To investigate the effects of a 900 MHz electromagnetic field (EMF) on bone mineral density (BMD) in rats, and to determine effects of α-lipoic acid (ALA) on EMF-exposed bone.

This 4-week experiment included 24 male and 24 female Wister albino rats equally distributed into three groups: group A included nonirradiated rats (control), group B included rats exposed to a 900 MHz EMF for 1 h/day for 4 weeks; and group C included rats that received ALA (50 mg/kg/day intraperitoneally) before exposure to the 900 MHz EMF. The BMD of the vertebrae and femora was measured, and then the animals were sacrificed and their bones dissected for histopathological examination. Malondialdehyde (MDA) in the serum was measured as a marker for oxidative stress.

There was no significant difference in BMD between male and female rats in the three groups studied. Hence, we compared the three groups irrespective of the sex. Lumbar and femoral BMD was significantly lower in the irradiated group compared with the control group (P<0.001). ALA-treated rats had apparently higher BMD compared with the irradiated group (P=0.190). Serum MDA was significantly higher in the irradiated group compared with the control group (P<0.001). The ALA-treated group had significantly lower MDA levels compared with the irradiated group (P=0.001). An abnormal osteoclast score was significantly more frequent in groups B (75%) and C (37.5%) compared with group A (6.3%; P<0.001).

An EMF of 900 MHz has been shown to cause oxidative damage to bone and consequently decrease BMD. The use of the antioxidant ALA has been suggested as a useful approach to protect bone against this adverse effect of radiation.

Frozen shoulder is a frequently encountered disorder of the shoulder and has a large impact on the quality of life of the patient. Frozen shoulder caused by diabetes mellitus is the most common musculoskeletal disease in diabetic patients. When the initial conservative management fails, arthroscopic capsular release is a reliable method for restoring motion with minimum morbidity.

Arthroscopic capsular release was performed on 24 patients (17 women and seven men) with adhesive capsulitis after the failure of conservative treatment. Two patients (one in each group) had bilateral affection. Thirteen patients (14 shoulders), mean age of 50 years (range 41–67), were included in group 1 (diabetic frozen shoulder), and the average duration from the onset of the disease to surgery was 11 months. Eleven patients (12 shoulders), mean age of 49 years (range 42–67), were included in group 2 (idiopathic frozen shoulder), and the average preoperative duration of pain was 10 months. Constant score and the University of California, Los Angeles (UCLA) scale were used for the evaluation of functional shoulders preoperatively and postoperatively.

There were no complications related to the arthroscopic procedure. The mean duration of follow-up was 28.4 and 31.6 months in groups 1 and 2, respectively. In comparison with the preoperative UCLA and constant scores, postoperatively, there was a significant increase in these scores in both the groups (P<0.05). With regard to the postoperative range of motion, there was a significant difference in shoulder abduction and internal rotation between both the groups (P<0.05).

Arthroscopic capsular release is an efficient procedure for the treatment of frozen shoulders when conservative treatment has failed. On comparing diabetic and idiopathic patients, there was no significant difference in terms of pain relief and recovery of motion, but there was a significant difference in the range of motion and constant score.

Although treatment of carpal tunnel syndrome includes various modalities, the optimal treatment of carpal tunnel syndrome has not been established yet. The purpose of this study was to evaluate the effect of local corticosteroid injection in the carpal tunnel.

Eighty-one hands from 67 patients with idiopathic carpal tunnel syndrome were treated with a local injection of methyl prednisolone. The patients were diagnosed clinically using special tests for diagnosing carpal tunnel. Electrophysiological studies in the form of nerve conduction were available for 46 patients.

Forty-five hands experienced complete symptom relief 3 and 6 months after injection. However, at 12 months, only 21 (29.6%) hands experienced complete relief of symptoms. There was significant improvement in the mean values of both distal motor latency (P=0.04) and distal sensory latency at the wrist (P=0.02) at 3 months, which were highly significant at 6 and 12 months (P=0.00).

We believe that treatment with a local corticosteroid can postpone surgery for carpal tunnel syndrome and we recommend local steroid injection when treating patients with carpal tunnel syndrome before considering surgery.

Although there is now almost universal agreement that the internal rotation contracture of the shoulder should be treated, there is little consensus on how to accomplish this. In this retrospective case study, we compare the results of subscapularis sliding combined with either latissimus dorsi or latissimus dorsi and teres major transfer o the rotator cuff for the treatment of this problem.

