Ankle fractures are one of the most common fractures affecting both the young and old. they are the third most common fracture in elderly patients. The appropriate method of fixation of those fractures is debatable especially for osteoporotic patients, osteoprosis renders commonly used internal fixation methods technically demanding and prone to failure. To compare distal fibula locked plate to nonlocked plate for treatment of Danis Weber type B fracture regarding union rate, union time, operation time, failure rate, and other complications. This study was conducted on 100 patients classified as a Weber B traumatic fracture. Fifty patients were undergoing open reduction internal fixation (ORIF) using locking plates (group A) and patients underwent ORIF using nonlocking plates (group B). The following parameters were assessed in both groups range of motion, union rate, union time, complications, operation time, American orthopedic foot and ankle society and failure rate. There was no statistically significant difference between both groups in operation time and blood loss. Length of hospital stays (days) and Time to full weight bearing, union time was lower in group A than group B. American orthopedic foot and ankle society was higher in group A than in group B. There was no statistically significant difference in range of motion (extension, flexion) between both groups. The rate of loosening of the distal screw and implant removal was higher in group B than in group A. No statistically significant difference was found between both groups regarding functional, radiological outcomes, and complications in patients less than or equal to 60 years old. Therefore, one-third plate is preferred in a young age in terms of cost-effectiveness. In patients over 60 years old, using the locking plates yields better stability, and functional and radiological outcome than non-locking plates.
踝关节骨折是影响年轻人和老年人的最常见骨折之一，在老年患者中占第三位。这些骨折的适当固定方法尚有争议，尤其是对于骨质疏松的患者，骨质增生使常用的内固定方法技术要求高且容易失败。 目的：比较腓骨远端锁定钢板和非锁定钢板治疗 Danis Weber B 型骨折的结合率、结合时间、手术时间、失败率和其他并发症。 这项研究针对 100 名被归类为韦伯 B 型创伤性骨折的患者进行。其中 50 名患者使用锁定钢板进行开放复位内固定术（ORIF）（A 组），另一名患者使用非锁定钢板进行开放复位内固定术（ORIF）（B 组）。对两组患者的活动范围、结合率、结合时间、并发症、手术时间、美国骨科足踝协会和失败率进行了评估。 两组在手术时间和失血量方面没有统计学差异。A 组的住院时间（天数）和完全负重时间、结合时间均低于 B 组；A 组的美国足踝矫形学会评分高于 B 组。在小于或等于 60 岁的患者中，两组在功能、放射学结果和并发症方面的差异无统计学意义。因此，就成本效益而言，三分之一钢板在年轻患者中更受欢迎。对于 60 岁以上的患者，使用锁定钢板比非锁定钢板具有更好的稳定性、功能和放射学效果。
{"title":"Distal fibula locked plate versus nonlocked plate for treatment of Danis Weber type B fracture comparative prospective study","authors":"Tameem M Elkateb, Islam Koriem, Abraam N Mourice","doi":"10.4103/eoj.eoj_143_23","DOIUrl":"https://doi.org/10.4103/eoj.eoj_143_23","url":null,"abstract":"\u0000 \u0000 \u0000 Ankle fractures are one of the most common fractures affecting both the young and old. they are the third most common fracture in elderly patients. The appropriate method of fixation of those fractures is debatable especially for osteoporotic patients, osteoprosis renders commonly used internal fixation methods technically demanding and prone to failure.\u0000 \u0000 \u0000 \u0000 To compare distal fibula locked plate to nonlocked plate for treatment of Danis Weber type B fracture regarding union rate, union time, operation time, failure rate, and other complications.\u0000 \u0000 \u0000 \u0000 This study was conducted on 100 patients classified as a Weber B traumatic fracture. Fifty patients were undergoing open reduction internal fixation (ORIF) using locking plates (group A) and patients underwent ORIF using nonlocking plates (group B). The following parameters were assessed in both groups range of motion, union rate, union time, complications, operation time, American orthopedic foot and ankle society and failure rate.\u0000 \u0000 \u0000 \u0000 There was no statistically significant difference between both groups in operation time and blood loss. Length of hospital stays (days) and Time to full weight bearing, union time was lower in group A than group B. American orthopedic foot and ankle society was higher in group A than in group B. There was no statistically significant difference in range of motion (extension, flexion) between both groups. The rate of loosening of the distal screw and implant removal was higher in group B than in group A.\u0000 \u0000 \u0000 \u0000 No statistically significant difference was found between both groups regarding functional, radiological outcomes, and complications in patients less than or equal to 60 years old. Therefore, one-third plate is preferred in a young age in terms of cost-effectiveness. In patients over 60 years old, using the locking plates yields better stability, and functional and radiological outcome than non-locking plates.\u0000","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"39 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139782566","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}
Mohamed Abdelaziz, Ehab Y Hassanin, Ahmed A Ibrahim
Odontoid fractures are common cervical spine fractures, lead to atlantoaxial instability, and constitute 10–20% of all cervical fractures. Almost two-thirds of all dens fractures are classified as type II according to the Anderson and D’ Alonzo classification system. An increased rate of nonunion of type II odontoid fractures with conservative measures has been reported. The technique of direct anterior screw fixation of the odontoid fracture has become increasingly popular since Bohler reported its use in 1982, and it is now widely used to treat type II. To evaluate the safety and efficacy of the anterior transodontoid screw fixation in odontoid fractures. Ten patients underwent anterior transodontoid single screw fixation for type II odontoid fractures according to the Anderson and D’ Alonzo classification system. All patients were operated on less than 3 months following trauma. All patients were males apart from one female with their ages ranging from 20 to 59 years with a mean age of 33.9 years. Patients were evaluated clinically and neurologically according to the American Spinal Injury Association scale, and radiologically using plain radiograph, computed tomography scan, and MRI. Good clinical and radiological (bony or fibrous) outcomes were achieved in all patients with no screw loosening, backing out, or proximal migration. There were no complications related to surgical procedure or neurological deterioration. Direct single anterior screw fixation has proved to be a very successful treatment method for type II odontoid fractures.
