Background Scaphoid fracture nonunion is a troublesome complication that if untreated will lead to avascular necrosis (AVN) of proximal pole, then carpal collapse, and degenerative arthritis. The proximal pole of the scaphoid vascular status is an important factor in determining the type of bone graft used whether vascularized or nonvascularized. The purpose of this study was to evaluate the results of a new technique in the reconstruction of AVN proximal pole scaphoid fracture nonunion by using proximal Hamate as an autograft to restore the shape of scaphoid and scapholunate mechanics and the effect of graft size on wrist mechanics. Patients and methods This was an interrupted time-series clinical trial (quasi-experimental) study that included 20 patients with nonunited proximal scaphoid fractures with AVN of the proximal part treated with excision of the proximal pole of scaphoid and reconstruct with the proximal pole of Hamate and reconstruction of scapholunate ligament. Results All fractures united, except two fractures, with a mean period of 10.2 weeks, the mean follow-up period was 11 months, there was an improvement in visual analog scale score from 8 (7–9) preoperative to 2 (0–5) postoperative and the final Mayo wrist score was 93.1 (range, 79–98). Conclusion The use of proximal hamate as an autograft to reconstruct the proximal osteocartilaginous surface of the scaphoid nonunited fractures with AVN of the proximal pole is a promising technique.
{"title":"Base of Hamate as a reconstruction for proximal pole scaphoid fractures","authors":"E. Tabl, Mahmoud Abouzied","doi":"10.4103/eoj.eoj_74_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_74_22","url":null,"abstract":"Background Scaphoid fracture nonunion is a troublesome complication that if untreated will lead to avascular necrosis (AVN) of proximal pole, then carpal collapse, and degenerative arthritis. The proximal pole of the scaphoid vascular status is an important factor in determining the type of bone graft used whether vascularized or nonvascularized. The purpose of this study was to evaluate the results of a new technique in the reconstruction of AVN proximal pole scaphoid fracture nonunion by using proximal Hamate as an autograft to restore the shape of scaphoid and scapholunate mechanics and the effect of graft size on wrist mechanics. Patients and methods This was an interrupted time-series clinical trial (quasi-experimental) study that included 20 patients with nonunited proximal scaphoid fractures with AVN of the proximal part treated with excision of the proximal pole of scaphoid and reconstruct with the proximal pole of Hamate and reconstruction of scapholunate ligament. Results All fractures united, except two fractures, with a mean period of 10.2 weeks, the mean follow-up period was 11 months, there was an improvement in visual analog scale score from 8 (7–9) preoperative to 2 (0–5) postoperative and the final Mayo wrist score was 93.1 (range, 79–98). Conclusion The use of proximal hamate as an autograft to reconstruct the proximal osteocartilaginous surface of the scaphoid nonunited fractures with AVN of the proximal pole is a promising technique.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121851285","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 Long-term survival of endoprosthetic implants is a major concern, with reported 20-year survival rates of lower limb tumor endoprostheses at only 25–38%. Mechanical failure of polyethylene (PE)-bearing surfaces may result in irreversible damage and contribute to osteolysis and aseptic loosening. The practice in our institution is to electively change replaceable parts of lower limb endoprosthesis ~7 years after index surgery. Patients and methods From 2014 to 2019, five patients underwent an elective change of parts at an average of 7 years from the initial surgery. All patients had rotating-hinge implants including one proximal tibia, three distal femurs, and one total femur prosthesis. Three had a fixed-poly (FP) with a rotating femur (Stryker GMRS), and two had a rotating mobile polyethylene (MP) design (Zimmer ZSS). PE liners, hinge pin protectors, and bushings were retrieved for analysis. The parts were examined for macroscopic wear and under a light microscope at up to 40 times magnification. Linear wear was measured at standardized points. Results There were no major perioperative complications. MP inserts showed minimal burnishing. FP liners showed macroscopically visible surface pitting and posterior edge delamination. Submillimeter linear wear was noted on PE liners, bushings, and hinge pin protectors, with minimal evidence of macroscopic wear. Conclusion Elective PE exchange is a possible option for extending the longevity of tumor endoprostheses. The optimal timing of surgery is to be determined. Our retrieval study suggests that 7 years is appropriate for the FP design but may be early for the MP design. Further studies are required to determine implant survival benefits.
