Background Ankle fracture in diabetic patients is a challenging condition owing to the inherent risk of complications with either operative or nonoperative treatment. However, operative treatment is considered the gold standard treatment for such cases. In this study, the hypothesis is that the glycated hemoglobin (HbA1c) could have a predictive value for postoperative outcomes and complications. Patients and methods A total of 34 diabetic patients with ankle fractures were included in this study. The patients are divided into two groups: the first group included patients with controlled diabetes (HbA1c<7) and the second group included patients with uncontrolled diabetes (HbA1c≥7). All patients were treated by standard open reduction and internal fixation. Results The complications rate was higher in the uncontrolled diabetes group (63.2%) than in the controlled diabetes group (26.6%). Preoperative HbA1c was higher in complicated patients than in uncomplicated patients (P=0.033), and postoperative HbA1c was also higher in complicated patients than in uncomplicated patients (P=0.031). The postoperative American Orthopedic Foot and Ankle Society (AOFAS) score was significantly higher in the controlled diabetes group than in the uncontrolled diabetes group (P=0.046). Conclusion The overall rate of complications was higher in the uncontrolled diabetes group (HbA1c≥7) than in the controlled diabetes group (HbA1c<7), with a statistically significant difference. These complications were mainly related to wound healing. Despite being statistically insignificant, poor radiological outcome was more common in the uncontrolled diabetes group. According to the postoperative AOFAS score, clinical outcome was more superior in the controlled diabetes group than in the uncontrolled diabetes group.
背景糖尿病患者踝关节骨折是一个具有挑战性的疾病，无论是手术治疗还是非手术治疗，都存在并发症的固有风险。然而，手术治疗被认为是这类病例的金标准治疗。在本研究中，假设糖化血红蛋白(HbA1c)对术后结局和并发症具有预测价值。患者与方法本研究共纳入34例糖尿病踝关节骨折患者。患者分为两组，第一组为控制糖尿病患者(HbA1c<7)，第二组为未控制糖尿病患者(HbA1c≥7)。所有患者均行标准切开复位内固定。结果糖尿病未控制组的并发症发生率(63.2%)高于糖尿病控制组(26.6%)。并发症患者术前HbA1c高于无并发症患者(P=0.033)，术后HbA1c高于无并发症患者(P=0.031)。糖尿病控制组术后美国骨科足踝学会(American Orthopedic Foot and Ankle Society, AOFAS)评分显著高于糖尿病未控制组(P=0.046)。结论糖尿病未控制组(HbA1c≥7)总并发症发生率高于糖尿病控制组(HbA1c<7)，差异有统计学意义。这些并发症主要与伤口愈合有关。尽管统计学上不显著，但不良的放射学结果在未控制的糖尿病组中更为常见。根据术后AOFAS评分，糖尿病控制组临床结局优于糖尿病未控制组。
{"title":"Glycated hemoglobin as a predictive factor for postoperative outcome in controlled versus uncontrolled diabetic patients with ankle fractures","authors":"A. Zakaria, A. Hussein, Mahmoud Abouzied","doi":"10.4103/eoj.eoj_18_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_18_22","url":null,"abstract":"Background Ankle fracture in diabetic patients is a challenging condition owing to the inherent risk of complications with either operative or nonoperative treatment. However, operative treatment is considered the gold standard treatment for such cases. In this study, the hypothesis is that the glycated hemoglobin (HbA1c) could have a predictive value for postoperative outcomes and complications. Patients and methods A total of 34 diabetic patients with ankle fractures were included in this study. The patients are divided into two groups: the first group included patients with controlled diabetes (HbA1c<7) and the second group included patients with uncontrolled diabetes (HbA1c≥7). All patients were treated by standard open reduction and internal fixation. Results The complications rate was higher in the uncontrolled diabetes group (63.2%) than in the controlled diabetes group (26.6%). Preoperative HbA1c was higher in complicated patients than in uncomplicated patients (P=0.033), and postoperative HbA1c was also higher in complicated patients than in uncomplicated patients (P=0.031). The postoperative American Orthopedic Foot and Ankle Society (AOFAS) score was significantly higher in the controlled diabetes group than in the uncontrolled diabetes group (P=0.046). Conclusion The overall rate of complications was higher in the uncontrolled diabetes group (HbA1c≥7) than in the controlled diabetes group (HbA1c<7), with a statistically significant difference. These complications were mainly related to wound healing. Despite being statistically insignificant, poor radiological outcome was more common in the uncontrolled diabetes group. According to the postoperative AOFAS score, clinical outcome was more superior in the controlled diabetes group than in the uncontrolled diabetes group.