Background The goal of operative treatment of severe hallux valgus (HV) is to offer relief of pain, correction of forefoot deformity, and a biomechanically functional foot. However, the authors are constantly exploring ways of moving from open surgery to minimally invasive techniques, replacing large incisions with small ‘ports’ through which the surgeon works. Percutaneous less-invasive techniques have been successfully used for mild to moderate HV deformities; however, controversy exists for their use in cases with more severe involvement. Aim The aim of this prospective study was to assess the clinical and radiological outcomes of a percutaneous minimally invasive technique for the management of severe HV deformity. Patients and methods Between July 2013 and June 2015, 36 feet in 24 active patients, comprising 18 female and six male patients, where 12 patients had bilateral involvement, met the selection criteria for symptomatic severe HV deformity and treated by a minimally invasive double metatarsal osteotomy technique. The procedure implied simple transverse-osteotomy, with lateral translation, of the first metatarsus both proximally and distally combined with selective distal soft-tissue dissection. Average patients’ age was 39.8 years. Clinically, the American Orthopedic Foot and Ankle Society score and the subjective patient satisfaction were evaluated. Radiologically, HV angle, distal metatarsal articular angle, intermetatarsal angle, and joint congruity were measured preoperatively, postoperatively, and at the end of the follow-up period. All data were statistically analyzed. Results The mean follow-up period was 21.3 months (range: 18–24 months). Union was achieved in all osteotomies in a mean of 6.67±0.45 weeks. Each radiological and clinical parameter showed a statistically significant improvement (P<0.001), with a negligible first-ray shortening (P=0.547) and a few complications. At the end of follow-up period, no patient was dissatisfied. Conclusions Percutaneous double first metatarsal osteotomy technique with selective distal soft-tissue dissection provides a simple, adequate reproducible procedure, and effective alternative for treatment of severe HV deformity in a minimally invasive procedure.
{"title":"Percutaneous double osteotomy of the first metatarsus for correction of severe hallux valgus deformity","authors":"W. Ewais","doi":"10.4103/eoj.eoj_36_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_36_21","url":null,"abstract":"Background The goal of operative treatment of severe hallux valgus (HV) is to offer relief of pain, correction of forefoot deformity, and a biomechanically functional foot. However, the authors are constantly exploring ways of moving from open surgery to minimally invasive techniques, replacing large incisions with small ‘ports’ through which the surgeon works. Percutaneous less-invasive techniques have been successfully used for mild to moderate HV deformities; however, controversy exists for their use in cases with more severe involvement. Aim The aim of this prospective study was to assess the clinical and radiological outcomes of a percutaneous minimally invasive technique for the management of severe HV deformity. Patients and methods Between July 2013 and June 2015, 36 feet in 24 active patients, comprising 18 female and six male patients, where 12 patients had bilateral involvement, met the selection criteria for symptomatic severe HV deformity and treated by a minimally invasive double metatarsal osteotomy technique. The procedure implied simple transverse-osteotomy, with lateral translation, of the first metatarsus both proximally and distally combined with selective distal soft-tissue dissection. Average patients’ age was 39.8 years. Clinically, the American Orthopedic Foot and Ankle Society score and the subjective patient satisfaction were evaluated. Radiologically, HV angle, distal metatarsal articular angle, intermetatarsal angle, and joint congruity were measured preoperatively, postoperatively, and at the end of the follow-up period. All data were statistically analyzed. Results The mean follow-up period was 21.3 months (range: 18–24 months). Union was achieved in all osteotomies in a mean of 6.67±0.45 weeks. Each radiological and clinical parameter showed a statistically significant improvement (P<0.001), with a negligible first-ray shortening (P=0.547) and a few complications. At the end of follow-up period, no patient was dissatisfied. Conclusions Percutaneous double first metatarsal osteotomy technique with selective distal soft-tissue dissection provides a simple, adequate reproducible procedure, and effective alternative for treatment of severe HV deformity in a minimally invasive procedure.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"81 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":"130927941","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 Osteoid osteoma (OO) is an osteogenic bone tumor. Clinically, it is characterized by night pain that improves with NSAID treatment. It appears in radiography as a small radiolucent nidus with sclerosis of the surrounding bone. Surgical excision is the classic treatment of choice. However, many noninvasive procedures have been used to avoid the morbidity associated with surgical treatment. The aim of this study was to evaluate the efficacy of modified technique of radiofrequency ablation (RFA) in the management of OO. Patients and methods A total of 37 patients with OO were treated with percutaneous computed tomography-guided RFA. Overall, 24 lesions were located in the femur, 10 in the tibia, two in the acetabulum, and one in scapula. The diagnosis was based on clinical symptoms, radiographs, computed tomography scan, and bone scintigraphy. Bone drilling was used to make a track to reach the nidus. The average follow-up period was 37 months. Results A total of 36 patients became pain free within a period of 12 h 3 weeks after the procedure. One patient experienced a milder form of pain. One patient had transient sciatica, which improved using corticosteroids and NSAIDs. Two patients had soft tissue infection treated using antibiotics. No recurrence was reported for at least 2.5 years. Conclusions RFA is a safe and effective treatment for OO lesions, especially for lesions, which is difficult to be managed surgically. The use of a bone drill facilitates the technique and decreases the operative time.
