Background: Scaphoid non-unions pose a great challenge to surgeons because of the multiple factors that may contribute to their causation.The etiology of the nonunion may be because of anatomic variations, fracture configuration, vascular problems, underlying metabolic problems, or the inadequacy of initial treatment.Percutaneous management of scaphoid non-unions offers the advantage of inducing minimal trauma to the soft tissues while adequately stabilizing the fracture site to induce union in a high percentage of cases.This study proves that percutaneous fixation of delayed or nonunited scaphoid fractures result in predictable satisfactory union rate and functional outcome, it proves that percutaneous Herbert's screw insertion carries no risk of damage to soft tissues or vascular supply. Also, the gap is not the determinant of time to union but actually it is the time since injury; the longer the time since injury the longer the time to union as long as the scaphoid alignment is maintained i.e. no humpback deformity.
We believe that tertiary centers should be prepared for mass causalities. A variety of orthopaedic implants should be within reach and that personnel should be trained to work under stressful environments with a well laid disaster management plan.
Background: Flexible flatfoot is a common condition that is characterized by hindfoot valgus with longitudinal medial-arch collapse. Many strategies for treatment have been reported but according to the current literature, controversy remains. Objectives: To compare the clinical and radiological outcomes of medializing calcaneal osteotomy utilizing modified step plate and subtalar arthroereisis utilizing conical subtalar implant for patients with symptomatic flexible pes planus. Methods: A prospective, randomized, double center study was conducted between May 2017 and May 2019 at the Foot and Ankle Department of Cairo University Hospital and El Sahel Teaching Hospital on 26 patients (37 feet) with flexible flat feet to compare between medial displacement calcaneal osteotomy using modified locked step plate (group A) compromising 17 feet and arthroereisis using subtalar implant (group B) compromising 20 feet. Results: By the end period of the study, 25 males and 12 females were available for our analysis of results with a mean follow-up period of 10.14 months (range 7–14 months), clinical scoring (American Orthopaedic Foot and Ankle Society score, Foot Functional Index) with radiological analysis revealed a non-significant difference between both groups, the overall complication rate was 16.2%. Conclusion: Both medial displacement calcaneal osteotomy and subtalar arthroereisis significantly improved radiographic and subjective clinical outcome measures in the surgical treatment of painful flexible planovalgus feet. The less-invasive nature and lower potential morbidity suggest that judicious use of arthroereisis implants is an appropriate alternative.
Objectives
This study aims to assess the effect of gradual correction after acute translation of the tibia in tibia vara using a two-ring Ilizarov frame on the correction of mechanical axis deviation (MAD), union time, and the rate of complications.
Patients and methods
Between September 2018 and January 2021, a total of 30 patients (25 males, 5 females; mean age: 20±5 years; range, 15 to 25 years) with adolescent tibia vara were included. The patients had a transverse fibular ostectomy and percutaneous tibial osteotomy below the level of the tibial tuberosity. Acute correction of the rotation deformity combined with acute translation was done. A tworing Ilizarov frame with a medial distractor and two lateral hinges were used to fix the osteotomy and the coronal plane deformity was gradually corrected.
Results
The mean follow-up was 24±4 months. All patients had improvement in the mechanical medial proximal tibial angle (mMPTA) and MAD postoperatively. There was an improvement in the Hospital for Special Surgery knee score at one year postoperatively. No neurovascular complications or union complications were observed.
Conclusion
Acute translation followed by gradual angulation of the proximal tibia in cases with adolescent tibia vara yields better correction of the mechanical axis with good functional and radiological outcomes.
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