Background

In poliomyelitis; hand to knee gait is the sum of quadriceps weakness and fixed knee flexion deformity. Limb shortening is another added problem. Usually, each problem is attacked separately; with variable end results and complication rates for each procedure.

Background

In poliomyelitis; hand to knee gait is the sum of quadriceps weakness and fixed knee flexion deformity. Limb shortening is another added problem. Usually, each problem is attacked separately; with variable end results and complication rates for each procedure.

Background

CRUS is difficult to treat. Many techniques have been tried in an effort to restore forearm rotation; however, they have not been successful. It is inadvisable by many authors to perform any operation with the hope of obtaining pronation and supination.

Background: Tibial plateau fractures are common injuries which often produce major disability. Open reduction and internal fixation of these fractures has a significant complication rate and numerous recent reports have a tendency to avoid open plating in favour of a variety of limited surgical approaches and percutaneous techniques usually in association with external fixation.

Patients and Methods: The technique of closed manipulation, indirect reduction and percutaneous screw fixation was attempted in 29 displaced tibial plateau fractures (Schatzker types I – IV) in 29 patients. Closed, indirect reduction was successful in only 25 fractures (86.2%); and the remaining four cases were excluded from the study. Patients` age ranged from 19 – 62 years (average 41 y.). Of the 25 fractures, 4 (16%) were open; type I or II Gustilo Anderson classification. Additional mini incision to raise a depressed articular fragment and to apply a bone graft was needed in 12 fractures (48%). Post operative cast or brace was applied for 3–5 weeks. Full weight bearing was started 8–12 weeks postoperatively.

Results: Anatomical reduction was achieved in 20 fractures (80%), and the remaining 5 (20%) were showing grade I residual step or gap formation. Bone healing was achieved in all cases (100 %); and occurred in 8 – 12 weeks (average 9.4 w.) Patients were followed for 24 – 37 months with an average of 30 months. According to the HSS knee score; there were 9 excellent (36%), 13 good (52%), and 3 fair (12%) final end results. According to the Iowa Knee Score there were 14 excellent (56%), 9 good (36%), and 2 fair (8%) final end results. Of these 25 patients, 76% (19 patients) were satisfied; and 24% (6 patients) were not satisfied by the final end result. There were no cases of loss of reduction, wound infection, or cases with poor final clinical outcome.

Conclusion: Indirect technique of reduction combined with percutaneous screw fixation could effectively reduce most displaced unicondylar tibial plateau fractures (Schatzker types I – IV) and is associated with good final outcome, with few reported complications.

Background: The majority of long bone nonunions occur in the tibia. Associations with infection, segmental bone loss, or shortening; are responsible for substantial morbidity. They are particularly recalcitrant to treatment, and consequently many alternative approaches to elicit their healing have been suggested.

Patients and Methods: Thirty three infected non-united tibial fractures (24–69y), with shortening or bone loss (3.5 – 9.5 cm.) and skin or other soft tissue complications; following repeated surgeries (3–7 previous operations) were operated upon. Seventeen fractures were subjected to debridement of the bone ends and soft tissues at the non-union site. Sixteen fractures were managed by simple compression at the fracture site. Mono-planer external fixators were applied to all cases, and distraction-callo-tasis principle was performed at a proximal (or distal) corticotomy to compensate for shortening or bone loss.

Results: In the first group: bone healing was achieved in 16 cases (94.1%) in 13 – 32 weeks (mean of 14.4 weeks). Infection was eradicated in 15 cases (88.2%); all were united. The mean length gained was 7 cm. Satisfactory results were obtained in 14 patients (82.3%) and unsatisfactory results in 3 patients (17.6%). There have been no refractures or loss of length after a follow-up of 2 years (range 2 – 2.5 y). In the second group: bone healing was achieved in 11 cases (68.7%) in 17 – 41 weeks (mean of 20.6 weeks); with infection eradication in only 7 of them (43.7%). The remaining 5 non-unions; all showed residual infection. The mean length gained was 6 cm. Satisfactory results were obtained in 8 patients (50%) and unsatisfactory results in 8 patients (50%). There have been two refractures in the united 11 cases after a follow-up of 2 years (range 2 – 2.7 y).

Conclusion: bone compression after debridement gives a higher success rate in achieving bone healing & eradication of infection in infected tibial non-union.