Background Congenital pseudarthrosis of the tibia (CPT) is a challenging problem in orthopedic practice, with high rates of non-union, refracture, and residual deformities. After union, long-term follow-up is required to manage late post-union complications. This study aimed to assess the outcomes of the Ilizarov technique in the management of CPT. Materials and methods This retrospective study included patients with CPT treated with the Ilizarov method between 2005 and 2018. Intramedullary rods were used in 9 cases and iliac bone graft was used in 12 cases. An orthosis was applied till the end of follow-up in all cases. The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used for the evaluation of the functional outcomes. Results This study included 16 patients, 11 males and 5 females, with an average age of 5.4 ± 2.8 years. Seven cases had multiple previous surgeries. Six patients had neurofibromatosis. The mean follow-up period was 5.8 ± 3.4 years. The average AOFAS score improved significantly from 47.5 ± 7.6 preoperatively to 78.9 ± 8.9 at the latest follow-up. Union was achieved in 15 cases, and persistent non-union occurred in one case. The clinical results were excellent in one patient, good in seven cases, fair in 6, and poor in 2 cases. The radiological results were excellent in one patient, good in seven cases, fair in seven, and poor in one case. Conclusions The Ilizarov technique combined with intramedullary rod and primary or secondary bone graft provides a high union rate of CPT and can achieve simultaneous effective management of problems related to pseudarthrosis, including non-union, deformity, limb shortening, and adjacent joint contracture and subluxation. Level of evidence Level IV.
Introduction: Successful treatment of knee comminuted periarticular fractures associated with osteoporosis and pre-existing arthritis is a challenging task.Methods: This is a prospective study on 27 patients who had comminuted intra and periarticular knee fractures and pre-existing arthritis. Fractures were classified according to Muller's AO classification. Primary knee arthroplasty was performed ± internal fixation following 4 weeks of splinting. A stem was added to the tibial tray and Legacy Constrained Condylar Knee (LCCK) or Rotating Hinge (RH) prosthesis were used depending on the level of ligament damage and bone defects. The Knee Society Score (KSS) and radiological evaluation were performed at 3, 6 and 12 months then annually thereafter.Results: The average age of this group of patients was 63 years (range 59–74). Sixteen knees received primary femoral component and Posterior Stabilized insert, while 8 had LCCK. RH implants were chosen in 2 and distal femoral replacement was necessary in one knee. Twenty five patients were available for the final review at an average 6 years in whom the KSS was 80 (range 75–89) points. All patients achieved full knee extension and average knee flexion of 110° (range 90–135°). One knee needed re-admission for early Debridement Antibiotic Irrigation and Retention (DAIR) but none of the knees was revised or awaiting revision.Conclusion: Knee arthroplasty achieves highly successful outcome when performed as a primary treatment for comminuted intra and periarticular knee fractures in elderly patients. Survival of implants and functional range of movement at midterm are excellent.
Objective: To assess the effectiveness of repair of chronic ruptured Achilles tendon by V-Y Plasty and plantaris tendon augmentation.Background: Treatment of chronic Achilles tendon rupture is still a challenge for most orthopedic surgeons. It is different from the acute Achilles tendon rupture as there are large gaps that will be bridged by scar tissue and muscle becomes infiltrated with fat, so ankle will be weak affecting the gait. Several techniques for reconstruction of Achilles tendon have been described, including tendon graft, turndown flap, and flexor hallucis longus augmentation and augmentation with synthetic materials. The superiority of one technique over another has not been demonstrated. Patient and Method:This retrospective study included nine patients with chronic Achilles tendon rupture who underwent surgery in our institution, between February 2013 and April 2016. The study group consisted of 7 male and 2 female, ranging in age from 28 to 52 years old with mean age of 40 years. 6 cases were right side and 3 were left. All patients were diagnosed by clinical examination, sonographic examination and MRI. Treatment was by doing V-Y plasty of tendo-Achilles to cross large gaps with augmentation of repair by plantaris tendon in all cases.Results: At the end of follow-up (range, 7-12 months), no major complications related to surgery occurred. No patient had re-rupture at any follow-up. All patients returned to their previous occupation. The Postoperative range of ankle movement equaled to that of the opposite side in 8 patients, but in one patient the ankle dorsi-flexion was 10° less than the contralateral side. All patients were able to stand on tip toes for 30 seconds at last follow up. Conclusion:Several surgical treatment options were described for reconstruction of a neglected Achilles tendon rupture but without definite data that support one technique over another. Whatever the technique, the final goal of surgical treatment is to restore the length tension relationship to provide sufficient plantar flexion power. Treatment with V-Y plasty of tendo-Achilles to cross large gaps with augmentation of repair by plantaris tendon provides adequate surgical option with no major complications and no re-ruptures avoiding complications of tendon transfer.
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