Pub Date : 2022-05-01DOI: 10.21608/ejor.2022.255096
Hassan H. Noaman, M. Abd-Ellah, Y. Soroor
Objective : The purpose of this study was to evaluate the incidence of hand stiffness and range of motion in patients with metacarpal fractures treated with internal fixation by low profile osteo-synthesis (Mini-plates). Materials and methods : A prospective study including thirty-six patients with metacarpal fracture was carried out in the period between June 2018 and June 2019 at Sohag University Hospital. All these 36 patients underwent internal fixation of metacarpal fracture by mini-plates. Evaluation of pain measured on a visual analog scale (VAS), active range of motion (ROM); and grip strength and postoperative follow up is up to one year. Results : Group of patients including thirty-six patients with metacarpal bone fractures underwent internal fixation by mini plate, the mode of trauma was Motor car accident in 26 cases (72.2%) and Assault in six cases (16.7%) hitting hard objects was in 4 cases (11.1%). No complications were reported in our cases except one case (2.8%) with wound dehiscence which improved with daily dressing and good antibiotics. Conclusion : Mini-plate and screws fixation of metacarpal fractures produces anatomical reduction of fractures with stabilization that is rigid enough to allow early mobilization, thereby preventing stiffness and hence good functional results.
{"title":"HOW TO AVOID HAND STIFFNESS IN METACARPAL FRACTURES?","authors":"Hassan H. Noaman, M. Abd-Ellah, Y. Soroor","doi":"10.21608/ejor.2022.255096","DOIUrl":"https://doi.org/10.21608/ejor.2022.255096","url":null,"abstract":"Objective : The purpose of this study was to evaluate the incidence of hand stiffness and range of motion in patients with metacarpal fractures treated with internal fixation by low profile osteo-synthesis (Mini-plates). Materials and methods : A prospective study including thirty-six patients with metacarpal fracture was carried out in the period between June 2018 and June 2019 at Sohag University Hospital. All these 36 patients underwent internal fixation of metacarpal fracture by mini-plates. Evaluation of pain measured on a visual analog scale (VAS), active range of motion (ROM); and grip strength and postoperative follow up is up to one year. Results : Group of patients including thirty-six patients with metacarpal bone fractures underwent internal fixation by mini plate, the mode of trauma was Motor car accident in 26 cases (72.2%) and Assault in six cases (16.7%) hitting hard objects was in 4 cases (11.1%). No complications were reported in our cases except one case (2.8%) with wound dehiscence which improved with daily dressing and good antibiotics. Conclusion : Mini-plate and screws fixation of metacarpal fractures produces anatomical reduction of fractures with stabilization that is rigid enough to allow early mobilization, thereby preventing stiffness and hence good functional results.","PeriodicalId":340257,"journal":{"name":"Egyptian Journal of Orthopedic Research","volume":"454 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122490585","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 : Treatment of displaced intra-articular calcaneal fractures (DIACFs) remains controversial and challenging to orthopaedic surgeons. Several procedures were used to treat DIACFs. There is no single approach that is universally applicable to all DIACFs. Objective:-The aim of this prospective study was to evaluate functional and radiographic outcomes of closed reduction and percutaneous cannulated screws fixation in treatment of Sanders type II & III DIACFs. Patients and methods : A prospective study was conducted on 14 patients (17 feet) with Sanders’ type II or III DIACFs, treated by closed reduction and fixation using cannulated screws, at orthopedics department of Sohag university hospital, between June 2020 and April 2022. Functional assessment was done by AOFAS score and VAS for pain. Radiographic assessment was done by measurement of three calcaneal angles (Gissane, Böhler’s and posterior facet inclination angles) and three calcaneal distances (height, length and width of calcaneus). Results : The mean age of patients at time of operation was 34.8 years. Vast majority of patients were males (78.6%). Involvement of right side was 57.1%. Mean operative time was 57 minutes. Mean AOFAS score was 85.9 points. Mean time of radiographic union was 8.9 weeks. Conclusion : The technique avoided wound complications associated with ORIF with advantage of shorter hospital stay. Patients are satisfied and had lower rate of subtalar arthritis.
