoperative and postoperative Rowe scores (P=0.000), while there is insignificance when comparing the two groups. Six patients (14.3%) in the transglenoid group suffered from recurrence of instability (two dislocations and four subluxations). Two of them needed second operation (open Laterjet procedure). In the anchor group, four (14.2%) patients suffered recurrence of symptoms of instability (two dislocations and two subluxations). Two of them required second operation. One patient of the first group suffered infection related to the sutures and the knot that required removal of the suture material. Conclusion Modified transglenoid suture technique is quietly equal to the repair with suture anchors for treatment of recurrent traumatic anterior shoulder instability.
{"title":"Arthroscopic Bankart repair: modified transglenoid sutures versus suture anchors more than 5 years: a retrospective study","authors":"Hossam Elbigawi, A. Ahmed","doi":"10.4103/eoj.eoj_93_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_93_21","url":null,"abstract":"Introduction Arthroscopic Bankart repair is a common procedure for treatment of recurrent traumatic anterior shoulder dislocation all over the world. Different studies compared the outcome of transglenoid sutures after different modifications with the outcome of suture anchors and they found no significant difference between the two procedures. Objective The aim of this study was to compare the long-term results of the modified transglenoid sutures through two holes and the use of suture anchors . Patients and methods Seventy patients were included in this study (42 for the transglenoid group and 28 for the second group). The mean follow-up period for the first (transglenoid) group was 7.19 years (range 5–11) and for the second (anchor) group 6.93 years (range 5–12). Results There is a significant difference in both groups between the preoperative and postoperative Rowe scores (P=0.000), while there is insignificance when comparing the two groups. Six patients (14.3%) in the transglenoid group suffered from recurrence of instability (two dislocations and four subluxations). Two of them needed second operation (open Laterjet procedure). In the anchor group, four (14.2%) patients suffered recurrence of symptoms of instability (two dislocations and two subluxations). Two of them required second operation. One patient of the first group suffered infection related to the sutures and the knot that required removal of the suture material. Conclusion Modified transglenoid suture technique is quietly equal to the repair with suture anchors for treatment of recurrent traumatic anterior shoulder instability.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126252244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/2665-9190.330536
Rashwan Amr
Introduction Acromioclavicular joint (ACJ) injuries can result from a multitude of causes. Most injuries occur during activities with high-impact risks such as contact sports, football, ice hockey, and wrestling, with male athletes at greater risk than female athletes. The stability of AC joint depends on the joint capsule, the acromioclavicular (AC) and coracoclavicular (CC) ligaments, and the intraarticular fibrocartilaginous disc. The choice of the required surgical technique for the management of AC disruption is a controversial issue owing to the abundance of the surgical options described for treatment. However, the clinical superiority of these procedures remains debatable, and various complications have been reported. Hypothesis This hypothesis is that the anatomical reconstruction of the CC ligaments may render better long-term functional and radiological results compared with the use of a hook plate in ACJ dislocations. Patients and methods This is a prospective nonrandomized comparative study that was held between August 2011 and January 2017 at Cairo University Hospitals. It included 64 patients with acute AC dislocation type III–VI and divided into two groups: group A, which underwent anatomic reconstruction of CC and AC ligaments, and group B, which underwent ACJ dislocation using the hook plate. The mean age of group A patients was 43.22±11.46 years, whereas it was 41.56±8.70 years in group B. There were 22 male and 10 female patients in group A compared with 21 male and 11 female patients in group B. The mean time from injury was 8.41±3.41 weeks in group A compared with 9.91±1.59 weeks in group B. The average follow-up was 64.06±4.24 months in group A versus 63.94±3.79 months in group B. The clinical outcome was assessed preoperatively and postoperatively at 1, 2, and 5 years using the visual analog scale, Constant score, and American shoulder and elbow surgeon score. Radiological assessment included the measurement of the CC distance (vertical displacement) and the anteroposterior (horizontal) displacement preoperatively and postoperatively at 1 year and at the final follow-up. Results Regarding the clinical outcome, the visual analog scale score improved from 7.06±1.22 preoperatively to 1.06±1.07 at 5-year follow-up in group A, whereas it improved from 7.5±0.92 preoperatively to 2.97±0.59 at 5-year follow-up in group B, with P=0.000. Similarly, the American shoulder and elbow surgeon score improved from 26.64±8.15 preoperatively to 92.06±5.37 postoperatively in group A, whereas in group B, it improved from 19.87±7.56 preoperatively to 77.1±5.40 postoperatively (P=0.000). The constant score in group A improved from 20.44±2.66 preoperatively to 92.91±3.64 postoperatively, and in group B, it improved from 20.13±2.29 preoperatively to 80.53±4.76 postoperatively (P=0.000). The radiological assessment at the final follow-up showed that the anteroposterior (horizontal) displacement in group A was 4.31±2.62 preoperatively and became 1.0
