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Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 59 - 59
1 Jan 2011
Shalaby S Morgan G Hanna M Hafez M Nakhla A Abbas A Zaman T Saavedra E Tross S
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Shockwave treatment in our unit is provided in conjunction with our Urological colleagues. Shock Wave Therapy has been used as a last option in patients with difficult and chronic Orthopaedic conditions with an informed consent for all patients.

Material and Methods: 28 patients from Ealing Hospital and West Middlesex Hospital were referred to The Lithotripsy unit at Charing Cross Hospital for Shock wave therapy.

Patients were consented by the Orthopaedic surgeon and the treatment was administered by urologist

The cases included:

4 Humeral fractures: 1 Case in HIV +ve 19 years old

5 Femoral non-union: 1 case bilateral in Osteogenesis imperfecta

4 Tibial non-union: 1 Recurent Fracture in 65 years old man

2 Osteochondritis of the Talus

2 Osteochondritis of the knee

4 Scaphoid fractures: 1 case had been fixed and grafted.

Medial Epicondyle fracture non union

5th Metacarpal Fracture

Trochanteric Bursitis

Tennis Elbow

4 Planter fasciitis

– The Shock wave Machine used is Storz SLX – F2 Electromagnetic shock wave generator which focus the shock wave low energy high frequency in focal zone with no harm to other tissues. Frequency 4 htz = 4 shockwave/sec

– Energy level 1–3 generate pressure value in the focal area of 5–30 megapascal

– Size of focal zone 9X 50 mm or 6X 28 mm

– Total shock wave applied per session 2000 to 3000 shock

– large focus and small focus were used in fracture of large bones and small bones respectively. Most of cases required 2–3 session with 4–6 weeks interval.

– in Soft tissue Treatment Less energy was used and patients required 1 to 2 sessions.

Results: There was complete resolution of symptoms in the 4 cases of soft tissues.

– Clinical and radiological union in 3 of the 4 Humeral Fracture including HIV+ve and in 2 of 3 tibial fracture and 1 of 2 scaphoid.

– 50% pain relief in Psedo arthrosis

– Union is promoted by Cellular stimulation and pain relief is by unknown mechanism but explained by increase vascularity and neuro-modulation.

– None of the patient’s have so far required subsequent operative interventions, several had residual symptoms.

Discussion: Shock wave therapy is a new consevative treatment modality used in orthopaedic as the last option before surgery but there is a need for RCT.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 206 - 206
1 May 2009
Shalaby S Shenouda E Rizkalla K Morgan G Amini A Hughes S Crock H
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Introduction: The purpose of the study was to evaluate the outcome of multiple spinal operations by an expert spinal surgeon HV Crock.

Materials and Methods: A retrospective review of 169 patients who had multiple spinal surgery including spinal Fusion and spinal decompression was undertaken. A special Questionnaire form was designed and sent to each patient to answer with an appointment for the patient to be seen and assessed in the spinal assessment clinic where data from the questionnaire, clinical notes and thorough clinical examinations were recorded in a spinal data base which covered the following sections:

Patients Symptoms

Treatment received

Spinal Operations

Body Diagram for shading the site of pain

Final outcome

Patient Satisfaction

Results:

– 76 patients 66% of the patients who replied “were satisfied” with the surgery.

– 38 patients 33% of the patients who replied were not satisfied.

– 58 patients did not reply as they were not interviewed.

There were no significant post-operative neurogenic complications, such as cauada equina syndrome or severe leg weakness interfering with standing and walking retirement. There was always a temporary relief followed by deterioration of symptoms after a period ranging between 1–2 years.

Conclusions: Overall, patients with failed back syndrome need to be evaluated and treated in a multidisciplinary setting, where a group of Health Care Professionals from various fields, such as Physiotherapy, Pain Management and Clinical Psychologist work together, towards the common goal for the benefit of the patient


The Journal of Bone & Joint Surgery British Volume
Vol. 88-B, Issue 12 | Pages 1642 - 1646
1 Dec 2006
Shalaby S Shalaby H Bassiony A

We report the results of limb salvage for non-metastatic osteosarcoma of the distal tibia using resection arthrodesis, autogenous fibular graft and fixation by an Ilizarov external fixator.

In six patients with primary osteosarcoma of the distal tibia who refused amputation, treatment with wide en bloc resection and tibiotalar arthrodesis was undertaken. The defect was reconstructed using non-vascularised free autogenous fibular strut graft in three patients and a vascularised pedicular fibular graft in three, all supplemented with iliac cancellous graft at the graft-host junction. An Ilizarov external fixator was used for stabilisation of the reconstruction.

In five patients sound fusion occurred at a mean of 13.2 months (8 to 20) with no evidence of local recurrence or deep infection at final follow-up. The mean post-operative functional score was 70% (63% to 73%) according to the Musculoskeletal Tumour Society scoring system. All five patients showed graft hypertrophy.

Union of the graft was faster in cases reconstructed by vascularised fibular grafts. One patient who had a poor response to pre-operative chemotherapy developed local tumour recurrence at one year post-operatively and required subsequent amputation.