{"title":"Elective hinge and polyethylene exchange for lower limb tumor endoprostheses: Is it a good idea?","authors":"M. Chan, L. Chan, M. Cheng","doi":"10.4103/eoj.eoj_11_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_11_22","url":null,"abstract":"Background Long-term survival of endoprosthetic implants is a major concern, with reported 20-year survival rates of lower limb tumor endoprostheses at only 25–38%. Mechanical failure of polyethylene (PE)-bearing surfaces may result in irreversible damage and contribute to osteolysis and aseptic loosening. The practice in our institution is to electively change replaceable parts of lower limb endoprosthesis ~7 years after index surgery. Patients and methods From 2014 to 2019, five patients underwent an elective change of parts at an average of 7 years from the initial surgery. All patients had rotating-hinge implants including one proximal tibia, three distal femurs, and one total femur prosthesis. Three had a fixed-poly (FP) with a rotating femur (Stryker GMRS), and two had a rotating mobile polyethylene (MP) design (Zimmer ZSS). PE liners, hinge pin protectors, and bushings were retrieved for analysis. The parts were examined for macroscopic wear and under a light microscope at up to 40 times magnification. Linear wear was measured at standardized points. Results There were no major perioperative complications. MP inserts showed minimal burnishing. FP liners showed macroscopically visible surface pitting and posterior edge delamination. Submillimeter linear wear was noted on PE liners, bushings, and hinge pin protectors, with minimal evidence of macroscopic wear. Conclusion Elective PE exchange is a possible option for extending the longevity of tumor endoprostheses. The optimal timing of surgery is to be determined. Our retrieval study suggests that 7 years is appropriate for the FP design but may be early for the MP design. Further studies are required to determine implant survival benefits.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127300626","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 Rupture of the anterior cruciate ligament (ACL) is one of the most common sports injuries of the knee joint. The results of combined ACL and anterolateral ligament (ALL) reconstruction have shown a significant improvement in clinical outcome. Objectives To evaluate clinical outcomes of combined ACL and ALL reconstruction in ACL-deficient knee. Patients and methods This study included 20 patients aged from 21 to 45 years, who presented with ACL-deficient knee. Combined ACL and ALL reconstruction were performed to all cases. Patients were followed up for 24 months postoperatively. Patient assessment included preinjury, preoperative and postoperative subjective and objective International Knee Documentation Committee, Tegner activity scale, and Lysholm scores. Results Our study showed that the postoperative mean Lysholm knee score (94.20 ± 4.55) was significantly improved than preoperative (65.62 ± 3.42) (P<0.001) and there were 17 (85%) patients postoperatively with an excellent score. Also, postoperative mean Tegner activity score and International Knee Documentation Committee (8.22 ± 1.64 and 87.25 ± 8.71, respectively) were significantly improved than the preoperative (6.73 ± 1.21 and 52.71 ± 11.35, respectively) values (P=0.031 and P<0.001, respectively). The instrumented knee laxity test was performed using a KT-1000 arthrometer where the mean of postoperative translation (3.28 ± 0.74 mm) was significantly lower than the preoperative (11.15 ± 0.82 mm) (P<0.001) value. Conclusion Our technique of combined ACL and ALL reconstruction was found to be effective in improving subjective and objective outcomes. Also, no serious complications were noted with this operative procedure.
{"title":"Clinical outcomes of percutaneous reconstruction of anterolateral ligament in anterior cruciate ligament-deficient knee in skeletally mature patients","authors":"M. Saleh","doi":"10.4103/eoj.eoj_24_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_24_22","url":null,"abstract":"Background Rupture of the anterior cruciate ligament (ACL) is one of the most common sports injuries of the knee joint. The results of combined ACL and anterolateral ligament (ALL) reconstruction have shown a significant improvement in clinical outcome. Objectives To evaluate clinical outcomes of combined ACL and ALL reconstruction in ACL-deficient knee. Patients and methods This study included 20 patients aged from 21 to 45 years, who presented with ACL-deficient knee. Combined ACL and ALL reconstruction were performed to all cases. Patients were followed up for 24 months postoperatively. Patient assessment included preinjury, preoperative and postoperative subjective and objective International Knee Documentation Committee, Tegner activity scale, and Lysholm scores. Results Our study showed that the postoperative mean Lysholm knee score (94.20 ± 4.55) was significantly improved than preoperative (65.62 ± 3.42) (P<0.001) and there were 17 (85%) patients postoperatively with an excellent score. Also, postoperative mean Tegner activity score and International Knee Documentation Committee (8.22 ± 1.64 and 87.25 ± 8.71, respectively) were significantly improved than the preoperative (6.73 ± 1.21 and 52.71 ± 11.35, respectively) values (P=0.031 and P<0.001, respectively). The instrumented knee laxity test was performed using a KT-1000 arthrometer where the mean of postoperative translation (3.28 ± 0.74 mm) was significantly lower than the preoperative (11.15 ± 0.82 mm) (P<0.001) value. Conclusion Our technique of combined ACL and ALL reconstruction was found to be effective in improving subjective and objective outcomes. Also, no serious complications were noted with this operative procedure.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121688963","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 Scaphoid is the most commonly injured carpal bone, with over two-thirds of scaphoid fractures occurring at the waist. The anatomy of the scaphoid makes these injuries susceptible to delayed unions or nonunions and can lead to significant morbidity and disability. Aim To evaluate the effect of bone marrow injection on bone healing in delayed presented fractures of scaphoid with percutaneous fixation via Herbert screw. Patient and methods Forty patients with delayed presented scaphoid fractures treated with percutaneous screw fixation and divided into two groups, group A augments the fixation with bone marrow injection, while group B suffices with fixation only. Results All fractures had complete union, but there is a significant acceleration in bone healing in group A than in group B with P value less than 0.05. This is reflected in the other results for group A, according to Mayo wrist score, we have 17 excellent and three good results, while in group B, there were 15 excellent, four good, and one patient with poor results due to nonunion that occurred. Conclusion The use of bone marrow is considered a simple and minimally invasive technique. It is safe and has no risk, so we recommend use of bone marrow injection with fixation of delayed presented fractures of scaphoid.