{"title":"Acromioclavicular hook plate versus anatomical reconstruction of coracoclavicular ligaments using hamstring autograft in acromioclavicular joint dislocation","authors":"Rashwan Amr","doi":"10.4103/2665-9190.330536","DOIUrl":"https://doi.org/10.4103/2665-9190.330536","url":null,"abstract":"Introduction Acromioclavicular joint (ACJ) injuries can result from a multitude of causes. Most injuries occur during activities with high-impact risks such as contact sports, football, ice hockey, and wrestling, with male athletes at greater risk than female athletes. The stability of AC joint depends on the joint capsule, the acromioclavicular (AC) and coracoclavicular (CC) ligaments, and the intraarticular fibrocartilaginous disc. The choice of the required surgical technique for the management of AC disruption is a controversial issue owing to the abundance of the surgical options described for treatment. However, the clinical superiority of these procedures remains debatable, and various complications have been reported. Hypothesis This hypothesis is that the anatomical reconstruction of the CC ligaments may render better long-term functional and radiological results compared with the use of a hook plate in ACJ dislocations. Patients and methods This is a prospective nonrandomized comparative study that was held between August 2011 and January 2017 at Cairo University Hospitals. It included 64 patients with acute AC dislocation type III–VI and divided into two groups: group A, which underwent anatomic reconstruction of CC and AC ligaments, and group B, which underwent ACJ dislocation using the hook plate. The mean age of group A patients was 43.22±11.46 years, whereas it was 41.56±8.70 years in group B. There were 22 male and 10 female patients in group A compared with 21 male and 11 female patients in group B. The mean time from injury was 8.41±3.41 weeks in group A compared with 9.91±1.59 weeks in group B. The average follow-up was 64.06±4.24 months in group A versus 63.94±3.79 months in group B. The clinical outcome was assessed preoperatively and postoperatively at 1, 2, and 5 years using the visual analog scale, Constant score, and American shoulder and elbow surgeon score. Radiological assessment included the measurement of the CC distance (vertical displacement) and the anteroposterior (horizontal) displacement preoperatively and postoperatively at 1 year and at the final follow-up. Results Regarding the clinical outcome, the visual analog scale score improved from 7.06±1.22 preoperatively to 1.06±1.07 at 5-year follow-up in group A, whereas it improved from 7.5±0.92 preoperatively to 2.97±0.59 at 5-year follow-up in group B, with P=0.000. Similarly, the American shoulder and elbow surgeon score improved from 26.64±8.15 preoperatively to 92.06±5.37 postoperatively in group A, whereas in group B, it improved from 19.87±7.56 preoperatively to 77.1±5.40 postoperatively (P=0.000). The constant score in group A improved from 20.44±2.66 preoperatively to 92.91±3.64 postoperatively, and in group B, it improved from 20.13±2.29 preoperatively to 80.53±4.76 postoperatively (P=0.000). The radiological assessment at the final follow-up showed that the anteroposterior (horizontal) displacement in group A was 4.31±2.62 preoperatively and became 1.0","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127967831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The introduction of sex-specific (SS) knee prosthesis designs was an approach to offer more sizing options and is based on the anatomic sex differences. These SS components were though to provide better fitting to female femora and consequently improve the clinical outcome. Materials and methods In the period between February 2011 and March 2013, a prospective superiority randomized controlled clinical trial was conducted to compare the clinical outcome of SS versus the standard posterior stabilized (PS) knee prosthesis in women. The primary outcome measure was the postoperative range of knee flexion, and the secondary outcome measure was the knee function as reflected on the performance of daily activities. The OXFORD Knee Score, Knee Society Score, and Knee Society Score for function were recorded preoperatively and then at 3, 12 months, and annually thereafter. Female patients with degenerative or inflammatory arthritis who were 50 years or older and their knee deformities were totally articular were included. A total of 64 patients with 80 knees were enrolled in this trial, and 40 knees were allocated to each group. Knees in the SS group had total knee arthroplasty using SS knee prosthesis, with SS femoral component (the experimental group), whereas knees in the PS group had standard PS knee design with standard femoral component (the control group). Equal randomization (1 : 1 ratio) was undertaken according to a computer-generated randomization table. Results The mean preoperative knee flexion range of motion (ROM) was 110 and 108° in the SS and PS groups, respectively. At the latest follow-up, the mean postoperative knee flexion ROM was 115 and 113° the SS and PS groups, respectively. The mean improvement in the knee flexion ROM in both groups was 5° (range: 0–25), with no statistically significant difference between the two groups. All knees except one had full extension. No statistically significant difference was observed between the two groups when the OXFORD Knee Score, the Knee Society Score, and the Knee Society Score for function were compared. Conclusion No clinical advantage was observed in the ROM or function between knees that received SS knee prosthesis when compared with those who received PS knee implants. The SS total knee arthroplasty though designed to provide better fitting to the female distal femur does not provide any clinical advantage over the standard PS knee prosthesis. A logic question is whether a separate implant is required for women or modifications to the knee prostheses geometry and more sizes are required to accommodate all patients? Level of evidence Level II.
