Background and aim A rotator cuff injury has a significant effect on the quality of life and overall health of patients. Surgical treatment for rotator cuff disease has been found to enhance general health and shoulder discomfort. The surgical repair of rotator cuff tears can be divided into three categories: open, mini-open, and arthroscopic. Independent studies comparing the long-term success of arthroscopically repaired rotator cuff injuries in terms of cuff integrity and clinical outcomes found that arthroscopically repaired rotator cuff injuries have success rates comparable to mini-open and open operations. As a result, the goal of this study was to compare the outcomes of open versus arthroscopic rotator cuff repair operations. Patients and methods A prospective cohort study was performed on 40 rotator cuff repair cases over a period of 18 months from January 2019 to June 2020 after obtaining approval from the local ethics committee. All included patients were divided into two groups: group A included 20 patients who had a single raw, arthroscopic rotator cuff repair, and group B included 20 patients who had an open rotator cuff repair by anchor sutures and acromioplasty. Data of shoulder side, admission date, discharge date, hospital stay duration, postoperative analgesia, procedure duration, intraoperative and postoperative complications, visual analog scale (VAS), and simple shoulder test were obtained for all patients. Results There were no significant changes in pain score VAS preoperatively and postoperatively or intraoperative and postoperative complications between the groups tested. Conclusion Arthroscopy repair and open repair are associated with similar clinical outcomes. No statistically significant differences were found in outcomes of postoperative simple shoulder test score, pain score VAS, and complications.
{"title":"Outcomes of all arthroscopic versus open rotator cuff repair","authors":"M. Saleh, M. Fadel","doi":"10.4103/eoj.eoj_126_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_126_21","url":null,"abstract":"Background and aim A rotator cuff injury has a significant effect on the quality of life and overall health of patients. Surgical treatment for rotator cuff disease has been found to enhance general health and shoulder discomfort. The surgical repair of rotator cuff tears can be divided into three categories: open, mini-open, and arthroscopic. Independent studies comparing the long-term success of arthroscopically repaired rotator cuff injuries in terms of cuff integrity and clinical outcomes found that arthroscopically repaired rotator cuff injuries have success rates comparable to mini-open and open operations. As a result, the goal of this study was to compare the outcomes of open versus arthroscopic rotator cuff repair operations. Patients and methods A prospective cohort study was performed on 40 rotator cuff repair cases over a period of 18 months from January 2019 to June 2020 after obtaining approval from the local ethics committee. All included patients were divided into two groups: group A included 20 patients who had a single raw, arthroscopic rotator cuff repair, and group B included 20 patients who had an open rotator cuff repair by anchor sutures and acromioplasty. Data of shoulder side, admission date, discharge date, hospital stay duration, postoperative analgesia, procedure duration, intraoperative and postoperative complications, visual analog scale (VAS), and simple shoulder test were obtained for all patients. Results There were no significant changes in pain score VAS preoperatively and postoperatively or intraoperative and postoperative complications between the groups tested. Conclusion Arthroscopy repair and open repair are associated with similar clinical outcomes. No statistically significant differences were found in outcomes of postoperative simple shoulder test score, pain score VAS, and complications.","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":"122212911","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 Several graft options exist for ACL. The traditional options are patellar tendon (PT), hamstring tendons (HT) and quadriceps tendon (QT). Nevertheless, they have some disadvantages. In recent decades, several efforts were exerted to find more graft sources for ACL reconstruction. One of these grafts is the peroneus longus tendon (PLT) autograft. This study was done to compare the results of soft tissue grafts; HT, PLT and QT for ACLR. Patients and Methods This is a prospective comparative study over 75 patients with deficient anterior cruciate ligament. Patients were admitted to El Hadra University Hospital between June 2019 till September 2020. Patients were classified randomly into 3 groups. The first group (Group A) were treated with ACLR using hamstring tendon (n=25). The second group (Group B) were treated using peroneus longus autograft (n=25). The third group (Group C) were treated using quadriceps tendon graft. All groups were matched for age, gender and duration from injury to surgery. Functional evaluation was done using Lysholm score, modified Cincinnati scale, IKDC score and VAS. The functional score of the ankle was assessed with the American Orthopedic Foot and Ankle Score and the Foot and Ankle Disability Index score at the end of follow up. Results There was no statistically significant difference between the 2 groups regarding the Lysholm, Tegner, IKDC, VAS, Kujala scores. However, there was a statistically significant difference regarding the SCAR score. Conclusion Peroneus longus tendon is a reliable alternative for ACL reconstruction especially in patients with inadequate or prematurely amputated hamstring autograft.
