Introduction Angular deformities around the knee are common during childhood and most cases are a variation in the normal growth pattern. Uncorrected deformities change the biomechanics by disturbing stress distribution on the knee joint weight-bearing surface. Monolateral external fixator with osteotomy has shown better results being simple, and offers accurate correction, a low complication rate, the ability to correct valgus, varus, and rotational deformities, with early mobilization of the patient. Patient and methods A multicenter study case series prospective study was conducted from January 2020 to January 2021. A total of 30 patients with coronal plane deformities were included in the study. Of them, 15 patients (all cases were unilateral, 9 left limbs and 6 right limbs) presented with genu valgum with an age range between 10 and 16 years, and mean age was 10.5 years. Eight patients presented with genu varum only and six cases presented with genu varum and internal tibial torsion (all cases were unilateral, seven right limbs and eight left limbs) with an age range between 10 and 16 years and a mean of was 12.4 years. Results There is a statistically significant decrease of tibiofemoral angle (TFA) and mechanical axis deviation (MAD) after surgical correction of genu valgum among the included children with P value=0.001, and there is a statistically significant increase of lateral distal femoral angle (LDFA) after surgical correction of genu valgum with P value=0.001. There is a statistically significant increase of TFA, medial proximal tibial angle (MPTA), and MAD after surgical correction of genu varum among the included children with P value=0.001. Conclusion Correction of multiplanar deformities around knee using monolateral external fixator has good results in genu valgus with the improvement of LDFA and TFA, and with the improvement of MPTA and TFA in genu varum and with correction of MAD in both of the deformity after surgical correction, with rotation correction using the ability of direction of Schanz placement.
{"title":"Correction of multiplanar deformities around the knee with monolateral external fixator","authors":"M. Fadel, Hossam El din El Taha","doi":"10.4103/eoj.eoj_120_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_120_21","url":null,"abstract":"Introduction Angular deformities around the knee are common during childhood and most cases are a variation in the normal growth pattern. Uncorrected deformities change the biomechanics by disturbing stress distribution on the knee joint weight-bearing surface. Monolateral external fixator with osteotomy has shown better results being simple, and offers accurate correction, a low complication rate, the ability to correct valgus, varus, and rotational deformities, with early mobilization of the patient. Patient and methods A multicenter study case series prospective study was conducted from January 2020 to January 2021. A total of 30 patients with coronal plane deformities were included in the study. Of them, 15 patients (all cases were unilateral, 9 left limbs and 6 right limbs) presented with genu valgum with an age range between 10 and 16 years, and mean age was 10.5 years. Eight patients presented with genu varum only and six cases presented with genu varum and internal tibial torsion (all cases were unilateral, seven right limbs and eight left limbs) with an age range between 10 and 16 years and a mean of was 12.4 years. Results There is a statistically significant decrease of tibiofemoral angle (TFA) and mechanical axis deviation (MAD) after surgical correction of genu valgum among the included children with P value=0.001, and there is a statistically significant increase of lateral distal femoral angle (LDFA) after surgical correction of genu valgum with P value=0.001. There is a statistically significant increase of TFA, medial proximal tibial angle (MPTA), and MAD after surgical correction of genu varum among the included children with P value=0.001. Conclusion Correction of multiplanar deformities around knee using monolateral external fixator has good results in genu valgus with the improvement of LDFA and TFA, and with the improvement of MPTA and TFA in genu varum and with correction of MAD in both of the deformity after surgical correction, with rotation correction using the ability of direction of Schanz placement.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"12 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":"129729114","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 involving the tubular bones of the hand are the most frequent of all skeletal injuries. The choice of treatment depends on a variety of clinical and radiological factors. The goal of treatment is restoration or preservation of the hand function. Objectives To compare the results of mini plate plus screw versus screw only in oblique and spiral metacarpal fractures. Patients and methods This is a randomized clinical trial that included 40 patients with oblique and spiral metacarpal fractures who divided into two groups according to management: either fixation by mini plate and mini screws (20 patients) or fixation by mini screws only (20 patients). Quick-DASH and total active motion (TAM) scoring systems were used to evaluate all patients on 4th, 12th, and 24th weeks postoperative. Results The mean value of TAM score in the mini plate group was significantly higher than screws only group at 4th week postoperative (P=0.007) while it was nonsignificantly higher at 12th and 24th week postoperative. Also, the mean value of DASH score in the mini plate group was significantly lower than screws only group at 4th week postoperative (P=0.0001) while it was nonsignificantly lower at 12th and 24th week postoperative. The total number of complicated patients in the mini plate group was 2 patients (10%) while it was 5 patients (25%) in the screw only group with significant difference between both groups (P=0.0001). Conclusion Although mini plate and screw group showed early mobilization of the affected hand and has significant Quick-DASH and TAM scores at 4th week postoperative, both groups revealed the same functional outcomes at the end of follow-up.