{"title":"Computerized tomography-guided radiofrequency ablation for osteoid osteoma: preliminary results","authors":"A. El Naggar, M. Shaban","doi":"10.4103/eoj.eoj_94_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_94_21","url":null,"abstract":"Background Osteoid osteoma (OO) is an osteogenic bone tumor. Clinically, it is characterized by night pain that improves with NSAID treatment. It appears in radiography as a small radiolucent nidus with sclerosis of the surrounding bone. Surgical excision is the classic treatment of choice. However, many noninvasive procedures have been used to avoid the morbidity associated with surgical treatment. The aim of this study was to evaluate the efficacy of modified technique of radiofrequency ablation (RFA) in the management of OO. Patients and methods A total of 37 patients with OO were treated with percutaneous computed tomography-guided RFA. Overall, 24 lesions were located in the femur, 10 in the tibia, two in the acetabulum, and one in scapula. The diagnosis was based on clinical symptoms, radiographs, computed tomography scan, and bone scintigraphy. Bone drilling was used to make a track to reach the nidus. The average follow-up period was 37 months. Results A total of 36 patients became pain free within a period of 12 h 3 weeks after the procedure. One patient experienced a milder form of pain. One patient had transient sciatica, which improved using corticosteroids and NSAIDs. Two patients had soft tissue infection treated using antibiotics. No recurrence was reported for at least 2.5 years. Conclusions RFA is a safe and effective treatment for OO lesions, especially for lesions, which is difficult to be managed surgically. The use of a bone drill facilitates the technique and decreases the operative time.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125999038","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}
M. Sobhy, Ahmed Khater, Yehia Haroon, Amr Abdelhady
Purpose The aim of this study was to compare the short-term outcomes and return to work/sport between open Latarjet procedure and arthroscopic Bankart repair in high-demand patients with recurrent post-traumatic anterior shoulder dislocation without significant bone loss. The authors hypothesized that open Latarjet procedure would allow for an earlier return to work and sports activity with lower rate of recurrence. Patients and methods This is a randomized clinical trial conducted on 30 high-demand patients with recurrent post-traumatic anterior shoulder dislocation. All patients had no significant glenoid or humeral head bone loss. Fifteen patients underwent arthroscopic Bankart repair and 15 patients underwent open Latarjet procedure. The main criteria for assessments were Rowe score, shoulder range of motion, and return to work/sport. Results The main findings of this study were that all patients returned to work/sport and the mean time was 6.4 months postoperatively. Patients who underwent open Latarjet procedure returned to work/sport more rapidly than patients who underwent arthroscopic Bankart repair (P=0.021). The mean postoperative Rowe score was higher in patients who underwent open Latarjet procedure. But was not statistically significant. Conclusions Both arthroscopic Bankart repair and open Latarjet procedure are valid surgical options and have adequate outcomes in the treatment of patients with recurrent post-traumatic anterior shoulder dislocation and participate in heavy shoulder activities. But patients with arthroscopic Bankart repair take a longer time to return to work/sport.