椎弓根骨折是常见的颈椎骨折，会导致寰枢椎不稳定，占所有颈椎骨折的 10-20%。根据 Anderson 和 D' Alonzo 的分类系统，近三分之二的椎弓根骨折属于 II 型。有报道称，采取保守措施后，II型蝶骨骨折的不愈合率有所增加。自1982年Bohler报告使用直接前方螺钉固定蝶骨骨折以来，该技术越来越受欢迎，目前已广泛用于治疗II型蝶骨骨折。 目的：评估经蝶骨前方螺钉固定治疗蝶骨骨折的安全性和有效性。 根据 Anderson 和 D' Alonzo 的分类系统，10 名患者接受了前方经蝶骨单螺钉固定术治疗 II 型蝶骨骨折。所有患者均在创伤后不到3个月接受手术。除一名女性外，所有患者均为男性，年龄在20至59岁之间，平均年龄为33.9岁。根据美国脊柱损伤协会量表对患者进行了临床和神经学评估，并使用普通X光片、计算机断层扫描和核磁共振成像对患者进行了放射学评估。 所有患者均获得了良好的临床和放射学（骨性或纤维性）结果，没有出现螺钉松动、后退或近端移位。手术过程中未出现并发症或神经功能恶化。 事实证明，直接单前路螺钉固定是治疗II型蝶骨骨折的一种非常成功的方法。
{"title":"Anterior odontoid lag screw fixation in type II odontoid fractures","authors":"Mohamed Abdelaziz, Ehab Y Hassanin, Ahmed A Ibrahim","doi":"10.4103/eoj.eoj_124_23","DOIUrl":"https://doi.org/10.4103/eoj.eoj_124_23","url":null,"abstract":"\u0000 \u0000 \u0000 Odontoid fractures are common cervical spine fractures, lead to atlantoaxial instability, and constitute 10–20% of all cervical fractures. Almost two-thirds of all dens fractures are classified as type II according to the Anderson and D’ Alonzo classification system. An increased rate of nonunion of type II odontoid fractures with conservative measures has been reported. The technique of direct anterior screw fixation of the odontoid fracture has become increasingly popular since Bohler reported its use in 1982, and it is now widely used to treat type II.\u0000 \u0000 \u0000 \u0000 To evaluate the safety and efficacy of the anterior transodontoid screw fixation in odontoid fractures.\u0000 \u0000 \u0000 \u0000 Ten patients underwent anterior transodontoid single screw fixation for type II odontoid fractures according to the Anderson and D’ Alonzo classification system. All patients were operated on less than 3 months following trauma. All patients were males apart from one female with their ages ranging from 20 to 59 years with a mean age of 33.9 years. Patients were evaluated clinically and neurologically according to the American Spinal Injury Association scale, and radiologically using plain radiograph, computed tomography scan, and MRI.\u0000 \u0000 \u0000 \u0000 Good clinical and radiological (bony or fibrous) outcomes were achieved in all patients with no screw loosening, backing out, or proximal migration. There were no complications related to surgical procedure or neurological deterioration.\u0000 \u0000 \u0000 \u0000 Direct single anterior screw fixation has proved to be a very successful treatment method for type II odontoid fractures.\u0000","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"70 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139783781","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}
Avulsion fractures of the tibial eminence during childhood are infrequent yet significant knee injuries. Given that the injury is equivalent to a rupture of the anterior cruciate ligament. The treatment strategy necessitates anatomic reduction to reestablish joint stability and reduce the risk of anterior impingement and flexion deformity. The aim of the study was to evaluate short-term results of arthroscopyassisted suture anchor fixation of tibial eminence avulsion in children. This study included 11 injured children with type III avulsion tibial eminence. The average age was 8.55 years. The study included nine boys and two girls. The mechanism of trauma was bicycle accident in seven children, twisting injury in two children, falling downstairs in one child, and jumping from a height in one case. All patients were able to return to their everyday activities within 6 months following the injury. The range of motion at the end of follow up was full in 10 (90.9%) patients and functional range in one (9.1%) patient. The knee stability was excellent by clinical examination. The successful application of this approach in preserving knee function following type III avulsion tibial eminence in pediatric patients has been demonstrated.