{"title":"Sex-specific versus standard posterior cruciate-substituting total knee prosthesis","authors":"A. Ebied, Hany Elsayed, O. Gamal","doi":"10.4103/eoj.eoj_67_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_67_21","url":null,"abstract":"Background The introduction of sex-specific (SS) knee prosthesis designs was an approach to offer more sizing options and is based on the anatomic sex differences. These SS components were though to provide better fitting to female femora and consequently improve the clinical outcome. Materials and methods In the period between February 2011 and March 2013, a prospective superiority randomized controlled clinical trial was conducted to compare the clinical outcome of SS versus the standard posterior stabilized (PS) knee prosthesis in women. The primary outcome measure was the postoperative range of knee flexion, and the secondary outcome measure was the knee function as reflected on the performance of daily activities. The OXFORD Knee Score, Knee Society Score, and Knee Society Score for function were recorded preoperatively and then at 3, 12 months, and annually thereafter. Female patients with degenerative or inflammatory arthritis who were 50 years or older and their knee deformities were totally articular were included. A total of 64 patients with 80 knees were enrolled in this trial, and 40 knees were allocated to each group. Knees in the SS group had total knee arthroplasty using SS knee prosthesis, with SS femoral component (the experimental group), whereas knees in the PS group had standard PS knee design with standard femoral component (the control group). Equal randomization (1 : 1 ratio) was undertaken according to a computer-generated randomization table. Results The mean preoperative knee flexion range of motion (ROM) was 110 and 108° in the SS and PS groups, respectively. At the latest follow-up, the mean postoperative knee flexion ROM was 115 and 113° the SS and PS groups, respectively. The mean improvement in the knee flexion ROM in both groups was 5° (range: 0–25), with no statistically significant difference between the two groups. All knees except one had full extension. No statistically significant difference was observed between the two groups when the OXFORD Knee Score, the Knee Society Score, and the Knee Society Score for function were compared. Conclusion No clinical advantage was observed in the ROM or function between knees that received SS knee prosthesis when compared with those who received PS knee implants. The SS total knee arthroplasty though designed to provide better fitting to the female distal femur does not provide any clinical advantage over the standard PS knee prosthesis. A logic question is whether a separate implant is required for women or modifications to the knee prostheses geometry and more sizes are required to accommodate all patients? Level of evidence Level II.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117129159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose The aim was to evaluate the incidence of infection and functional outcome of these injuries. Patients and methods A total of 14 patients with open-talar fracture dislocations or total dislocations of the talus were managed and the functional results evaluated between November 2012 and December 2016. Eleven of these patients were males and three were females. The injuries were sustained between the 20- and 50-year age group . The right side was affected in 10 and the left side was injured in four patients. Road traffic accident was the cause in nine patients and fall from the height was the cause in five patients. The principles of management were debridement and minimal fixation of fractures. Results The mean follow-up period was 33 months (range: 16–50 months). Two of 14 cases (14.2%) developed infection. One patient had resolved clinically with antibiotics alone. One patient had persistent drainage 4 months after injury and required late ankle and subtalar arthrodesis. The functional outcome according to Boston Children’s Hospital ankle grading system was excellent in six (42.85%), good in five (35.71%), fair in two (14.28%), and failure in one (7.14%). There was no evidence of osteonecrosis or collapse of the talar dome. Conclusion In conclusion, patients with major open-fracture dislocation of the talus have a significant incidence of the best results with modern orthopedic techniques that dramatically decreased the rates of infection, avascular necrosis (AVN), and poor functional results although continued work is required to improve patient care and outcomes. Open-talar fractures should be managed as emergently including administration of broad-spectrum antibiotics, irrigation of the wound, operative debridement, reduction, and minimal fixation.