{"title":"Short-term outcomes of arthroscopic Bankart repair versus open Latarjet procedure in high-demand patients with recurrent anterior shoulder dislocation without significant bone loss","authors":"M. Sobhy, Ahmed Khater, Yehia Haroon, Amr Abdelhady","doi":"10.4103/eoj.eoj_92_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_92_21","url":null,"abstract":"Purpose The aim of this study was to compare the short-term outcomes and return to work/sport between open Latarjet procedure and arthroscopic Bankart repair in high-demand patients with recurrent post-traumatic anterior shoulder dislocation without significant bone loss. The authors hypothesized that open Latarjet procedure would allow for an earlier return to work and sports activity with lower rate of recurrence. Patients and methods This is a randomized clinical trial conducted on 30 high-demand patients with recurrent post-traumatic anterior shoulder dislocation. All patients had no significant glenoid or humeral head bone loss. Fifteen patients underwent arthroscopic Bankart repair and 15 patients underwent open Latarjet procedure. The main criteria for assessments were Rowe score, shoulder range of motion, and return to work/sport. Results The main findings of this study were that all patients returned to work/sport and the mean time was 6.4 months postoperatively. Patients who underwent open Latarjet procedure returned to work/sport more rapidly than patients who underwent arthroscopic Bankart repair (P=0.021). The mean postoperative Rowe score was higher in patients who underwent open Latarjet procedure. But was not statistically significant. Conclusions Both arthroscopic Bankart repair and open Latarjet procedure are valid surgical options and have adequate outcomes in the treatment of patients with recurrent post-traumatic anterior shoulder dislocation and participate in heavy shoulder activities. But patients with arthroscopic Bankart repair take a longer time to return to work/sport.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128979799","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 Total hip arthroplasty has proven to be one of the most successful operations done in orthopedic surgery. Preoperative planning, including meticulous history, examination, and preoperative templating, is quite important and must be done to all cases as a routine. Numerous studies used surrogates for clinical success rates that included satisfaction of the patient, reduced pain, improvement of function, and the absence of the need for further surgery. Minimizing leg-length discrepancy and restoring offset to normal is very important for good functional outcome, patient satisfaction, and quality of life. Aim of the study Radiological and functional assessment of restoring the leg length and hip offset after total hip replacement. Also, to compare different methods used to decrease leg-length discrepancy with the method used in this study. Patients and methods A prospective study of 50 patients (31 males and 19 females) with arthritic hips for various reasons undergoing either cemented or uncemented total hip arthroplasty. The mean age was 47 years old. Preoperative history and examination for all patients was done, preoperative and postoperative evaluation of offset and limb length was done for all patients, and preoperative and postoperative evaluation of hip function using Harris hip score (HHS) was done in addition to evaluation of abductor muscles’ power. Variable intraoperative methods were used to minimize the limb-length discrepancy (LLD) after the operation. Results There was a statistical significance between hip offset pre- and postoperative and between LLD preoperative and postoperative. HHS was improved postoperative. Conclusion Limb-length restoration is very important for improvement of HHS. The intraoperative clinical method is much effective to minimize LLD as other methods, although it is much easier to apply.
{"title":"Assessment of restoration of leg length and femoral offset after total hip arthroplasty","authors":"Hatem M. Bakr, M. Mahran","doi":"10.4103/eoj.eoj_91_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_91_21","url":null,"abstract":"Background Total hip arthroplasty has proven to be one of the most successful operations done in orthopedic surgery. Preoperative planning, including meticulous history, examination, and preoperative templating, is quite important and must be done to all cases as a routine. Numerous studies used surrogates for clinical success rates that included satisfaction of the patient, reduced pain, improvement of function, and the absence of the need for further surgery. Minimizing leg-length discrepancy and restoring offset to normal is very important for good functional outcome, patient satisfaction, and quality of life. Aim of the study Radiological and functional assessment of restoring the leg length and hip offset after total hip replacement. Also, to compare different methods used to decrease leg-length discrepancy with the method used in this study. Patients and methods A prospective study of 50 patients (31 males and 19 females) with arthritic hips for various reasons undergoing either cemented or uncemented total hip arthroplasty. The mean age was 47 years old. Preoperative history and examination for all patients was done, preoperative and postoperative evaluation of offset and limb length was done for all patients, and preoperative and postoperative evaluation of hip function using Harris hip score (HHS) was done in addition to evaluation of abductor muscles’ power. Variable intraoperative methods were used to minimize the limb-length discrepancy (LLD) after the operation. Results There was a statistical significance between hip offset pre- and postoperative and between LLD preoperative and postoperative. HHS was improved postoperative. Conclusion Limb-length restoration is very important for improvement of HHS. The intraoperative clinical method is much effective to minimize LLD as other methods, although it is much easier to apply.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129974122","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 tibial fractures are notorious for being associated with skin complications such as wound dehiscence and infection. The use of angle-stable external locked plate has a dual advantage, acting as an external fixator, which avoids the complications associated with conventional open surgery, and avoiding the cumbersome bulky external frames traditionally used for lower limb fractures. Moreover, joint spanning is not necessary in this technique, leaving the ankle joint free, avoiding joint stiffness commonly associated with the conventional frames. Patients and methods A total of 56 patients with closed distal tibial fractures were randomly assigned in two equal groups. Group A comprised patients treated with the conventional open reduction and internal fixation, whereas group B comprised patients treated with external locked plate (supracutaneous plate). The patients were assessed according to the Klemn and Borner scoring system at the end of follow-up. Results Group B patients had significantly better clinical and radiological outcome than group A. The union in group B was more rapid (12.96±2.74 weeks) than in group A (18.68±12.12 weeks), with a statistically significant difference between them. The rate of complications was significantly less in the group B, with only three patients having superficial self-limiting infection in comparison with group A, with 11 patients having deep infection and skin dehiscence with exposure of the plate. None of the cases of group B developed implant failure, whereas seven cases in group A developed implant failure. Conclusion Treatment of closed distal tibial fractures by external locked plate could result in a better functional outcome than conventional open reduction and internal fixation, while avoiding the skin complications associated with the conventional plating. Level of evidence Level II: prospective randomized double-blinded study.