{"title":"PERCUTANEOUS CANNULATED SCREWS FOR TREATMENT OF DISPLACED INTRA-ARTICULAR CALCANEAL FRACTURES: A PROSPECTIVE STUDY","authors":"Hossam El-Azab, Khalaf Fathy Elsayed Ahmed, Abdelrahman Hafez Khalefa, Ashraf Rashad Marzouk","doi":"10.21608/ejor.2022.255093","DOIUrl":"https://doi.org/10.21608/ejor.2022.255093","url":null,"abstract":"Background : Treatment of displaced intra-articular calcaneal fractures (DIACFs) remains controversial and challenging to orthopaedic surgeons. Several procedures were used to treat DIACFs. There is no single approach that is universally applicable to all DIACFs. Objective:-The aim of this prospective study was to evaluate functional and radiographic outcomes of closed reduction and percutaneous cannulated screws fixation in treatment of Sanders type II & III DIACFs. Patients and methods : A prospective study was conducted on 14 patients (17 feet) with Sanders’ type II or III DIACFs, treated by closed reduction and fixation using cannulated screws, at orthopedics department of Sohag university hospital, between June 2020 and April 2022. Functional assessment was done by AOFAS score and VAS for pain. Radiographic assessment was done by measurement of three calcaneal angles (Gissane, Böhler’s and posterior facet inclination angles) and three calcaneal distances (height, length and width of calcaneus). Results : The mean age of patients at time of operation was 34.8 years. Vast majority of patients were males (78.6%). Involvement of right side was 57.1%. Mean operative time was 57 minutes. Mean AOFAS score was 85.9 points. Mean time of radiographic union was 8.9 weeks. Conclusion : The technique avoided wound complications associated with ORIF with advantage of shorter hospital stay. Patients are satisfied and had lower rate of subtalar arthritis.","PeriodicalId":340257,"journal":{"name":"Egyptian Journal of Orthopedic Research","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131562729","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 : 2022-05-01DOI: 10.21608/ejor.2022.255097
A. Shiha, Hassan H. Noaman, Ahmed Addosooki, Mohamed Abo Al-Ezz
Background : Brachial plexus birth palsy (BPBP) occurs in 1.5 per 1,000 live births, resulting from traction to the brachial plexus during delivery. Surgical treatment of the secondary shoulder dysfunction following BPBP aims to accomplish three goals: restoration of passive motion by contracture release, realignment of dysplastic glenohumeral joint, and augmentation of muscle power in the weak domains of shoulder movement. Objectives : To study the importance of reduction of the glenohumeral joint with soft tissue release and tendon transfer in treatment of internal rotation contracure deformity of shoulder in cases of O.B.P.P. Patients and methods: This prospective study was done in Microsurgery Unit Orthopedic department, Sohag University Hospitals including all patients with brachial plexus birth palsy with internal rotation contracure of the shoulder with mild to moderate glenohumeral dysplasia. The patients included in this series had a diagnosis of brachial plexus birth palsy and glenohumeral dysplasia classified as type II, III, or IV on the Waters scale; had undergone joint reduction, soft-tissue rebalancing, and tendon transfers; and the average follow up was three years. Results: Mean glenoid version improved from -33° to -7° following muscle rebalancing and soft-tissue releases. The percentage of the humeral head anterior to the middle of the glenoid improved from 8% to 43%. The average duration of clinical and radiographic follow-up was thirty-six months; improvements in both shoulder motion and glenohumeral joint morphology were seen early and were maintained during the follow up period. Conclusion: Latissimus dorsi and teres major tendon transfers to rotator cuff, combined with appropriate extra-articular musculotendinous lengthenings and joint reduction, result in improved shoulder function and glenohumeral joint remodeling in the majority of patients with brachial plexus birth palsy with mild to moderate dysplasia.