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"7 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":"123363237","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 Scapular fractures occur due to direct trauma to the upper-back area. The incidence of scapular fractures is rare, with 1% of all fractures and 3–5% of upper-limb fractures. Up to 88% of these fractures occur because of high-energy mechanisms, mostly coincidentally with rib fractures due to motor-vehicle crashes. Standard treatment of scapular fractures is still controversial. There was no consensus about the best indication for surgical management and therapeutic choice of the scapular fracture. Patients and methods This study is a retrospective review of 13 patients with comminuted scapular fracture type V. According to Ideberg classification, 11 males and two females with a mean age of 39.7 years (range, 25–62) were treated by open reduction and internal fixation using the modified Judet approach in the lateral position between March 2014 and April 2018. Results The time for surgery was 5.8 days (range, 2–15). All patients achieved radiological union in almost 12 weeks, ranging from 7 to 14 weeks. The average follow-up of the patients included in the study was 3 years. Conclusion Open reduction and internal fixation provide an excellent outcome in patients with comminuted intra-articular fracture scapula.
{"title":"Long-term outcome of open reduction and internal fixation of scapular fractures","authors":"A. Darwish","doi":"10.4103/eoj.eoj_8_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_8_22","url":null,"abstract":"Background Scapular fractures occur due to direct trauma to the upper-back area. The incidence of scapular fractures is rare, with 1% of all fractures and 3–5% of upper-limb fractures. Up to 88% of these fractures occur because of high-energy mechanisms, mostly coincidentally with rib fractures due to motor-vehicle crashes. Standard treatment of scapular fractures is still controversial. There was no consensus about the best indication for surgical management and therapeutic choice of the scapular fracture. Patients and methods This study is a retrospective review of 13 patients with comminuted scapular fracture type V. According to Ideberg classification, 11 males and two females with a mean age of 39.7 years (range, 25–62) were treated by open reduction and internal fixation using the modified Judet approach in the lateral position between March 2014 and April 2018. Results The time for surgery was 5.8 days (range, 2–15). All patients achieved radiological union in almost 12 weeks, ranging from 7 to 14 weeks. The average follow-up of the patients included in the study was 3 years. Conclusion Open reduction and internal fixation provide an excellent outcome in patients with comminuted intra-articular fracture scapula.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"31 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":"129187278","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 This study compares between the results of MRI and diagnostic arthroscopy of the knee to evaluate meniscal tears. Patients and methods A total of 32 patients who had undergone MRI of the knee between March 2018 and May 2020 were selected for the study in whom arthroscopy had also been performed. All knees had been investigated for possible meniscal tears. The MRI results were compared with those of arthroscopy. The arthroscopic results were used as the gold standard to recognize if meniscal tear is present or not. Of the 32 patients, 24 were males and eight were females. The average age was 31 years (range, 22–45 years). Patients who had a discoid lateral meniscus, history of meniscal surgery, or prior surgery on the injured knee were excluded from the study. The sensitivity, specificity, and accuracy were calculated based on arthroscopic findings. Results The time between MRI and arthroscopy was 7–10 weeks (average, 8 weeks). In certain cases, a difference was noted between the MRI and arthroscopic findings for revealing the meniscal tears. False-positive MRI result was found in one (3.1%) patient and false-negative MRI result was found in five (15.6%) patients. The accuracy of MRI in the evaluation of meniscal tears was 90.58%. Conclusions MRI is a noninvasive and exceptionally a sensitive method of investigation that may detect early and slight abnormalities within the menisci. However, MRI is not 100% accurate; if MRI result is reported as negative but the patient keeps complaining of continuing symptoms, then arthroscopy should be considered.
