American Research Journal of Orthopedics and Traumatology

Mohamed Othman*, Ahmed El-Malt, Ahmed Nahla

Background: Posttraumatic stiff elbow is a frequent and disabling complication and causes difficulty in placement of hand in space and hence limits the functional capacity. It poses challenges for management. The initial management should be nonoperative and surgical treatment is indicated when conservative measures for a reasonable period fail to achieve the functional range of motion. The aim of this study was to assess the outcome of open arthrolysis of posttraumatic elbow stiffness.Patients and Methods: A prospective study was conducted at our institution, between 2013 and 2016, on open surgical release of posttraumatic elbow stiffness in 16 elbows of 16 patients (who were available for follow-up examination). The mean age of the patients was 22±4.2 years (range: 12-36 yrs). The mean time interval between injury and surgical release was 8.3±2 months (range: 3 -12 months). The surgical approach was: lateral (n=10), medial (n=3) and combined lateral and medial (n=3). All patients underwent extensive rehabilitation, starting immediately after the procedure.Results: The mean follow-up period was 8.5±2 months (range: 7-13months), The preoperative total flexion/extension arc improved from a mean of 40˚± 10.5 to 105˚± 21.5 (60 to 135) at the final follow-up, with a mean gain of 65˚± 4. The mean preoperative Mayo Clinic Elbow Performance Score of 60 ±17.5 points (20-70), improved at the final follow-up to 85 ± 8.8 points (70 to 100), with a mean gain of 25 ± 4.5 points. The results were excellent in six elbows, good in seven, fair in two and poor in one. Therefore, a satisfactory functional outcome was achieved in 81.25% of cases. Superficial infection occurred in one patient (that cured on antibiotic and local care) but, no deep infection. One case of preoperative ulnar nerve deficit recovered finally after anterior transposition. Two patients had postoperative transient paresthesia of ulnar nerve, but without a measurable motor or sensory deficit. Recurrence of stiffness occurred in one patient (6.25%), who was a 12 years old uncooperative patient.Conclusion: The open release of posttraumatic elbow stiffness provides a useful gain in range of motion and marked improvement of elbow function, especially in motivated co-operative patients.

Background: The neglected DDH with adaptive changes in bone and soft tissue is difficult to treat and canlead to permanent disability. The aim of treatment of these cases to establish normal anatomy of the femur andacetabulum to promote normal development of the hip.Aim of the Work: The aim of this study is to evaluate of the results of one–stage surgical treatment of DDH inchildren between 3-5 years of age.Patients and Methods: A prospective study on 36 children (40 hips) presented by DDH at age between 3-5years old, 16 hips were Tonnis grade III and 24 hips were grade IV. Open reduction, derotation femoral osteotomywith shortening was done for all hips, Varusangulation for excessive valgus was add to the osteotomy in 16 hips(40%), and Degapel vicosteotomy was added to femoral osteotomy in 24 hips (60%). Post operatively hipspica was done for all the patients for twelve weeks.Results: The mean follow- up period was 40 months (range 24 - 60 months). Clinically, according to Mc Kaysystem, the outcome was excellent for 20 hips (50%) were, good in 14 hips (35%), fair in 4(10%), and poor in2 h i p s (5%). Radiologically, the Severin’s classification criteria for 22 hips (55%) were excellent, in 12 hips(30%) were good, fair in 4 (10%), and were poor in 2 (5 %).Conclusion: One stage hip reconstruction operation is a good approach to treat the cases with late presenteddevelopmental dysplasia of hip (DDH). A stable concentric reduction can be achieved which help in remodelingof the acetabulum and stable concentric reduction of the dislocated hip. Tonnis grade III dislocation of DDH isrisky for residual acetabular dysplasia and subluxation after one stage hip reconstruction.

Kyle Andrews M.D., Lucas McKean B.S., Vithal Shendge M.D.

Acetabular fractures can complicate hip arthroplasty and result in higher rates of intraoperative complications and worse long-term outcomes1. Previous studies have shown increased rates of acetabular-sided complications and worse long-term outcomes in the setting of prior acetabular fractures. We present a total hip arthroplasty complicated by severe post-traumatic arthritis and a vascular necrosis. The patient was found to have a Paprosky Type IIA acetabular defect with exposed intra-articular hardware due to aprevious both-column acetabulum fracture treated with open reduction and internal fixation. Cancellous autograft was used for acetabular reconstruction and a cementless acetabular cup was inserted, as survival has been shown to be superior to cemented cups in patients with acetabular deficiency. Subsequent follow-up showed well fixated components with a good functional outcome in this patient.

Background: THA remains the only helpful solution in advanced stages of hip arthritis, but on the long run the intervention is associated with higher failure rates compared with THA in an older population. Our prospective study evaluates the results of THA in young age group of patients with post-traumatic hip arthritis.Patients and method: Forty eight patients (36 males, 12 females) with mean age of 36 years (range 31 to 46 years) with traumatic avascular necrosis of the femoral head were operated on in the period from January 2009 to May 2015. Unilateral cementless total hip arthroplasty was performed in all patients. Indications for surgery were severe pain and loss of function in the hip. Plain X-ray was used for the diagnosis in all cases, and CT scan was needed in cases of acetabular fractures. In 24 patients AVN occurred after internal fixation of acetabular fractures, fracture proximal femur in 16 cases, and hip dislocation in 8 cases.Results: The mean Harris Hip Score 32 was improved from 38 (preoperatively) to 82 (3 years postoperative). Twelve patients had excellent score, twenty eight good, six fair, and two patients with poor score. Improvements were seen in the range of motion in all the patients as compared to preoperative period.Conclusion: The management of post-traumatic arthritis of the hip in young and active patients continues to be a difficult challenge. Results of cementless hip arthroplasties are good and encouraging in treating this group of patients.

