American Research Journal of Orthopedics and Traumatology

Reda H. Elkady1, Hamed Abuelkhair, MD2, and Sherif El-Aidy MD3

Background: Crescent fracture is defined disruption of part of the sacroiliac joint completed as a fracture iliacwing posteriorly. It can be fixed by a variety of methods. Closed reduction and iliosacral screw fixation can provideadequate stabilization in certain cases of crescent fractures.Patients And Methods: The clinical study was aim at evaluating the clinical outcomes and functional scores of 30patients (22 male and 8 female patients) aging from 28 to 54 years old. This study included 30 patients with LCfractures of pelvis and had been operated between April 2000 and June 2010. Plain X ray and CT of the pelvis weredone for all cases. Day’s classification and exclusion of dysmorphic sacra were done. Percutaneous IS was used inall patients who were selected as Day type II and III. The average follow-up period was 14 months (range: 12–21months). The principal goal of surgical intervention was the accurate and stable reduction of the sacroiliac joint.Results: There was minimal blood loss in all cases. The clinical outcome was good in all patients; there wereno healing complications, postoperative neurological deficits, or residual rotational malalignment of the limb.Using Majeed scoring system for functional assessment; Mean score of the 30 cases was 87 points (55–100 points);20 (66.5%) patients had greater than 85 points (excellent), 9 (30%) patients had 65–84 points (good), and one(5.5%) patients 52 and 64 points (poor).Discussion and conclusion: Percutaneous IS screw fixation is a valuable option in treatment of types II andIII crescent fractures, with almost no blood loss and short intraoperative duration. The functional results of thepatients treated by IS was good in average.Level of evidence: The level of evidence was IV (case series).

Emad Abd-Elhady MD1; and Mohamed El-Sadek MD2

Background: Angular deformities of the lower extremities cause activity-related pain, altered gait mechanics, andjoint instability, and these are exacerbated by periods of growth. Conservative usually fails to correct deformity;correction of deformity by hemiepiphysiodesis has become the standard surgical technique of treatment.Objective: The aim of this study to evaluate temporary hemiepiphysiodesis around the knee to modulate growthwith eight-Plate technique in patient with genu valgum.Material and method: A prospective study between January 2015 and December 2019, we evaluated the patientsas a single group to assess the effectiveness of temporary hemiepiphysiodesis as a method of correction of genuvalgum. The study included 29 patients with one patient was male and had unilateral valgus left knee and was lostin the follow up after removal of the plate and the remaining 28 patients were 22 bilateral 78.6% and 6 unilateral22.4% (50 knees) four patients with right side14.3% and two patient left side 7.1% with coronal genu valgumdeformity indicated for surgical treatment. There were 19 boys (67.8%) and 9 girls (32.2%) and all of them weretreated by temporary hemiepiphysiodesis using eight-plate technique. The mean average age of the children at atime of the operation was 7.8±2.3`years (range, 4–12.5 years).Result: The entire patient had complete correction of the deformity. The mean follow-up was 31±7.8 months(range 20-48 months) after plate removal. Two patients reached skeletal maturity at the final follow up. The eightplateswere inserted on the medial distal femur (MDF) in 6 patients (21.4%), in proximal tibia (MPT) in 6 (21.4%)patients and on both femur and tibia (MPT+MDF) in 16 patients (57.2%). All patients achieved complete deformitycorrection after plate removal mean duration 19±4.6 months (14-29 months) and the mean Intermalleolardistances before the procedure was 19.2±4.3 changed postoperative to 1.2±1 with P. value > 0.001 and the meanmLDFA changed from 79.2±5 to 87.2±1.5 and the P. value > 0.001 after the procedure.Conclusion: Temporary hemiepiphysiodesis using eight-Plates is a delicate, straight forward and successfulstrategy used to treat genu valgum by modulating growth. Slight overcorrection is alluring because of therebound phenomenon, particularly in young patients with high development potential and risk groups, forexample, obese children.