{"title":"MRI versus diagnostic arthroscopy of the knee to evaluate meniscal tears","authors":"H. Ali, Mohamed Yehya","doi":"10.4103/eoj.eoj_14_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_14_22","url":null,"abstract":"Background This study compares between the results of MRI and diagnostic arthroscopy of the knee to evaluate meniscal tears. Patients and methods A total of 32 patients who had undergone MRI of the knee between March 2018 and May 2020 were selected for the study in whom arthroscopy had also been performed. All knees had been investigated for possible meniscal tears. The MRI results were compared with those of arthroscopy. The arthroscopic results were used as the gold standard to recognize if meniscal tear is present or not. Of the 32 patients, 24 were males and eight were females. The average age was 31 years (range, 22–45 years). Patients who had a discoid lateral meniscus, history of meniscal surgery, or prior surgery on the injured knee were excluded from the study. The sensitivity, specificity, and accuracy were calculated based on arthroscopic findings. Results The time between MRI and arthroscopy was 7–10 weeks (average, 8 weeks). In certain cases, a difference was noted between the MRI and arthroscopic findings for revealing the meniscal tears. False-positive MRI result was found in one (3.1%) patient and false-negative MRI result was found in five (15.6%) patients. The accuracy of MRI in the evaluation of meniscal tears was 90.58%. Conclusions MRI is a noninvasive and exceptionally a sensitive method of investigation that may detect early and slight abnormalities within the menisci. However, MRI is not 100% accurate; if MRI result is reported as negative but the patient keeps complaining of continuing symptoms, then arthroscopy should be considered.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"76 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":"115670709","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 Although subtrochanteric valgus osteotomy is considered the standard surgical management of developmental coxa vara, the method of fixation of the osteotomy is still a debate. This study aimed to assess the results and to evaluate the efficacy of percutaneous osteotomy and fixation by monolateral external fixator for the treatment of developmental coxa vara. Patients and methods Between December 2017 and February 2020, we conducted a prospective study that involved 10 cases (four females and six males). The patients’ ages at the time of presentation ranged from 4.5 to 12 years with a mean of 6.7 years. All patients underwent percutaneous osteotomy and fixation by a monolateral external fixator. The mean follow-up period was 21 months (range, 14–28 months). Radiological evaluation depended on epiphyseal Hilgenreiner angle and neck-shaft angle, clinical evaluation depended on the IOWA score (it is the hip score of University of IOWA in USA). Results There was a significant improvement of the mean values of epiphyseal Hilgenreiner angle (80.6–29.1°), neck-shaft angle (86.9–129°), and IWOA score (58.4–92.2), there was one case of postoperative abductor tightening treated by abductor release and two cases of superficial pin-tract discharge treated by oral antibiotics and all three cases had excellent IOWA score at the last follow-up. Conclusion Using percutaneous valgus osteotomy and fixation by monolateral frame provides a reliable, less-invasive, low-cost option for the treatment of developmental coxa vara.