We retrospectively analyzed 63 patients with an internal rotation contracture of the shoulder secondary to brachial plexus birth palsy. They were treated with subscapularis sliding combined with either latissimus dorsi transfer (group A: n=18) or latissimus dorsi and teres major transfer (group B: n=45) to the rotator cuff. The age of the patients at the time of surgery ranged from 8 months to 9 years (average: 42.71±20.64 months). The average postoperative follow-up was 19.43±11.41 months (range: 12–72 months). We used a modification of the Gilbert shoulder grading system for assessment of patients.

All the patients showed a statistically significant improvement in active shoulder abduction, external rotation, and Gilbert grade, but the differences between the two groups were not highly significant. However, there was a statistically significant higher incidence of external rotation contracture in group B.

Subscapularis sliding and latissimus dorsi transfer to the rotator cuff is a satisfactory treatment, with a significantly lower incidence of developing external rotation contracture compared with combined latissimus and teres major transfer. Our modifications of the Gilbert grading system aid the classification of all kinds of cases and have prognostic significance.

Although described as early as 1910, the most appropriate treatment for Kienböck disease has not been established yet. Multiple treatment modalities are advocated to tackle this condition.

This study was conducted to evaluate the effectiveness of arthrodiastasis as a new treatment modality on the revascularization of the lunate bone in Kienböck disease. This proposal is based on the successful application of arthrodiastasis in Perthes disease.

Between 2007 and 2010, seven patients with Kienböck disease were operated upon and retrospectively reviewed. In all patients, ring fixator distraction was applied. Clinical examination of the patients was carried out by observing the range of movement of the wrist and grip strength. Radiological classification was made according to Lichtman and Degnan’s classification. All patients underwent an MRI before surgery and at the end of 2-year follow-up.

Assessment of pain according to the visual analogue scale showed improvement from an average of 7.0 to an average of 3.57. Range of wrist motion showed an increase in all directions. All patients resumed a near normal life pattern with a satisfaction scale rating of an average of 3.71 on a 0–5 scale. No remarkable complications were observed, except for pin tract infection in two patients.

Distraction arthrodiastasis has been proven to be an effective treatment modality for patients in early stages of Kienböck disease. It is believed that this technique of arthrodiastasis will help the ischemic lunate to revascularize. Further large-scale studies are encouraged to evaluate and modify this treatment modality. The participants of the study were treated in accordance with standard ethical guidelines.

Primary total knee arthroplasty (TKA) has proven to be a highly successful operation, with survival rates approaching 95% at 15-year follow-up periods. The results of revision TKA are less encouraging. The poorer results of revision arthroplasty have been associated with multiple factors including loss of host bone stock, extensor mechanism problems, ligamentous instability or soft tissue incompetence, malalignment, and infection.

A total of 18 patients between 56 and 83 years of age (average 65.5 years) underwent revision knee replacement with the reconstruction of defects between December 2002 and December 2009 with the use of metallic augments alone in 10 cases and combined with a bone graft in five cases and a corticocancellous graft fixed with screws in three cases with a follow-up duration ranging between 48 and 56 months (average 52 months).

In terms of the knee score, 22% of the cases showed excellent results, whereas 78% of the cases showed good results, with no fair or poor results. In terms of the knee function score, 61% of the cases showed excellent results, 33% of the cases showed good results, whereas 6% of the cases (one patient) showed a fair result; there were no poor results.

The short-term and medium-term results of revision TKA with the use of a posterior-stabilized prosthesis and reconstruction of defects with modular metal augments, an autogenous bone graft, or both have been favorable.

As the use of the standard anterior approach to the dorsal spine using thoracotomy is associated with considerable morbidity, video-assisted thoracic surgery (VATS) has been used as a less invasive approach for many intrathoracic disease processes, such as dorsal spine tuberculous infection. We performed VATS in patients with kyphotic deformity secondary to tuberculous vertebral osteomyelitis, attempting to reduce the morbidity attributable to standard open thoracotomy surgery.

A total of 42 patients with tuberculous dorsal spine spondylodiscitis were managed by VATS. The technique included simultaneous posterior fixation combined with anterior thoracoscopic debridement and anterior reconstruction with the patient positioned in a prone position. Patients were evaluated using the Oswestry score, American Spinal Injury Association neurological evaluation, plain radiography in anteroposterior, lateral projections measuring the modified Cobb angle, computed tomography-guided biopsy if needed, and MRI.