{"title":"Distal tibial fractures: comparison between external locked plate and conventional open reduction and internal fixation","authors":"Bahaa A Motawea","doi":"10.4103/eoj.eoj_101_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_101_21","url":null,"abstract":"Background Distal tibial fractures are notorious for being associated with skin complications such as wound dehiscence and infection. The use of angle-stable external locked plate has a dual advantage, acting as an external fixator, which avoids the complications associated with conventional open surgery, and avoiding the cumbersome bulky external frames traditionally used for lower limb fractures. Moreover, joint spanning is not necessary in this technique, leaving the ankle joint free, avoiding joint stiffness commonly associated with the conventional frames. Patients and methods A total of 56 patients with closed distal tibial fractures were randomly assigned in two equal groups. Group A comprised patients treated with the conventional open reduction and internal fixation, whereas group B comprised patients treated with external locked plate (supracutaneous plate). The patients were assessed according to the Klemn and Borner scoring system at the end of follow-up. Results Group B patients had significantly better clinical and radiological outcome than group A. The union in group B was more rapid (12.96±2.74 weeks) than in group A (18.68±12.12 weeks), with a statistically significant difference between them. The rate of complications was significantly less in the group B, with only three patients having superficial self-limiting infection in comparison with group A, with 11 patients having deep infection and skin dehiscence with exposure of the plate. None of the cases of group B developed implant failure, whereas seven cases in group A developed implant failure. Conclusion Treatment of closed distal tibial fractures by external locked plate could result in a better functional outcome than conventional open reduction and internal fixation, while avoiding the skin complications associated with the conventional plating. Level of evidence Level II: prospective randomized double-blinded study.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129937106","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 Patients who have hip osteoarthritis secondary to Legg–Calvé–Perthes disease (LCPD) have deformities of the acetabulum and femoral head; few studies have presented the outcome and risks associated with total hip arthroplasty (THA) for patients with a history of LCPD. Aim The aim of this study was to evaluate the results and complications associated with THA for LCPD. Patients and methods Thirty-four patients with secondary hip osteoarthritis as a sequelae of LCPD underwent cementless THA. Their average age was 38.7 years old (range: 26–65 years old), while the average follow-up period was 6.5 years (range: 5–10 years). The patients were evaluated clinically (using the Harris hip score) and radiologically. Results The Harris hip score improved from 48.2 points preoperatively to 92.8 points at the time of the last follow-up. The shortening of the affected limb has improved from −1.6 to 0.2 cm. The complications included three cases of intraoperative femur fractures and three cases of sciatic nerve palsy that developed after extensive lengthening of the lower limb. Patients with a history of previous childhood hip surgery were significantly younger at the time of arthroplasty when compared with patients who were treated nonoperatively (P=0.0006). Conclusion Hip arthroplasty showed good outcomes in patients with LCPD at an average of 6 years follow-up. Intraoperative fractures and nerve injuries are common. Caution should be taken while restoring leg length as stretching the sciatic nerve may result in a permanent deficit.