{"title":"Open-fracture dislocation of the talus","authors":"E. Abed","doi":"10.4103/eoj.eoj_84_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_84_21","url":null,"abstract":"Purpose The aim was to evaluate the incidence of infection and functional outcome of these injuries. Patients and methods A total of 14 patients with open-talar fracture dislocations or total dislocations of the talus were managed and the functional results evaluated between November 2012 and December 2016. Eleven of these patients were males and three were females. The injuries were sustained between the 20- and 50-year age group . The right side was affected in 10 and the left side was injured in four patients. Road traffic accident was the cause in nine patients and fall from the height was the cause in five patients. The principles of management were debridement and minimal fixation of fractures. Results The mean follow-up period was 33 months (range: 16–50 months). Two of 14 cases (14.2%) developed infection. One patient had resolved clinically with antibiotics alone. One patient had persistent drainage 4 months after injury and required late ankle and subtalar arthrodesis. The functional outcome according to Boston Children’s Hospital ankle grading system was excellent in six (42.85%), good in five (35.71%), fair in two (14.28%), and failure in one (7.14%). There was no evidence of osteonecrosis or collapse of the talar dome. Conclusion In conclusion, patients with major open-fracture dislocation of the talus have a significant incidence of the best results with modern orthopedic techniques that dramatically decreased the rates of infection, avascular necrosis (AVN), and poor functional results although continued work is required to improve patient care and outcomes. Open-talar fractures should be managed as emergently including administration of broad-spectrum antibiotics, irrigation of the wound, operative debridement, reduction, and minimal fixation.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"181 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132224852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The main goal in the treatment of femoral neck fractures in the elderly is to enable early mobilization. Hemiarthroplasty is considered the gold standard line of treatment. In the past decade, total hip replacement (THR) was introduced to the orthopedic community with the advantage of better pain relief and functional outcome. However, the reported dislocation rates after THR in femoral neck fractures remained higher than the rates after hemiarthroplasty. Nowadays, there is renewed interest in dual mobility cups to solve the problems of hip instabilities for various reasons. Dual mobility cups aim to decrease the dislocation rate by associating two articular surfaces: one with a larger diameter situated between a metallic cup and a polyethylene insert, thus utilizing the concept of a large head size to reduce dislocation, and the other one with a smaller diameter situated between the femoral head and the retentive polyethylene insert to achieve more mobility. The authors believe that the results of the dual mobility concept after femoral neck fractures are under-reported, with few papers discussing the outcome specifically in the Egyptian population. Aim This study was carried out to assess the dislocation rate and clinical results for cemented THR with a dual mobility cup as the treatment of femoral neck fractures in elderly patients, after a minimum period of 1 year. Settings and design A prospective case series study was carried out at El Hadara University Hospital, Alexandria University. Patients and methods This study included 31 patients (32 hips) with displaced femoral neck fractures who were admitted to El Hadara University Hospital, Alexandria, Egypt. Their mean age was 66.6±6.3 years. There were 15 females and 16 males. All the patients were treated using a cemented dual mobility cup for THR using the standard posterior approach. Functional assessment was performed using the Harris hip score (HHS) with the assistance of physiotherapists to avoid bias. Results No dislocations were encountered in this series over 1 year of follow-up. The mean operative time was 136.9 min. The average blood loss was 756.3 ml. The mean HHS improved over the follow-up period from 80.3±7.9 (95% confidence interval: 74–86) at 12 weeks to an average of 92.6±11.1 (95% confidence interval: 88.7–96.5) at the 1-year follow-up. This increase in HHS was not statistically significant (P=0.143). Conclusions Dual mobility cup THR is a good method for the treatment of displaced femoral neck fractures in the elderly as it provides good stability, pain relief, and good function.
