• Users Online: 291
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login
Export selected to
Reference Manager
Medlars Format
RefWorks Format
BibTex Format
   Table of Contents - Current issue
April-June 2019
Volume 54 | Issue 2
Page Nos. 97-191

Online since Tuesday, August 18, 2020

Accessed 12,326 times.
View as eBookView issue as eBook
Access StatisticsIssue statistics
Hide all abstracts  Show selected abstracts  Export selected to  Add to my list

Temporary hemiepiphysiodesis for idiopathic genu valgum p. 97
Mohamed Abdeen
Background For correction of angular deformity, the medial eight-plate system has been proposed as a safe and minimally invasive technique. The purpose of this study was to assess the results and the degree of correction obtained with this procedure in patients with idiopathic genu valgum. Patients and methods This study was a prospective study of 19 valgus deformities of the knee in 11 patients treated with medial hemiepiphysiodesis using one medial eight-plate. The tibiofemoral angle and the anatomic lateral distal femoral angle were assessed on anteroposterior radiographs of the lower extremity taken at multiple time intervals. Results A total of 19 deformities in 11 patients were reviewed. The average time of follow-up from index surgery was 11.7 months, with an average correction time of 11.2 months. The tibiofemoral angle was corrected from a mean of 12.2° preoperatively to 4.6° postoperatively; the anatomic lateral distal femoral angle was also corrected from a mean of 79.7° preoperatively to a mean of 84.05° postoperatively. There were no instrumentation breakages. Conclusion Hemiepiphysiodesis with medial eight plate provides an effective and predictable correction of idiopathic genu valgum. There is a trend toward faster correction in younger patients.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Treatment of congenital vertical talus by reverse Ponseti technique p. 101
Mohamed Y Ali, Mohamed T Mohamed
Background Congenital vertical talus (CVT), also known as congenital convex pes valgus, is a rigid flatfoot deformity characterized by fixed hindfoot equinus and an irreducible talonavicular dislocation. This deformity can either be idiopathic and isolated or can occur with other conditions such as neural tube defects (myelomeningocele and spina bifida occulta), neuromuscular disorders like cerebral palsy and anterior horn cell disease, and in chromosomal aberrations like Down’s syndrome. The use of serial manipulation and plaster cast treatment followed by minimal surgical interventions has provided good early results in the treatment of idiopathic CVT. The method of cast correction of a vertical talus is based on a specific way of manipulating the foot so as to gradually reduce the talonavicular joint. The principles are similar to those used in the Ponseti method of clubfoot correction. Aim of the study To evaluate the management and the outcome of patients with CVT managed with reverse Ponseti technique, and minimal surgical intervention. Patients and methods This prospective study included 25 feet in 17 patients with CVT, comprising eight patients with bilateral and nine with unilateral involvement. The study was done at the new Children Hospital Cairo University between January 2013 and December 2015. The follow-up period ranged from 10 to 14 months, with an average period of 11.6 months. Inclusion criteria were patients diagnosed to have idiopathic CVT and no age limit, and exclusion criteria were previous operative release and cases associated with neuromuscular disorders or syndromes. Results Three (12%) cases were classified as excellent, 12 (48%) cases were classified as good, eight (32%) cases were classified as fair, and two (8%) cases were classified as poor. Conclusion Favorable results were obtained using the reverse Ponseti method of closed manipulation and then limited open reduction and fixation with a pin in the talonavicular joint and percutaneous Achilles tenotomy. There were also fewer complications compared with extensive operative treatments, by avoiding more extensive surgery.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Management of open tibial fractures type IIIB by segment transfer using limb reconstruction system fixator p. 110
Shady S Elbeshry, Khaled A.A Alabd
Purpose To evaluate the effectiveness of bone transport using limb reconstruction system (LRS) fixator and early coverage in open-type IIIB tibial fractures with massive bone and soft tissue loss. Patients and methods In this study, eight patients with type IIIB open tibial fractures were managed by initial debridement and fixation by LRS uniplanar external fixator. A second-stage rotational myocutaneous flap coverage and osteotomy for segment transfer was done within 14 days. All patients were followed up till full union. Results Full union was achieved in all patients. A total of five patients needed iliac bone graft at the docking site. Union occurred in an average external fixator index of 45.3 days/cm. No flap coverage infection occurred, and there was no significant limb malalignment. Significant limb shortening occurred only in one patient. Conclusion LRS fixator is an effective definitive method for management of open tibial fractures with massive bone loss and soft tissue defects. It is easy to apply, allows early intervention by plastic surgeons to obtain soft tissue coverage, and also allows early patient rehabilitation and joint mobilization.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Arthroscopic repair of combined anterior and superior cuff tear p. 116