{"title":"Total hip arthroplasty after Legg–Calvé–Perthes disease","authors":"M. Abdelkhalek, Moheib S. Ahmed, Ayman M. Ali","doi":"10.4103/eoj.eoj_97_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_97_21","url":null,"abstract":"Background Patients who have hip osteoarthritis secondary to Legg–Calvé–Perthes disease (LCPD) have deformities of the acetabulum and femoral head; few studies have presented the outcome and risks associated with total hip arthroplasty (THA) for patients with a history of LCPD. Aim The aim of this study was to evaluate the results and complications associated with THA for LCPD. Patients and methods Thirty-four patients with secondary hip osteoarthritis as a sequelae of LCPD underwent cementless THA. Their average age was 38.7 years old (range: 26–65 years old), while the average follow-up period was 6.5 years (range: 5–10 years). The patients were evaluated clinically (using the Harris hip score) and radiologically. Results The Harris hip score improved from 48.2 points preoperatively to 92.8 points at the time of the last follow-up. The shortening of the affected limb has improved from −1.6 to 0.2 cm. The complications included three cases of intraoperative femur fractures and three cases of sciatic nerve palsy that developed after extensive lengthening of the lower limb. Patients with a history of previous childhood hip surgery were significantly younger at the time of arthroplasty when compared with patients who were treated nonoperatively (P=0.0006). Conclusion Hip arthroplasty showed good outcomes in patients with LCPD at an average of 6 years follow-up. Intraoperative fractures and nerve injuries are common. Caution should be taken while restoring leg length as stretching the sciatic nerve may result in a permanent deficit.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129624477","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}
Bahaa El Serwi, Mahmoud Hadhood, Y. Allam, A. E. El Deen, O. Sherif
Background Anterior cervical discectomy has proven to be a safe and effective procedure for the treatment of degenerative disc disease. The anterior approach allows direct visualization of the entire interspace and wide decompression of the anterior aspect of cervical spinal cord and nerve roots; it may be undertaken in cases of multilevel disease and interbody fusion may be performed if required. Patients and methods A total of 20 patients aged from 20 to 65 years, 16 females and four males with symptomatic cervical disc disease, presented in the outpatient clinic, Menoufia University hospital from 2012 to 2014, were examined and followed up prospectively, The mean age was 43.25±9.06 (range: 28–60) years. There were 13 patients (65%) with radiculopathy only, two patients (10%) with mylopathy only, and five patients (10%) with radiculomylopathy; seven cases were affected by mylopathy graded according to Ranawat grading. There were 37 levels affected among the 20 patients. C5,6 was the commonly affected level 1 (40.5%), then C4,5 11 (29.7%), then C6,7 7 (18.9%), and the least one was C3,4 4 (10.8%). Five cases were operated by using a microscope. Anterior cervical discectomy and fusion (ACDF) were performed using polyetheretherketone (PEEK) cages and local bone graft. Results The mean operative time per microscopic level was 64.5 min, the nonmicroscopic level was 47 min.The only intraoperative complication was external jugular-vein ligation that occurred in two cases (nonmicroscopic). The only postoperative complication was difficulty in swallowing, which occurred in 13 cases (11 nonmicroscopic and two microscopic). The mean of preoperative interbody ratio was 1.8±0.2, 12 months postoperatively the mean was 1.9± 0.2.There was a statistically significant difference in the mean of the interbody ratio preoperative and at 12 months. The mean preoperative disc space height was 3.3±0.8 mm, 12 months postoperative was 5.8±0.9. There was a statistically significant difference in the mean disc space height preoperative and 12 months postoperative. Rate of fusion at 12 months: three levels were average fusion, 26 levels were good fusion, and eight levels were excellent fusion. Conclusion Patients receiving ACDF with local bone graft combined with a PEEK cage had significantly shorter operation time, lower perioperative complication rates, and better radiological results comparing with those with an iliac bone graft alone. It seems that the local bone graft with a PEEK cage appears to be a safe alternative to the iliac bone graft for ACDF.