{"title":"THE EFFECT OF TENDON TRANSFERS AND GLENOHUMERAL REDUCTION IN CASES OF O.B.P.P. WITH INTERNAL ROTATION CONTRACTURE","authors":"A. Shiha, Hassan H. Noaman, Ahmed Addosooki, Mohamed Abo Al-Ezz","doi":"10.21608/ejor.2022.255097","DOIUrl":"https://doi.org/10.21608/ejor.2022.255097","url":null,"abstract":"Background : Brachial plexus birth palsy (BPBP) occurs in 1.5 per 1,000 live births, resulting from traction to the brachial plexus during delivery. Surgical treatment of the secondary shoulder dysfunction following BPBP aims to accomplish three goals: restoration of passive motion by contracture release, realignment of dysplastic glenohumeral joint, and augmentation of muscle power in the weak domains of shoulder movement. Objectives : To study the importance of reduction of the glenohumeral joint with soft tissue release and tendon transfer in treatment of internal rotation contracure deformity of shoulder in cases of O.B.P.P. Patients and methods: This prospective study was done in Microsurgery Unit Orthopedic department, Sohag University Hospitals including all patients with brachial plexus birth palsy with internal rotation contracure of the shoulder with mild to moderate glenohumeral dysplasia. The patients included in this series had a diagnosis of brachial plexus birth palsy and glenohumeral dysplasia classified as type II, III, or IV on the Waters scale; had undergone joint reduction, soft-tissue rebalancing, and tendon transfers; and the average follow up was three years. Results: Mean glenoid version improved from -33° to -7° following muscle rebalancing and soft-tissue releases. The percentage of the humeral head anterior to the middle of the glenoid improved from 8% to 43%. The average duration of clinical and radiographic follow-up was thirty-six months; improvements in both shoulder motion and glenohumeral joint morphology were seen early and were maintained during the follow up period. Conclusion: Latissimus dorsi and teres major tendon transfers to rotator cuff, combined with appropriate extra-articular musculotendinous lengthenings and joint reduction, result in improved shoulder function and glenohumeral joint remodeling in the majority of patients with brachial plexus birth palsy with mild to moderate dysplasia.","PeriodicalId":340257,"journal":{"name":"Egyptian Journal of Orthopedic Research","volume":"46 S217","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132227700","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 : 2022-05-01DOI: 10.21608/ejor.2022.255094
Marwan Shams Eldin Yousief, Yasser Othman Sorour
Objectives : The study's aim is to assess the benefit of abductor hallucis tenotomy (AHT) in idiopathic talipes equinovarus as a treatment of adduction deformity of forefoot during serial casting. Methods : A study of fifty cases (50) children (72 feet) history of idiopathic clubfeet had been treated prospectively in (Abo El Reesh pediatric hospital-Kasr Al Ainy) between February 2017 and August 2018 (18 months). Fifty 50 cases (72 feet) managed with abductor hallucis tenotomy added to serial casting for treating forefoot adduction with Ponseti method. Results and conclusion : 50 cases (72 feet) managed abductor hallucis tenotomy added to Ponseti and, followed up 9 months. 97% success rate, mean Pirani score was 0.4, the abductor hallucis tenotomy reduces the length and number of casts, as well as the expense and likelihood of leg atrophy and relapse.
目的:本研究的目的是评估外展拇腱切断术(AHT)治疗特发性马蹄内翻时前足内收畸形的疗效。方法:对2017年2月至2018年8月(18个月)在(Abo El Reesh儿科医院- kasr Al Ainy)接受前瞻性治疗的50例(50)例(72英尺)特发性内翻足患儿进行研究。用Ponseti法治疗前足内收50例(72英尺)，采用外展拇肌腱切断术加连续铸造治疗。结果与结论:50例(72尺)成功行拇外展肌腱切断术加Ponseti术，随访9个月。成功率97%，平均皮拉尼评分为0.4，外展幻觉肌腱切断术减少了石膏的长度和数量，减少了费用和腿部萎缩和复发的可能性。
{"title":"ROLE OF ABDUCTOR HALLUCIS RELEASE WITH PONSETI METHOD FOR TREATING FOREFOOT ADDUCTION IN IDIOPATHIC CONGENITAL TALIPES EQUINOVARUS","authors":"Marwan Shams Eldin Yousief, Yasser Othman Sorour","doi":"10.21608/ejor.2022.255094","DOIUrl":"https://doi.org/10.21608/ejor.2022.255094","url":null,"abstract":"Objectives : The study's aim is to assess the benefit of abductor hallucis tenotomy (AHT) in idiopathic talipes equinovarus as a treatment of adduction deformity of forefoot during serial casting. Methods : A study of fifty cases (50) children (72 feet) history of idiopathic clubfeet had been treated prospectively in (Abo El Reesh pediatric hospital-Kasr Al Ainy) between February 2017 and August 2018 (18 months). Fifty 50 cases (72 feet) managed with abductor hallucis tenotomy added to serial casting for treating forefoot adduction with Ponseti method. Results and conclusion : 50 cases (72 feet) managed abductor hallucis tenotomy added to Ponseti and, followed up 9 months. 97% success rate, mean Pirani score was 0.4, the abductor hallucis tenotomy reduces the length and number of casts, as well as the expense and likelihood of leg atrophy and relapse.","PeriodicalId":340257,"journal":{"name":"Egyptian Journal of Orthopedic Research","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126459835","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 : 2022-05-01DOI: 10.21608/ejor.2022.255095
Hassan H. Noaman, Ahmed Faisal, Hossam Hosny, Yasser Othman Sorour
Background: Diaphyseal tibial shaft fractures are the second most common fracture in hospitalized children resulting from both high and low energy trauma. Operative treatment requires implants that do not violate open physes and have less complications rate than traditional treatment methods. Flexible intramedullary nails had gained popularity for treatment of paediatric diaphyseal tibial shaft fractures. Patients and Methods: 45 patients with diaphyseal tibial fracture were treated by flexible intramedullary nails. There were 30 male and 15 females. The youngest patient in our study was 10 years old while the oldest was 18 years old. Functional and radiological evaluations were done for all patients at the last follow up. Results: Most common mechanism of injury was road traffic accident followed by falling from height. 62.2 % of the cases had simple fracture (28 patient) while 26.7% of cases (12 patients) had type I open fractures and 11.1 % of the cases (5 patients) had type II open fractures. All fractures achieved full fracture union at a mean of 12 week with range from 10 to 18 week. Two cases suffered from nonunion that treated later on by bone grafting. One patient had postoperative fracture angulation. Conclusion: Flexible intramedullary nails can be used safely in adolescents with satisfactory results. It provides acceptable fracture redction and rapid healing with an acceptable rate of complications and return to unrestricted physical activity.