{"title":"Suture anchor fixation of displaced tibial eminence avulsion fracture in children","authors":"Elsayed Elforse, Ayman El-Tabbaa","doi":"10.4103/eoj.eoj_140_23","DOIUrl":"https://doi.org/10.4103/eoj.eoj_140_23","url":null,"abstract":"\u0000 \u0000 \u0000 Avulsion fractures of the tibial eminence during childhood are infrequent yet significant knee injuries. Given that the injury is equivalent to a rupture of the anterior cruciate ligament. The treatment strategy necessitates anatomic reduction to reestablish joint stability and reduce the risk of anterior impingement and flexion deformity. The aim of the study was to evaluate short-term results of arthroscopyassisted suture anchor fixation of tibial eminence avulsion in children.\u0000 \u0000 \u0000 \u0000 This study included 11 injured children with type III avulsion tibial eminence. The average age was 8.55 years. The study included nine boys and two girls. The mechanism of trauma was bicycle accident in seven children, twisting injury in two children, falling downstairs in one child, and jumping from a height in one case.\u0000 \u0000 \u0000 \u0000 All patients were able to return to their everyday activities within 6 months following the injury. The range of motion at the end of follow up was full in 10 (90.9%) patients and functional range in one (9.1%) patient. The knee stability was excellent by clinical examination.\u0000 \u0000 \u0000 \u0000 The successful application of this approach in preserving knee function following type III avulsion tibial eminence in pediatric patients has been demonstrated.\u0000","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"59 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139844530","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}
Mohamed Abdelaziz, Ehab Y Hassanin, Ahmed A Ibrahim
Odontoid fractures are common cervical spine fractures, lead to atlantoaxial instability, and constitute 10–20% of all cervical fractures. Almost two-thirds of all dens fractures are classified as type II according to the Anderson and D’ Alonzo classification system. An increased rate of nonunion of type II odontoid fractures with conservative measures has been reported. The technique of direct anterior screw fixation of the odontoid fracture has become increasingly popular since Bohler reported its use in 1982, and it is now widely used to treat type II. To evaluate the safety and efficacy of the anterior transodontoid screw fixation in odontoid fractures. Ten patients underwent anterior transodontoid single screw fixation for type II odontoid fractures according to the Anderson and D’ Alonzo classification system. All patients were operated on less than 3 months following trauma. All patients were males apart from one female with their ages ranging from 20 to 59 years with a mean age of 33.9 years. Patients were evaluated clinically and neurologically according to the American Spinal Injury Association scale, and radiologically using plain radiograph, computed tomography scan, and MRI. Good clinical and radiological (bony or fibrous) outcomes were achieved in all patients with no screw loosening, backing out, or proximal migration. There were no complications related to surgical procedure or neurological deterioration. Direct single anterior screw fixation has proved to be a very successful treatment method for type II odontoid fractures.