{"title":"Dual mobility cup as a treatment of displaced femoral neck fractures in elderly: stability and function","authors":"Tarek A. Elkhadrawe","doi":"10.4103/eoj.eoj_72_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_72_21","url":null,"abstract":"Background The main goal in the treatment of femoral neck fractures in the elderly is to enable early mobilization. Hemiarthroplasty is considered the gold standard line of treatment. In the past decade, total hip replacement (THR) was introduced to the orthopedic community with the advantage of better pain relief and functional outcome. However, the reported dislocation rates after THR in femoral neck fractures remained higher than the rates after hemiarthroplasty. Nowadays, there is renewed interest in dual mobility cups to solve the problems of hip instabilities for various reasons. Dual mobility cups aim to decrease the dislocation rate by associating two articular surfaces: one with a larger diameter situated between a metallic cup and a polyethylene insert, thus utilizing the concept of a large head size to reduce dislocation, and the other one with a smaller diameter situated between the femoral head and the retentive polyethylene insert to achieve more mobility. The authors believe that the results of the dual mobility concept after femoral neck fractures are under-reported, with few papers discussing the outcome specifically in the Egyptian population. Aim This study was carried out to assess the dislocation rate and clinical results for cemented THR with a dual mobility cup as the treatment of femoral neck fractures in elderly patients, after a minimum period of 1 year. Settings and design A prospective case series study was carried out at El Hadara University Hospital, Alexandria University. Patients and methods This study included 31 patients (32 hips) with displaced femoral neck fractures who were admitted to El Hadara University Hospital, Alexandria, Egypt. Their mean age was 66.6±6.3 years. There were 15 females and 16 males. All the patients were treated using a cemented dual mobility cup for THR using the standard posterior approach. Functional assessment was performed using the Harris hip score (HHS) with the assistance of physiotherapists to avoid bias. Results No dislocations were encountered in this series over 1 year of follow-up. The mean operative time was 136.9 min. The average blood loss was 756.3 ml. The mean HHS improved over the follow-up period from 80.3±7.9 (95% confidence interval: 74–86) at 12 weeks to an average of 92.6±11.1 (95% confidence interval: 88.7–96.5) at the 1-year follow-up. This increase in HHS was not statistically significant (P=0.143). Conclusions Dual mobility cup THR is a good method for the treatment of displaced femoral neck fractures in the elderly as it provides good stability, pain relief, and good function.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128957657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Open ankle arthrodesis has been the standard operative treatment for any case of advanced osteoarthritis ankle, but the arthroscopic technique is gained popularity. Patients methods This study was conducted retrospectively reviewing surgeries undertaken between January 2010 and June 2012 for ankles with osteoarthritis. The authors performed 42 ankle arthrodesis procedures on 42 patients. A total of 20 patients were included in group A (arthroscopic ankle fusion), and the other 22 patients were in group B (open anterior ankle fusion). Patients of each group were assessed using preoperative Ankle Osteoarthritis Scale (AOS) score; both the pain and disability components were used to calculate the total score. Results In group A, all the cases were united, with the average time for union being 12.8±1.19 weeks. Of 20 ankles, 65% showed signs of clinical and radiological union by 12 weeks. The early results showed major decrease in AOS from 116±8.6 preoperatively to 19.4±2.3 postoperatively. This shows that the arthroscopic fusion was able to decrease the score by an average of 97.7±10.2 points. Long-term follow-up was 71.8±8.6 months and showed that the early postoperative results did not change significantly: 55% of patients still had excellent outcome, and four patients (20%) develop subtalar osteoarthritis. In group B, 21 cases (>95%) were united, with an average time to union of 13.3±5.6 weeks. The early results showed major decrease in AOS from 114±7.24 preoperatively to 26.68±6.95 postoperatively. This shows that the open anterior fusion was able to decrease the score by an average of 88.2±7.2 points. Long-term follow up was 83.5±12 months and showed that the early postoperative results changed significantly, where nine patients (40.9%) still had excellent outcome, and nine patients (40.9%) developed subtalar osteoarthritis and four of them needed further subtalar fusion. Conclusion This was a comparative study that involved two groups with two techniques of ankle fusion, showing early and late results. There was no significant difference between both the groups regarding early results, but long-term follow-up clarifies the advantages of arthroscopic fusion technique.