ACL有几种移植选择。传统的选择是髌骨肌腱(PT)，腘绳肌腱(HT)和股四头肌肌腱(QT)。然而，它们也有一些缺点。近几十年来，为寻找更多ACL重建的移植物来源进行了多次努力。其中一种是腓骨长肌腱(PLT)自体移植。本研究是为了比较软组织移植的结果;ACLR的HT、PLT和QT。患者和方法:对75例前交叉韧带缺损患者进行前瞻性比较研究。患者于2019年6月至2020年9月期间入住埃尔哈德拉大学医院。患者随机分为3组。第一组(A组)采用腘绳肌腱ACLR治疗(n=25)。第二组(B组)采用自体腓骨长肌移植治疗(n=25)。第三组(C组)采用股四头肌肌腱移植治疗。所有组的年龄、性别和从受伤到手术的持续时间都是匹配的。功能评价采用Lysholm评分、改良辛辛那提量表、IKDC评分和VAS。随访结束时采用American Orthopedic Foot and ankle score和Foot and ankle Disability Index评分评估踝关节功能评分。结果两组患者Lysholm、Tegner、IKDC、VAS、Kujala评分比较，差异均无统计学意义。然而，在SCAR评分方面存在统计学上的显著差异。结论腓骨长肌腱是前交叉韧带重建的可靠选择，特别是在腘绳肌腱移植不充分或过早截肢的患者中。
{"title":"Comparative study between peroneus longus, semitendinosus tendon, and quadriceps tendon graft for anterior cruciate ligament reconstruction: short-term results","authors":"A. Waly, H. Gawish","doi":"10.4103/eoj.eoj_127_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_127_21","url":null,"abstract":"Background Several graft options exist for ACL. The traditional options are patellar tendon (PT), hamstring tendons (HT) and quadriceps tendon (QT). Nevertheless, they have some disadvantages. In recent decades, several efforts were exerted to find more graft sources for ACL reconstruction. One of these grafts is the peroneus longus tendon (PLT) autograft. This study was done to compare the results of soft tissue grafts; HT, PLT and QT for ACLR. Patients and Methods This is a prospective comparative study over 75 patients with deficient anterior cruciate ligament. Patients were admitted to El Hadra University Hospital between June 2019 till September 2020. Patients were classified randomly into 3 groups. The first group (Group A) were treated with ACLR using hamstring tendon (n=25). The second group (Group B) were treated using peroneus longus autograft (n=25). The third group (Group C) were treated using quadriceps tendon graft. All groups were matched for age, gender and duration from injury to surgery. Functional evaluation was done using Lysholm score, modified Cincinnati scale, IKDC score and VAS. The functional score of the ankle was assessed with the American Orthopedic Foot and Ankle Score and the Foot and Ankle Disability Index score at the end of follow up. Results There was no statistically significant difference between the 2 groups regarding the Lysholm, Tegner, IKDC, VAS, Kujala scores. However, there was a statistically significant difference regarding the SCAR score. Conclusion Peroneus longus tendon is a reliable alternative for ACL reconstruction especially in patients with inadequate or prematurely amputated hamstring autograft.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"54 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":"132844527","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 Carpometacarpal (CMC) joint fracture–dislocation of the second to the fifth finger is a rare hand injury associated with high-energy trauma. Due to severe swelling and overlapping of bones on the radiograph of the wrist–hand, dislocations are missed. We reported on a series of eight patients with CMC joint fracture–dislocation treated with closed reduction and percutaneous K-wire fixation. Patients and methods Eight cases of CMC joint fracture–dislocation were retrospectively studied. All patients were treated with closed reduction and fixation with K-wire. Functional assessment was done with Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Results The average QuickDASH score was observed to have improved from 75.76 to 1.9 from 6 weeks to 14 months of duration. Of the eight patients, three patients had a QuickDASH score of 0 at the end of 14 months. Conclusions Careful hand examination and radiographic assessment are necessary to avoid a missed diagnosis of CMC joint fracture–dislocation. Early closed reduction and fixation lead to excellent recovery of hand function.