Mohamed A El Sheikh
Purpose The aim of this study is to evaluate the results of arthroscopic repair of combined anterior and superior cuff tear. Patients and methods One-stage arthroscopic repair of concomitant supraspinatus and subscapularis tendon tear was performed in 25 patients. All patients were evaluated at a minimum 1-year follow-up with a visual analog scale score for pain; subjective shoulder value, which was used for subjective evaluation of the affected shoulder as a percentage of the normal one; range of motion; the American Shoulder and Elbow Surgeons score; and University of California at Los Angeles scores for clinical assessment. Belly-Press test and lift-off test, in particular back-to-hand distance, were used to evaluate subscapularis function. Empty can test was used to evaluate the supraspinatus strength. Results The mean age at the time of surgery was 53.9±11.3 years. The rate of dominant arm involvement was 60% of the patients. At the final follow-up, the mean visual analog scale score improved significantly to 0.38±0.01 points postoperatively (P<0.01). The mean subjective shoulder value improved from 36.5±6.98 preoperatively to 89.9±7.52 at the end of follow-up, and this was significant (P<0.001).The mean American Shoulder and Elbow Surgeons score improved significantly to 90.8±8.45 at the mean 1-year follow-up (P<0.001). The mean University of California at Los Angeles score improved significantly to 30.4±3.85 at the end of follow-up (P<0.001). Patients gained a significant reduction of belly-press angle from 36.5±12.5 to 13.9±3.25 (P<0.0026). Back-to-hand distance significantly improved from 2.95±0.68 to 6.0±1.33 cm (P<0.0033). The mean active forward flexion and the mean active internal rotation significantly improved postoperatively, whereas the mean active external rotation was nonsignificantly reduced. Of the 25 shoulders, 23 (92%) were considered by the patients to be much better or better as a result of the operation. Conclusion The arthroscopic tackling of concomitant shoulder anterior and superior rotator cuff tears showed satisfactory results and fastened the return to normal activity at 1-year follow-up, as well as postoperative stiffness was avoided. Level of evidence: Level III, case–control study.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Chronic anteromedial rotatory instability of the knee: technique and results of a near-anatomical reconstruction p. 126
Mohamed Aboelnour Badran, Abd Elrhman Elganiny
Background Superficial and deep medial collateral ligament (MCL) together with the posterior oblique ligament (POL) works in harmony to control anteromedial rotatory instability (AMRI) throughout the knee range of motion (ROM). Associated anterior cruciate ligament (ACL) injury will accentuate the instability in all directions, adding more challenge to the management plan. This pattern of injury is a common type of combined ligamentous knee injury. Hypothesis Near-anatomical reconstruction of both ACL/MCL will restore knee AMRI to normal, with minimal ROM deficit. Patients and methods Twenty-five patients with chronic combined ACL and MCL injury (>3 months since injury) were included in this study. Anatomical ACL with percutaneous MCL–POL were performed and the patients were assessed at 2 years for knee stability, ROM, and complications. Results The mean subjective International Knee Documentation Committee scores for the patients were 43.32±7.58, range 28–60; at the end of follow-up, the mean was 94.76±3.7, range 89–100, P value less than 0.0001. The knee stability was restored to normal in 84% of patients and nearly normal in 16% of patients. Conclusion Anatomical ACL with percutaneous MCL–POL reconstruction yields very good results in cases of chronic AMRI. This technique is associated with little morbidity and can be done through minimally invasive incisions.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

A simple reduction technique for the posterior column in acetabular fractures p. 133
Osama A Al-Wahab Seleem
Background Posterior acetabular column injuries can happen as an isolated fracture or can be associated with other acetabular fractures. The aim of this study was to evaluate the validity of a new technique in the reduction and fixation of fractures involving the posterior acetabular column. Patients and methods A prospective study which included 35 patients with displaced acetabular fractures (≥3 mm). Of the patients, 24 were men and 11 were women. The age of the patients’ ranged from 25 to 50 years with a mean of 37.9 years. All patients had injuries to the posterior column, either isolated or associated with other types of acetabular fractures. The follow-up period ranged from 24 to 36 months with a mean of 28.8 months. Results Perfect or anatomical reduction of the posterior column was achieved and maintained in 25 (71.43%) patients. Near perfect or near-anatomical reduction of the posterior column was achieved and