{"title":"FLEXIBLE INTRAMEDULLARY NAILS FOR FIXATION OF ADOLESCENT DIAPHYSEAL TIBIAL SHAFT FRACTURES","authors":"Hassan H. Noaman, Ahmed Faisal, Hossam Hosny, Yasser Othman Sorour","doi":"10.21608/ejor.2022.255095","DOIUrl":"https://doi.org/10.21608/ejor.2022.255095","url":null,"abstract":"Background: Diaphyseal tibial shaft fractures are the second most common fracture in hospitalized children resulting from both high and low energy trauma. Operative treatment requires implants that do not violate open physes and have less complications rate than traditional treatment methods. Flexible intramedullary nails had gained popularity for treatment of paediatric diaphyseal tibial shaft fractures. Patients and Methods: 45 patients with diaphyseal tibial fracture were treated by flexible intramedullary nails. There were 30 male and 15 females. The youngest patient in our study was 10 years old while the oldest was 18 years old. Functional and radiological evaluations were done for all patients at the last follow up. Results: Most common mechanism of injury was road traffic accident followed by falling from height. 62.2 % of the cases had simple fracture (28 patient) while 26.7% of cases (12 patients) had type I open fractures and 11.1 % of the cases (5 patients) had type II open fractures. All fractures achieved full fracture union at a mean of 12 week with range from 10 to 18 week. Two cases suffered from nonunion that treated later on by bone grafting. One patient had postoperative fracture angulation. Conclusion: Flexible intramedullary nails can be used safely in adolescents with satisfactory results. It provides acceptable fracture redction and rapid healing with an acceptable rate of complications and return to unrestricted physical activity.","PeriodicalId":340257,"journal":{"name":"Egyptian Journal of Orthopedic Research","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129804669","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 : 2021-12-01DOI: 10.21608/ejor.2021.225619
Shazly Mousa, A. Hafez, A. Fawaz, Emad El-Deen Abd-Elmotalb, Moustafa Elsayed, M. Ali
The aim of this study is to compare final outcome in short term follow up in patients with isolated anterior cruciate ligament injury (ACL) and those associated with meniscal injury. This was a prospective study of 30 cases of ACL injury in sohag university hospital divided into two groups , group A containing patients with isolated ACL injury and group B containing patients with associated meniscal injury both groups examined preoperative and postoperative for knee stability and meniscal injury, knee X-ray and MRI done preoperatively for all patient then anatomi csingle bundle ACL reconstruction hamstring tendon fixed by interference screws and partial meniscectomy for associated meniscal injury. All patient assessed by lysholm score preoperative and six months postoperative and result compared. Result showing negative significant effect of meniscal injury on final out comes. Keyword: Anatomic ACL reconstruction, Associated meniscal injury, Knee arthroscopy, knee injury, Hamstering tendon graft.