{"title":"Carpometacarpal joint fracture–dislocation of the second to fifth finger","authors":"M. Safy","doi":"10.4103/eoj.eoj_140_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_140_21","url":null,"abstract":"Background Carpometacarpal (CMC) joint fracture–dislocation of the second to the fifth finger is a rare hand injury associated with high-energy trauma. Due to severe swelling and overlapping of bones on the radiograph of the wrist–hand, dislocations are missed. We reported on a series of eight patients with CMC joint fracture–dislocation treated with closed reduction and percutaneous K-wire fixation. Patients and methods Eight cases of CMC joint fracture–dislocation were retrospectively studied. All patients were treated with closed reduction and fixation with K-wire. Functional assessment was done with Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Results The average QuickDASH score was observed to have improved from 75.76 to 1.9 from 6 weeks to 14 months of duration. Of the eight patients, three patients had a QuickDASH score of 0 at the end of 14 months. Conclusions Careful hand examination and radiographic assessment are necessary to avoid a missed diagnosis of CMC joint fracture–dislocation. Early closed reduction and fixation lead to excellent recovery of hand function.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"16 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":"121168302","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}
H. Hussein, Mohamed El-Hariry, Mostafa Awad, F. Hayyawi, Mohamed Hussein
Acetabular fractures in pregnant patients are usually rare scenarios. The management of traumatized pregnant patients is challenging due to their specific physiological and anatomical body changes, the possible exposure to teratogenic radiation, and risky therapeutic interventions. We report a 27-year-old pregnant patient with a gestational age of 22 weeks presented with a T-shape acetabular fracture after road traffic accident. The fracture was surgically managed by open reduction and internal fixation using combined posterior and modified Stoppa approaches to the acetabulum. A normal viable infant was delivered through cesarian delivery 10 weeks after trauma. Modified Stoppa approach for acetabulum can be used safely in acetabular fracture fixation in pregnant patients with less invasiveness, similar scar of cesarian section, better visualization of the quadrilateral plate of the acetabulum, and less maternal morbidity.
{"title":"Modified Stoppa approach for acetabular fracture in a pregnant patient: case report and review of literature","authors":"H. Hussein, Mohamed El-Hariry, Mostafa Awad, F. Hayyawi, Mohamed Hussein","doi":"10.4103/eoj.eoj_13_22","DOIUrl":"https://doi.org/10.4103/eoj.eoj_13_22","url":null,"abstract":"Acetabular fractures in pregnant patients are usually rare scenarios. The management of traumatized pregnant patients is challenging due to their specific physiological and anatomical body changes, the possible exposure to teratogenic radiation, and risky therapeutic interventions. We report a 27-year-old pregnant patient with a gestational age of 22 weeks presented with a T-shape acetabular fracture after road traffic accident. The fracture was surgically managed by open reduction and internal fixation using combined posterior and modified Stoppa approaches to the acetabulum. A normal viable infant was delivered through cesarian delivery 10 weeks after trauma. Modified Stoppa approach for acetabulum can be used safely in acetabular fracture fixation in pregnant patients with less invasiveness, similar scar of cesarian section, better visualization of the quadrilateral plate of the acetabulum, and less maternal morbidity.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"135 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":"117339321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-21DOI: 10.21203/rs.3.rs-1239613/v1
Ihab I El-Desouky
Background Adults commonly develop isolated patellofemoral arthritis (PFA). Platelet-rich plasma (PRP) was beneficial in the conservative treatment of tibiofemoral knee osteoarthritis. This study compares patient complaints prior to and following PRP injection for isolated PFA during conservative treatment. Patients and methods The study included 18 female patients with unilateral PFA between the ages of 25 and 40. They received a single dose of PRP injections after failing to respond to conservative treatment. The outcome measures, which included the visual analog scale and Kujala scores, were compared with a matched group of 18 patients managed conservatively but successfully. Both groups got the same physiotherapy treatment and kept up with it, until the final assessment for a year. Results At the final follow-up, the PRP group’s visual analog scale was significantly improved compared with their pre-injection status, with a P value of 0.001. However, no statistically significant difference was evident between the PRP and the non-PRP groups that improved with conservative treatment (P>0.9). Comparable results were present between the two groups’ Kujala scores. Conclusion Patients with isolated PFA who do not respond to conservative treatment may benefit from a single PRP injection, which may postpone or eliminate the need for surgical treatment. Level of evidence: III, a retrospective case–control study.