{"title":"Management of oblique and spiral metacarpal fractures with mini plate and screw versus screws only","authors":"M. Saleh, A. Toreih","doi":"10.4103/eoj.eoj_125_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_125_21","url":null,"abstract":"Background Fractures involving the tubular bones of the hand are the most frequent of all skeletal injuries. The choice of treatment depends on a variety of clinical and radiological factors. The goal of treatment is restoration or preservation of the hand function. Objectives To compare the results of mini plate plus screw versus screw only in oblique and spiral metacarpal fractures. Patients and methods This is a randomized clinical trial that included 40 patients with oblique and spiral metacarpal fractures who divided into two groups according to management: either fixation by mini plate and mini screws (20 patients) or fixation by mini screws only (20 patients). Quick-DASH and total active motion (TAM) scoring systems were used to evaluate all patients on 4th, 12th, and 24th weeks postoperative. Results The mean value of TAM score in the mini plate group was significantly higher than screws only group at 4th week postoperative (P=0.007) while it was nonsignificantly higher at 12th and 24th week postoperative. Also, the mean value of DASH score in the mini plate group was significantly lower than screws only group at 4th week postoperative (P=0.0001) while it was nonsignificantly lower at 12th and 24th week postoperative. The total number of complicated patients in the mini plate group was 2 patients (10%) while it was 5 patients (25%) in the screw only group with significant difference between both groups (P=0.0001). Conclusion Although mini plate and screw group showed early mobilization of the affected hand and has significant Quick-DASH and TAM scores at 4th week postoperative, both groups revealed the same functional outcomes at the end of follow-up.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"23 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":"129481328","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 key to success in femoral shaft nonunion cases is the achievement of mechanical stability. We aimed to provide the clinical outcome of dual-fixation femoral shaft fracture nonunion using intramedullary nailing and plate augmentation in the same setting. Patients and methods This was a retrospective study of 12 patients with femoral shaft fracture aseptic nonunion operated at our university hospital between January 2017 and June 2021. All patients underwent revision surgery with synchronous nailing and plate augmentation. Demographics, comorbidities, history of previous trauma, fracture healing, and complications were recorded. We also reviewed radiological images. Results Twelve patients (nine males and three females) with a mean age of 31.1±9.8 years were included. Six patients had a previous fixation with an intramedullary nail, five with a plate, and one with an external fixator. Ten patients had atrophic nonunion, and two patients had hypertrophic nonunion. Patients achieved fracture healing after the surgical intervention, except two patients required another surgical intervention for delayed union as bone grafting (at 6 and 8 months, respectively). At the end of the study, they achieved fracture healing in all patients. The mean healing time was 6.1±2.4 months. Conclusion s Good mechanical stability and hence union can be achieved with synchronous nailing and plate augmentation as a treatment option for femoral shaft fracture aseptic nonunion.