{"title":"ANATOMIC FEMORAL TUNNEL PLACEMENT IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING HAMSTERING COMPARING RESULTS BETWEEN ISOLATED ACL INJURY AND ASSOCIATED MENISCAL INJURY","authors":"Shazly Mousa, A. Hafez, A. Fawaz, Emad El-Deen Abd-Elmotalb, Moustafa Elsayed, M. Ali","doi":"10.21608/ejor.2021.225619","DOIUrl":"https://doi.org/10.21608/ejor.2021.225619","url":null,"abstract":"The aim of this study is to compare final outcome in short term follow up in patients with isolated anterior cruciate ligament injury (ACL) and those associated with meniscal injury. This was a prospective study of 30 cases of ACL injury in sohag university hospital divided into two groups , group A containing patients with isolated ACL injury and group B containing patients with associated meniscal injury both groups examined preoperative and postoperative for knee stability and meniscal injury, knee X-ray and MRI done preoperatively for all patient then anatomi csingle bundle ACL reconstruction hamstring tendon fixed by interference screws and partial meniscectomy for associated meniscal injury. All patient assessed by lysholm score preoperative and six months postoperative and result compared. Result showing negative significant effect of meniscal injury on final out comes. Keyword: Anatomic ACL reconstruction, Associated meniscal injury, Knee arthroscopy, knee injury, Hamstering tendon graft.","PeriodicalId":340257,"journal":{"name":"Egyptian Journal of Orthopedic Research","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130582335","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 : 2021-12-01DOI: 10.21608/ejor.2021.225624
Khalaf N. Ahmed, Ashraf Marzouk, Hossam El-Azab, A. Hafez
Displaced intra-articular calcaneus fractures (DIACFs) are sources of potential disability to the patient, economic burden to the society and a treatment challenge to the average orthopaedic surgeon. Up to date, there is no single approach that is universally applicable to all DIACFs. ORIF can be associated with significant wound complications. Conservative treatment may not be acceptable in a young active patient because of malunion and secondary subtalar osteoarthritis. The minimally invasive surgery (MIS) for DIACFs strives to strike a balance between ORIF and conservative treatment. The aim of this prospective study was to evaluate the functional and radiographic outcomes of closed reduction and percutaneous multiple K-wires fixation as a minimally invasive technique for treatment of Sanders type II & III DIACFs. This prospective study was conducted on 14 patients (9 males and 5 females) with 17 displaced intra-articular calcaneal fractures, managed by closed reduction and multiple K-wires fixation in Sohag university hospitals. The results were assessed at the end of follow up clinically using AOFAS ankle-hind foot scale and radiographically by plain radiographs. The mean age at time of operation was 36.57 ± 12.005 (range, 23-57) years. The right side was affected in 6 (42.9%) patients, while the left in 5 (35.7%) and there were 3(21.4%) patients with bilateral involvement. The patients were consecutive; 9 (64.3%) were males and 5 (35.7%) were females. The most common mechanism of injury was falling from height in 11(78.6%) patients. Four (28.6%) patients were smokers. The mean time lapsed to surgery was 5.07 ± 4.35 (range, 1-14) days. The mean length of follow-up was 10.07 ± 3.95 (range, 6-17) months. The mean AOFAS score at the final follow up was 74.4 ±12.73 (range, 45−90) points. There was a significant reduction of the mean VAS score for pain from 7.31 pre-operatively to 3.54 at the 4th week post-operatively, and to 1.69 at the final follow-up, (P values <0.001). Radiographic evaluation of the hindfoot revealed post-operative improvement of Böhler’s angle, angle of Gissane, posterior facet inclination angle, calcaneal width, length, and height. Closed reduction and minimally invasive internal fixation through percutaneous multiple K-Wire fixation is an effective treatment for carefully selected cases of DIACFs with acceptable functional and radiographic results and fewer complication rates.