Dorsal spine tuberculosis was managed efficiently and safely in all cases using VATS. Except for one case, there was no recurrence of infection, and hence, there was no need for open thoracotomy to revise the procedure. The operative time and blood loss of the endoscopic technique were comparable with those of the open technique.

VATS is an effective and safe procedure in the management of kyphotic dorsal deformity because of tuberculous spondylodiscitis. Debridement, decompression of the spinal canal, and anterior reconstruction can be performed using the endoscopic approach, with less morbidity compared with thoracotomy.

High-risk geriatric patients with ‘intertrochanteric’ fractures are difficult candidates for open reduction and internal fixation because of restricted availability of modern anaesthetic techniques. The aim of this study was to analyse the results of external fixation of ‘intertrochanteric’ fractures in high-risk geriatric patients as a safer alternative to open internal fixation.

Thirty patients of an average age of 65.9 years were treated by external fixation for their intertrochanteric fractures. Patients in the study had Evans stable intertrochanteric fractures and unstable fractures that could be reduced to an anatomical or nearly anatomical position by closed manipulation under fluoroscopy. The average follow-up period was 24 months (range 12–40 months).

There were no mortality cases in the early postoperative period, but the number of mortality cases within 6 months after surgery was seven patients (23.3%); three patients missed follow-up and 20 patients completed the follow-up. Sound fracture healing was achieved in all patients. The final result was satisfactory in 90% of patients (40% excellent and 50% good), fair in 5% of patients and poor in another 5% of patients.

Treatment of intertrochanteric fractures by external fixation is a simple noninvasive procedure and can be performed under local anaesthesia together with narcotic analgesic support. It allows early mobilization, and implant removal is easy. Therefore, treatment of intertrochanteric fractures by external fixation is a practical solution in high-risk geriatric patients.

Proximal tibia fractures with metaphyseal comminution present a difficult treatment challenge. Minimally invasive plate fixation (osteosynthesis) (MIPO) has theoretical advantages for the treatment of these injuries. This report presents the clinical results of the MIPO system for the treatment of a series of patients with complex proximal tibia fractures.

Between March 2003 and February 2007, 28 consecutive patients with comminuted proximal tibia metaphyseal fractures with intra-articular extension were treated with MIPO in Benha Faculty of Medicine. The mean age of the patients was 37 years (range between 21 and 60 years). There were 22 closed fractures and six grade I open fractures (Gustilo Anderson classification).

The average follow-up was 23 months (range 12–48). In 26 (92.8%) out of 28 patients, the fracture heeled after the index procedure and had satisfactory results. One patient had a fair result because of valgus malalignment and replating was performed. One patient had a poor result because of deep infection and loosening. Postoperative fracture alignment was satisfactory in 26 out of the 28 cases and was maintained in all patients at union. There was no deep venus thrombosis or compartment syndrome.

The MIPO can be used safely to treat complex proximal tibia fractures without the need for additional medial stabilization. Surgeons attempting to use MIPO should familiarize themselves with the significant technical differences between these and traditional plating systems to ensure satisfactory results.

Although acromio-clavicular joint dissociation is not a common injury, it may cause some limitations in activities. Types III, IV, and V need operative repair. In this study a simple technique has been advocated to reduce and maintain reduction of the acromio-clavicular joint using no. 5 nonabsorbable suture material while the resutured coraco-clavicular (CC) ligament heals.

Twenty-one patients with types IV and V acromio-clavicular dissociation were included in this study. In all cases, the acromio-clavicular joint was reduced and maintained using no. 5 nonabsorbable suture material passed as a loop under the coracoid process and through a tunnel drilled through the distal clavicle. The CC ligament was then resutured.

After a follow-up period of 6–9 years all patients resumed their preinjury level of activity with significant improvement in the UCLA, ASES, and Constant scores.

Results of this technique show a good outcome with no loss of reduction, except in a single case, during the long follow-up period. We could not prove that the good results were due to the healing of the CC ligament. The patients were able to resume their daily activities and contact sports without any noticeable deformity, feeling of weakness, pain, or limitation of range of motion (compared with the contralateral side). This technique does not involve the use of metallic implants, which would require another surgery to remove them, nor does it require the use of expensive synthetic grafts or a graft harvested from a distant donor site.

Fracture of the distal radius is the type of fracture most commonly seen in emergency departments. The understanding of nonsurgical and surgical care of distal radius fractures is evolving with recently developed methods affixation. It is worthwhile to review some new methods of treatment, the role of bone grafting and synthetic substitutes, the principles of complex fracture management, and the treatment of common complications of distal radius fractures.