{"title":"Clinical outcomes of dual fixation of femoral shaft fracture nonunion: synchronous nailing and plate augmentation","authors":"A. Elbarbary, Emad Badawy, I. Badr","doi":"10.4103/eoj.eoj_111_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_111_21","url":null,"abstract":"Background The key to success in femoral shaft nonunion cases is the achievement of mechanical stability. We aimed to provide the clinical outcome of dual-fixation femoral shaft fracture nonunion using intramedullary nailing and plate augmentation in the same setting. Patients and methods This was a retrospective study of 12 patients with femoral shaft fracture aseptic nonunion operated at our university hospital between January 2017 and June 2021. All patients underwent revision surgery with synchronous nailing and plate augmentation. Demographics, comorbidities, history of previous trauma, fracture healing, and complications were recorded. We also reviewed radiological images. Results Twelve patients (nine males and three females) with a mean age of 31.1±9.8 years were included. Six patients had a previous fixation with an intramedullary nail, five with a plate, and one with an external fixator. Ten patients had atrophic nonunion, and two patients had hypertrophic nonunion. Patients achieved fracture healing after the surgical intervention, except two patients required another surgical intervention for delayed union as bone grafting (at 6 and 8 months, respectively). At the end of the study, they achieved fracture healing in all patients. The mean healing time was 6.1±2.4 months. Conclusion s Good mechanical stability and hence union can be achieved with synchronous nailing and plate augmentation as a treatment option for femoral shaft fracture aseptic nonunion.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"1 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":"129889832","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 Internal fixation of distal humeral fractures is challenging because of complex anatomy and articular or metaphyseal comminution. Bi-columnar locked plating (orthogonal or parallel) is the standard method of fixation the success of which requires a rigid stable construct to optimize stability. The aim of this retrospective study was to evaluate the outcome of fixation of type-C distal humeral fractures by orthogonal locked plates and to determine the causes of early mechanical failure according to O’Driscoll criteria of optimized fixation stability. Settings and design A retrospective study conducted in Benha University Hospital. Patients and methods A review of 34 patients with type-C distal humeral fractures fixed with orthogonal anatomical locking plates through the period from 2014 to 2019, and evaluation of their outcome after 24–36 months. Radiographic images were reviewed for O’Driscoll criteria of optimized fixation, and complications were recorded. Results Functional outcome was assessed with Mayo elbow performance score. Twenty patients had an excellent outcome, seven patients good and seven fair in whom, O’Driscoll criteria for optimized fixation stability were not met and fixation was revised. All patients showed radiological union of fractures after about 3 months from definitive fixation. Multivariate analysis of the collected data was done by SPSS software to determine the cumulative percent of its factors and its relation with the final outcome. Conclusion Internal fixation of type-C distal humeral fractures by anatomically precontoured locking plates must be optimized according to O’Driscoll criteria to avoid early mechanical failure, revision surgery, and to achieve satisfactory functional outcome.
{"title":"Functional outcome of internal fixation of complex intraarticular fractures of the distal humerus (OTA-AO type-C) in focus of O’Driscoll criteria for optimized stability","authors":"A. Khamis, S. Shoulah","doi":"10.4103/eoj.eoj_103_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_103_21","url":null,"abstract":"Introduction Internal fixation of distal humeral fractures is challenging because of complex anatomy and articular or metaphyseal comminution. Bi-columnar locked plating (orthogonal or parallel) is the standard method of fixation the success of which requires a rigid stable construct to optimize stability. The aim of this retrospective study was to evaluate the outcome of fixation of type-C distal humeral fractures by orthogonal locked plates and to determine the causes of early mechanical failure according to O’Driscoll criteria of optimized fixation stability. Settings and design A retrospective study conducted in Benha University Hospital. Patients and methods A review of 34 patients with type-C distal humeral fractures fixed with orthogonal anatomical locking plates through the period from 2014 to 2019, and evaluation of their outcome after 24–36 months. Radiographic images were reviewed for O’Driscoll criteria of optimized fixation, and complications were recorded. Results Functional outcome was assessed with Mayo elbow performance score. Twenty patients had an excellent outcome, seven patients good and seven fair in whom, O’Driscoll criteria for optimized fixation stability were not met and fixation was revised. All patients showed radiological union of fractures after about 3 months from definitive fixation. Multivariate analysis of the collected data was done by SPSS software to determine the cumulative percent of its factors and its relation with the final outcome. Conclusion Internal fixation of type-C distal humeral fractures by anatomically precontoured locking plates must be optimized according to O’Driscoll criteria to avoid early mechanical failure, revision surgery, and to achieve satisfactory functional outcome.