椎弓根骨折是常见的颈椎骨折，会导致寰枢椎不稳定，占所有颈椎骨折的 10-20%。根据 Anderson 和 D' Alonzo 的分类系统，近三分之二的椎弓根骨折属于 II 型。有报道称，采取保守措施后，II型蝶骨骨折的不愈合率有所增加。自1982年Bohler报告使用直接前方螺钉固定蝶骨骨折以来，该技术越来越受欢迎，目前已广泛用于治疗II型蝶骨骨折。 目的：评估经蝶骨前方螺钉固定治疗蝶骨骨折的安全性和有效性。 根据 Anderson 和 D' Alonzo 的分类系统，10 名患者接受了前方经蝶骨单螺钉固定术治疗 II 型蝶骨骨折。所有患者均在创伤后不到3个月接受手术。除一名女性外，所有患者均为男性，年龄在20至59岁之间，平均年龄为33.9岁。根据美国脊柱损伤协会量表对患者进行了临床和神经学评估，并使用普通X光片、计算机断层扫描和核磁共振成像对患者进行了放射学评估。 所有患者均获得了良好的临床和放射学（骨性或纤维性）结果，没有出现螺钉松动、后退或近端移位。手术过程中未出现并发症或神经功能恶化。 事实证明，直接单前路螺钉固定是治疗II型蝶骨骨折的一种非常成功的方法。
{"title":"Anterior odontoid lag screw fixation in type II odontoid fractures","authors":"Mohamed Abdelaziz, Ehab Y Hassanin, Ahmed A Ibrahim","doi":"10.4103/eoj.eoj_124_23","DOIUrl":"https://doi.org/10.4103/eoj.eoj_124_23","url":null,"abstract":"\u0000 \u0000 \u0000 Odontoid fractures are common cervical spine fractures, lead to atlantoaxial instability, and constitute 10–20% of all cervical fractures. Almost two-thirds of all dens fractures are classified as type II according to the Anderson and D’ Alonzo classification system. An increased rate of nonunion of type II odontoid fractures with conservative measures has been reported. The technique of direct anterior screw fixation of the odontoid fracture has become increasingly popular since Bohler reported its use in 1982, and it is now widely used to treat type II.\u0000 \u0000 \u0000 \u0000 To evaluate the safety and efficacy of the anterior transodontoid screw fixation in odontoid fractures.\u0000 \u0000 \u0000 \u0000 Ten patients underwent anterior transodontoid single screw fixation for type II odontoid fractures according to the Anderson and D’ Alonzo classification system. All patients were operated on less than 3 months following trauma. All patients were males apart from one female with their ages ranging from 20 to 59 years with a mean age of 33.9 years. Patients were evaluated clinically and neurologically according to the American Spinal Injury Association scale, and radiologically using plain radiograph, computed tomography scan, and MRI.\u0000 \u0000 \u0000 \u0000 Good clinical and radiological (bony or fibrous) outcomes were achieved in all patients with no screw loosening, backing out, or proximal migration. There were no complications related to surgical procedure or neurological deterioration.\u0000 \u0000 \u0000 \u0000 Direct single anterior screw fixation has proved to be a very successful treatment method for type II odontoid fractures.\u0000","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"217 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139843473","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}
Ayman A A Samad, Emad G. K. EL-BANNA, Tarek M Makhlouf, Ahmed G Mostafa
Degenerative spondylolisthesis and lumbar disk degeneration are common degenerative diseases of the spine that may lead to lower back pain and radicular leg pain. The perfect surgical treatment remains a point of debate; interbody fusion has been recognized as having a ‘golden role’ in the treatment of lumbar degenerative diseases, but spinal interbody fusion with polyetheretherketone (PEEK) cage surgery often incurs numerous complications such as cage retropulsion, nonunion, and high cost. We hypothesize that the autologous strut laminar graft will show clinical and radiological results similar to those obtained using a PEEK cage. To compare the primary outcome (clinical pain relief) and the secondary outcome (radiological signs of union and rate of fusion) when using strut laminar graft versus PEEK cage in posterior lumbar interbody fusion (PLIF) technique in the surgical management of degenerative lumbar diseases. Forty patients with single-level lumbar degenerative disk disease and/or degenerative spondylolisthesis grades 1 or 2 underwent PLIF surgery between November 2017 and December 2020. All patients were randomly divided into two groups according to the method of fusion (group A: laminar strut graft and group B: PEEK cage). Single-level PLIF was performed in all patients. Clinical, radiological, functional, and perioperative data were recorded and compared. The mean follow-up was 22 ± 6 months. Clinical improvement and radiological fusion were significantly documented in each group (P>0.05). However, no significant difference existed between the two groups regarding demographic, radiological, and functional outcomes. The results suggest that the laminar strut graft when used instead of the cage seems to be an equally safe and low-priced method of interbody fusion.