maintained in another six (17.14%) patients. Three (8.57%) patients had good reduction of the posterior column which was maintained till union, while one (2.86%) patient had imperfect reduction of the posterior column. According to the Harris hip score, the clinical outcome was excellent in 12 (34.29%) patients, good in 17 (48.57%) patients, fair in five (14.29%) patients, and poor in one (2.85%) patient. The operative time for reduction and fixation of the posterior column using this technique ranged from 15 to 20 min with a mean of 18 min. No permanent complications happed during this study. Conclusion The technique described in this study is a simple technique for open reduction without the need for such bulky instrumentations with rapid internal fixation. This method of reduction and fixation is considered useful, safe, and comparable to all the previous described reduction and fixation techniques.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The impact of posterior tibial slope on knee flexion in PCl sacrificing total knee arthroplasty p. 140
Mohamed A Elsheikh
Introduction Range of motion (ROM) is one of the critical factors in determination of the total knee arthroplasty effectiveness. Increased motion is associated with improved function and increased patient satisfaction. Posterior tibial slope has been theorized as advantageous to ROM. The purpose of this study is to evaluate and quantify the effect of the tibial slope on the postoperative maximal knee flexion. Patients and methods A total of 60 patients who had undergone total knee arthroplasty with the posterior stabilized prostheses were divided into two groups; each group included 30 patients. The only difference between groups was the use of a 0° (group A) or 7° (group B) posterior sloped tibial cutting block. Preoperative ROM and Hospital for Special Surgery knee scores were prospectively obtained from each patient. Similar data were obtained for all patients at 3 months after surgery and at each patient’s follow-up examination. Preoperative and postoperative radiographs of each surgical knee were obtained and measured to determine the tibial slope angle. Results Use of the 0° cutting block in group 1 resulted in a mean postoperative proximal tibial slope of 1.3°±2.96° (range: −3° to 7°), whereas using the 7° cutting block in group 2 resulted in a mean postoperative proximal tibial slope of 7.27°±2.66° (range: 1°–11°). The difference between the groups was statistically significant (P=0.001). The mean values of the postoperative maximal flexion angles were 115.2°±12.59° (range: 91°–130°) and 122.5°±11.96° (range: 94°–136°) in groups 1 and 2, respectively. There was a significant difference in the maximal flexion between the two groups (P=0.0125). Conclusion An increase in the posterior tibial slope can significantly increase the postoperative maximal knee flexion.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Ankle fusion by Ilizarov external fixator p. 146
Abdel-Salam A Ahmed
Introduction Arthrodesis is a salvage procedure for patients with a destroyed, painful ankle joint to restore pain-free ambulation. The paper aimed to evaluate the results of ankle arthrodesis using the Ilizarov external fixator to treat end-stage tibiotalar arthritis. Patients and methods This retrospective study included 20 patients who had been treated with ankle fusion by Ilizarov fixator performed from December 2007 to January 2014. Their mean age was 44.95 years. Eight patients were females. The underlying pathology was septic ankle destruction, post-traumatic osteoarthritis, and rheumatoid arthritis. Avascular necrosis of talus was present in three cases. Seventeen patients had previous surgical procedures with a mean of 2.15 surgeries. Five patients had a failed previous arthrodesis. Six patients had associated equinus deformity. The mean preoperative American Orthopaedic Foot and Ankle Society Ankle-Hind foot score was 26. Results The mean follow-up period was 28.15 months. The mean external fixation period was 15.75 weeks. Sound fusion was achieved in all patients without additional operative procedures. Infection was controlled in all septic ankles. Pin-tract infections were observed in seven cases. In three cases, wires or half-pins needed to be removed. One ankle was fused in mild varus. One patient reported moderate daily diffuse pain. The mean postoperative American Orthopaedic Foot and Ankle Society Ankle-Hind foot score was 75.45. Patients reported functional satisfaction with the results. Conclusions The use of the Ilizarov external fixator provides a successful salvage method that offers solid bony fusion, optimal alignment, and eradication of infection in complex ankle pathology or failed previous arthrodesis.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Conversion total knee arthroplasty after arthrodesis using rotatory hinge revision system p. 154
Haytham Abdelazim, Mohammed H Hashem