{"title":"Percutaneous osteotomy and simple monolateral frame for treatment of developmental coxa vara","authors":"A. Ramy, Mohammed H. Hashem","doi":"10.4103/eoj.eoj_19_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_19_22","url":null,"abstract":"Objectives Although subtrochanteric valgus osteotomy is considered the standard surgical management of developmental coxa vara, the method of fixation of the osteotomy is still a debate. This study aimed to assess the results and to evaluate the efficacy of percutaneous osteotomy and fixation by monolateral external fixator for the treatment of developmental coxa vara. Patients and methods Between December 2017 and February 2020, we conducted a prospective study that involved 10 cases (four females and six males). The patients’ ages at the time of presentation ranged from 4.5 to 12 years with a mean of 6.7 years. All patients underwent percutaneous osteotomy and fixation by a monolateral external fixator. The mean follow-up period was 21 months (range, 14–28 months). Radiological evaluation depended on epiphyseal Hilgenreiner angle and neck-shaft angle, clinical evaluation depended on the IOWA score (it is the hip score of University of IOWA in USA). Results There was a significant improvement of the mean values of epiphyseal Hilgenreiner angle (80.6–29.1°), neck-shaft angle (86.9–129°), and IWOA score (58.4–92.2), there was one case of postoperative abductor tightening treated by abductor release and two cases of superficial pin-tract discharge treated by oral antibiotics and all three cases had excellent IOWA score at the last follow-up. Conclusion Using percutaneous valgus osteotomy and fixation by monolateral frame provides a reliable, less-invasive, low-cost option for the treatment of developmental coxa vara.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"62 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":"124850348","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}
Coronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome-coronavirus-2). This virus uses as receptors the angiotensin-converting enzyme 2 and the transmembrane protease serine 2, which are also present in cells of the musculoskeletal system. Their presence can explain how coronavirus disease 2019 can cause general symptoms such as myalgia and arthralgia, as well as chronic back pain and articulation-specific symptoms such as shoulder capsulitis and hip and knee osteonecrosis.
{"title":"Coronavirus disease and the musculoskeletal system: a narrative review","authors":"M. Daher, A. Sebaaly","doi":"10.4103/eoj.eoj_34_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_34_22","url":null,"abstract":"Coronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome-coronavirus-2). This virus uses as receptors the angiotensin-converting enzyme 2 and the transmembrane protease serine 2, which are also present in cells of the musculoskeletal system. Their presence can explain how coronavirus disease 2019 can cause general symptoms such as myalgia and arthralgia, as well as chronic back pain and articulation-specific symptoms such as shoulder capsulitis and hip and knee osteonecrosis.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"6 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":"130583500","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 Acute patellar dislocation is a common knee injury. The main injured structure is the medial patellofemoral ligament (MPFL). This ligament is the main static stabilizer against lateral patellar dislocation. Many surgical techniques have been described for the management of MPFL tear. The gold standard graft used for reconstruction is the hamstring. This study was done to compare the results of quadriceps tendon sling with semitendinosus graft for MPFL reconstruction (MPFLR). Patients and methods A prospective comparative study was held on 62 patients in El-Hadra University hospital between March 2018 and November 2019. Patients were divided into two groups. Group A had quadriceps graft and group B had semitendinosus graft for MPFLR. Patients were matched for age, sex, and body mass index. All cases were assessed clinically and functionally over 12 months of follow-up. Results There was no statistically significant difference between the 2 groups regarding Lysholm, Tegner, International Knee Documentation Committee, Visual Analog Scale, and Kujala scores. However, there was a statistically significant difference regarding the SCAR score. Conclusion Quadriceps tendon sling is a reliable alternative for MPFLR, especially in patients with small patellae or previous anterior cruciate ligament reconstruction.