1Mohamed I Kotb MD, Mohamed, 2Mohammad Abd El Aziz Ali MD, and 3Reda H El-kady MD

Blood loss during total knee replacement (TKR) remains a significant concern. The purpose of this study is tocompare the effect of systemic use versus local use of tranexamic acid on blood loss and transfusion requirementsin total knee replacement. Tranexamic acid (TXA) is an effective hemostatic agent used for the reduction ofblood loss and transfusion. However, the safety profile of TXA remains in question due to a potential increasedrisk of venous thrombosis.Patients and methods: In this study, 80 patients underwent TKR, and were divided into two groups based onwhether they received a systemic tranexamic acid intra-operatively, or a local infiltration of tranexamic acid.Groups were then compared for mean calculated total blood volume (TBV) loss, transfusion rates, and kneerange of movement.Results: The groups were compared after TKA, and the results showed that Mean TBV loss was similar betweengroups: systemic tranexamic acid use mean was 705 ml (281 to 1744), local use mean was 712 ml(261 to 2308)(p = 0.929).Conclusions: no statistical difference between the two groups on decreasing blood loss and transfusionrequirement in TKA.

1Mohammad Abd El Aziz Ali MD, and 2Reda H El-kady MD

Objective: To evaluate the functional outcome of pedicled functional isolated long head of triceps transfer tobiceps tendon in failed primary nerve repair or patients seek treatment after 18 month from injury of upperbrachial plexus palsy for elbow flexion. Restoring elbow flexion with preserved elbow extension as total transferof triceps to biceps tendon sacrifices active extension so in our cases we preserve the medial head which is themain elbow extensor and lateral head of triceps.Methods : Our study, including only patients who had biceps grade 0 - 2 and triceps grade 4 – 5 in injury ofupper brachial plexus palsy , who underwent anterior transfer of isolated long head of the triceps muscle. Theaffected left side (10) , right side (8) sex ( 12 male ) ( 6 female ) , type of accident ( obstetric brachial plexuspalsy (6) , traumatic brachial plexus palsy (12) strength of elbow flexion, complications and patient satisfactionwere investigated in 18 cases.Results: the age range was from 3 to 52 years, with a mean of 25.7 years. The minimum time between injury andsurgery was 18 months (range 18-74 months). All the patients at final follow up said that they were satisfiedwith the procedure. Evaluation Of Elbow function according to Pothula ( 2017 ) after Independent elbow flexionand extension by isolated long head of triceps transfer for reconstruction of elbow flexion : very good results in10 cases (55.6 %) , good results in 5 cases ( 27.8 ) , fair results in 2 cases ( 11.1 % ) and failure results in 1 case( 5.6 %). So Satisfactory results of isolated long head of triceps transfer for reconstruction of elbow flexion inupper brachial plexus palsy was in 15 cases (83.4 %). Fair results was in 2 cases who were in the left side injurywhich were not the dominant side of the cases and the patients were satisfied and also failure results in 1 casewho revised surgery and operated with lateral head of triceps to biceps and tensioning and the patient wassatisfied. 3 cases had complications (initial hematoma in 2 cases and insufficient tensioning in 1 case).Conclusion: Restoring elbow flexion with preserved elbow extension as total transfer of triceps to biceps tendonsacrifices active extension. Independent elbow flexion and extension by isolated long head of triceps transfer tobiceps tendon in old brachial plexus palsy is effective, simple and less technically demanding procedure.

1Mohammad Abd El Aziz Ghieth MD, 2Mohamed A. Sebaai MD, and 3Mohamed I Kotb MD

Objective: This study Outlines the technique and evaluates the functional outcome of modified step cut 3 Dosteotomy for pediatric post traumatic cubitus varus deformity avoiding drawbacks of biplanner osteotomylike residual deformity, lateral prominence, loss of fixation and ulnar nerve palsies.Patients and methods: 24 cases (18 boys and 6 girls) suffered from post traumatic cubitus varus deformitydue to mal-united supracondylar fracture humerus. Age ranged from 3 to 13 years old (mean 5 years old).Mean management time was 3.3 years (1.5–6 years) after the injury using a modified step-cut 3 D osteotomy.The average follow-up period was 2 years (1–3.5 years). Objective assessment included measurement ofpreoperative and postoperative lateral prominence index, carrying angle and range of elbow motion. Resultswere graded excellent, good or poor according to the Oppenheim criteria.Results: There were 18 excellent, 5 good and 1 poor result. A residual varus of 5° was seen in the single patientwith poor result. None of the patients showed a prominent lateral humeral condyle or formation of hypertrophic scar.Conclusion: A modified step-cut 3 D osteotomy is a safe and simple osteotomy which prevents lateralprominence and provides excellent outcomes in most of the patients. The modified step-cut osteotomyprocedure, was superior to the conventional lateral closing wedge osteotomy regarding the lateral humeralcondyle prominence, less scaring and better cosmoses.