Background: The muscle imbalance of the shoulder results in weak external rotation and abduction. Active internal rotation and adduction can cause glenohumeral joint deformity with late posterior dislocation.Patients and Methods: In this prospective study from 2004 to 2009, thirty four patients, 18 females and 16 males with mean age of 4 years (1-7 years). The right side was affected in 19 cases while the left side was affected in 15 cases. All patients were suffering from obstetrical brachial plexus palsy (OBPP) with internal rotation contracture and defective shoulder abduction plus posterior dislocation or subluxation of the humeral head. These patients were treated with soft tissue release (subscapularis slide and anterior soft tissues release) with or without tendon transfer (latissimus dorsi & teres major to infraspinatus).Conclusion: The subscapularis release can provide objective functional benefit, but this degraded over time. The transfer of teres major and latissimus dorsi to infraspinatus is a useful procedure for correction of defective shoulder abduction and external rotation in (OBPP) as it increases the stabilizing action of the rotator cuff allowing the deltoid muscle to act with maximal force.

Background: The management of acute Rockwood type III Acromioclavicular joint (ACJ) dislocation remains controversial. Good-to-excellent results can be obtained with nonsurgical management, however, surgical management for type III acute ACJ dislocation restores joint anatomy, thus avoiding obvious deformity, persistent pain and residual symptoms.Methods: In this prospective studynineteen (14 men, 5 women) patients, withRockwood type III (ACJ) dislocation, underwent coracoclavicular (CC)ligament reconstructive surgery using a semitendinosus autograft and a triple non-absorbable suture-cerclage. The mean patient age was 33.1 years (range, 19-46). All patients were evaluated clinically preoperativeand at final follow-up usingVisual Analogue Scale,Constant Shoulder Score and DASH scoreand evaluatedradiologicallypreoperative, on the second day postoperative and at final follow-upusingCoracoclavicular distance (CCD) difference to the unaffected side.The mean follow-up was 25 months (range, 18-37).Results: At the final follow-up, the Visual Analogue Scale (mean 0.7) revealed a good to excellent clinical outcome. The mean Constant-Murley score was 95.2 (range 77–100). The DASH score (mean 3.52 points). The difference in the CCD compared to the contralateral side was <5 mm for 17 patients, between 5-10 mm for 2 patients. In the anteroposterior (AP) plane, 19 (100%) of the patients maintained complete reduction.Conclusion: Acromioclavicular joint reduction with reconstruction of the coracoclavicular ligament using semitendinosus tendon autograft and a triple non-absorbable suture-cerclageappears to be a good means with satisfactory clinical and radiological results for treating acute Rockwood type II Acromioclavicular dislocation.

Mohsen Fawzy Omar, MD1, Mohammed a Gheith, MD2

Background: Due to the avascular nature of the articular cartilage and the limited stem cell population the lesions of articular cartilage have limited ability to repair. Another factor is the constant and repeated loads on the articular cartilage of the knee that create unsound mechanical environment for healing.Objective: To evaluate the results of osteochondral autograft technique in treatment of chondral and osteochondral defects.Material and Methods: From May 2013 to November 2016 sixteen patients with chondral or osteochondral defects of one of the femoral condyles were treated using the osteochondral grafts technique. Open technique was used in (10 patients) and arthroscopic technique in (6 cases). For patient evaluation we used two scores: the chondral defect scoring system, and Lysholm score.Results: according to the Chondral defect scoring system, significant improvement of the subjective score of the pain, swelling, locking and full weight bearing. The mean total (CGSS - objective & subjective) was improved from 47.6 (SD±15.3) preoperatively to a postoperative mean of 83 (SD±11.2). The Lysholm score shown significant improvement for the Limp, locking sensation, using cane, giving way, swelling, climbing stairs and also for squatting.Conclusion: Mosaicoplasty as one-step procedure, has low morbidity, independent of laboratory use. Based upon the results of this study, osteochondral autograft is a good solution for treatment of full thickness cartilage damage.

Background: posttraumatic cubitus varus is a common complication after elbow fractures. There are different types of osteotomy and fixation methods used in correction of cubitus varus. Each has its advantages and disadvantages.Patients and method: Ten cases of cubitus varus in young adult treated with lateral closing wedge osteotomy and fixation with posterior Y plate. Preoperative X-ray was taken for each patient with both elbows in full extension and forearm in full supination. Carrying angle at the affected and normal side are measured and angle to be corrected and the base of lateral closing wedge osteotomy was calculated preoperatively.Results: No patient had functional problem resulting from the deformity as ulnar nerve palsy or posterolateral instability. Mean operative time was 96.5 min.Preoperative carrying angle was23.9deg decreased to 4.6deg valgus postoperatively. Lateral condylar prominence was 6.07% and decreased to -8.89% postoperatively. Time of complete healing of osteotomy site was a range from 10week to 14week with a mean of 12.2 week. Mean follow up period was 12.8month with a range from12months to14months. Full range of motion returned in 8 cases after 12week.Conclusion: Lateral closing wedge osteotomy and fixation with posterior Y plate is effective and safe technique in treatment of cubitus varus deformity in young adult.Adequate correction of the deformity can be achieved with preservation of the patient preoperative range of motion together with good patient satisfaction and minimal complication rate.