{"title":"Comparative study between quadriceps tendon sling and semitendinosus graft for medial patellofemoral ligament reconstruction","authors":"A. Waly","doi":"10.4103/eoj.eoj_128_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_128_21","url":null,"abstract":"Background Acute patellar dislocation is a common knee injury. The main injured structure is the medial patellofemoral ligament (MPFL). This ligament is the main static stabilizer against lateral patellar dislocation. Many surgical techniques have been described for the management of MPFL tear. The gold standard graft used for reconstruction is the hamstring. This study was done to compare the results of quadriceps tendon sling with semitendinosus graft for MPFL reconstruction (MPFLR). Patients and methods A prospective comparative study was held on 62 patients in El-Hadra University hospital between March 2018 and November 2019. Patients were divided into two groups. Group A had quadriceps graft and group B had semitendinosus graft for MPFLR. Patients were matched for age, sex, and body mass index. All cases were assessed clinically and functionally over 12 months of follow-up. Results There was no statistically significant difference between the 2 groups regarding Lysholm, Tegner, International Knee Documentation Committee, Visual Analog Scale, and Kujala scores. However, there was a statistically significant difference regarding the SCAR score. Conclusion Quadriceps tendon sling is a reliable alternative for MPFLR, especially in patients with small patellae or previous anterior cruciate ligament reconstruction.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113956216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Blood loss during total joint replacement has serious implications on patients affecting their ability to immediately start the postoperative enhanced recovery program. Tranexamic acid (TA) is well known for its ability to reduce blood loss during arthroplasty. Vitamin K has an important physiological role in the clotting cascade, but its action is delayed and dose sensitive. Study settings and design A prospective comparative study conducted in Benha University Hospital. Patients and methods In all, 150 patients were randomly divided into three groups, each included 50 patients. Group A received both TA and vitamin K1, group B received only vitamin K1, and group C received only TA. Perioperative blood parameters tested included hemoglobin level, hematocrit percentage, platelet count, prothrombin time, partial thromboplastin time, and fibrinogen level. Intraoperative and postoperative blood losses and the amount of blood transfusion were reported. A surgeon satisfaction score was created to assess the degree of intraoperative bleeding. Results The mean perioperative differences in blood parameters and amount of blood loss were evaluated with the post-hoc test. Group A showed a statistically significant less changes in blood parameters and less blood loss than the other groups, and group B showed less postoperative blood losses. Conclusion Combined administration of TA and vitamin K with cementless total hip replacement proved efficient in reducing intraoperative and postoperative blood losses and the need for blood transfusion. This was reflected on the patient’s ability to start the enhanced recovery program immediately, reduced the duration of postoperative hospital stay, and the overall cost of operation.
{"title":"Combined administration of tranexamic acid and vitamin K proved perioperative blood loss reduction with cementless total hip replacement: a prospective randomized controlled study","authors":"A. Khamis, Saad Shoulah, Dina Abdelhamid","doi":"10.4103/eoj.eoj_106_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_106_21","url":null,"abstract":"Introduction Blood loss during total joint replacement has serious implications on patients affecting their ability to immediately start the postoperative enhanced recovery program. Tranexamic acid (TA) is well known for its ability to reduce blood loss during arthroplasty. Vitamin K has an important physiological role in the clotting cascade, but its action is delayed and dose sensitive. Study settings and design A prospective comparative study conducted in Benha University Hospital. Patients and methods In all, 150 patients were randomly divided into three groups, each included 50 patients. Group A received both TA and vitamin K1, group B received only vitamin K1, and group C received only TA. Perioperative blood parameters tested included hemoglobin level, hematocrit percentage, platelet count, prothrombin time, partial thromboplastin time, and fibrinogen level. Intraoperative and postoperative blood losses and the amount of blood transfusion were reported. A surgeon satisfaction score was created to assess the degree of intraoperative bleeding. Results The mean perioperative differences in blood parameters and amount of blood loss were evaluated with the post-hoc test. Group A showed a statistically significant less changes in blood parameters and less blood loss than the other groups, and group B showed less postoperative blood losses. Conclusion Combined administration of TA and vitamin K with cementless total hip replacement proved efficient in reducing intraoperative and postoperative blood losses and the need for blood transfusion. This was reflected on the patient’s ability to start the enhanced recovery program immediately, reduced the duration of postoperative hospital stay, and the overall cost of operation.