American Research Journal of Orthopedics and Traumatology

Waleed Faisal, MD, Mohammed Elhefnawy, MD, Mohammed M El-Zohairy, MD

Background: The physeal manipulation (guided growth) provides a method for angular deformity correction of the knee joint with fewer complications than an osteotomy.The temporary partial growth arrest is of the least invasive physeal manipulation proceduresMaterial and Methods: Eighteen children patients (12 boys and 6 girls) with 36 knee angular deformities were treated by temporary epiphysiodesis method using the eight-plate (8-plate). Non-locked titanium 4.5-mm cannulated screws were used with the plate. The mean average age of the children at a time of the operation was 6.5 years (range, 4–11 years).Results: All patients achieved complete deformity correction after plate removal and 2 cases had intended over correction of 8-10 degrees due to anticipated deformity recurrence because of the cause of deformity was Blount’s disease. These cases get corrected at three years the final follow-up after removal of the plates. Neutral mechanical axis with no MAD was the sign of complete correction.Conclusion: The technique of eight-plate with its pivoting screw and plate design is a valid technique for angular knee deformities correction. According to the outcome of this study, we recommend using eight-Plate technique in correcting knee joint angular deformities with the proper patient selection.

Waleed Faisal, Mohammed Elattar, Emad Abd-Elhadi

Purpose: Medial open wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. The abnormal load on the medial compartment of the knee is directed to the lateral compartment with this procedure. A gap occurs on the proximal tibia while providing adequate correction. Filling this gap with bone grafts or synthetic materials has gained wide acceptance for preventing bone union problems or osteotomy site collapse. The aim of this study is to report our results of MOWHTOs performed without any bone graft or any other synthetic materials.Patients and Methods: We evaluated 20patients MOWHTOs that have been performed between 2014 and 2018. Age of the patients ranged from 18 to 40. Fifteenpatients were females and five of them were males. The follow-up time was 12 months.Results: All osteotomies united without loss of correction. The meanbone union time was 12.8 weeks. We did not have any major complication regarding the technique.Conclusion: The results of our study have shown that we can achieve satisfactory and good results by performing MOWHTO procedure without using any bone grafts or synthetic materials. 

Amro I Zanfaly, MD*, Mohammed S Elattar, MD, Mohammed Elsadek, MD

Background: The distal humeral fractures in adults are complex and technically demanding. Most cases often need operative treatment. Many methods of fixation were evolved with the better imaging and new techniques and implants.Patients and Methods: Fourteen patients, nine males and five females, with fracture of the distal humerus were treated with double tension band wiring through the period from May 2014 to June 2018. Patient’s age ranged from 26 – 52 (average: 36 y). DASH score (The Disabilities of the Arm, Shoulder and Hand) [12] was used for subjective evaluation; and pain at last follow-up was measured using an analog scale (0 being no pain and 10 significant pain).Results: Clinically: By the end of follow up the DASH score ranged from 5 to 21 (average: 13.8 points). The pain scale analog ranged from 0 to 3 with average of 1.2 points. Radiologically: All fractures were united with average of 16 weeks range (12-18 weeks). There was no elbow stiffness or heterotopic bone ossification.Conclusion: trans-osseous tension band wiring technique is an acceptable technique for treatment of supracondylar intracapsular fractures with good results. As regarding the small number of patients of this study, we recommend this technique for further research and large number of patients.

Background: Total hip replacement (THR) is one treatment option for failed hip fracture fixation. It is considered as a salvage procedure for older patients, patients with poor bone stock, avascular necrosis of the femoral head, associated with damaged acetabular articular cartilage.Patients and Methods: Total hip replacement was done for forty patients with failed internal fixation of trochanteric femoral fractures, 28 males and 12 females completed the follow up and six patients were lost. The procedure was carried out through a lateral exposure in all cases. Harris hip score (HHS) was used for clinical evaluation preoperatively, postoperatively. Radiographic evaluation comprising anteroposterior radiographic views of the pelvis and femur and a lateral view of the femur were performed at follow-up visits.Results: The mean time of follow up was 48 months (range from 36-72 months). The mean Harris hip score was improved from a mean of 24 points preoperative to 88 points at final follow up. Pain relief and gait correction were noted at the final follow up. Twenty eight patients (70%) could freely walk outdoors using a cane or elbow crutch; eight patients (20 %) had a limited walking ability using two axillary crutches, and four patients (10 %) were able to walk indoors only.Conclusion: Total hip arthroplasty is a good salvage procedure after failed internal fixation of trochanteric femoral fractures. Individual selection of the implant depends upon the age of patient, level of activity, the bone stock of proximal femur, and the condition of the acetabulum. To maintain stability, reattachment of the greater trochanter should be done. To avoid intraoperative fractures of osteoporotic bone, dislocation of the hip should be very careful.

Raymond E. Kennedy, MD1*, Mark K. Lane, MD2

Compartment syndrome is developed by a build-up of pressure in an enclosed space in the body, and can be caused by trauma, medical conditions that alter fluid balance, exercise, or can be iatrogenic. A decrease in the microcirculation pressure gradient causes local ischemia, making compartment syndrome a true medical and surgical emergency often requiring a fasciotomy to reduce intra-compartmental pressures and restore microscopic flow. A 22-year-old female presented with bilateral upper extremity pain and swelling after vigorous exercise and her exam revealed a decreased range of motion, tense skin over the affected areas, as well as rising CPK levels, which led to the early diagnosis of acute compartment syndrome. Surgical release was immediately performed bilaterally with delayed primary closure. The patient regained full function and range of motion in both arms, without any short or long-term complications. Acute compartment syndrome is a limb-threatening emergency. Rapid diagnosis and early surgical treatment with fasciotomy is necessary to regain function and circulation to the affected area, and effectively save the limb. Delayed diagnosis and/or surgical treatment puts the patient and the affected limb at risk, and even with eventual treatment, allows for the development of complications such as Volkmann’s contractures and acute renal failure.