Objective Patients with knee arthrodesis experience many daily activities and limitations affecting their life quality. The purpose of this study was to report and discuss the outcome of our cases of knee arthrodesis converted to total knee arthroplasty. Patients and methods In the period from August 2015 to December 2017, the authors conducted a prospective study that included six patients (one female and five males) with sound knee arthrodesis. All patients underwent conversion total knee arthroplasty using rotatory hinge revision system. Patients’ ages ranged from 35 to 66 years. Patients were evaluated using Knee Society Clinical Score and Knee Injury and Osteoarthritis Outcome Score. Results The average follow-up period was 24.5 months (18–36 months). At the final follow-up, average knee flexion was 87.5° (70°–100°). Knee Society Clinical Score and Knee Injury and Osteoarthritis Outcome Score score increased form an average of 31.8 (28.4–34.8) preoperatively to 66.6 (58.6–74.4) at the final follow-up. The authors had an average final Knee society score of 67.6, ranging from 53 to 78. Three cases experienced postoperative complications, representing 50% of the study group, two cases had superficial wound infection, and a case had skin edge necrosis; all were successfully managed, with no long-term complications. Conclusion Conversion total knee arthroplasty is a hope for patients who cannot tolerate the effect of knee arthrodesis in their lives. Awareness of the risks, proper patient selection, good preoperative planning, and adequate management of complications can help the patients to have satisfactory results.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Functional outcomes following arthroscopic ankle arthrodesis for isolated ankle arthrosis p. 161
Mohamed H Khalil, Moustafa R Hafez
Background Painful ankle arthrosis is a challenging orthopedic problem. Ankle arthrodesis is deemed to be the treatment of choice for painful ankle arthrosis that failed to respond to conservative management. The arthroscopic technique in ankle arthrodesis revealed a better pain control during the postoperative period, less morbidity, a faster return to a normal life after rehabilitation, and reduced costs compared with open arthrodesis. The aim of this study was to evaluate the functional outcomes of arthroscopic ankle arthrodesis (AAA) using the American Orthopedic Foot and Ankle Society (AOFAS) score of the heel and hind foot. Patients and methods A total of 31 patients with advanced ankle arthrosis underwent AAA, comprising 20 (64.5%) male patients and 11 (35.5%) female patients. The mean age of the patients was 31.74 (range: 18–54) years. The right ankle joint was involved in 18 (58.1%) patients, whereas the left ankle was affected in 13 (41.9%) cases. Moreover, 27 (87.1%) patients had post-traumatic ankle arthrosis, whereas four (12.9%) patients had postseptic ankle arthrosis. Functional assessment was done at 3, 6, and 12 months after surgery using the AOFAS score of the heel and hind foot. Results The mean follow-up period was 12.87 (range: 12–16) months. The mean operative time was 87.9 (range: 75–120)min. The mean AOFAS score of the heel and hind foot improved significantly from 39.71 (range: 17–65) preoperative to 82.61 (range: 57–92) points at the final follow-up period. Ankle joint fusion was accomplished in 28 (90.3%) patients after a mean time interval of 9.32 (range: 8–12) weeks. Conclusion AAA proved to be a successful and safe method of treatment in resistant end-stage ankle arthrosis with satisfactory functional outcomes.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The use of cemented dual mobility acetabular cup in revision hip arthroplasty p. 168
Ayman Fathy, Mostafa Ashoub
Purpose Instability is always an important problem after both primary and revision total hip arthroplasty (rTHA). Dual mobility or tripolar unconstrained acetabular components give a solution for preventing and treating instability. Results of many studies using dual mobility cups (DMC) with mid-term to long-term follow-up support their effectiveness. Complications such as intraprosthetic dislocation (IPD) and accelerated wear have been studied, although they seem to be less significant in older, low-demand patients. However, their use in younger patients should be with caution owing to the lack of current data concerning this high-demand patient population. The aim of this study is to analyze the short-term results of cemented DMCs in rTHA. Specifically, we evaluated the following: clinical outcomes and scoring, dislocation, IPD rates, and other complications. Patients and methods The results of a single design of DMC was prospectively evaluated in a continuous series of 20 rTHAs. Follow-up period was of at least 2 years. Mean age of the patients was 66.8 years old. Results At the 2-year mean follow-up, the dislocation rate was 5%, and the IPD rate was 0%. Improvement of the hip score, function, pain, and range of motion was noticed. Conclusion DMCs demonstrated a low dislocation rate in rTHA but did not solve problems related to perioperative technical errors. Moreover, IPD did not appear to be a concern when compared with the gain of preventing instability.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Functional outcomes of conservative versus operative management of displaced midshaft clavicular fracture: a comparative study p. 174
Mohamed M.F Sharaby