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"169 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132162727","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 In elderly patients, distal femoral fractures are mostly related to osteoporosis. Osteoporosis weakens the supracondylar region, resulting in complex intra-articular fractures and metaphyseal comminution. The prevalence of knee osteoarthritis (OA) in this age group may affect the final functional outcome after fixation. The study assessed the relationship between pre-injury OA stage and postoperative functional outcome after fracture fixation by monoaxial lock plates. Patients and methods A prospective study was conducted between November 2016 and May 2019. A total of 38 cases of distal femoral joint fractures, including 18 extra-articular fractures (group-1; 33-A) with an average age of 67.6 ± 4 years and 20 cases of complete articular fractures (group-2; 33-C) with mean age of 69.2 ± 2.9 years, were included. Domestic fall was the mode of trauma, and the fractures were treated with a monoaxial distal femoral locked compression plate through a mini-invasive incision. Pre-injury knee conditions were assessed according to Knee Injury and Osteoarthritis Outcome Score. The final 1-year outcome was assessed using the Knee Society Score systems. Results In extra-joint fractures, the mean healing time was 17.6 ± 1.1 weeks (16–20 weeks), and in the complete articular fractures, the mean healing time was 23 ± 2.3 weeks (20–30 weeks). Complications were recorded as a single case of nonunion development that needed revision and grafting, and the union was achieved 20 weeks later. Joint line pain was observed in 15 (39%) of all patients. The final result of the Knee Society Score system for group 1 fractures was 74.7 ± 8.3 (60–90), and the mean for group 2 was 65.2 ± 9.5 (50–80). P value was less than 0.001. A clear correlation between the degree of pre-injury OA (Knee Injury and Osteoarthritis Outcome Score) and the final functional outcome (P=0.7) was identified, regardless of the severity of the fracture. Conclusion Monoaxial locking plate fixation for distal femoral fractures in the elderly population is a stable construct to stabilize this osteoporotic bone. It allows sound healing; however, the functional outcome is affected by the pre-injury joint OA.
{"title":"Is geriatric patient satisfaction related to pre-injury osteoarthritis after locking plate fixation for distal femoral fractures?","authors":"Ihab I El-Desouky, K. Hafez, Ayman A. Shaheen","doi":"10.4103/eoj.eoj_4_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_4_22","url":null,"abstract":"Objectives In elderly patients, distal femoral fractures are mostly related to osteoporosis. Osteoporosis weakens the supracondylar region, resulting in complex intra-articular fractures and metaphyseal comminution. The prevalence of knee osteoarthritis (OA) in this age group may affect the final functional outcome after fixation. The study assessed the relationship between pre-injury OA stage and postoperative functional outcome after fracture fixation by monoaxial lock plates. Patients and methods A prospective study was conducted between November 2016 and May 2019. A total of 38 cases of distal femoral joint fractures, including 18 extra-articular fractures (group-1; 33-A) with an average age of 67.6 ± 4 years and 20 cases of complete articular fractures (group-2; 33-C) with mean age of 69.2 ± 2.9 years, were included. Domestic fall was the mode of trauma, and the fractures were treated with a monoaxial distal femoral locked compression plate through a mini-invasive incision. Pre-injury knee conditions were assessed according to Knee Injury and Osteoarthritis Outcome Score. The final 1-year outcome was assessed using the Knee Society Score systems. Results In extra-joint fractures, the mean healing time was 17.6 ± 1.1 weeks (16–20 weeks), and in the complete articular fractures, the mean healing time was 23 ± 2.3 weeks (20–30 weeks). Complications were recorded as a single case of nonunion development that needed revision and grafting, and the union was achieved 20 weeks later. Joint line pain was observed in 15 (39%) of all patients. The final result of the Knee Society Score system for group 1 fractures was 74.7 ± 8.3 (60–90), and the mean for group 2 was 65.2 ± 9.5 (50–80). P value was less than 0.001. A clear correlation between the degree of pre-injury OA (Knee Injury and Osteoarthritis Outcome Score) and the final functional outcome (P=0.7) was identified, regardless of the severity of the fracture. Conclusion Monoaxial locking plate fixation for distal femoral fractures in the elderly population is a stable construct to stabilize this osteoporotic bone. It allows sound healing; however, the functional outcome is affected by the pre-injury joint OA.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129853881","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}
Elhussein Elgengehy, Z. Little, S. Munshi, R. Nair, N. Little, G. Talawadekar