{"title":"Comparative study of posterior lumbar interbody fusion by strut laminar autograft versus cage in degenerative lumbar spine diseases","authors":"Ayman A A Samad, Emad G. K. EL-BANNA, Tarek M Makhlouf, Ahmed G Mostafa","doi":"10.4103/eoj.eoj_138_23","DOIUrl":"https://doi.org/10.4103/eoj.eoj_138_23","url":null,"abstract":"\u0000 \u0000 \u0000 Degenerative spondylolisthesis and lumbar disk degeneration are common degenerative diseases of the spine that may lead to lower back pain and radicular leg pain. The perfect surgical treatment remains a point of debate; interbody fusion has been recognized as having a ‘golden role’ in the treatment of lumbar degenerative diseases, but spinal interbody fusion with polyetheretherketone (PEEK) cage surgery often incurs numerous complications such as cage retropulsion, nonunion, and high cost. We hypothesize that the autologous strut laminar graft will show clinical and radiological results similar to those obtained using a PEEK cage.\u0000 \u0000 \u0000 \u0000 To compare the primary outcome (clinical pain relief) and the secondary outcome (radiological signs of union and rate of fusion) when using strut laminar graft versus PEEK cage in posterior lumbar interbody fusion (PLIF) technique in the surgical management of degenerative lumbar diseases.\u0000 \u0000 \u0000 \u0000 Forty patients with single-level lumbar degenerative disk disease and/or degenerative spondylolisthesis grades 1 or 2 underwent PLIF surgery between November 2017 and December 2020. All patients were randomly divided into two groups according to the method of fusion (group A: laminar strut graft and group B: PEEK cage). Single-level PLIF was performed in all patients. Clinical, radiological, functional, and perioperative data were recorded and compared.\u0000 \u0000 \u0000 \u0000 The mean follow-up was 22 ± 6 months. Clinical improvement and radiological fusion were significantly documented in each group (P>0.05). However, no significant difference existed between the two groups regarding demographic, radiological, and functional outcomes.\u0000 \u0000 \u0000 \u0000 The results suggest that the laminar strut graft when used instead of the cage seems to be an equally safe and low-priced method of interbody fusion.\u0000","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"43 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139782487","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}
Osam Mohamed Metwally, Reda Hussien ElKady, Ehab Mohamed Shehata
Background A delayed union was defined as when the fracture fails to unite within the expected time. Delayed union becomes nonunion when the fracture healing stops (at least 6 months). Intramedullary nailing has proven to be a good treatment option in the management of long bones fracture. The aim of this study is to obtain union in nonunited long bones fractures fixed previously by intramedullary nails by using of augmentation plating and bone grafting to obtain the best outcome. Patients and methods The study included 18 patients of nonunited long bones fractures fixed previously by intramedullary nails treated with augmentation plating and bone grafting with maintaining the nail in situ. Full history, clinical and radiological examination were performed. All subjects gave their informed consent prior to their inclusion in the study. Eight cases with femoral fracture nonunion were performed through the lateral approach of the femur. Seven cases of tibial fracture nonunion were performed through the anterior approach of the tibia, Three cases of humeral nonunion was performed using the posterior approach of the humerus. In the postoperatively follow-up, function was assessed using Dash score and Lower extremity functional score. Results There was an excellent improvement for bone union occurred to 94.4% of studied patients. Furthermore lower extremities function percent ranged between 92.5-100 with mean±SD 98.1 ± 2.56, and humerus Dash score ranged between 4.16-6.66 with mean±SD 5.41 ± 1.77. There was statistically insignificant difference between the period of nonunion bone per months and fracture bone criteria of studied patients P>0.05. Also, there is statistically insignificant difference between lower extremities function score percent after implant procedure and fracture bone criteria of studied patients P > 0.05. Conclusion Augmentation plating is an excellent solution for the management of nonunited nailed long bones fractures with maintaining the nail in situ, especially with instability at nonunion site and comminution or gap nonunion.
{"title":"Augmentation plates and bone grafting for treatment of nonunited long bones fractures fixed by intramedullary nails","authors":"Osam Mohamed Metwally, Reda Hussien ElKady, Ehab Mohamed Shehata","doi":"10.4103/eoj.eoj_77_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_77_22","url":null,"abstract":"Background A delayed union was defined as when the fracture fails to unite within the expected time. Delayed union becomes nonunion when the fracture healing stops (at least 6 months). Intramedullary nailing has proven to be a good treatment option in the management of long bones fracture. The aim of this study is to obtain union in nonunited long bones fractures fixed previously by intramedullary nails by using of augmentation plating and bone grafting to obtain the best outcome. Patients and methods The study included 18 patients of nonunited long bones fractures fixed previously by intramedullary nails treated with augmentation plating and bone grafting with maintaining the nail in situ. Full history, clinical and radiological examination were performed. All subjects gave their informed consent prior to their inclusion in the study. Eight cases with femoral fracture nonunion were performed through the lateral approach of the femur. Seven cases of tibial fracture nonunion were performed through the anterior approach of the tibia, Three cases of humeral nonunion was performed using the posterior approach of the humerus. In the postoperatively follow-up, function was assessed using Dash score and Lower extremity functional score. Results There was an excellent improvement for bone union occurred to 94.4% of studied patients. Furthermore lower extremities function percent ranged between 92.5-100 with mean±SD 98.1 ± 2.56, and humerus Dash score ranged between 4.16-6.66 with mean±SD 5.41 ± 1.77. There was statistically insignificant difference between the period of nonunion bone per months and fracture bone criteria of studied patients P>0.05. Also, there is statistically insignificant difference between lower extremities function score percent after implant procedure and fracture bone criteria of studied patients P > 0.05. Conclusion Augmentation plating is an excellent solution for the management of nonunited nailed long bones fractures with maintaining the nail in situ, especially with instability at nonunion site and comminution or gap nonunion.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121832648","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}