{"title":"Percutaneous screw fixation with bone marrow injection in delayed fracture scaphoid, is it effective: a randomized control study","authors":"E. Tabl, Osama M Essay","doi":"10.4103/eoj.eoj_54_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_54_22","url":null,"abstract":"Background Scaphoid is the most commonly injured carpal bone, with over two-thirds of scaphoid fractures occurring at the waist. The anatomy of the scaphoid makes these injuries susceptible to delayed unions or nonunions and can lead to significant morbidity and disability. Aim To evaluate the effect of bone marrow injection on bone healing in delayed presented fractures of scaphoid with percutaneous fixation via Herbert screw. Patient and methods Forty patients with delayed presented scaphoid fractures treated with percutaneous screw fixation and divided into two groups, group A augments the fixation with bone marrow injection, while group B suffices with fixation only. Results All fractures had complete union, but there is a significant acceleration in bone healing in group A than in group B with P value less than 0.05. This is reflected in the other results for group A, according to Mayo wrist score, we have 17 excellent and three good results, while in group B, there were 15 excellent, four good, and one patient with poor results due to nonunion that occurred. Conclusion The use of bone marrow is considered a simple and minimally invasive technique. It is safe and has no risk, so we recommend use of bone marrow injection with fixation of delayed presented fractures of scaphoid.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123743157","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 Congenital knee dislocation (CKD) is deformity of the knee characterized by unnatural hyperextension with severely restricted knee flexion. It may either be idiopathic or a part of any syndrome (Larsen’s syndrome, myelomeningocele, and arthrogryposis multiplex congenita). As the incidence of CDK is very low (~1/100 000 live births, which is about 1% of the incidence of congenital hip dislocation). Aim To identify the results of conservative management of the group of CKD at birth, especially grade I and grade II according to Tarek CDK grading system (Abdelaziz and Samir grading of CDK) and identify the problems encountered during the process. Patients and methods Between January 2016 and February 2021, 24 infants with 34 CDK were treated at Al-Azhar University Hospital, Assiut branch. Age at the time of initial treatment ranged from 3 to 45 days, average 17 days. Fourteen infants were male and 10 infants were female. Eight cases were affected on the right side, six cases were affected on the left side, and 10 cases were affected bilaterality. Follow-up ranged from 1 to 3 years, average 2.3 years. The serial casting was started weekly, aiming to achieve more than 90° passive flexion, the number of the cast ranged from one to six casts, average three casts. Then, the cast was discontinued and a back splint has been given to the 14 patients to be used at nighttime only. Results All parents were satisfied with the outcome. Satisfaction was assessed by asking the parent(s) to grade their child’s condition at the final follow-up on a scale of 0 to 5, with ‘0’ meaning totally unsatisfied and ‘5’ meaning extremely satisfied. Parent(s) who graded their child at ‘3 or more’ were considered satisfied. Twenty-two knees achieved excellent results, 10 knees achieved good results, and two knees achieved fair results. All knees that achieved excellent results were grade I/grade II and had been treated by serial casting only. The cast was changed every 1 week, average duration of cast was 21 days. The only two knees were grade III that underwent V-Y quadricepsplasty and had excellent results. Conclusion If CDK was diagnosed early after birth and timely treatment initiated successful, conservative management can be easily done even in the higher grades of classification of CKD.