Purpose Management of displaced midthird clavicle fractures is still controversial. Recent studies have shown a high incidence of symptomatic malunion and nonunion following nonoperative treatment of displaced midshaft clavicular fractures, with other studies showing no much improvement in shoulder function following operative treatment. The aim of this study is to compare patient-oriented and surgeon-based outcomes after nonoperative treatment with results following operative treatment of acute completely displaced midshaft clavicular fractures. Patients and methods This retrospective study was carried out on 91 patients with a displaced midshaft fracture of the clavicle distributed into two groups, with the first group managed conservatively and the second group with open reduction and internal fixation. Outcome analysis included standard clinical follow-up and the Constant shoulder score, the disability of the arm, shoulder and hand score, as well as radiological evaluation. Deformity evaluation included measurement of displacement, shortening, and angulation in both immediate posttrauma radiograph and final radiographs. Results Mean follow-up duration was 28.7±13.3 months in the nonoperative group and 20.4±5 months in the operative group. The mean time to radiographic union was 16.4±3.3 weeks in the nonoperative group compared with 15.6±3 weeks in the operative group (P=0.00). All fractures in the operative group united compared with six nonunions (12.5%) in the nonoperative group, and 12 symptomatic malunions (25%) occurred in the nonoperative group. Constant shoulder scores were significantly better for the operative group at all follow-ups (P=0.00). The disability of the arm, shoulder and hand score showed also significant improvement within the operative group (P=0.00). Conclusion In this study, primary open reduction and internal plate fixation of acute displaced midshaft clavicular fractures resulted in improved outcomes − including both patient-oriented outcome and surgeon-based outcome − and a decreased rate of nonunion and symptomatic malunion compared with nonoperative treatment. Shorting and displacement were found significantly related to decreased shoulder function.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Early functional results of the subvastus and medial parapatellar approaches in total knee arthroplasty p. 182
Ahmed M Kholeif, Yasser A.-F Radwan, Ali M.R Mansour, Ayman M Mansour, Hesham A.H Almoalem
Introduction A number of techniques for total knee replacement have been described to allow for easier surgical technique but with preservation of the integrity of extensor mechanism, and one of them is the subvastus (SV) approach. It causes less damage to the extensor mechanism and blood supply, which will cause less pain in the postoperative period and earlier return of quadriceps strength. Patients and methods Forty primary total knee replacement patients were divided into two groups, each with 20 patients. Group I had a medial parapatellar (MPP) approach and group II had the SV approach. Results The SV approach allowed earlier straight leg raising, shorter hospital stay, earlier quadriceps strength improvement, and better stair score and function score when compared with the traditional MPP group. Conclusion The SV approach for primary total knee arthroplasty is less invasive than the conventional MPP approach when considering vascular and muscular anatomy.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Evaluation of treatment of freiberg disease by debridement and metatarsal head resection p. 187
Nehad El Mahboub
Introduction Freiberg disease is an ischemic form of necrosis of the head of metatarsals, mainly the second; it is less common in the third and fourth. Affection of the head of the first and fifth is rare. Many factors are responsible for Freiberg disease, including stress overloading, microfractures, vascular impairment, and constitutional etiologies. The disease was classified by Smillie into five stages based on the radiological findings. Patients and methods Between December 2011 and June 2018 at the Misr University for Science and Technology hospital, 20 patients with late stages of Freiberg disease, stage IV and V according to Smillie classification, underwent debridement and resection of the affected head. Diagnosis is done by clinical and radiological examination, and all patients were categorized. The age was from 20 to 50 years, with an average of 32.6±8.5 years. The right side was affected in 14 patients, whereas the left side was affected in six patients. According to Smillie classification, nine cases were class IV and 11 cases were class V. All patients were followed up for Kitaoka’s items. Results All patients were improved regarding pain and function, and no cases with severe or constant pain, or limited daily or recreational activities were reported. No cases used especial shoes or brace at the final follow-up. Infection was not reported in this study. The final score improved in all cases from 52±14 (range: 29–69) to 89±7 (range: 80–100). Conclusion Metatarsal head resection after debridement is an effective and easy procedure for treatment of late stages of Freiberg disease with no hardware and allows early weight bearing and fast pain relief.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Subscribe this journal
Submit articles
Most popular articles
Joiu us as a reviewer
Email alerts
Recommend this journal