Background Tears of the distal biceps tendon are unusual and most often result from an injury or lifting a heavy object. These tears are usually complete and the muscle is separated from the bone and retracted back, causing weakness in supination and mid-prone elbow flexion. We present our results of patients undergoing repairs of these tears using the tension slide technique through a single longitudinal anterior incision who were followed up for a minimum of 1 year. Patients and methods A total of 17 patients with acute distal biceps tendon rupture were treated surgically by two surgeons, at two independent centers, using the tension slide technique (Arthrex) between 2017 and 2019. Patients were evaluated retrospectively at a minimum of 1-year follow-up using the patient-reported outcomes Quick Disabilities of the Arm, Shoulder, and Hand (DASH), Oxford elbow score (OES) and EQ-5D-5L. Results The average age at the time of injury was 49 years. All patients were right-hand dominant. Eleven injuries were on the right and remaining on the left side. All patients were males, and there was no documented history of anabolic steroid use. The average time to surgery, following injury, was 6 weeks. The mean postoperative DASH score was 4.4, the average OES was 49.17, and mean European quality of life five dimension (EQ5D) Vas was 84. The elbow range of motion (ROM) was comparable to the healthy contralateral side. There were no reported major complications, although we did have two (11%) minor complications: one case with delayed wound healing and the second patient with a delayed infection, treated with oral antibiotics for 14 days. Conclusions The utilization of the tension slide technique for repair of acute distal tendon biceps rupture using Endobutton and interference screw is safe. The complications were minor, and the function was excellent as reflected with OES and DASH scores.
{"title":"One-year minimum follow-up results following distal biceps tendon repair using tension slide technique","authors":"Elhussein Elgengehy, Z. Little, S. Munshi, R. Nair, N. Little, G. Talawadekar","doi":"10.4103/eoj.eoj_2_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_2_22","url":null,"abstract":"Background Tears of the distal biceps tendon are unusual and most often result from an injury or lifting a heavy object. These tears are usually complete and the muscle is separated from the bone and retracted back, causing weakness in supination and mid-prone elbow flexion. We present our results of patients undergoing repairs of these tears using the tension slide technique through a single longitudinal anterior incision who were followed up for a minimum of 1 year. Patients and methods A total of 17 patients with acute distal biceps tendon rupture were treated surgically by two surgeons, at two independent centers, using the tension slide technique (Arthrex) between 2017 and 2019. Patients were evaluated retrospectively at a minimum of 1-year follow-up using the patient-reported outcomes Quick Disabilities of the Arm, Shoulder, and Hand (DASH), Oxford elbow score (OES) and EQ-5D-5L. Results The average age at the time of injury was 49 years. All patients were right-hand dominant. Eleven injuries were on the right and remaining on the left side. All patients were males, and there was no documented history of anabolic steroid use. The average time to surgery, following injury, was 6 weeks. The mean postoperative DASH score was 4.4, the average OES was 49.17, and mean European quality of life five dimension (EQ5D) Vas was 84. The elbow range of motion (ROM) was comparable to the healthy contralateral side. There were no reported major complications, although we did have two (11%) minor complications: one case with delayed wound healing and the second patient with a delayed infection, treated with oral antibiotics for 14 days. Conclusions The utilization of the tension slide technique for repair of acute distal tendon biceps rupture using Endobutton and interference screw is safe. The complications were minor, and the function was excellent as reflected with OES and DASH scores.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132659837","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}
Hydatid disease is a zoonosis that is caused by parasites that belong to the Echinococcus species of the Taeniidae family of cestodes. Echinococcus cysts are caused by dog tapeworms and it is found in many low income areas. We present a case of a South African woman with extensive hydatid disease of the pelvis.
{"title":"Case report: South African female with pelvic hydatid disease","authors":"Nabeela Adam","doi":"10.4103/eoj.eoj_137_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_137_21","url":null,"abstract":"Hydatid disease is a zoonosis that is caused by parasites that belong to the Echinococcus species of the Taeniidae family of cestodes. Echinococcus cysts are caused by dog tapeworms and it is found in many low income areas. We present a case of a South African woman with extensive hydatid disease of the pelvis.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116440055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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