{"title":"Effectiveness of intra-articular injection of platelet-rich plasma in isolated patellofemoral arthritis","authors":"Ihab I El-Desouky","doi":"10.21203/rs.3.rs-1239613/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-1239613/v1","url":null,"abstract":"Background Adults commonly develop isolated patellofemoral arthritis (PFA). Platelet-rich plasma (PRP) was beneficial in the conservative treatment of tibiofemoral knee osteoarthritis. This study compares patient complaints prior to and following PRP injection for isolated PFA during conservative treatment. Patients and methods The study included 18 female patients with unilateral PFA between the ages of 25 and 40. They received a single dose of PRP injections after failing to respond to conservative treatment. The outcome measures, which included the visual analog scale and Kujala scores, were compared with a matched group of 18 patients managed conservatively but successfully. Both groups got the same physiotherapy treatment and kept up with it, until the final assessment for a year. Results At the final follow-up, the PRP group’s visual analog scale was significantly improved compared with their pre-injection status, with a P value of 0.001. However, no statistically significant difference was evident between the PRP and the non-PRP groups that improved with conservative treatment (P>0.9). Comparable results were present between the two groups’ Kujala scores. Conclusion Patients with isolated PFA who do not respond to conservative treatment may benefit from a single PRP injection, which may postpone or eliminate the need for surgical treatment. Level of evidence: III, a retrospective case–control study.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123047185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The advantages of minimally invasive plate osteosynthesis (MIPO) are less soft tissue dissection and less blood loss with excellent results. This study aims to assess the outcomes of MIPO in treating humeral shaft fractures. Patients and methods Anterior MIPO was performed on 30 patients from March 2017 to January 2019. The inclusion criteria for this prospective study included a fracture located at the middle third of the humeral shaft, a fracture with polytrauma, and fractures with early conservative treatment failure. Type A fracture was the most common according to the AO-OTA classification (13 cases), followed by type B (11 cases) and type C (six cases). The space between biceps and brachialis was identified, and a locking compression plate or limited contact dynamic compression plate was used. The minimum follow-up period was 1 year. The outcome measurements included fracture union, alignment, infection, range of motion, functional assessment as per the University of California at Los Angeles shoulder score, and elbow function as evaluated using the Mayo elbow performance index. Results The mean operation time was 90.30 min (range, 80–180 min), and mean radiation exposure was 204 s (range, 110—420 s). All fractures united. The mean fracture union time was 15.3 weeks (range, 10–18 weeks). There was no incidence of implant failures. The mean University of California at Los Angeles end-result score was 34 points (range, 32–35). The mean Mayo elbow performance index was 98 points (range, 90–100). The mean range of motion was 135° (range, 100–140°). The functional outcome was satisfactory. Conclusion MIPO is an excellent method for treating humeral shaft fractures. It might decrease the perioperative complications with a reduced operation time.
{"title":"Evaluation of the results of anterior minimally invasive plate osteosynthesis in treating humeral shaft fractures","authors":"H. Ali, Mohamed Yehya","doi":"10.4103/eoj.eoj_114_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_114_21","url":null,"abstract":"Background The advantages of minimally invasive plate osteosynthesis (MIPO) are less soft tissue dissection and less blood loss with excellent results. This study aims to assess the outcomes of MIPO in treating humeral shaft fractures. Patients and methods Anterior MIPO was performed on 30 patients from March 2017 to January 2019. The inclusion criteria for this prospective study included a fracture located at the middle third of the humeral shaft, a fracture with polytrauma, and fractures with early conservative treatment failure. Type A fracture was the most common according to the AO-OTA classification (13 cases), followed by type B (11 cases) and type C (six cases). The space between biceps and brachialis was identified, and a locking compression plate or limited contact dynamic compression plate was used. The minimum follow-up period was 1 year. The outcome measurements included fracture union, alignment, infection, range of motion, functional assessment as per the University of California at Los Angeles shoulder score, and elbow function as evaluated using the Mayo elbow performance index. Results The mean operation time was 90.30 min (range, 80–180 min), and mean radiation exposure was 204 s (range, 110—420 s). All fractures united. The mean fracture union time was 15.3 weeks (range, 10–18 weeks). There was no incidence of implant failures. The mean University of California at Los Angeles end-result score was 34 points (range, 32–35). The mean Mayo elbow performance index was 98 points (range, 90–100). The mean range of motion was 135° (range, 100–140°). The functional outcome was satisfactory. Conclusion MIPO is an excellent method for treating humeral shaft fractures. It might decrease the perioperative complications with a reduced operation time.