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"215 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":"131898587","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 This study compares the outcomes, 6 months postoperative, of femoral fracture interventions featuring nondisplaced and displaced butterfly fragments. The progress of healing, presence or absence of cortical defects, pain score after 6 months, and necessity of revision surgery are measured. Materials and methods This is a retrospective cohort study reviewing 100 patients with butterfly femur fractures treated with an intramedullary nail at King Fahad Hospital Hofuf. The patients were divided into two groups: one, of 48 patients, with displaced butterfly fragments after surgery and a second group of 52 patients with nondisplaced butterfly fragments, and all butterfly fragment was not fixed by any method, none of the fragment approximated by close or open reduction methods. Result In the first group, 38 patients (79.2%) showed delayed union 6 months after surgery, 30 (62.5%) had a cortical defect, 6 (12.5%) required revision surgery, and 42 (87.5%) still reported feeling pain. In the second group, 8 patients (15.4%) showed delayed union, none had cortical defects, 4 (07.7%) required revision surgery, and 10 (19.2%) reported pain 6 months after surgery. Conclusion Displaced butterfly fragments should be reduced to near-anatomical alignment to prevent delayed union, cortical defects, and pain.
{"title":"Reduction of butterfly fragments in femur fractures: a comparative analysis","authors":"Omer Alrasheed","doi":"10.4103/eoj.eoj_116_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_116_21","url":null,"abstract":"Purpose This study compares the outcomes, 6 months postoperative, of femoral fracture interventions featuring nondisplaced and displaced butterfly fragments. The progress of healing, presence or absence of cortical defects, pain score after 6 months, and necessity of revision surgery are measured. Materials and methods This is a retrospective cohort study reviewing 100 patients with butterfly femur fractures treated with an intramedullary nail at King Fahad Hospital Hofuf. The patients were divided into two groups: one, of 48 patients, with displaced butterfly fragments after surgery and a second group of 52 patients with nondisplaced butterfly fragments, and all butterfly fragment was not fixed by any method, none of the fragment approximated by close or open reduction methods. Result In the first group, 38 patients (79.2%) showed delayed union 6 months after surgery, 30 (62.5%) had a cortical defect, 6 (12.5%) required revision surgery, and 42 (87.5%) still reported feeling pain. In the second group, 8 patients (15.4%) showed delayed union, none had cortical defects, 4 (07.7%) required revision surgery, and 10 (19.2%) reported pain 6 months after surgery. Conclusion Displaced butterfly fragments should be reduced to near-anatomical alignment to prevent delayed union, cortical defects, and pain.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"1 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":"131147542","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 clavicle fractures are less common than mid-shaft fractures with a higher rate of nonunion if displaced. Different methods for fixation exist and each has its advantages and disadvantages. Fixation with anatomically precontoured locked plate with lateral extension proved satisfactory results with minimal complications. Settings and design This prospective study was conducted in Banha University Hospital. Patients and methods Twenty-three patients with Neer type-V distal clavicular fractures were fixed by distal clavicular locked plate with lateral extension and loop suturing of the coracoclavicular (CC) osseo-ligamentous fragment that is small to be fixed with a screw. The outcome was evaluated clinically by the Oxford shoulder score and radiologically for union, residual deformity, and nonunion through a 12–18-month follow-up period. Results The functional outcome was excellent in 19 cases, good in three, and fair in one. Minor complications were reported in six cases including periclavicular hypoesthesia, superficial wound infection, and post-traumatic rotator cuff tendinitis. Conclusion The distal clavicle anatomically precontoured the locked plate with lateral extension combined with loop suturing of the small CC osseo-ligamentous fragment that is not amenable for fixation with a screw is an excellent option for fixation of Neer type-V distal clavicle fracture with no need for additional implant to reattach the CC ligaments.