{"title":"Arthroscopic versus open ankle fusion: early and late results","authors":"Khaled S. Salama, Mohamed I Rakha","doi":"10.4103/eoj.eoj_78_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_78_21","url":null,"abstract":"Background Open ankle arthrodesis has been the standard operative treatment for any case of advanced osteoarthritis ankle, but the arthroscopic technique is gained popularity. Patients methods This study was conducted retrospectively reviewing surgeries undertaken between January 2010 and June 2012 for ankles with osteoarthritis. The authors performed 42 ankle arthrodesis procedures on 42 patients. A total of 20 patients were included in group A (arthroscopic ankle fusion), and the other 22 patients were in group B (open anterior ankle fusion). Patients of each group were assessed using preoperative Ankle Osteoarthritis Scale (AOS) score; both the pain and disability components were used to calculate the total score. Results In group A, all the cases were united, with the average time for union being 12.8±1.19 weeks. Of 20 ankles, 65% showed signs of clinical and radiological union by 12 weeks. The early results showed major decrease in AOS from 116±8.6 preoperatively to 19.4±2.3 postoperatively. This shows that the arthroscopic fusion was able to decrease the score by an average of 97.7±10.2 points. Long-term follow-up was 71.8±8.6 months and showed that the early postoperative results did not change significantly: 55% of patients still had excellent outcome, and four patients (20%) develop subtalar osteoarthritis. In group B, 21 cases (>95%) were united, with an average time to union of 13.3±5.6 weeks. The early results showed major decrease in AOS from 114±7.24 preoperatively to 26.68±6.95 postoperatively. This shows that the open anterior fusion was able to decrease the score by an average of 88.2±7.2 points. Long-term follow up was 83.5±12 months and showed that the early postoperative results changed significantly, where nine patients (40.9%) still had excellent outcome, and nine patients (40.9%) developed subtalar osteoarthritis and four of them needed further subtalar fusion. Conclusion This was a comparative study that involved two groups with two techniques of ankle fusion, showing early and late results. There was no significant difference between both the groups regarding early results, but long-term follow-up clarifies the advantages of arthroscopic fusion technique.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123146476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The aim of Letournel classification was to identify accurately the pathological anatomy of the fractured acetabulum. For orthopedic residents, this classification system is somewhat cumbersome. An important objective is to facilitate the understanding of this classification system among the junior residents. The aim of this study was to compare two educational tools, namely the systematic analysis of the plain films and the 3D computed tomography (CT) scans in improving the diagnostic performance of orthopedic residents. Patients and methods Twenty x-rays set for acetabular fractures, including A/P, iliac, and obturator view, were selected from our hospital database. These sets were prepared in a quiz form. Thirty residents were asked to diagnose the given fracture using x-rays only. Then, the residents were randomly allocated to two groups. Group I was asked to repeat the same quiz with the addition of 3D CT-reformatted images (A/P and obliques). Group II was asked to analyze the same x-rays using an algorithm. Data collected included the training period of the resident, the answers in pre- and post-tests together with the subjective assessment of how difficult each diagnosis was. Results While the two groups showed a significant and similar improvement in reaching the right diagnosis, using the algorithm was significantly easier. Conclusion Compared with the advanced imaging technology, plain x-ray film if analyzed systemically is an easier way to understand Letournel classification when educating junior orthopedic residents.