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126712397","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 Medial meniscus root tears usually lead to loss of hoop tension of the meniscus and result in high-contact pressure in the medial compartment of the knee. Surgical management of those types of tears is mandatory to restore hope tension and to save medial compartment. This study was done to evaluate the necessity of medial root repair with high tibial osteotomy (HTO) for treatment of medial meniscus root tears. Patients and methods This is a prospective comparative study over 60 patients with medial meniscal root tears. The patients were classified randomly into three groups. The first group (group A) was treated with isolated medial meniscus posterior root tear repair (n=20). The second group (group B) was treated with isolated open-wedge high HTO (n=20). The third group (group C) was treated using combined medial meniscal root repair with high tibial open-wedge osteotomy (n=20). A clinical evaluation was made using range of motion (ROM) and pain assessment. Functional evaluation was done using Lysholm score and Hospital for Special Surgery score. Radiological evaluation was done using follow-up standing Lyon–Schuss films. Results Regarding the patients’ reported outcome measures, one-way analysis of variance was calculated to compare means between the three groups. The results of isolated root repair were the worst and there was no statistically significant difference between groups B and C. Conclusion Results recommend isolated HTO as a solo fast-attack procedure with reliable durable clinical and radiological outcomes for the treatment of root tears of the posterior horn of the medial meniscus.
背景:内侧半月板根撕裂通常导致半月板环张力的丧失，并导致膝关节内侧腔室的高接触压力。手术治疗这些类型的撕裂是必要的，以恢复希望张力和保存内侧隔室。本研究旨在评估采用胫骨高位截骨术(HTO)治疗内侧半月板根撕裂的必要性。患者和方法:本研究对60例半月板内侧根撕裂患者进行前瞻性比较研究。患者随机分为三组。第一组(A组)采用孤立的内侧半月板后根撕裂修复术(n=20)。第二组(B组)采用离体开楔形高HTO治疗(n=20)。第三组(C组)采用内侧半月板根修复联合胫骨高位开楔截骨术(n=20)。使用活动度(ROM)和疼痛评估进行临床评估。功能评价采用Lysholm评分和Hospital for Special Surgery评分。放射学评价采用随访立片Lyon-Schuss。结果对患者报告的结局指标进行单因素方差分析，比较三组间的均数。B组和c组间的差异无统计学意义。结论:推荐孤立HTO作为治疗内侧半月板后角根撕裂的快速治疗方法，具有可靠、持久的临床和放射学结果。
{"title":"Comparative study between isolated medial meniscus root repair versus open-wedge high tibial osteotomy versus combined approach in patients with root tears, 2-year follow-up","authors":"A. Waly","doi":"10.4103/eoj.eoj_130_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_130_21","url":null,"abstract":"Background Medial meniscus root tears usually lead to loss of hoop tension of the meniscus and result in high-contact pressure in the medial compartment of the knee. Surgical management of those types of tears is mandatory to restore hope tension and to save medial compartment. This study was done to evaluate the necessity of medial root repair with high tibial osteotomy (HTO) for treatment of medial meniscus root tears. Patients and methods This is a prospective comparative study over 60 patients with medial meniscal root tears. The patients were classified randomly into three groups. The first group (group A) was treated with isolated medial meniscus posterior root tear repair (n=20). The second group (group B) was treated with isolated open-wedge high HTO (n=20). The third group (group C) was treated using combined medial meniscal root repair with high tibial open-wedge osteotomy (n=20). A clinical evaluation was made using range of motion (ROM) and pain assessment. Functional evaluation was done using Lysholm score and Hospital for Special Surgery score. Radiological evaluation was done using follow-up standing Lyon–Schuss films. Results Regarding the patients’ reported outcome measures, one-way analysis of variance was calculated to compare means between the three groups. The results of isolated root repair were the worst and there was no statistically significant difference between groups B and C. Conclusion Results recommend isolated HTO as a solo fast-attack procedure with reliable durable clinical and radiological outcomes for the treatment of root tears of the posterior horn of the medial meniscus.