{"title":"Managment of congenital knee dislocation by gradual reduction with serial casting","authors":"Ibrahim Abuomira","doi":"10.4103/eoj.eoj_42_23","DOIUrl":"https://doi.org/10.4103/eoj.eoj_42_23","url":null,"abstract":"Background Congenital knee dislocation (CKD) is deformity of the knee characterized by unnatural hyperextension with severely restricted knee flexion. It may either be idiopathic or a part of any syndrome (Larsen’s syndrome, myelomeningocele, and arthrogryposis multiplex congenita). As the incidence of CDK is very low (~1/100 000 live births, which is about 1% of the incidence of congenital hip dislocation). Aim To identify the results of conservative management of the group of CKD at birth, especially grade I and grade II according to Tarek CDK grading system (Abdelaziz and Samir grading of CDK) and identify the problems encountered during the process. Patients and methods Between January 2016 and February 2021, 24 infants with 34 CDK were treated at Al-Azhar University Hospital, Assiut branch. Age at the time of initial treatment ranged from 3 to 45 days, average 17 days. Fourteen infants were male and 10 infants were female. Eight cases were affected on the right side, six cases were affected on the left side, and 10 cases were affected bilaterality. Follow-up ranged from 1 to 3 years, average 2.3 years. The serial casting was started weekly, aiming to achieve more than 90° passive flexion, the number of the cast ranged from one to six casts, average three casts. Then, the cast was discontinued and a back splint has been given to the 14 patients to be used at nighttime only. Results All parents were satisfied with the outcome. Satisfaction was assessed by asking the parent(s) to grade their child’s condition at the final follow-up on a scale of 0 to 5, with ‘0’ meaning totally unsatisfied and ‘5’ meaning extremely satisfied. Parent(s) who graded their child at ‘3 or more’ were considered satisfied. Twenty-two knees achieved excellent results, 10 knees achieved good results, and two knees achieved fair results. All knees that achieved excellent results were grade I/grade II and had been treated by serial casting only. The cast was changed every 1 week, average duration of cast was 21 days. The only two knees were grade III that underwent V-Y quadricepsplasty and had excellent results. Conclusion If CDK was diagnosed early after birth and timely treatment initiated successful, conservative management can be easily done even in the higher grades of classification of CKD.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116267060","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 purpose of this study is to evaluate the results of the anatomical reconstruction of a posterolateral corner (PLC) using a technique of combined fibula-and tibia-based anatomic reconstruction using a single semitendinosus autograft with posterior tibial cortical surface fixation using a titanium staple. Patients and methods Between August 2016 and July 2018, 13 male patients with chronic PLC injury underwent a PLC reconstruction of the knee by a modified anatomical PLC reconstruction using a technique of combined fibula-and tibia-based anatomic reconstruction using a single semitendinosus autograft with posterior tibial cortical fixation using a titanium staple. Instability was the main complaint, the mean age was 27.54 ± 4.63 with motorcycle accident being the most common cause of injury in five (38.5%) patients, contact sport was the second common cause of injury in four (30.8%) patients, twisting injury represented 15.4%, and motor vehicle injury in 15.4%. The mean time from injury to surgery was 3.54 ± 1.51 months, all cases had associated injuries; seven cases presented as combined PLC and anterior cruciate ligament injuries with one case having chondral lesion and another case having medial meniscal injury; the other five cases had combined PLC and posterior cruciate ligament injury with one case having a medial meniscal injury. The mean follow-up period was 11.31 ± 2.78 months. Before surgery as well as at the final follow-up, all study patients completed the subjective Lysholm and International Knee Documentation Committee (IKDC) questionnaires. The side-to-side difference (SSD) of the lateral joint opening in stress varus radiographs and external rotation angle (dial test) were measured. Results The final results at the end of the follow-up period showed marked improvement in IKDC and Lysholm score presented as a significant improvement of IKDC score from the preoperative mean score 25.92 ± 7.02–71.08 ± 4.39 (P<0.001) and Lysholm score improvement from 33.4 ± 5.7 to 87.7 ± 8.5 (P<0.001). Improvement of SSD of lateral joint opening in stress radiographs from 6.1 ± 0.6 to 3.4 ± 0.3 mm (P<0.001) and SSD of the external rotation angle (dial test) improved from 26.5 ± 3.8° preoperatively to 7.7 ± 3.3° postoperatively (P<0.001). Conclusion Anatomical PLC reconstruction using the fibular tunnel technique using a single semitendinosus graft with posterior cortical fixation at the tibial side using a titanium staple is a simple technique that gives excellent short-term follow-up results that need long-term follow-up to determine the graft function, especially in cases of multiple-ligament injured knee.