{"title":"Anterior cervical discectomy and fusion by polyetheretherketon cage in degenerative disc diseases","authors":"Bahaa El Serwi, Mahmoud Hadhood, Y. Allam, A. E. El Deen, O. Sherif","doi":"10.4103/eoj.eoj_89_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_89_21","url":null,"abstract":"Background Anterior cervical discectomy has proven to be a safe and effective procedure for the treatment of degenerative disc disease. The anterior approach allows direct visualization of the entire interspace and wide decompression of the anterior aspect of cervical spinal cord and nerve roots; it may be undertaken in cases of multilevel disease and interbody fusion may be performed if required. Patients and methods A total of 20 patients aged from 20 to 65 years, 16 females and four males with symptomatic cervical disc disease, presented in the outpatient clinic, Menoufia University hospital from 2012 to 2014, were examined and followed up prospectively, The mean age was 43.25±9.06 (range: 28–60) years. There were 13 patients (65%) with radiculopathy only, two patients (10%) with mylopathy only, and five patients (10%) with radiculomylopathy; seven cases were affected by mylopathy graded according to Ranawat grading. There were 37 levels affected among the 20 patients. C5,6 was the commonly affected level 1 (40.5%), then C4,5 11 (29.7%), then C6,7 7 (18.9%), and the least one was C3,4 4 (10.8%). Five cases were operated by using a microscope. Anterior cervical discectomy and fusion (ACDF) were performed using polyetheretherketone (PEEK) cages and local bone graft. Results The mean operative time per microscopic level was 64.5 min, the nonmicroscopic level was 47 min.The only intraoperative complication was external jugular-vein ligation that occurred in two cases (nonmicroscopic). The only postoperative complication was difficulty in swallowing, which occurred in 13 cases (11 nonmicroscopic and two microscopic). The mean of preoperative interbody ratio was 1.8±0.2, 12 months postoperatively the mean was 1.9± 0.2.There was a statistically significant difference in the mean of the interbody ratio preoperative and at 12 months. The mean preoperative disc space height was 3.3±0.8 mm, 12 months postoperative was 5.8±0.9. There was a statistically significant difference in the mean disc space height preoperative and 12 months postoperative. Rate of fusion at 12 months: three levels were average fusion, 26 levels were good fusion, and eight levels were excellent fusion. Conclusion Patients receiving ACDF with local bone graft combined with a PEEK cage had significantly shorter operation time, lower perioperative complication rates, and better radiological results comparing with those with an iliac bone graft alone. It seems that the local bone graft with a PEEK cage appears to be a safe alternative to the iliac bone graft for ACDF.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128500721","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 Both bone forearm fractures are common injuries in children and adolescents. In adolescent patients, such fractures may be less frequently amenable to nonoperative management due to the decreased remodeling potential in children approaching skeletal maturity. These fractures are often managed surgically using intramedullary nails (IMNs) or plate fixation. Significant controversy exists between the use of the IMNs and plate fixation for diaphyseal both bone forearm fractures in adolescents. Objective This study aimed to evaluate plates and screws versus IMNs in the management of both bone forearm fractures in adolescents. Patients and methods Twenty patients were enrolled in a prospective study, 12 males and eight females, their ages ranging from 10 to 14 years (average 11.75). The mean follow-up duration was 13.2 months (ranging from 8 to 18 months). According to our protocol, patients with odd numbers (group A) were treated with plate and screws, and IMNs were used to treat those with even numbers (group B). Results The mean operative time in group A was 63.5 min (ranging from 55 to 75 min), while in group B, the mean operative time was 37 min (ranging from 35 to 45 min) (P<0.001). The mean time of use of an intraoperative image intensifier in group A was 2 s, ranging from 0 to 7 s. Comparatively, the mean time in group B was 57.5 s, ranging from 45 to 65 s, P value less than 0.001. The union time in both groups ranged from 6 to 8 weeks; the result was statistically nonsignificant. In terms of the supination and pronation range of motion (ROM), group A showed almost no change compared with the other side, at the final follow-up, while group B showed 15° mean loss in the supination ROM, ranging from 5° to 20°, with almost no loss in the pronation ROM (P=0.032). In terms of operative time for implant removal, the time needed to remove plates and screws ranged from 30 to 65 min (average 40 min), while the time needed for removal of elastic nails ranged from 10 to 18 min (average 12 min); the result was statistically significant. Conclusion IM nailing was found to be superior to plates and screws in the management of adolescent both bone forearm fractures in terms of operative time needed for fixation and removal. However, plates and screws had the advantage that they involved limited intraoperative exposure to the image intensifier. Level of evidence Level I.
