Abstract Introduction Miserable malalignment syndrome is a complex torsional lower limb deformity with limited consensus on surgical treatment. We present the outcome of de-rotation of the tibia alone using an external fixator. Methods Fifteen patients (22 segments) were operated on between 2012 and 2020; 13 presented with anterior knee pain, and two presented with out-toeing. Gait analysis was done in nine patients, and CT scan rotational profile, including tibial tubercle–trochlear groove distance, femoral version, and tibial torsion, were calculated. Kujala knee pain score and visual analogue pain score (VAS) were recorded. All underwent infra-tubercular osteotomy of the tibia and midshaft osteotmy of the fibula and application of a hexapod circular frame to gradually internally rotate the tibia until the foot aligned with the patella. Results There was no preoperative clinical or radiographic evidence for patellar instability, femoral anteversion 30° (21°–54°), and external tibial torsion 50° (37–70). The mean age at surgery was 21 years (12–37) with a mean follow-up of 20 months (9–83). All osteotomies healed, and the frames were removed at a mean of 111 days (80–168). The mean VAS score improved from 8(5–9) to 1(0–4) postoperatively ( P < 0.001). The mean Kujala knee pain score increased from 53 (30–75) to 92 (54–100) postoperatively ( P < 0.001). The mean preoperative foot progression angle (FPA) was 37° (20°–50°), with 13 postoperatively walking with neutral FPA. One patient walked with symmetrical + 10° and the other with − 5° FPA. All patients reported relief of knee pain and were satisfied with the alignment. Conclusion Gradual correction of severe external tibia torsion with a hexapod external fixator and an infra-tubercle tibial osteotomy could provide an optimum method to eliminate knee pain and improve limb alignment in miserable malalignment syndrome.
Background: Hip fracture is common, with the reported lifetime prevalence of 20% for women and 10% for men.Despite recent advances in the techniques and instrumentation of orthopedic procedures, however, hip fracture surgery is still commonly associated with substantial blood loss, subsequent acute anaemia, and the need for transfusion.Postoperative anaemia in patients with hip fracture may lead to decreased ambulation, reduced functional independence and reduced walking distance on discharge Objective: To evaluate the efficacy of preoperative vs. intraoperative IV-TXA on postoperative blood loss following hip fracture surgery.Patients and Methods: A prospective randomized controlled study that was held on thirty adult patients with hip fracture who had a surgery.Results: The drains were removed in day 2. Mean volume of blood in the drain at day 0 was 140.00 ± 60.36 ml in group A as compared to 163.33 ± 66.73 ml in group B. Mean volume of blood in the drain at day 2 was 142.00 ± 85.54 ml in group A as compared 123.33 ± 56.27 ml in group B. Conclusion:The present study demonstrated that there is no significant difference between preoperative versus intraoperative IV-TXA in reducing blood loss in patients undergoing surgeries for hip and proximal femoral fractures.Additionally TXA administration in both groups caused a reduction in postoperative anemia and need for transfusion without significantly increasing the risk of thromboembolic events including DVT.This would in turn, help to avoid complications related with transfusion of blood and blood products.
Mineralization in the Wadi Hammad area is represented by polymetallic vein-type and occurs in four modes, they are mineralized main quartz vein, silicified shear zone, associated hydrothermal alterations, and breccia zones.They mainly occur in the contact between Dokhanvolcanics and Younger granites and are confined to and controlled by the Wadi Hammad shear zone.The study revealed that Dokhan volcanics have adakitic nature and are formed by slab melt.Accordingly, these rocks are favorable sites for the formation of Au-(Cu)deposits.Hammad granite rocks are characterized bymetaluminous to weakly peraluminous, span the boundary between the ilmenite-magnetite series, transitional between moderately and strongly oxidized granites, situated a relatively shallow to moderate depths (20 to 30 km), and started to crystallize at temperatures around 800 °C.It is suggested that mineralization in WadiHammad formed due to intrusion of the strongly oxidizing, water-and volatile-rich, and alkaline to alkaliecalcic magma into the adakiticDokhan volcanic leads to circulation of these fluids in the latter leaching the available metals (Au and base metals).The leached metals are deposited in preexisting open fissures at the cold end of convective cells near the surface form Au (Cu)-rich quartz veins.