目的:本研究的目的是评估采用单股半腱肌自体移植物和钛钉胫骨后皮质面固定的腓骨-胫骨联合解剖重建技术重建后外侧角(PLC)的结果。患者和方法在2016年8月至2018年7月期间，13名男性慢性PLC损伤患者接受了膝关节PLC重建，采用改良的结构PLC重建技术，采用腓骨和胫骨为基础的联合解剖重建，使用单个半腱肌自体移植物和胫骨后皮质钛钉固定。不稳定是主要的主诉，平均年龄为27.54±4.63岁，摩托车事故是5例(38.5%)患者最常见的损伤原因，接触性运动是4例(30.8%)患者第二常见的损伤原因，扭转伤占15.4%，机动车伤占15.4%。从损伤到手术平均时间为3.54±1.51个月，所有病例均伴有损伤;PLC合并前交叉韧带损伤7例，其中软骨损伤1例，内侧半月板损伤1例;其他5例合并PLC和后交叉韧带损伤，1例内侧半月板损伤。平均随访时间11.31±2.78个月。在手术前以及最后随访时，所有研究患者都完成了Lysholm和国际膝关节文献委员会(IKDC)的主观问卷调查。测量应力内翻x线片上关节外侧开口的侧对侧差(SSD)和外旋角度(dial test)。结果随访结束时，IKDC和Lysholm评分均有明显改善，IKDC评分由术前平均(25.92±7.02-71.08±4.39)分显著改善(P<0.001)， Lysholm评分由33.4±5.7分改善至87.7±8.5分(P<0.001)。应力片关节外侧开口SSD由术前6.1±0.6 mm改善至3.4±0.3 mm (P<0.001)，外旋角SSD (dial test)由术前26.5±3.8°改善至术后7.7±3.3°(P<0.001)。结论采用半腱肌单支植骨及胫骨侧后侧皮质骨钉固定的腓骨隧道技术进行PLC解剖重建是一种简单的技术，短期随访效果良好，特别是在膝关节多韧带损伤的情况下，需要长期随访以确定植骨功能。
{"title":"Modified anatomical posterolateral corner reconstruction of the knee using combined fibula-and tibia-based anatomic reconstruction with tibial posterior cortical fixation using a titanium staple","authors":"Elsayed Elforse","doi":"10.4103/eoj.eoj_66_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_66_22","url":null,"abstract":"Purpose The purpose of this study is to evaluate the results of the anatomical reconstruction of a posterolateral corner (PLC) using a technique of combined fibula-and tibia-based anatomic reconstruction using a single semitendinosus autograft with posterior tibial cortical surface fixation using a titanium staple. Patients and methods Between August 2016 and July 2018, 13 male patients with chronic PLC injury underwent a PLC reconstruction of the knee by a modified anatomical PLC reconstruction using a technique of combined fibula-and tibia-based anatomic reconstruction using a single semitendinosus autograft with posterior tibial cortical fixation using a titanium staple. Instability was the main complaint, the mean age was 27.54 ± 4.63 with motorcycle accident being the most common cause of injury in five (38.5%) patients, contact sport was the second common cause of injury in four (30.8%) patients, twisting injury represented 15.4%, and motor vehicle injury in 15.4%. The mean time from injury to surgery was 3.54 ± 1.51 months, all cases had associated injuries; seven cases presented as combined PLC and anterior cruciate ligament injuries with one case having chondral lesion and another case having medial meniscal injury; the other five cases had combined PLC and posterior cruciate ligament injury with one case having a medial meniscal injury. The mean follow-up period was 11.31 ± 2.78 months. Before surgery as well as at the final follow-up, all study patients completed the subjective Lysholm and International Knee Documentation Committee (IKDC) questionnaires. The side-to-side difference (SSD) of the lateral joint opening in stress varus radiographs and external rotation angle (dial test) were measured. Results The final results at the end of the follow-up period showed marked improvement in IKDC and Lysholm score presented as a significant improvement of IKDC score from the preoperative mean score 25.92 ± 7.02–71.08 ± 4.39 (P<0.001) and Lysholm score improvement from 33.4 ± 5.7 to 87.7 ± 8.5 (P<0.001). Improvement of SSD of lateral joint opening in stress radiographs from 6.1 ± 0.6 to 3.4 ± 0.3 mm (P<0.001) and SSD of the external rotation angle (dial test) improved from 26.5 ± 3.8° preoperatively to 7.7 ± 3.3° postoperatively (P<0.001). Conclusion Anatomical PLC reconstruction using the fibular tunnel technique using a single semitendinosus graft with posterior cortical fixation at the tibial side using a titanium staple is a simple technique that gives excellent short-term follow-up results that need long-term follow-up to determine the graft function, especially in cases of multiple-ligament injured knee.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130590594","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 Despite Scarf osteotomy was described earlier in the 20th century, it was popularized later in 2000 after modification of the original technique. The combined Scarf–Akin osteotomies were described for surgical correction of the hallux valgus, but with no significant consideration for the patient satisfaction. Patients and methods Twenty-three patients with unilateral painful hallux valgus deformity were treated with combined Scarf and Akin osteotomies. All patients were evaluated clinically (using American Orthopedic Foot and Ankle Society-Hallux Metatarsophalangeal–Interphalangeal scale scores) and radiologically (hallux valgus angle, intermetatarsal angle, union, evidence of degenerative changes, and joint congruity) after 12 months of follow-up. All the patients were then asked about their satisfaction and if they would undergo the same surgery under similar circumstances in the future. Results There were 15 females and eight males with an average age 38.8 ± 2.4 years. The mean preoperative American Orthopedic Foot and Ankle Society was 55.4 that significantly improved to 87.2 postoperatively (P<0.001). There was a significant reduction of the mean hallux valgus angle and the mean intermetatarsal angle preoperatively and postoperatively (P=0.03 and 0.034, respectively). One patient complained of a prominent screw postoperatively, while two patients suffered from superficial wound infection. At 12 months postoperatively, all operated patients were satisfied with their results and indicated that they would be happy to undergo surgery again under similar circumstances. Conclusion Despite the short follow-up period in our study, the combined Scarf and Akin osteotomies are a safe and effective method for treatment for hallux valgus deformity that provides statistically significant clinical and radiographic improvements with excellent patient satisfaction. Level of evidence Level-IV case-series study.