{"title":"Surgical management of adolescent both bone forearm fractures using a plate and screws versus an intramedullary elastic nail","authors":"Ebeed Yasin","doi":"10.4103/eoj.eoj_100_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_100_21","url":null,"abstract":"Background Both bone forearm fractures are common injuries in children and adolescents. In adolescent patients, such fractures may be less frequently amenable to nonoperative management due to the decreased remodeling potential in children approaching skeletal maturity. These fractures are often managed surgically using intramedullary nails (IMNs) or plate fixation. Significant controversy exists between the use of the IMNs and plate fixation for diaphyseal both bone forearm fractures in adolescents. Objective This study aimed to evaluate plates and screws versus IMNs in the management of both bone forearm fractures in adolescents. Patients and methods Twenty patients were enrolled in a prospective study, 12 males and eight females, their ages ranging from 10 to 14 years (average 11.75). The mean follow-up duration was 13.2 months (ranging from 8 to 18 months). According to our protocol, patients with odd numbers (group A) were treated with plate and screws, and IMNs were used to treat those with even numbers (group B). Results The mean operative time in group A was 63.5 min (ranging from 55 to 75 min), while in group B, the mean operative time was 37 min (ranging from 35 to 45 min) (P<0.001). The mean time of use of an intraoperative image intensifier in group A was 2 s, ranging from 0 to 7 s. Comparatively, the mean time in group B was 57.5 s, ranging from 45 to 65 s, P value less than 0.001. The union time in both groups ranged from 6 to 8 weeks; the result was statistically nonsignificant. In terms of the supination and pronation range of motion (ROM), group A showed almost no change compared with the other side, at the final follow-up, while group B showed 15° mean loss in the supination ROM, ranging from 5° to 20°, with almost no loss in the pronation ROM (P=0.032). In terms of operative time for implant removal, the time needed to remove plates and screws ranged from 30 to 65 min (average 40 min), while the time needed for removal of elastic nails ranged from 10 to 18 min (average 12 min); the result was statistically significant. Conclusion IM nailing was found to be superior to plates and screws in the management of adolescent both bone forearm fractures in terms of operative time needed for fixation and removal. However, plates and screws had the advantage that they involved limited intraoperative exposure to the image intensifier. Level of evidence Level I.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126961322","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 Inadequate bone stock is frequently encountered in total knee arthroplasty and may be found in primary and revision procedures. Different techniques and devices for their management include additional bone resection, shifting of the components, filling the defect with cement with or without reinforcing screws or mesh, bone grafting, modular metal augmentation, or custom components. The modular augmentations are particularly useful in restoring the proper anteroposterior dimension as well as distal positioning of the joint line. In this study, the authors evaluate the use of metal augmentation for the management of deficient bone stock in total knee arthroplasty. Patients and methods A prospective study was done through the period between June 2014 and June 2017 on 30 knee arthroplasties, both primary and revision cases in 28 patients with bone deficiency consistent with Anderson Orthopedic Research Institute type II, treated by metal augmentation using different types of tibial and femoral augments applied to a posterior-stabilized prosthesis. The mean follow-up was 19 months. Eighteen cases (60%) were primary knee arthroplasties, and 12 cases (40%) were revision knee arthroplasties. Assessment at follow-up included clinical assessment through the knee society clinical rating system and radiographic assessment through the knee society roentgengraphic evaluation system. Results At the last follow-up, the average clinical knee society score was 80.4 (range from 16 to 93) compared with the average preoperative knee society score of 32 (range from 6 to 51). Only tibial radiolucent lines appeared in zones 1, 2 (nine cases), zones 3, 4 (four cases), and zone 5 in one case. All were nonprogressive radiolucent lines, except for two cases that progressed to aseptic loosening, and only one of them to a varus subsidence of the tibial implant. Conclusion Modular metal augmentation is a successful way for reconstruction of bone defects encountered in total knee arthroplasty through preservation of joint line and bone stock.
{"title":"Management of bone deficiency by metal augmentation in total knee arthroplasty","authors":"S. Abdeldayem, Z. Zakaria, Radwan G. Metwaly","doi":"10.4103/eoj.eoj_98_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_98_21","url":null,"abstract":"Background Inadequate bone stock is frequently encountered in total knee arthroplasty and may be found in primary and revision procedures. Different techniques and devices for their management include additional bone resection, shifting of the components, filling the defect with cement with or without reinforcing screws or mesh, bone grafting, modular metal augmentation, or custom components. The modular augmentations are particularly useful in restoring the proper anteroposterior dimension as well as distal positioning of the joint line. In this study, the authors evaluate the use of metal augmentation for the management of deficient bone stock in total knee arthroplasty. Patients and methods A prospective study was done through the period between June 2014 and June 2017 on 30 knee arthroplasties, both primary and revision cases in 28 patients with bone deficiency consistent with Anderson Orthopedic Research Institute type II, treated by metal augmentation using different types of tibial and femoral augments applied to a posterior-stabilized prosthesis. The mean follow-up was 