Fibular Hemimelia is not just a fibular anomaly but there is entire limb involvement with varied expression in each segment. Factors which we have considered in treatment are the amount of fibula present, percentage of shortening, tibial and leg deformity and foot deformity. Residual or recurrent foot deformity is the prime reason for unsatisfactory results, so we have used Paley's classification which takes into consideration foot deformity. Our series is of 29 cases, Paley type I-7, Type II-6, Type III-16 and none of type IV. Tibial lengthening (+/−) bow correction was performed in 28 cases. Supramalleolar osteotomy was done in 4 cases. In foot, soft tissue release only was done in 6 cases and soft tissue release with osteotomy (subtalar or calcaneal) was done in 14 cases. Amputation was done in 2 cases. Age ranged from 11 months to 16 years. Mean follow up was 4.2 years. Mean lengthening was 3.5 cm. Desires lengthening was achieved in 21/29 cases and plantigrade foot was achieved in 16/29 cases. Complications faced were recurrence of foot deformity, knee valgus, knee fixed flexion deformity, knee subluxation and pin tract problems. Less than 3 rays and more than 25 cm of limb length discrepancy were poor prognostic factors. We had 7 excellent, 16 good and 6 poor results. To conclude, it is difficult to achieve the aim of plantigrade foot and limb length equality in all cases but radical surgery with foot correction and tibial lengthening can give good results.
Patient's non acceptance of a bulky external fixator, the incidence of fractures of the regenerate, muscle transfixion giving rise to contractures especially in the Tendo Achilles, increased index of consolidation and the frequency of infections has made Limb lengthening with external fixators alone unpopular. In a retrospective study, we evaluated the technique of limb lengthening over a sub muscular plate combined with Ilizarov external fixator as an alternative to external fixator alone and whether the combined procedure is successful in reducing the external fixator period. 15 patients (14 with length discrepancy in the lower limb and 1 with low stature) and a total of 16 limbs (15 tibiae and 1 femur) were lengthened over a sub muscular plate fixed on the proximal segment followed by corticotomy and application of external fixator. Lengthening was achieved at 1 mm/day followed by distal segment fixation with three or four screws on reaching the target length. The pre operative target length was successfully achieved in all patients at a mean of 4.4 cm (2.2 to 6.5 cm). The mean duration of external fixation was 59.2 days (33 to 107 days) with the mean external fixation index at 16.7 days/cm (10.95 to 23.78). Infection complicated the procedure in two patients and one patient had mild Tendo Achilles contracture. Lengthening over a plate drastically reduces the time external fixator needs to worn and is preferred by patients to limb lengthening over an external fixator alone. patient Lengthening over a plate provides an alternative method for limb lengthening, can be applied to children with open physes and to deformed bones.
To assess the accuracy of posterior and anterolateral methods of injection into the subacromial space (SAS) of the shoulder. Ethical approval was obtained and 50 patients (23 women and 27 men) with mean age of 64.5 years (42-87 years) and clinical diagnosis of subacromial impingement were recruited. Patients with old or recent shoulder fracture, bleeding disorders, and allergy to iodine were excluded. All injections were given by the consultant or an experienced registrar after obtaining informed consent. Patients were randomised into posterior and anterolateral groups and the method of injection was revealed by opening sealed envelopes just before the injection. A combination of 3mls 0.5% bupivacaine and 2mls of radiographic dye (Niopam) was injected in the subacromial space (SAS) using either anterolateral (n-22) and posterior approaches (28). AP and lateral radiographs of shoulder were taken after injection and were reported by a Consultant Radiologist blinded to the method of injection. Visual analogue scale (VAS) and Constant-Murley shoulder score was used to assess pain and function respectively. Both scores were determined before and 30 minutes after the injection.Aims
Patients and methods