Objective To evaluate the results of fixation of intra articular calcaneus fracture using Sinus Tarsi Approach, bone block substitute, and screws fixation. Background Minimal invasive techniques for treatment calcaneus fractures have developed to overcome soft tissue complications associated with the traditional lateral approach. Sinus Tarsi approach has the advantage of visualization of posterior part of subtalar joint. Methods All patients underwent preoperative calcaneal lateral and axial radiographs and CT scan of the injured foot. The injured type was graded according to the Sanders classification on the basis of the CT scan findings. Bohler and Gissane angles were measured as anatomical parameters before surgery. Sinus Tarsi Approach was done for all patients, in addition to use of percutaneous screws fixation and bone block graft substitute. Results A total of 17 patients were included in our study. The mean age was 37.8 years. At the end of follow-up, radiological evaluation was done by measuring the Bohler angle and the angle of Gissan. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score was calculated at the end of the follow-up for all cases. Excellent results were found in7 patients, good results in 8 patients and fair results in only 2 patients. There was a statistically significant improvement of Bohler angle at the end of the follow-up. Conclusion Treatment of intra articular calcaneal fractures using Sinus Tarsi Approach with a bone block substitute and screws can provide satisfactory clinical outcomes.
{"title":"Treatment of intra articular fracture calcaneus using sinus tarsi approach, bone block substitute, and screws","authors":"Mohamed Samy","doi":"10.4103/eoj.eoj_3_23","DOIUrl":"https://doi.org/10.4103/eoj.eoj_3_23","url":null,"abstract":"Objective To evaluate the results of fixation of intra articular calcaneus fracture using Sinus Tarsi Approach, bone block substitute, and screws fixation. Background Minimal invasive techniques for treatment calcaneus fractures have developed to overcome soft tissue complications associated with the traditional lateral approach. Sinus Tarsi approach has the advantage of visualization of posterior part of subtalar joint. Methods All patients underwent preoperative calcaneal lateral and axial radiographs and CT scan of the injured foot. The injured type was graded according to the Sanders classification on the basis of the CT scan findings. Bohler and Gissane angles were measured as anatomical parameters before surgery. Sinus Tarsi Approach was done for all patients, in addition to use of percutaneous screws fixation and bone block graft substitute. Results A total of 17 patients were included in our study. The mean age was 37.8 years. At the end of follow-up, radiological evaluation was done by measuring the Bohler angle and the angle of Gissan. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score was calculated at the end of the follow-up for all cases. Excellent results were found in7 patients, good results in 8 patients and fair results in only 2 patients. There was a statistically significant improvement of Bohler angle at the end of the follow-up. Conclusion Treatment of intra articular calcaneal fractures using Sinus Tarsi Approach with a bone block substitute and screws can provide satisfactory clinical outcomes.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131337280","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 Changes of posterior tibial slope following complex tibial plateau fractures have not been fully evaluated in the literature. Some studies indicated that arthritic changes that occur following tibial plateau fracture were more correlated to deformity and instability rather than articular surface step-off. The aim of this study was to evaluate the midterm clinical effects following changes in the posterior slope that might be associated with reconstruction of complex tibial plateau fractures. Patients and methods This retrospective cohort study was carried out on 112 patients operated by internal fixation following complex tibial plateau fracture within 4 weeks of the incident of injury. Modified Rasmussen score was used for both clinical and radiological evaluations in addition to final evaluation of the slope by computed tomography scan. The Knee Injury and Osteoarthritis Outcome Score was used for subjective evaluation of the clinical results, and Kellgren–Lawrence radiological grading was used for osteoarthritis grading. Results The mean flexion was 118.8 ± 13.0° (range, 90–140) in GI and 119.7 ± 13.5° (range, 70–140) in GII, and the mean extension deficit was 1.6 ± 2.7° (range, 0–10) in GI compared with 1.9 ± 2.9° (range, 0–10) in GII. The mean clinical Rasmussen score was 26.3 ± 2.9 (18–30) in GI and 26.1 ± 3.2 (16–30) in GII. The mean Knee Injury and Osteoarthritis Outcome Score in GI was 79.3 ± 5.1 compared with 77.7 ± 5.6 in GII. According to Kellgren–Lawrence grading system for osteoarthritis, there were 23 patients with grades 2 and 3 osteoarthritis in GI compared with 32 cases in GII. The study showed a statistically significant correlation between decreased tibial slope and limitation of extension. Otherwise, there were no statistically significances between changes of tibial slope and stability, pain, or the overall postoperative knee score. Conclusion Changes in posterior slope angle of the tibial plateau during fracture fixation is an important factor that can significantly affect range of motion, particularly extension. Osteoarthritis is higher in patients with disturbed posterior slope; however, a larger sample is needed for possible significance. Level of evidence: therapeutic level IV.