{"title":"PERCUTANEOUS KIRSCHNER WIRES FOR THE TREATMENT OF DISPLACED INTRA-ARTICULAR FRACTURES OF CALCANEUS: A PROSPECTIVE STUDY","authors":"Khalaf N. Ahmed, Ashraf Marzouk, Hossam El-Azab, A. Hafez","doi":"10.21608/ejor.2021.225624","DOIUrl":"https://doi.org/10.21608/ejor.2021.225624","url":null,"abstract":"Displaced intra-articular calcaneus fractures (DIACFs) are sources of potential disability to the patient, economic burden to the society and a treatment challenge to the average orthopaedic surgeon. Up to date, there is no single approach that is universally applicable to all DIACFs. ORIF can be associated with significant wound complications. Conservative treatment may not be acceptable in a young active patient because of malunion and secondary subtalar osteoarthritis. The minimally invasive surgery (MIS) for DIACFs strives to strike a balance between ORIF and conservative treatment. The aim of this prospective study was to evaluate the functional and radiographic outcomes of closed reduction and percutaneous multiple K-wires fixation as a minimally invasive technique for treatment of Sanders type II & III DIACFs. This prospective study was conducted on 14 patients (9 males and 5 females) with 17 displaced intra-articular calcaneal fractures, managed by closed reduction and multiple K-wires fixation in Sohag university hospitals. The results were assessed at the end of follow up clinically using AOFAS ankle-hind foot scale and radiographically by plain radiographs. The mean age at time of operation was 36.57 ± 12.005 (range, 23-57) years. The right side was affected in 6 (42.9%) patients, while the left in 5 (35.7%) and there were 3(21.4%) patients with bilateral involvement. The patients were consecutive; 9 (64.3%) were males and 5 (35.7%) were females. The most common mechanism of injury was falling from height in 11(78.6%) patients. Four (28.6%) patients were smokers. The mean time lapsed to surgery was 5.07 ± 4.35 (range, 1-14) days. The mean length of follow-up was 10.07 ± 3.95 (range, 6-17) months. The mean AOFAS score at the final follow up was 74.4 ±12.73 (range, 45−90) points. There was a significant reduction of the mean VAS score for pain from 7.31 pre-operatively to 3.54 at the 4th week post-operatively, and to 1.69 at the final follow-up, (P values <0.001). Radiographic evaluation of the hindfoot revealed post-operative improvement of Böhler’s angle, angle of Gissane, posterior facet inclination angle, calcaneal width, length, and height. Closed reduction and minimally invasive internal fixation through percutaneous multiple K-Wire fixation is an effective treatment for carefully selected cases of DIACFs with acceptable functional and radiographic results and fewer complication rates.","PeriodicalId":340257,"journal":{"name":"Egyptian Journal of Orthopedic Research","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126988604","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 : 2021-12-01DOI: 10.21608/ejor.2021.225625
Shazly Mousa, A. Hafez, N. Hasan, Khalaf N. Ahmed
Congenital talipes equinovarus (clubfoot) is one of the most common congenital anomalies encountered in pediatric orthopedics. Its incidence is about 1:1000 live births. It remains a challenge not only to understand its genetic origins but also to provide effective long-term treatment and prevention of recurrences. Clubfoot can lead to serious walking problems if left untreated. Conservative treatment with the Ponseti method has revolutionized the clubfoot treatment and has been adopted globally in the last decades. Surgical treatment is indicated only after failure of conservative methods. Surgical release rate of the idiopathic clubfoot has decreased significantly since the emergence of the Ponseti method. The aim of this study was the evaluation of using ponseti technique for correction of cases of idiopathic CTEV deformity by clinical and radiological follow up aiming at determining benefits, drawbacks and obstacles to this technique . Between March 2020 and March 2021, total of 26 patients with 40 feet affected with congenital talipes equinovarus were treated using the Ponseti technique at the outpatient clinic of the orthopedics department of Sohag university hospital. Pirani scoring system was used for clinical evaluation of clubfeet. All patients had pre-treatment , post-correction and last follow-up plain radiographs that included antero-posterior (AP) and lateral dorsiflexion stress views of the feet. The antero-posterior and lateral talo-calcaneal angles (TCA) were measured and were used to calculate the talocalcaneal index (TCI). 16 patients (61.5%) were male, 10 (38.5%) patients were female. 14 patients (53.8%) had bilateral involvement, 12 patients (46.2) were unilateral. The age of patients at the time of presentation varied from one week to one and a half year with the mean age was 5 months. The mean number of the casts required was greater for the group that required tenotomy than the group that did not require tenotomy. Tenotomies were performed on 14 feet of 40 (35%) while 26 feet (65%) did not require tenotomy. The average initial Pirani score in this study was 5.0 range from (2-10) while the average final Pirani score ranged from (1 -1.5). Final results of correction according to Pirani score were excellent in 18 feet (45%), Fair in 20 feet (50%), and poor in 2 feet (5%). There was a statistically significant improvement in the mean values of the radiological parameters including TCA on AP and lateral views, and TCI after treatment when compared with the values at presentation. Ponseti technique of serial manipulation and cast is an easy, efficient, economical and reliable method of CTEV correction when it is applied early with 95 % success rate.