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"129 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115382046","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 Displaced femoral neck fractures (DFNFs) are increasingly common in elderly patients. Hip arthroplasty, the recommended treatment of DFNF, consists of the total hip arthroplasty (THA) and hemiarthroplasty (HA). THA is superior to HA in younger patients. However, there are concerns whether the more substantial surgical trauma and higher dislocation rate would trade off the advantages of THA due to frailty and lower physical demands in the elderly over 75 years. Objective This study was designed to compare the clinical score, dislocation rate, and functional outcome between the dual mobility total hip replacement and the bipolar hemiarthroplasty (BHA) in the treatment of FNFs and which of them is more successful. Patients and methods A comparative randomized prospective study was conducted on 50 patients with DFNFs. All cases were operated upon in Helwan University Hospitals, divided them into two equal groups: the first group was treated by total hip replacement with a dual mobility cup (DMC) and the second group was treated by BHA. Full analysis of history detailed examination and primarily samples are taken during the period study from February 2020 to April 2021. Results There is a statistically significant improvement in modified Harris hip score (MHHS) in the last follow-up at 9 months later in favor to DMC group compared with BHA group (P<0.001). The postoperative MHHS in the last follow-up of DMC ranged from 68 to 92 with the mean of 85.96±5.47, whereas in BHA group, ranged from 60 to 89 with the mean of 78.04±8.40. Conclusion THA may be a preferred management option for active elderly patients over 75 years, which can provide superior hip function and life quality with acceptable risks. Strict management should be followed to prevent dislocation after a THA, especially within the first 6 months.
{"title":"Hemiarthroplasty vs. tripolar total hip arthroplasty in the treatment of displaced femoral neck fractures in old-age patients","authors":"Mohammed Rabie Saleh, Anas Mansour Nasser","doi":"10.4103/eoj.eoj_115_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_115_21","url":null,"abstract":"Background Displaced femoral neck fractures (DFNFs) are increasingly common in elderly patients. Hip arthroplasty, the recommended treatment of DFNF, consists of the total hip arthroplasty (THA) and hemiarthroplasty (HA). THA is superior to HA in younger patients. However, there are concerns whether the more substantial surgical trauma and higher dislocation rate would trade off the advantages of THA due to frailty and lower physical demands in the elderly over 75 years. Objective This study was designed to compare the clinical score, dislocation rate, and functional outcome between the dual mobility total hip replacement and the bipolar hemiarthroplasty (BHA) in the treatment of FNFs and which of them is more successful. Patients and methods A comparative randomized prospective study was conducted on 50 patients with DFNFs. All cases were operated upon in Helwan University Hospitals, divided them into two equal groups: the first group was treated by total hip replacement with a dual mobility cup (DMC) and the second group was treated by BHA. Full analysis of history detailed examination and primarily samples are taken during the period study from February 2020 to April 2021. Results There is a statistically significant improvement in modified Harris hip score (MHHS) in the last follow-up at 9 months later in favor to DMC group compared with BHA group (P<0.001). The postoperative MHHS in the last follow-up of DMC ranged from 68 to 92 with the mean of 85.96±5.47, whereas in BHA group, ranged from 60 to 89 with the mean of 78.04±8.40. Conclusion THA may be a preferred management option for active elderly patients over 75 years, which can provide superior hip function and life quality with acceptable risks. Strict management should be followed to prevent dislocation after a THA, especially within the first 6 months.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133569026","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 Meniscal root tears represent a functional loss; therefore, they greatly increase the risk of osteoarthritis. Root re-insertion aims to restore the anatomy and biomechanical function of the knee, reducing the risk of arthritis. Different techniques have been described. Preparation of the bed and instrumentation remains a challenge. Aim To demonstrate good early clinical outcomes after root re-insertion using accessory supra-meniscal portal, which helps both preparation and instrumentation of the bed. Patients and methods Between January 2019 and August 2019, we operated on 16 patients who met our inclusion criteria, having root tears of the medial meniscus. All patients underwent arthroscopic evaluation and re-insertion of the root tear medial meniscus using heavy braided suture material shuttled through a tibial tunnel and tied over a bone button. An accessory supra-meniscal portal was used to facilitate instrumentation and suture management. All patients were followed up for 2 years, and the Lysholm knee score was used for assessment at the final follow-up. Results A total of 16 patients were operated upon and followed up for a mean of 24 months. The mean Lysholm score improved from 73.5±12.61 preoperatively to 93.75±6.90 postoperatively, with a P value of 0.001. The mean preoperative and postoperative Lysholm scores were higher for the traumatic tears as compared with degenerative tears. Older patients showed lower functional outcomes. Conclusion Root re-insertion helps restore knee function and biomechanics, thereby prevents detrimental arthritis. Younger patients and those who have sustained traumatic injuries are more likely to improve as compared with elder patients and degenerative tears.