{"title":"Consequences of sagittal malalignment following reconstruction of complex tibial plateau fractures","authors":"M. Sharaby, Mohamed Abuheif","doi":"10.4103/eoj.eoj_2_23","DOIUrl":"https://doi.org/10.4103/eoj.eoj_2_23","url":null,"abstract":"Purpose Changes of posterior tibial slope following complex tibial plateau fractures have not been fully evaluated in the literature. Some studies indicated that arthritic changes that occur following tibial plateau fracture were more correlated to deformity and instability rather than articular surface step-off. The aim of this study was to evaluate the midterm clinical effects following changes in the posterior slope that might be associated with reconstruction of complex tibial plateau fractures. Patients and methods This retrospective cohort study was carried out on 112 patients operated by internal fixation following complex tibial plateau fracture within 4 weeks of the incident of injury. Modified Rasmussen score was used for both clinical and radiological evaluations in addition to final evaluation of the slope by computed tomography scan. The Knee Injury and Osteoarthritis Outcome Score was used for subjective evaluation of the clinical results, and Kellgren–Lawrence radiological grading was used for osteoarthritis grading. Results The mean flexion was 118.8 ± 13.0° (range, 90–140) in GI and 119.7 ± 13.5° (range, 70–140) in GII, and the mean extension deficit was 1.6 ± 2.7° (range, 0–10) in GI compared with 1.9 ± 2.9° (range, 0–10) in GII. The mean clinical Rasmussen score was 26.3 ± 2.9 (18–30) in GI and 26.1 ± 3.2 (16–30) in GII. The mean Knee Injury and Osteoarthritis Outcome Score in GI was 79.3 ± 5.1 compared with 77.7 ± 5.6 in GII. According to Kellgren–Lawrence grading system for osteoarthritis, there were 23 patients with grades 2 and 3 osteoarthritis in GI compared with 32 cases in GII. The study showed a statistically significant correlation between decreased tibial slope and limitation of extension. Otherwise, there were no statistically significances between changes of tibial slope and stability, pain, or the overall postoperative knee score. Conclusion Changes in posterior slope angle of the tibial plateau during fracture fixation is an important factor that can significantly affect range of motion, particularly extension. Osteoarthritis is higher in patients with disturbed posterior slope; however, a larger sample is needed for possible significance. Level of evidence: therapeutic level IV.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123434571","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}
Ahmed K El Ghazawy, Mohamed Ismail Kotb, Ahmed Saeed Younis
Aim We compared the clinical outcomes of fixing lateral malleolus fractures with lateral or posterior plating in combined lateral and posterior malleolar ankle fractures. Methods We randomized thirty patients with ankle fractures involving the posterior and lateral malleoli into two groups. In group 1, we dissected laterally, raising a lateral skin and subcutaneous flap to allow lateral fixation of the lateral malleolus. In group 2, we did not raise the flap fixing the lateral malleolus posteriorly by deep dissection and retracting the peroneal tendons laterally. During the follow-up period, we assessed pain at six months and at the end of the follow-up, ankle range of motion, wound complications, reoperation rates, fracture union, implant failure, and foot and ankle disability index (FADI). Results The mean follow-up period was 24.33 months. The mean age of the included participants was 41.76 ± 7.3 years. The mean visual analogue score VAS score at six months follow-up was 2.13 ± 0.54 in group 1 and 3.6 ± 0.76 in group 2, which decreased to one in group 1 and two in group 2 at the end of follow-up. The mean FADI was 89.8 ± 3.76 in group 1 and 90.7 ± 2.45 in group 2. The reoperation rate was 6.6% in group 1 and 26.6% in group 2 Fixation of all posterior malleolus fractures was done in all patients, union was achieved with no complications. Conclusion There is no clinical difference between lateral and posterior plating of the lateral malleolus through the posterolateral approach.