尽管围巾截骨术早在20世纪就被描述，但在对原始技术进行修改后，于2000年后期得到推广。联合Scarf-Akin截骨术用于拇外翻的手术矫正，但没有明显考虑患者的满意度。患者与方法对23例单侧疼痛性拇外翻畸形患者行Scarf联合Akin截骨术。随访12个月后，对所有患者进行临床评估(采用美国骨科足踝学会-拇跖指骨-指间量表评分)和影像学评估(拇外翻角、跖间角、愈合、退行性改变的证据和关节全齐性)。然后，所有的患者都被问及他们的满意度，以及他们是否会在未来类似的情况下接受同样的手术。结果女性15例，男性8例，平均年龄38.8±2.4岁。美国骨科足踝学会(American orthopaedic Foot and Ankle Society)术前平均评分为55.4分，术后平均评分为87.2分(P<0.001)。术前、术后平均拇外翻角、平均跖间角均明显减小(P=0.03、0.034)。1例患者术后螺钉突出，2例患者术后创面感染。术后12个月，所有患者均对手术结果满意，并表示愿意在类似情况下再次接受手术。结论尽管我们的研究随访时间较短，但联合Scarf和Akin截骨术是治疗拇外翻畸形的一种安全有效的方法，具有统计学意义的临床和影像学改善，患者满意度高。证据水平:iv级病例系列研究。
{"title":"Short-term evaluation of combined Scarf and Akin osteotomies for treatment of hallux valgus: a prospective study","authors":"A. Zakaria, El Sayed Bayomy","doi":"10.4103/eoj.eoj_20_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_20_22","url":null,"abstract":"Background Despite Scarf osteotomy was described earlier in the 20th century, it was popularized later in 2000 after modification of the original technique. The combined Scarf–Akin osteotomies were described for surgical correction of the hallux valgus, but with no significant consideration for the patient satisfaction. Patients and methods Twenty-three patients with unilateral painful hallux valgus deformity were treated with combined Scarf and Akin osteotomies. All patients were evaluated clinically (using American Orthopedic Foot and Ankle Society-Hallux Metatarsophalangeal–Interphalangeal scale scores) and radiologically (hallux valgus angle, intermetatarsal angle, union, evidence of degenerative changes, and joint congruity) after 12 months of follow-up. All the patients were then asked about their satisfaction and if they would undergo the same surgery under similar circumstances in the future. Results There were 15 females and eight males with an average age 38.8 ± 2.4 years. The mean preoperative American Orthopedic Foot and Ankle Society was 55.4 that significantly improved to 87.2 postoperatively (P<0.001). There was a significant reduction of the mean hallux valgus angle and the mean intermetatarsal angle preoperatively and postoperatively (P=0.03 and 0.034, respectively). One patient complained of a prominent screw postoperatively, while two patients suffered from superficial wound infection. At 12 months postoperatively, all operated patients were satisfied with their results and indicated that they would be happy to undergo surgery again under similar circumstances. Conclusion Despite the short follow-up period in our study, the combined Scarf and Akin osteotomies are a safe and effective method for treatment for hallux valgus deformity that provides statistically significant clinical and radiographic improvements with excellent patient satisfaction. Level of evidence Level-IV case-series study.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126270581","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 Distal radius fractures (DRFs) are commonly encountered in orthopedic practice, especially in elderly patients. A number of clinical papers have supported the idea that anatomic restoration of the distal end of the radius is essential to gain superior results. Purpose To introduce a systematic review and meta-analysis about the results of DRF treatment in the elderly with nonoperative treatment in comparison with percutaneous pinning. Patients and methods This meta-analysis and systematic review were conducted in accordance with PRISMA guidelines. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until November 2020, using combinations of the following search terms: DRF, wrist fractures, Colles fractures and Smith fractures, conservative treatment, nonoperative treatment, nonsurgical treatment, surgical treatment, operative, pinning, elderly, and older. Reference lists of relevant studies were manually searched. Results In total, five studies were included from 2005 to 2011 with total cases 265. There was statistically significant heterogeneity in the studies (I2=86.21%, P<0.0001). Using the random-effect model, the outcome results revealed that extension was significantly different in percutaneous pinning and casting group versus nonsurgical group (mean, 95% confidence interval: 69.89–93.69) with absence of publication bias. Conclusion The outcome results revealed that there was no significant difference between the nonsurgical and percutaneous pinning treatments of DRF in the elderly regarding grip strength, pronation, supination range of motion, and ulnar variance (pre). We also found that there was no clinically significant difference in the functional (Patient-Rated Wrist Evaluation and Disabilities of Arm, Shoulder and Hand) scores. Thus, the two methods have similar results.