{"title":"Results of fixation of comminuted Neer type-V distal clavicle fractures by locked plates and coracoclavicular osseo-ligamentous loop sutures","authors":"A. Khamis, S. Shoulah","doi":"10.4103/eoj.eoj_105_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_105_21","url":null,"abstract":"Background Distal clavicle fractures are less common than mid-shaft fractures with a higher rate of nonunion if displaced. Different methods for fixation exist and each has its advantages and disadvantages. Fixation with anatomically precontoured locked plate with lateral extension proved satisfactory results with minimal complications. Settings and design This prospective study was conducted in Banha University Hospital. Patients and methods Twenty-three patients with Neer type-V distal clavicular fractures were fixed by distal clavicular locked plate with lateral extension and loop suturing of the coracoclavicular (CC) osseo-ligamentous fragment that is small to be fixed with a screw. The outcome was evaluated clinically by the Oxford shoulder score and radiologically for union, residual deformity, and nonunion through a 12–18-month follow-up period. Results The functional outcome was excellent in 19 cases, good in three, and fair in one. Minor complications were reported in six cases including periclavicular hypoesthesia, superficial wound infection, and post-traumatic rotator cuff tendinitis. Conclusion The distal clavicle anatomically precontoured the locked plate with lateral extension combined with loop suturing of the small CC osseo-ligamentous fragment that is not amenable for fixation with a screw is an excellent option for fixation of Neer type-V distal clavicle fracture with no need for additional implant to reattach the CC ligaments.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"108 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":"116547680","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 : 2022-01-01DOI: 10.21608/bjas.2022.221228
Emiel Abd Al-Masseih, M. Mashhour, H. Farag, Mahmoud Abouzied
Background Flexible flatfoot is a common problem of premature patients. There are different procedures described for the treatment of this condition. The calcaneal stop is an easy and simple procedure for its treatment. In this study, we evaluate this technique as a valuable one. Patients and methods This study was performed on 20 feet in 12 patients (seven males and five females) with flexible flatfeet (eight bilateral and four unilateral cases) who were treated with a calcaneal-stop procedure. They had the following inclusion criteria: (a) skeletal-immaturity patients; (b) symptomatic flexible flatfoot deformity (pain, function, and activity limitations) not responsive to conservative treatment. The evaluation was done clinically by American Orthopedic Foot and Ankle Society Ankle–Hindfoot score, and hindfoot valgus angle. Radiological evaluation was done by calcaneal-pitch angles, Kite’s angle, talar-declination angle, lateral Meary’s angle, and talonavicular-coverage angle. Results Clinical and functional outcomes of all patients were evaluated, before surgery, and at 3 and 6 months after surgery. The American Orthopedic Foot and Ankle Society score mean increased from 70.6 (SD 4.8) to 88.4 (SD 7.4) at the end of the study. Heel valgus improved from 11.45 (SD 3.02) to 2.7 (SD 1.3) at the end of the study. The calcaneal-pitch angle increased from 13.4 (SD 1.1) to 16.1 (SD 1.4) at the end of the study. Talar-declination angle decreased from 41.9 (SD 5.0) to 32.8 (SD 4.5) at the end. Kite angle changed from 29.6 (SD 3.1) preoperatively to 26.7 (SD 2.7) finally. Talonavicular-coverage angle improved from 22.4 (SD 5.4) to 11.2 (SD 5.68) at the end. Lateral Meary’s talocalcaneal angle decreased from 20.55±6.9 to 14.3±4.73 at 6 months after surgery. There was significant satisfaction of 11 (91.6%) patients with one patient who showed some pain at the site of operation with no need for screw removal. Conclusion There was significant improvement (P<0.00001) of all clinical and radiological parameters. The changes were mainly after surgery. There was an increased improvement with time, however, it was not statically significant. The main problem of flatfeet is patient dissatisfaction, which requires intervention. The calcaneal-stop procedure is an easy and simple procedure, with a minimal complication for the management of flexible flatfeet.