{"title":"Teaching Letournel classification: systematic analysis of x-rays using algorithm versus 3D computed tomography scan","authors":"Hammad As, Abu-Sheasha","doi":"10.4103/eoj.eoj_88_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_88_21","url":null,"abstract":"Background The aim of Letournel classification was to identify accurately the pathological anatomy of the fractured acetabulum. For orthopedic residents, this classification system is somewhat cumbersome. An important objective is to facilitate the understanding of this classification system among the junior residents. The aim of this study was to compare two educational tools, namely the systematic analysis of the plain films and the 3D computed tomography (CT) scans in improving the diagnostic performance of orthopedic residents. Patients and methods Twenty x-rays set for acetabular fractures, including A/P, iliac, and obturator view, were selected from our hospital database. These sets were prepared in a quiz form. Thirty residents were asked to diagnose the given fracture using x-rays only. Then, the residents were randomly allocated to two groups. Group I was asked to repeat the same quiz with the addition of 3D CT-reformatted images (A/P and obliques). Group II was asked to analyze the same x-rays using an algorithm. Data collected included the training period of the resident, the answers in pre- and post-tests together with the subjective assessment of how difficult each diagnosis was. Results While the two groups showed a significant and similar improvement in reaching the right diagnosis, using the algorithm was significantly easier. Conclusion Compared with the advanced imaging technology, plain x-ray film if analyzed systemically is an easier way to understand Letournel classification when educating junior orthopedic residents.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125343925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Lumbosacral instability is one of the causes of failed back surgery syndrome, and it is characterized by loss of disc height with translational and in many cases rotational instability in the sagittal plane. Transforaminal lumbar interbody fusion (TLIF) is a modification of posterior lumbar interbody fusion that requires less retraction of the thecal sac and neural element. TLIF corrects most of the pathologies in patients with iatrogenic lumbar instability as it provides rigid stabilization of the spine with high incidence of fusion, decompression of central and lateral recess with facet and disc resection, restoration of disc and foraminal heights together with sagittal plane deformity correction. Aim This study was carried out to evaluate the efficacy of TLIF in the treatment of patient with iatrogenic lumbar instability. Patients and methods A total of 16 cases were diagnosed as iatrogenic lumbar instability according to the radiological method proposed by Dupuis and colleagues. Sex distribution was nine females and seven males. Plain radiograph (static and dynamic) and MRI with gadolinium enhancement were done for all patients. Single-level transforaminal lumbar interbody fusion (TILF) was performed in 11 cases and double-level TLIF was performed in five cases. Clinical evaluation was made using Oswestry disability index. Patients were examined for occurrence of solid interbody fusion at 9- and 12-month follow-up visits. Result A total of 14 patients showed obvious clinical improvement with reduction of their Oswestry disability index from 76.75% preoperatively to 36.9% at 6 month and 22.7% after 1 year. Overall, two cases had shown no clinical improvement: one had deep wound infection and the other had pseudoarthrosis. Solid fusion occurred in 14 (87.5%) cases. One case with pseudoarthrosis was the patient who had developed deep wound infection; the other case was a patient undergoing double-level TILF with pseudoarthrosis at L5–S1. Conclusion TLIF is a safe and effective technique in the treatment of patients with postlaminectomy lumbar instability with minimal complication rate.
{"title":"Transforaminal lumbar interbody fusion in iatrogenic lumbar instability","authors":"W. Nafea, Mohsen Fawzy, A. Elnagar","doi":"10.4103/eoj.eoj_31_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_31_21","url":null,"abstract":"Background Lumbosacral instability is one of the causes of failed back surgery syndrome, and it is characterized by loss of disc height with translational and in many cases rotational instability in the sagittal plane. Transforaminal lumbar interbody fusion (TLIF) is a modification of posterior lumbar interbody fusion that requires less retraction of the thecal sac and neural element. TLIF corrects most of the pathologies in patients with iatrogenic lumbar instability as it provides rigid stabilization of the spine with high incidence of fusion, decompression of central and lateral recess with facet and disc resection, restoration of disc and foraminal heights together with sagittal plane deformity correction. Aim This study was carried out to evaluate the efficacy of TLIF in the treatment of patient with iatrogenic lumbar instability. Patients and methods A total of 16 cases were diagnosed as iatrogenic lumbar instability according to the radiological method proposed by Dupuis and colleagues. Sex distribution was nine females and seven males. Plain radiograph (static and dynamic) and MRI with gadolinium enhancement were done for all patients. Single-level transforaminal lumbar interbody fusion (TILF) was performed in 11 cases and double-level TLIF was performed in five cases. Clinical evaluation was made using Oswestry disability index. Patients were examined for occurrence of solid interbody fusion at 9- and 12-month follow-up visits. Result A total of 14 patients showed obvious clinical improvement with reduction of their Oswestry disability index from 76.75% preoperatively to 36.9% at 6 month and 22.7% after 1 year. Overall, two cases had shown no clinical improvement: one had deep wound infection and the other had pseudoarthrosis. Solid fusion occurred in 14 (87.5%) cases. One case with pseudoarthrosis was the patient who had developed deep wound infection; the other case was a patient undergoing double-level TILF with pseudoarthrosis at L5–S1. Conclusion TLIF is a safe and effective technique in the treatment of patients with postlaminectomy lumbar instability with minimal complication rate.