{"title":"Comparison of treatment outcomes between nonsurgical and percutaneous pinning of distal radius fracture in elderly: systematic review and meta-analysis","authors":"Mohamed Hegazy, H. Farag, Ahmed Abdellatif","doi":"10.4103/eoj.eoj_117_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_117_21","url":null,"abstract":"Background Distal radius fractures (DRFs) are commonly encountered in orthopedic practice, especially in elderly patients. A number of clinical papers have supported the idea that anatomic restoration of the distal end of the radius is essential to gain superior results. Purpose To introduce a systematic review and meta-analysis about the results of DRF treatment in the elderly with nonoperative treatment in comparison with percutaneous pinning. Patients and methods This meta-analysis and systematic review were conducted in accordance with PRISMA guidelines. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until November 2020, using combinations of the following search terms: DRF, wrist fractures, Colles fractures and Smith fractures, conservative treatment, nonoperative treatment, nonsurgical treatment, surgical treatment, operative, pinning, elderly, and older. Reference lists of relevant studies were manually searched. Results In total, five studies were included from 2005 to 2011 with total cases 265. There was statistically significant heterogeneity in the studies (I2=86.21%, P<0.0001). Using the random-effect model, the outcome results revealed that extension was significantly different in percutaneous pinning and casting group versus nonsurgical group (mean, 95% confidence interval: 69.89–93.69) with absence of publication bias. Conclusion The outcome results revealed that there was no significant difference between the nonsurgical and percutaneous pinning treatments of DRF in the elderly regarding grip strength, pronation, supination range of motion, and ulnar variance (pre). We also found that there was no clinically significant difference in the functional (Patient-Rated Wrist Evaluation and Disabilities of Arm, Shoulder and Hand) scores. Thus, the two methods have similar results.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114802494","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 Fractures of the calcaneus pose a great challenge both to surgeons and patients. They are considered life-changing injuries. Anatomical reduction of fragments is one of the important variables affecting outcome. Extensile lateral approach has been used widely to facilitate good visualization and reduction. Skin complications like wound infection and dehiscence are a major concern. Therefore minimally invasive approaches came to fame. However, the use of less rigid fixation in minimally invasive techniques has led to inferior results. Aim The aim was to combine the merits of rigid fixation and minimally invasive approaches. Patients and methods Twenty-three patients with calcaneal fractures were operated upon and followed for a mean of 6 months. All patients were operated upon in the prone or lateral position under tourniquet. A miniopen sinus tarsi approach was used for fracture reduction and fixation. The latter was achieved using a calcaneal miniplate and screws. Patients were assessed radiographically for restoration of Bohler and Gissane angles, clinically using American Orthopedic Foot and Ankle Society score (AOFAS) and the visual analog score for pain. Results All patients showed a significant improvement in the mean Bohler and Gissane angles. The majority of the patients scored very good on the AOFAS score, the mean being 83 ± 4. The mean visual analog scale was 3. Mean time to full weight bearing was 12.5 ± 2 weeks after full radiological union was achieved. Conclusion Miniplate fixation through miniopen approach combines the merits of open reduction and internal fixation and minimally invasive techniques. Longer follow-up is however required to establish its superiority over screw-only fixation constructs.