{"title":"Early functional outcomes after medial meniscal posterior root tear repair","authors":"A. Seifeldin, Begad Abdelrazek","doi":"10.4103/eoj.eoj_131_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_131_21","url":null,"abstract":"Background Meniscal root tears represent a functional loss; therefore, they greatly increase the risk of osteoarthritis. Root re-insertion aims to restore the anatomy and biomechanical function of the knee, reducing the risk of arthritis. Different techniques have been described. Preparation of the bed and instrumentation remains a challenge. Aim To demonstrate good early clinical outcomes after root re-insertion using accessory supra-meniscal portal, which helps both preparation and instrumentation of the bed. Patients and methods Between January 2019 and August 2019, we operated on 16 patients who met our inclusion criteria, having root tears of the medial meniscus. All patients underwent arthroscopic evaluation and re-insertion of the root tear medial meniscus using heavy braided suture material shuttled through a tibial tunnel and tied over a bone button. An accessory supra-meniscal portal was used to facilitate instrumentation and suture management. All patients were followed up for 2 years, and the Lysholm knee score was used for assessment at the final follow-up. Results A total of 16 patients were operated upon and followed up for a mean of 24 months. The mean Lysholm score improved from 73.5±12.61 preoperatively to 93.75±6.90 postoperatively, with a P value of 0.001. The mean preoperative and postoperative Lysholm scores were higher for the traumatic tears as compared with degenerative tears. Older patients showed lower functional outcomes. Conclusion Root re-insertion helps restore knee function and biomechanics, thereby prevents detrimental arthritis. Younger patients and those who have sustained traumatic injuries are more likely to improve as compared with elder patients and degenerative tears.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131892132","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}
Aim This article aims to describe a case of a 28-year-old male patient with progressively worsening of myelopathic symptoms owing to a large T4-5 thoracic disc herniation with severe cord compression. Background A 28-year-old male patient was referred to the clinic by a neurologist for worsening of bilateral lower extremity numbness, tingling, and progressive weakness over a period of few months with a clinical examination significant for severe myelopathy and imaging confirming a large thoracic disc herniation. Procedure T4-5 left hemilaminectomy and transfacet discectomy with unilateral right T4/T5 fixation and fusion were done. Outcomes The patient experienced delayed postoperative paraplegia that was reversible despite negative imaging studies, suggesting intraoperative incidental trauma to the cord or progressive postoperative cord edema. Scientific message Literature review of similar cases is presented as well as learning points from this challenging case. If the posterior approach is to be used, complete thorough decompression of the cord is advisable to minimize the risk of complications.
{"title":"High thoracic disc herniation: a case-based discussion with a review of literature","authors":"Ali M Maziad","doi":"10.4103/eoj.eoj_23_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_23_21","url":null,"abstract":"Aim This article aims to describe a case of a 28-year-old male patient with progressively worsening of myelopathic symptoms owing to a large T4-5 thoracic disc herniation with severe cord compression. Background A 28-year-old male patient was referred to the clinic by a neurologist for worsening of bilateral lower extremity numbness, tingling, and progressive weakness over a period of few months with a clinical examination significant for severe myelopathy and imaging confirming a large thoracic disc herniation. Procedure T4-5 left hemilaminectomy and transfacet discectomy with unilateral right T4/T5 fixation and fusion were done. Outcomes The patient experienced delayed postoperative paraplegia that was reversible despite negative imaging studies, suggesting intraoperative incidental trauma to the cord or progressive postoperative cord edema. Scientific message Literature review of similar cases is presented as well as learning points from this challenging case. If the posterior approach is to be used, complete thorough decompression of the cord is advisable to minimize the risk of complications.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129700526","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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