{"title":"Calcaneal-stop procedure for treatment of pediatric flexible flatfoot","authors":"Emiel Abd Al-Masseih, M. Mashhour, H. Farag, Mahmoud Abouzied","doi":"10.21608/bjas.2022.221228","DOIUrl":"https://doi.org/10.21608/bjas.2022.221228","url":null,"abstract":"Background Flexible flatfoot is a common problem of premature patients. There are different procedures described for the treatment of this condition. The calcaneal stop is an easy and simple procedure for its treatment. In this study, we evaluate this technique as a valuable one. Patients and methods This study was performed on 20 feet in 12 patients (seven males and five females) with flexible flatfeet (eight bilateral and four unilateral cases) who were treated with a calcaneal-stop procedure. They had the following inclusion criteria: (a) skeletal-immaturity patients; (b) symptomatic flexible flatfoot deformity (pain, function, and activity limitations) not responsive to conservative treatment. The evaluation was done clinically by American Orthopedic Foot and Ankle Society Ankle–Hindfoot score, and hindfoot valgus angle. Radiological evaluation was done by calcaneal-pitch angles, Kite’s angle, talar-declination angle, lateral Meary’s angle, and talonavicular-coverage angle. Results Clinical and functional outcomes of all patients were evaluated, before surgery, and at 3 and 6 months after surgery. The American Orthopedic Foot and Ankle Society score mean increased from 70.6 (SD 4.8) to 88.4 (SD 7.4) at the end of the study. Heel valgus improved from 11.45 (SD 3.02) to 2.7 (SD 1.3) at the end of the study. The calcaneal-pitch angle increased from 13.4 (SD 1.1) to 16.1 (SD 1.4) at the end of the study. Talar-declination angle decreased from 41.9 (SD 5.0) to 32.8 (SD 4.5) at the end. Kite angle changed from 29.6 (SD 3.1) preoperatively to 26.7 (SD 2.7) finally. Talonavicular-coverage angle improved from 22.4 (SD 5.4) to 11.2 (SD 5.68) at the end. Lateral Meary’s talocalcaneal angle decreased from 20.55±6.9 to 14.3±4.73 at 6 months after surgery. There was significant satisfaction of 11 (91.6%) patients with one patient who showed some pain at the site of operation with no need for screw removal. Conclusion There was significant improvement (P<0.00001) of all clinical and radiological parameters. The changes were mainly after surgery. There was an increased improvement with time, however, it was not statically significant. The main problem of flatfeet is patient dissatisfaction, which requires intervention. The calcaneal-stop procedure is an easy and simple procedure, with a minimal complication for the management of flexible flatfeet.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"10 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":"114647713","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 Tibial-plateau fractures are challenging for orthopedic surgeons. The gold-standard treatment for most tibial-plateau fractures is open-reduction internal fixation using either screws only or plates and screws. Recently, arthroscopy has invaded the field of trauma as a useful aid in the management of intra-articular fractures. The main advantages of arthroscopic reduction and internal fixation for tibial-plateau fractures are direct visualization of intra-articular fractures, accurate fracture reduction, and diagnosis and treatment of meniscal and ligamentous injuries. This study was done to compare the results of open-reduction internal fixation versus arthroscopic reduction and internal fixation for tibial-plateau fractures. Patients and methods A prospective comparative study was held in EL Hadra University Hospital between January 2017 and December 2019 over 56 patients. In all patients, the fracture was fixed using two to three cannulated screws. In the first group, the fixation was done using arthroscopy, while in the second group, the fixation was done using arthrotomy. All cases were assessed using Rasmussen clinical and radiological forms, Lysholm, and International Knee Documentation Committee (IKDC) scores. The minimum follow-up was 24 months since index surgery. Results There was no statistically significant difference between the two groups regarding the clinical and radiological Rasmussen scores. Moreover, the results of the Lysholm and IKDC were comparable. However, the arthroscopic group had longer operative time than the arthrotomy group. Conclusion Arthroscopic fixation technique was not inferior to open technique for management of Schatzker I–III fracture types with excellent comparable clinical and radiological outcomes while avoiding the drawbacks of the open approach.