{"title":"CLINICAL AND RADIOLOGICAL ASSESSMENT OF THE EFFECTIVENESS OF PONSETI TECHNIQUE IN TREATMENT OF CONGENITAL TALIPES EQUINOVARUS","authors":"Shazly Mousa, A. Hafez, N. Hasan, Khalaf N. Ahmed","doi":"10.21608/ejor.2021.225625","DOIUrl":"https://doi.org/10.21608/ejor.2021.225625","url":null,"abstract":"Congenital talipes equinovarus (clubfoot) is one of the most common congenital anomalies encountered in pediatric orthopedics. Its incidence is about 1:1000 live births. It remains a challenge not only to understand its genetic origins but also to provide effective long-term treatment and prevention of recurrences. Clubfoot can lead to serious walking problems if left untreated. Conservative treatment with the Ponseti method has revolutionized the clubfoot treatment and has been adopted globally in the last decades. Surgical treatment is indicated only after failure of conservative methods. Surgical release rate of the idiopathic clubfoot has decreased significantly since the emergence of the Ponseti method. The aim of this study was the evaluation of using ponseti technique for correction of cases of idiopathic CTEV deformity by clinical and radiological follow up aiming at determining benefits, drawbacks and obstacles to this technique . Between March 2020 and March 2021, total of 26 patients with 40 feet affected with congenital talipes equinovarus were treated using the Ponseti technique at the outpatient clinic of the orthopedics department of Sohag university hospital. Pirani scoring system was used for clinical evaluation of clubfeet. All patients had pre-treatment , post-correction and last follow-up plain radiographs that included antero-posterior (AP) and lateral dorsiflexion stress views of the feet. The antero-posterior and lateral talo-calcaneal angles (TCA) were measured and were used to calculate the talocalcaneal index (TCI). 16 patients (61.5%) were male, 10 (38.5%) patients were female. 14 patients (53.8%) had bilateral involvement, 12 patients (46.2) were unilateral. The age of patients at the time of presentation varied from one week to one and a half year with the mean age was 5 months. The mean number of the casts required was greater for the group that required tenotomy than the group that did not require tenotomy. Tenotomies were performed on 14 feet of 40 (35%) while 26 feet (65%) did not require tenotomy. The average initial Pirani score in this study was 5.0 range from (2-10) while the average final Pirani score ranged from (1 -1.5). Final results of correction according to Pirani score were excellent in 18 feet (45%), Fair in 20 feet (50%), and poor in 2 feet (5%). There was a statistically significant improvement in the mean values of the radiological parameters including TCA on AP and lateral views, and TCI after treatment when compared with the values at presentation. Ponseti technique of serial manipulation and cast is an easy, efficient, economical and reliable method of CTEV correction when it is applied early with 95 % success rate.","PeriodicalId":340257,"journal":{"name":"Egyptian Journal of Orthopedic Research","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126537040","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 : 2021-12-01DOI: 10.21608/ejor.2021.225618
Wessam Tawfeek, A. Shiha, A. Addosooki, Moustafa Elsayed
Treatment of frozen shoulder directed to improve the shoulder range of motion. Various interventions have been described including arthroscopic release. The optimal method of release is still controversy. Release of the rotator interval and coracohumeral ligament is considered a minimal invasive technique with promising results. A prospective study of 32 patients suffered from resistant frozen shoulder treated by arthroscopic rotator interval release. Visual Analog Score (VAS), active and passive range of motion of the affected shoulder was measured and UCLA (University of California Los Angeles) score was measured and compared pre-operatively during postoperative 1,3,12 months follow up. The mean VAS was 8±1.02 preoperative, 4±1.05 post after 1 month, 2.59±1.13 post after 3 months and 1.91±1.4 post after 12 months whereas the mean UCLA score was 26.84±3.13 post after 1 month, 30.34±2.88 Post after 3 month31.16±3.57 Post after 1 year 31.16 at 12 months. These patients demonstrated a statistically significant increase in shoulder motion in all 4 directions. VAS and UCLA score were statistically improve postoperatively. Arthroscopic rotator interval and coracohumeral ligament release for adhesive capsulitis are encouraging and provide an effective treatment modality to provide pain relief restore joint function.