{"title":"Posterior versus lateral plating of lateral malleolus fractures using a posterolateral approach","authors":"Ahmed K El Ghazawy, Mohamed Ismail Kotb, Ahmed Saeed Younis","doi":"10.4103/eoj.eoj_49_23","DOIUrl":"https://doi.org/10.4103/eoj.eoj_49_23","url":null,"abstract":"Aim We compared the clinical outcomes of fixing lateral malleolus fractures with lateral or posterior plating in combined lateral and posterior malleolar ankle fractures. Methods We randomized thirty patients with ankle fractures involving the posterior and lateral malleoli into two groups. In group 1, we dissected laterally, raising a lateral skin and subcutaneous flap to allow lateral fixation of the lateral malleolus. In group 2, we did not raise the flap fixing the lateral malleolus posteriorly by deep dissection and retracting the peroneal tendons laterally. During the follow-up period, we assessed pain at six months and at the end of the follow-up, ankle range of motion, wound complications, reoperation rates, fracture union, implant failure, and foot and ankle disability index (FADI). Results The mean follow-up period was 24.33 months. The mean age of the included participants was 41.76 ± 7.3 years. The mean visual analogue score VAS score at six months follow-up was 2.13 ± 0.54 in group 1 and 3.6 ± 0.76 in group 2, which decreased to one in group 1 and two in group 2 at the end of follow-up. The mean FADI was 89.8 ± 3.76 in group 1 and 90.7 ± 2.45 in group 2. The reoperation rate was 6.6% in group 1 and 26.6% in group 2 Fixation of all posterior malleolus fractures was done in all patients, union was achieved with no complications. Conclusion There is no clinical difference between lateral and posterior plating of the lateral malleolus through the posterolateral approach.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115781392","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}
Objectives To evaluate the results of iliac bone grafting with threaded Kirschner wires (K-wires) fixation in treating of nonunited middle third scaphoid fractures. Background Scaphoid nonunion is a common complication after scaphoid fractures as it is an intra-articular fracture with high fracture mobility and instability. In addition, the scaphoid is devoid of periosteum along with impaired vascularity. Scaphoid nonunion results in carpal collapse with secondary osteoarthritis. To avoid that, the aim of treatment should be to enhance the biology of fracture through bone grafting and provide adequate stability of the fracture in an anatomic alignment. Patients and methods This study is a prospective case series of 30 patients with nonunited middle third scaphoid fractures admitted to an academically supervised trauma center from June 2018 to June 2020. They were managed by open reduction, refreshment of the scaphoid nonunion site with iliac crest bone grafting, and threaded K-wires fixation in an anatomical alignment. The mean age was 28.58 ± 4.47 years. Postoperative clinical outcomes were evaluated using the Quick disabilities of arm, shoulder and hand (DASH) score, and modified Mayo wrist score. Postoperative radiological union and scaphoid alignment were assessed. The minimum period of follow-up was one year. Results One year postoperatively, the mean modified Mayo wrist score was 81.67 ± 9.39 and the mean Quick DASH score was 25.67 ± 14.97. Radiologically, the union was achieved in 86.7%. The mean union time was 11.92 ± 1.54 weeks. Conclusions Threaded K-wires fixation with iliac bone grafting is an effective method for treating nonunited middle third scaphoid fractures.
{"title":"Evaluation of treatment of nonunited middle third scaphoid fractures using threaded Kirschner wires fixation with iliac bone grafting","authors":"A. Abosalem, A. Shams, Mohamed Samy","doi":"10.4103/eoj.eoj_60_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_60_22","url":null,"abstract":"Objectives To evaluate the results of iliac bone grafting with threaded Kirschner wires (K-wires) fixation in treating of nonunited middle third scaphoid fractures. Background Scaphoid nonunion is a common complication after scaphoid fractures as it is an intra-articular fracture with high fracture mobility and instability. In addition, the scaphoid is devoid of periosteum along with impaired vascularity. Scaphoid nonunion results in carpal collapse with secondary osteoarthritis. To avoid that, the aim of treatment should be to enhance the biology of fracture through bone grafting and provide adequate stability of the fracture in an anatomic alignment. Patients and methods This study is a prospective case series of 30 patients with nonunited middle third scaphoid fractures admitted to an academically supervised trauma center from June 2018 to June 2020. They were managed by open reduction, refreshment of the scaphoid nonunion site with iliac crest bone grafting, and threaded K-wires fixation in an anatomical alignment. The mean age was 28.58 ± 4.47 years. Postoperative clinical outcomes were evaluated using the Quick disabilities of arm, shoulder and hand (DASH) score, and modified Mayo wrist score. Postoperative radiological union and scaphoid alignment were assessed. The minimum period of follow-up was one year. Results One year postoperatively, the mean modified Mayo wrist score was 81.67 ± 9.39 and the mean Quick DASH score was 25.67 ± 14.97. Radiologically, the union was achieved in 86.7%. The mean union time was 11.92 ± 1.54 weeks. Conclusions Threaded K-wires fixation with iliac bone grafting is an effective method for treating nonunited middle third scaphoid fractures.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134607015","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：