{"title":"Comparative study between arthroscopic reduction and internal fixation versus open-reduction internal fixation for tibial-plateau fractures","authors":"A. Waly, H. Gawish","doi":"10.4103/eoj.eoj_129_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_129_21","url":null,"abstract":"Background Tibial-plateau fractures are challenging for orthopedic surgeons. The gold-standard treatment for most tibial-plateau fractures is open-reduction internal fixation using either screws only or plates and screws. Recently, arthroscopy has invaded the field of trauma as a useful aid in the management of intra-articular fractures. The main advantages of arthroscopic reduction and internal fixation for tibial-plateau fractures are direct visualization of intra-articular fractures, accurate fracture reduction, and diagnosis and treatment of meniscal and ligamentous injuries. This study was done to compare the results of open-reduction internal fixation versus arthroscopic reduction and internal fixation for tibial-plateau fractures. Patients and methods A prospective comparative study was held in EL Hadra University Hospital between January 2017 and December 2019 over 56 patients. In all patients, the fracture was fixed using two to three cannulated screws. In the first group, the fixation was done using arthroscopy, while in the second group, the fixation was done using arthrotomy. All cases were assessed using Rasmussen clinical and radiological forms, Lysholm, and International Knee Documentation Committee (IKDC) scores. The minimum follow-up was 24 months since index surgery. Results There was no statistically significant difference between the two groups regarding the clinical and radiological Rasmussen scores. Moreover, the results of the Lysholm and IKDC were comparable. However, the arthroscopic group had longer operative time than the arthrotomy group. Conclusion Arthroscopic fixation technique was not inferior to open technique for management of Schatzker I–III fracture types with excellent comparable clinical and radiological outcomes while avoiding the drawbacks of the open approach.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"69 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":"114173511","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 For most femoral neck fractures in young adults, the recommended fixation technique is with multiple cancellous lag screws. The Pauwels types I and II fractures are the most amenable to this type of fixation. A Pauwels type III fracture is a vertically oriented fracture with more than 50° inclination angle from the horizontal line on an anteroposterior radiograph. This fracture is both axially and rotationally unstable and experiences increased shear forces leading to a higher rate of failure and nonunion. The treatment of this type of fracture remains controversial. Various treatment modalities have been proposed to improve the outcome of the treatment, such as treatment with valgus osteotomy and fixation with dynamic hip screw (DHS) and cannulated screws. The valgus osteotomy converts the shear force into compression increasing the stability of the implant. Patient and methods A total of 12 patients (10 males and two females) with acute Pauwels type III femoral neck fractures in the age group 22–48 years (mean, 28.5 years) were managed with valgus osteotomy and fixation with DHS and cannulated screws. The patients were followed up from 1 to 3 years (mean, 20 months). Results Clinically, the patients were evaluated according to the Harris Hip Score. Excellent results were achieved in eight patients, good in three, and fair in one. No evidence of infection occurred in any patient. Radiologically, the fracture united in all cases 6 months postoperatively. Avascular necrosis occurred in one case. Conclusion Vertical femoral neck fractures in young adults can be safely managed using valgus osteotomy and fixation with DHS augmented by cannulated screws.