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127427947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Isthmic spondylolisthesis means slippage of one vertebra relative to the next caudal vertebra as a result of an abnormality in the pars interarticularis. Isthmic spondylolisthesis has three subtypes: subtype A in which there is stress fracture of the pars (spondylolysis), subtype B in which the pars is elongated, and subtype C in which there is acute fracture of the pars. Isthmic spondylolisthesis is the most common cause of low back pain in adolescents. Spinal fusion is the mainstay of the surgical treatment of low-grade isthmic spondylolisthesis. Spinal fusion can be achieved by posterolateral fusion (PLF) or circumferential fusion. The three basic techniques for circumferential fusion include anterior lumbar interbody fusion, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion (TLIF). Patients and methods Fifty patients with low-grade isthmic spondylolisthesis managed with spinal fusion at the Zagazig University Hospital. Patients were divided into two groups: group I included patients managed by TLIF and group II included patients managed by PLF. The mean age of patients was 34.6 years (range: 26–43 years) in group I and 36.8 years (range: 28–46) in group II. Sex distribution was nine males and 16 females in group I and seven males and 18 females in group II. Exclusion criteria included patients with high-grade spondylolisthesis, traumatic spondylolisthesis, degenerative spondylolisthesis, neoplastic spondylolisthesis, patients with acute or chronic infection, and congenital malformation. Results No patients were dropped in the follow-up. In both groups, the mean visual analog scale (VAS) for back pain and leg pain and the Oswestry disability index (ODI) showed statistically significant difference between the values obtained preoperatively and the values obtained at the 1-year follow-up visit. In comparison between both groups for the change in the VAS for back and leg pain and ODI score, group I gave a significant difference regarding the change in the VAS for back pain compared to group II. However, the change in the VAS for leg pain and ODI was not statistically significant. Conclusion Both TLIF and PLF are effective options for the treatment of low-grade isthmic spondylolisthesis in adults. However, TLIF gives better clinical outcome, so it is considered a better option.
{"title":"Transforaminal lumbar interbody fusion versus posterolateral fusion for the treatment of low-grade isthmic spondylolisthesis in adults","authors":"A. El Naggar, S. Elgawhary, M. Khalid","doi":"10.4103/eoj.eoj_85_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_85_21","url":null,"abstract":"Background Isthmic spondylolisthesis means slippage of one vertebra relative to the next caudal vertebra as a result of an abnormality in the pars interarticularis. Isthmic spondylolisthesis has three subtypes: subtype A in which there is stress fracture of the pars (spondylolysis), subtype B in which the pars is elongated, and subtype C in which there is acute fracture of the pars. Isthmic spondylolisthesis is the most common cause of low back pain in adolescents. Spinal fusion is the mainstay of the surgical treatment of low-grade isthmic spondylolisthesis. Spinal fusion can be achieved by posterolateral fusion (PLF) or circumferential fusion. The three basic techniques for circumferential fusion include anterior lumbar interbody fusion, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion (TLIF). Patients and methods Fifty patients with low-grade isthmic spondylolisthesis managed with spinal fusion at the Zagazig University Hospital. Patients were divided into two groups: group I included patients managed by TLIF and group II included patients managed by PLF. The mean age of patients was 34.6 years (range: 26–43 years) in group I and 36.8 years (range: 28–46) in group II. Sex distribution was nine males and 16 females in group I and seven males and 18 females in group II. Exclusion criteria included patients with high-grade spondylolisthesis, traumatic spondylolisthesis, degenerative spondylolisthesis, neoplastic spondylolisthesis, patients with acute or chronic infection, and congenital malformation. Results No patients were dropped in the follow-up. In both groups, the mean visual analog scale (VAS) for back pain and leg pain and the Oswestry disability index (ODI) showed statistically significant difference between the values obtained preoperatively and the values obtained at the 1-year follow-up visit. In comparison between both groups for the change in the VAS for back and leg pain and ODI score, group I gave a significant difference regarding the change in the VAS for back pain compared to group II. However, the change in the VAS for leg pain and ODI was not statistically significant. Conclusion Both TLIF and PLF are effective options for the treatment of low-grade isthmic spondylolisthesis in adults. However, TLIF gives better clinical outcome, so it is considered a better option.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"1989 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131110355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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