19 months. Eighteen cases (60%) were primary knee arthroplasties, and 12 cases (40%) were revision knee arthroplasties. Assessment at follow-up included clinical assessment through the knee society clinical rating system and radiographic assessment through the knee society roentgengraphic evaluation system. Results At the last follow-up, the average clinical knee society score was 80.4 (range from 16 to 93) compared with the average preoperative knee society score of 32 (range from 6 to 51). Only tibial radiolucent lines appeared in zones 1, 2 (nine cases), zones 3, 4 (four cases), and zone 5 in one case. All were nonprogressive radiolucent lines, except for two cases that progressed to aseptic loosening, and only one of them to a varus subsidence of the tibial implant. Conclusion Modular metal augmentation is a successful way for reconstruction of bone defects encountered in total knee arthroplasty through preservation of joint line and bone stock.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129393812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective The aim was to assess the effectiveness of gradual correction of severe flexion deformity of the knee by Ilizarov fixator. Background Acute correction of severe knee-flexion contractures (KFC) with soft-tissue release, osteotomy, or both may lead to serious complications. In contrast, gradual correction of KFC, a circular frame, and a constrained hinge, avoids acute stretch injury to soft tissues, with a low recurrence rate. Patients and methods Between March 2011 and February 2017, 16 patients with 21 affected knees included 12 male and four female patients, the age ranged from 4 to 58 years, and mean (20.81 years), unilateral in 11 patients, and bilateral in five patients. The etiology was maltreated deep burns in two patients, four patients with arthrogryposis multiplex congenita, one had systemic lupus erythematosis, two had poliomyelitis, two complicated femoral lengthening, two had fibular hemimelia, complicated trauma in one case, and septic arthritis in two patients. Only gradual correction by Ilizarov fixator was used, except in one case where additional corrective osteotomy was done for hyperextended distal femur. Results The mean duration of the fixator was 3.9 months (range: 3–8 months). The follow-up period ranged from 4 to 48 months after frame removal with a mean of 10.8 months. Extension range significantly increases from the mean of −83°, to a mean of −4.7° at late follow-up (P<0.05). Mean flexion range was 35.9° that improved at late follow-up to a mean of 63.3°. The arc of motion postoperative was nearly the same of the preoperative with a mild increase. Two cases had recurrence of the KFC (15°) and knee subluxation, four cases had reversible excessive arthodiastasis of the knee joint, and two cases had epiphyseal injury in proximal tibia during the early stages of correction of the deformity. Conclusion Gradual distraction of the contracted tissues around the knee joint by Ilizarov fixator is a highly efficient and safe method that can address all components of intractable severe flexion contracture of the knee joint whatever the etiology of the deformity. There is a significant increase in the extension range and low recurrence rate compared with any other treatment method converting a nonambulant patient to an active ambulant one with a low complication rate.
{"title":"Outcome of severe fixed-flexion deformity of the knee managed by ring fixator","authors":"A. Zayda","doi":"10.4103/eoj.eoj_90_21","DOIUrl":"https://doi.org/10.4103/eoj.eoj_90_21","url":null,"abstract":"Objective The aim was to assess the effectiveness of gradual correction of severe flexion deformity of the knee by Ilizarov fixator. Background Acute correction of severe knee-flexion contractures (KFC) with soft-tissue release, osteotomy, or both may lead to serious complications. In contrast, gradual correction of KFC, a circular frame, and a constrained hinge, avoids acute stretch injury to soft tissues, with a low recurrence rate. Patients and methods Between March 2011 and February 2017, 16 patients with 21 affected knees included 12 male and four female patients, the age ranged from 4 to 58 years, and mean (20.81 years), unilateral in 11 patients, and bilateral in five patients. The etiology was maltreated deep burns in two patients, four patients with arthrogryposis multiplex congenita, one had systemic lupus erythematosis, two had poliomyelitis, two complicated femoral lengthening, two had fibular hemimelia, complicated trauma in one case, and septic arthritis in two patients. Only gradual correction by Ilizarov fixator was used, except in one case where additional corrective osteotomy was done for hyperextended distal femur. Results The mean duration of the fixator was 3.9 months (range: 3–8 months). The follow-up period ranged from 4 to 48 months after frame removal with a mean of 10.8 months. Extension range significantly increases from the mean of −83°, to a mean of −4.7° at late follow-up (P<0.05). Mean flexion range was 35.9° that improved at late follow-up to a mean of 63.3°. The arc of motion postoperative was nearly the same of the preoperative with a mild increase. Two cases had recurrence of the KFC (15°) and knee subluxation, four cases had reversible excessive arthodiastasis of the knee joint, and two cases had epiphyseal injury in proximal tibia during the early stages of correction of the deformity. Conclusion Gradual distraction of the contracted tissues around the knee joint by Ilizarov fixator is a highly efficient and safe method that can address all components of intractable severe flexion contracture of the knee joint whatever the etiology of the deformity. There is a significant increase in the extension range and low recurrence rate compared with any other treatment method converting a nonambulant patient to an active ambulant one with a low complication rate.","PeriodicalId":171084,"journal":{"name":"The Egyptian Orthopaedic Journal","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128927160","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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