{"title":"ARTHROSCOPIC RELEASE OF ROTATOR INTERVAL AS A TREATMENT OF FROZEN SHOULDER","authors":"Wessam Tawfeek, A. Shiha, A. Addosooki, Moustafa Elsayed","doi":"10.21608/ejor.2021.225618","DOIUrl":"https://doi.org/10.21608/ejor.2021.225618","url":null,"abstract":"Treatment of frozen shoulder directed to improve the shoulder range of motion. Various interventions have been described including arthroscopic release. The optimal method of release is still controversy. Release of the rotator interval and coracohumeral ligament is considered a minimal invasive technique with promising results. A prospective study of 32 patients suffered from resistant frozen shoulder treated by arthroscopic rotator interval release. Visual Analog Score (VAS), active and passive range of motion of the affected shoulder was measured and UCLA (University of California Los Angeles) score was measured and compared pre-operatively during postoperative 1,3,12 months follow up. The mean VAS was 8±1.02 preoperative, 4±1.05 post after 1 month, 2.59±1.13 post after 3 months and 1.91±1.4 post after 12 months whereas the mean UCLA score was 26.84±3.13 post after 1 month, 30.34±2.88 Post after 3 month31.16±3.57 Post after 1 year 31.16 at 12 months. These patients demonstrated a statistically significant increase in shoulder motion in all 4 directions. VAS and UCLA score were statistically improve postoperatively. Arthroscopic rotator interval and coracohumeral ligament release for adhesive capsulitis are encouraging and provide an effective treatment modality to provide pain relief restore joint function.","PeriodicalId":340257,"journal":{"name":"Egyptian Journal of Orthopedic Research","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130435258","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 : 2021-12-01DOI: 10.21608/ejor.2021.225617
K. Kenawy, A. Kasim, Nahla Mahmoud, Mahmoud Saif-Al-Islam, Khalid Naser
Schistosomiasis is one of the most prevalent tropical diseases in the world. Spinal cord neuroschistosomiasis is an uncommon complication mainly due to infestation by Schistosoma mansoni and may be caused by Schistosoma haematobium. Diagnosis depends on detection of anti-bilharzial antibodies and MRI of lumbar spine. The main treatment is medical. Surgery is an option for resistant cases. From January 2009 to January 2020, we reviewed patients with conus medullaris bilharziasis, who received different modalities of management. Clinical presentation, treatment plans, outcomes, and complications were reported. We studied 21 patients with conus bilharziasis. Males constituted 95.2 % and the age ranged from 8-12 years with a mean of 9.8 years. Low back pain and hypothesia were present in 100 % of patients while retention of urine in 95.2%. Examination of urine for S. haematobium ova was negative in 100 %, while stool examination for S. mansoni ova was positive in 4.8%. Mild to moderate expansion of the distal spinal cord and conus medullaris was seen in 100 % of MR images. After medical treatment; complete improvement was achieved in 71.4%, and partial improvement in 9.5%. Surgery was done in 19 % after failure of medical treatment and physiotherapy of whom, 4.8 % improved completely, 4.8 % improved partially while no improvement occurred in 9.5%. Conus lesions in endemic areas should trigger the possibility of Bilharziasis. Early diagnosis by MRI and positive antibilharzial antibodies is essential for management to avoid complications.
{"title":"MANAGEMENT OF BILHARZIASIS OF THE CONUS MEDULLARIS","authors":"K. Kenawy, A. Kasim, Nahla Mahmoud, Mahmoud Saif-Al-Islam, Khalid Naser","doi":"10.21608/ejor.2021.225617","DOIUrl":"https://doi.org/10.21608/ejor.2021.225617","url":null,"abstract":"Schistosomiasis is one of the most prevalent tropical diseases in the world. Spinal cord neuroschistosomiasis is an uncommon complication mainly due to infestation by Schistosoma mansoni and may be caused by Schistosoma haematobium. Diagnosis depends on detection of anti-bilharzial antibodies and MRI of lumbar spine. The main treatment is medical. Surgery is an option for resistant cases. From January 2009 to January 2020, we reviewed patients with conus medullaris bilharziasis, who received different modalities of management. Clinical presentation, treatment plans, outcomes, and complications were reported. We studied 21 patients with conus bilharziasis. Males constituted 95.2 % and the age ranged from 8-12 years with a mean of 9.8 years. Low back pain and hypothesia were present in 100 % of patients while retention of urine in 95.2%. Examination of urine for S. haematobium ova was negative in 100 %, while stool examination for S. mansoni ova was positive in 4.8%. Mild to moderate expansion of the distal spinal cord and conus medullaris was seen in 100 % of MR images. After medical treatment; complete improvement was achieved in 71.4%, and partial improvement in 9.5%. Surgery was done in 19 % after failure of medical treatment and physiotherapy of whom, 4.8 % improved completely, 4.8 % improved partially while no improvement occurred in 9.5%. Conus lesions in endemic areas should trigger the possibility of Bilharziasis. Early diagnosis by MRI and positive antibilharzial antibodies is essential for management to avoid complications.","PeriodicalId":340257,"journal":{"name":"Egyptian Journal of Orthopedic Research","volume":"239 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122814457","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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