Background: Although tension band wiring is the traditional method to fix the transverse patellar fracture, there are many published studies regarding the use of other metallic implants to fix the patellar fracture.This study aims to find out the good choice of fixation by performing a systematic review of the literature to compare clinical and radiological outcomes of the studies that use metallic implants to fix transverse patellar fractures.Methods: The following keywords (patella cerclage, patella wire, patella plate, patella fixation, tension band) were used to perform a systematic search of literature until 2021.All abstracts were reviewed, and the selection of these abstracts was then performed based on the inclusion and/or exclusion criteria.Results: A total of 19 studies involving 1264 patients were included (623 males and 641 females).The tension band with K wires method was the most used method in the studies followed by tension with cannulated screws, plates, and lag interfragmentary screws respectively.95.4 % of patients had a complete union.TBCS had lower postoperative complications, less hardware failure, and short healing time, but no significant difference between TBCS and TBKW regarding the range of motion and operative time. Conclusion:TBCS technique had a low risk of hardware failure and complication in comparison to the TBKW technique while no superior method regarding ROM and operative time.On the other hand, plate osteosynthesis and isolated interfragmentary screws may provide other choices for the fixation of transverse patella fractures but it needs more trials and studies to be confirmed to be effective.
Background: Sacubitril/valsartan, a novel angiotensin receptor-neprilysin inhibitor (ARNI), has emerged as a promising therapeutic option for heart failure patients with reduced ejection fraction (HFrEF).This study aimed to assess the safety and efficacy of sacubitril/valsartan in symptomatic NYHA class II-III heart failure patients with mildly reduced ejection fraction compared to patients with reduced ejection fraction.Methods: This was a multicenter prospective observational study conducted at Benha university hospital, Qaliobia , Egypt and Al-Zaitoun specialized hospital, Cairo, Egypt.The study enrolled 100 patients diagnosed with heart failure, divided into two groups: Group I (n=50) with reduced ejection fraction and Group II (n=50) with mildly reduced ejection fraction.The patients' medical and medication history, including comorbidities, were recorded.The 6-minute walk test (6MWT) was conducted at baseline and after 10 weeks of intervention with sacubitril/valsartan.The outcome measures were changes in 6MWT distance, and occurrence of adverse effects.Results: The study participants exhibited a high prevalence of comorbidities, with hypertension at 75%, diabetes mellitus at 61%, and ischemic heart disease at 54%.Atrial fibrillation showed a lower prevalence at 15%.In the medication history, 56% of participants had prior use of ARBs, 44% had used ACE inhibitors, and 88% were concurrently on Beta-Blockers.There was no statistical significance between baseline characteristics in both groups as regards demographic data, prevalence of comorbidities and heart failure medications.After 10 weeks of intervention, a slight improvement in the 6MWT distance was observed in both groups, although not statistically significant (P=0.062).Conclusions: The study demonstrated the high prevalence of comorbidities in both groups of the study with no statistically significant difference.. Sacubitril/valsartan therapy resulted in a slight improvement in the 6MWT distance in both groups.