{"title":"Open reduction and internal fixation of depressed intra-articular calcaneal fractures through a miniopen approach","authors":"Begad Abdelrazek, M. Waly","doi":"10.4103/eoj.eoj_3_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_3_22","url":null,"abstract":"Background Fractures of the calcaneus pose a great challenge both to surgeons and patients. They are considered life-changing injuries. Anatomical reduction of fragments is one of the important variables affecting outcome. Extensile lateral approach has been used widely to facilitate good visualization and reduction. Skin complications like wound infection and dehiscence are a major concern. Therefore minimally invasive approaches came to fame. However, the use of less rigid fixation in minimally invasive techniques has led to inferior results. Aim The aim was to combine the merits of rigid fixation and minimally invasive approaches. Patients and methods Twenty-three patients with calcaneal fractures were operated upon and followed for a mean of 6 months. All patients were operated upon in the prone or lateral position under tourniquet. A miniopen sinus tarsi approach was used for fracture reduction and fixation. The latter was achieved using a calcaneal miniplate and screws. Patients were assessed radiographically for restoration of Bohler and Gissane angles, clinically using American Orthopedic Foot and Ankle Society score (AOFAS) and the visual analog score for pain. Results All patients showed a significant improvement in the mean Bohler and Gissane angles. The majority of the patients scored very good on the AOFAS score, the mean being 83 ± 4. The mean visual analog scale was 3. Mean time to full weight bearing was 12.5 ± 2 weeks after full radiological union was achieved. Conclusion Miniplate fixation through miniopen approach combines the merits of open reduction and internal fixation and minimally invasive techniques. Longer follow-up is however required to establish its superiority over screw-only fixation constructs.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129812720","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 Osteoarthritis (OA) is a chronic disease that can be treated by several modality, one of which intra-articular injection. Hyaluronic acid (HA) and platelet-rich plasma (PRP) were approved in the management of OA grade 2 and grade 3 with good response. The aim of this study was to compare the effect of intra-articular injection of PRP versus HA in patients with knee OA grade 4. Patients and methods The study was carried out on 67 patients having knee OA grade 4, who were divided into two groups: group 1 included 33 patients who were treated with intra-articular injection of leukocyte-low PRP, and group 2 included 34 patients who were treated with intra-articular injection of high-molecular-weight hyaluronic acid. Both groups were evaluated according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and MRI before and 6 months after injection. Results In group 1, there were no statistically significant improvements in total WOMAC score and WOMAC score of pain, stiffness, and function in both knees and no statistically significant difference in cartilage thickness of the knee measured by MRI. In group 2, there were statistically significant improvement in total WOMAC score and WOMAC score of pain and function in both knees, no statistically significant improvement in WOMAC score of stiffness, and no statistically significant differences in cartilage thickness of the knee measured by MRI. Comparing the two groups, intra-articular injection of HA showed significant improvement than that of PRP in the management of grade 4 knees OA. Conclusions The effect of intra-articular injection of HA is better than that of PRP in the management of grade 4 knees OA.
骨关节炎(OA)是一种慢性疾病，可通过多种方式治疗，其中一种是关节内注射。透明质酸(HA)和富血小板血浆(PRP)被批准用于治疗2级和3级OA，疗效良好。本研究的目的是比较4级膝关节炎患者关节内注射PRP和HA的效果。患者与方法研究对象为67例膝关节骨性关节炎4级患者，分为2组:1组33例采用关节内注射低白细胞PRP治疗，2组34例采用关节内注射高分子量透明质酸治疗。两组分别在注射前和注射后6个月根据Western Ontario and McMaster university Osteoarthritis Index (WOMAC)和MRI进行评估。结果1组患者双膝疼痛、僵硬、功能的总WOMAC评分及WOMAC评分均无统计学意义改善，MRI测量膝关节软骨厚度差异无统计学意义。2组患者双膝总WOMAC评分、疼痛与功能WOMAC评分改善均有统计学意义，膝关节僵硬度WOMAC评分改善无统计学意义，膝关节MRI软骨厚度差异无统计学意义。两组比较，HA关节内注射治疗4级膝关节炎的效果明显优于PRP。结论关节内注射HA治疗4级膝关节炎的效果优于PRP。
{"title":"Intra-articular platelet-rich plasma versus hyaluronic acid injections in patients with advanced knee osteoarthritis","authors":"A. El-Zayat, Haytham El Sayed","doi":"10.4103/eoj.eoj_119_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_119_21","url":null,"abstract":"Background Osteoarthritis (OA) is a chronic disease that can be treated by several modality, one of which intra-articular injection. Hyaluronic acid (HA) and platelet-rich plasma (PRP) were approved in the management of OA grade 2 and grade 3 with good response. The aim of this study was to compare the effect of intra-articular injection of PRP versus HA in patients with knee OA grade 4. Patients and methods The study was carried out on 67 patients having knee OA grade 4, who were divided into two groups: group 1 included 33 patients who were treated with intra-articular injection of leukocyte-low PRP, and group 2 included 34 patients who were treated with intra-articular injection of high-molecular-weight hyaluronic acid. Both groups were evaluated according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and MRI before and 6 months after injection. Results In group 1, there were no statistically significant improvements in total WOMAC score and WOMAC score of pain, stiffness, and function in both knees and no statistically significant difference in cartilage thickness of the knee measured by MRI. In group 2, there were statistically significant improvement in total WOMAC score and WOMAC score of pain and function in both knees, no statistically significant improvement in WOMAC score of stiffness, and no statistically significant differences in cartilage thickness of the knee measured by MRI. Comparing the two groups, intra-articular injection of HA showed significant improvement than that of PRP in the management of grade 4 knees OA. Conclusions The effect of intra-articular injection of HA is better than that of PRP in the management of grade 4 knees OA.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128073179","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：