{"title":"Primary treatment of femoral neck fracture in young adults using valgus osteotomy and fixation by dynamic hip screw combined with cannulated screw","authors":"A. El Naggar, W. Nafea, Mohsen Fawzy","doi":"10.4103/eoj.eoj_53_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_53_21","url":null,"abstract":"Background For most femoral neck fractures in young adults, the recommended fixation technique is with multiple cancellous lag screws. The Pauwels types I and II fractures are the most amenable to this type of fixation. A Pauwels type III fracture is a vertically oriented fracture with more than 50° inclination angle from the horizontal line on an anteroposterior radiograph. This fracture is both axially and rotationally unstable and experiences increased shear forces leading to a higher rate of failure and nonunion. The treatment of this type of fracture remains controversial. Various treatment modalities have been proposed to improve the outcome of the treatment, such as treatment with valgus osteotomy and fixation with dynamic hip screw (DHS) and cannulated screws. The valgus osteotomy converts the shear force into compression increasing the stability of the implant. Patient and methods A total of 12 patients (10 males and two females) with acute Pauwels type III femoral neck fractures in the age group 22–48 years (mean, 28.5 years) were managed with valgus osteotomy and fixation with DHS and cannulated screws. The patients were followed up from 1 to 3 years (mean, 20 months). Results Clinically, the patients were evaluated according to the Harris Hip Score. Excellent results were achieved in eight patients, good in three, and fair in one. No evidence of infection occurred in any patient. Radiologically, the fracture united in all cases 6 months postoperatively. Avascular necrosis occurred in one case. Conclusion Vertical femoral neck fractures in young adults can be safely managed using valgus osteotomy and fixation with DHS augmented by cannulated screws.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128880330","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 Short-segment posterior fixation (SSPF) is liable to failure in unstable thoracolumbar fracture because of disruption of load-bearing anterior column. Intermediate screw and intracorporeal transpedicular grafting increase the stability of construct and enhance fracture healing, thereby avoiding long-segment posterior fixation and demanding anterior surgery in unstable thoracolumbar fracture. Patients and methods There were 20 patients with unstable thoracolumbar fractures treated with SSPF and TIG. These patients were followed for at least 14 months for to assess clinical improvement and the ability of the technique to reduce the fractures and maintain kyphosis correction with absence of implant failure. Result All patients were operated within the first week, with a mean time delay of 3.4 days. There were no cases with deep postoperative infection, iatrogenic dural tear, deterioration of neurologic deficit, or implant failure. The mean local kyphosis angle was 22.9° preoperatively, 9.7° postoperatively, and 11° at final examination. The mean anterior height collapse was 55.9% preoperatively, 87.5% postoperatively, and 79.8% at final examination. Conclusion SSPF with intermediate screw and TIG is an effective and safe technique in the treatment of unstable thoracolumbar fracture, with good clinical and radiological results.
{"title":"Making short-segment posterior fixation more successful in treatment of unstable thoracolumbar fracture","authors":"W. Nafea, Mohsen Fawzy","doi":"10.4103/eoj.eoj_70_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_70_21","url":null,"abstract":"Background Short-segment posterior fixation (SSPF) is liable to failure in unstable thoracolumbar fracture because of disruption of load-bearing anterior column. Intermediate screw and intracorporeal transpedicular grafting increase the stability of construct and enhance fracture healing, thereby avoiding long-segment posterior fixation and demanding anterior surgery in unstable thoracolumbar fracture. Patients and methods There were 20 patients with unstable thoracolumbar fractures treated with SSPF and TIG. These patients were followed for at least 14 months for to assess clinical improvement and the ability of the technique to reduce the fractures and maintain kyphosis correction with absence of implant failure. Result All patients were operated within the first week, with a mean time delay of 3.4 days. There were no cases with deep postoperative infection, iatrogenic dural tear, deterioration of neurologic deficit, or implant failure. The mean local kyphosis angle was 22.9° preoperatively, 9.7° postoperatively, and 11° at final examination. The mean anterior height collapse was 55.9% preoperatively, 87.5% postoperatively, and 79.8% at final examination. Conclusion SSPF with intermediate screw and TIG is an effective and safe technique in the treatment of unstable thoracolumbar fracture, with good clinical and radiological results.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133808748","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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