Background: Femoral shaft fractures in children are serious injuries requiring hospitalisation.Different fixation methods were described.Aim: We present a novel technique using external fixator to facilitate and control the reduction intraoperatively, which would allow for easier sub muscular plate application.Methods: We have retrospectively reviewed five boys and five girls.Polyaxial clamps and rods were applied to the sagittally-oriented bone screws, the reduction was done manually, and the clamps were tightened after achieving the proper alignment.The sub muscular plate was applied, and then clamps and bone screws were removed.Results: The mean age at surgery was 12 years.The mean body weight was 42 kg.There were six type A fractures, two type B and two type C. The mean preoperative haemoglobin concentration was 12.29 g/dl.No blood transfusion was needed.The operative time averaged 122 minutes, and the mean hospital stay after was 2 days.The patients reported no pain at a mean of 1.6 weeks.All fractures united, without neither malalignment nor length discrepancy, at a mean of 8.3 weeks (range 6-12 weeks).Neither wound healing problems nor deep infections happened.Conclusion: External fixator-assisted internal fixation of paediatric femoral fractures would facilitate the accuracy and control of fracture reduction and allow minimally invasive percutaneous osteosynthesis.
Background: Venous thromboembolic prophylaxis after major orthopaedic surgeries is an essential topic to review and has a lot of controversies and differences regarding which method to emphasize and the duration of each method of prophylaxis to be used in daily practice in orthopaedic surgery.Here we mentioned the review of literature with respect to thromboembolic prophylaxis in orthopaedic surgery including the latest guidelines and we made a meta-analysis of data from many studies regarding the use of different pharmacological agents after major orthopaedic surgeries like total hip replacement (THR), total knee replacement (TKR), hip fracture and knee arthroscopic surgery.
Aim The localization of sequestrum in chronic osteomyelitis (COM) is crucial in preoperative planning. The identification of sequestrum on plain X-ray could be difficult. CT and MRI were reported to show the sequestrum. We aimed to analyze the sequestrum characteristics on 18F-FDG-PET-CT images. Methods A prospective study included all patients diagnosed with long-bone chronic osteomyelitis. All patients had preoperative 18F-FDG-PET-CT. Images were analyzed using RadiAnt DICOM Viewer. Axial cuts were used to measure the Standard Uptake Ratio (SUV)max in the Region of Interest (ROI) in the sequestrum, the surrounding area, and the normal bone in the same cut. Surgical debridement was done as standard; samples were taken for microbiology and histopathology, and the intraoperative finding was documented. Results Nineteen patients (17 males/2 females) were operated on in one center between October/2021 and Jan/2023 at a mean age of 32±18. There were 10 tibias, 7 femurs, one ulna, and one fibula. Ten had postoperative COM, six open fractures, and three hematogenous OM. They all showed sequestrum on PET-CT; the dead bone appeared void, surrounded by a halo of increased uptake. There was a trend of lower uptake in the sequestrum compared to the halo around. The mean SUVmax at the sequestrum was 4.18±3.16, compared to the surrounding halo, 7.08±5.81. The normal bone has a mean SUVmax of 1.61±1.42. Sequestrum was removed successfully in all cases. Conclusion 18F-FDG-PET-CT can precisely localize the sequestrum preoperatively, it has a lower uptake than tissues around it. This would facilitate planning and improve the quality of debridement.
Osteomyelitis is a challenge in diagnosis and treatment. 18F-FDG PET-CT provides a non-invasive tool for diagnosing and localizing osteomyelitis with a sensitivity reaching 94% and specificity reaching 100%. We aimed to assess the agreement in identifying the geographic area of infected bone and planned resection on plain X-ray versus 18F-FDG PET-CT.Clinical photos and X-rays of ten osteomyelitis patients were shown to ten consultant surgeons; they were asked to draw the area of infection and extent of planned surgical debridement; data will be compared to 18F-FDG PET-CT results.We tested the agreement between the surgeons in every parameter. Regarding height, there was poor agreement between surgeons. Regarding perimeter, the ten surgeons showed low-moderate agreement. The ten surgeons showed a low-moderate agreement for circularity. Results document the variability of assessment and judgement based on plain X-rays. In comparison to PET-CT, All parameters were significantly different in favour of 18F-FDG PET-CT over X-ray (P < 0.001).18F FDG PET-CT provides a three-dimensional tool for localizing the exact location of the infected bone and differentiating it from the normal bone. Thus, it could be beneficial in precise pre-operative planning and surgical debridement of chronic osteomyelitis.
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