Mahmoud A. Mahran

Quadricepsplasty: A sustained functional achievement in front of a deteriorated flexion gain

METHODS Nineteen cases of extension contracture were operated upon by modified technique of Judet quadricepsplasty, one female and eighteen males. Results were evaluated by HSSKF score as well as Judet criteria. PURPOSE The hypothesis is that recurrence of adhesions underneath the quadriceps leads to loss of some of the gained intraoperative flexion range. RESULTS In this series, flexion range deteriorates but this was found to be statistically non significant on the functional score of the patients.

Slipped capital femoral epiphysis: a review of management in the hip impingement era

Slipped capital femoral epiphysis (SCFE) remains the most common adolescent hip disorder. Most cases present with stable slips, and in situ fixation is the most commonly adopted treatment worldwide. The introduction of the concept of femoroacetabular impingement and subsequent studies have revealed SCFE-related hip impingement to be a significant pre-arthritic condition, and the previously suggested remodeling of the proximal femur after in situ fixation has been called into question. Complex proximal femoral osteotomies and more recently intra-articular procedures via surgical hip dislocation have been employed. The literature is still lacking a strong evidence to undertake such aggressive procedures. Moreover, the application of a particular procedure regarding the nature of the slip, being stable or unstable, the degree of the slip, and the condition of the physis has not been extensively described in the literature. The purpose of this article is to outline the SCFE-related hip impingement, to review the best evidence for the current treatment options for both stable and unstable slips, and to develop an algorithm for decision making.

Combined Anterior and Posterior Lumbar Rhizotomy for Treatment of Mixed Dystonia and Spasticity in Children With Cerebral Palsy

BACKGROUND: Children with cerebral palsy (CP) can present with severe secondary dystonia with or without associated spasticity of their extremities. OBJECTIVE: To assess the outcomes of combined anterior and posterior lumbar rhizotomy for the treatment of mixed hypertonia in the lower extremities of children with CP. METHODS: Fifty children with CP were subjected to combined anterior and posterior lumbar rhizotomies in a prospective study. Clinical outcome measurements were recorded preoperatively and were evaluated at 2, 6, and 12 months postoperatively. The operative techniques were performed by laminotomy from L1-S1, and intraoperative monitoring was used in all cases. All patients underwent intensive postoperative physiotherapy programs. RESULTS: Changes in muscle tone, joint range of motion, and dystonia were significant (P = .000) at postoperative assessment visits. CONCLUSION: This study demonstrated the potential of combined anterior and posterior lumbar rhizotomies to improve activities of daily living in children with CP and with mixed spasticity and dystonia. ABBREVIATIONS: BAD, Barry-Albright Dystonia Scale CAPR, combined anterior and posterior lumbar rhizotomy CP, cerebral palsy ITB, intrathecal baclofen MAS, modified Ashworth Scale ROM, range of motion SDR, selective dorsal rhizotomy

Open reduction internal fixation versus external fixation with limited internal fixation for displaced comminuted closed pilon fractures: A randomised prospective study

Background Pilon fractures involve the dome of the distal tibial articular surface. The optimal treatment for high-energy pilon fractures remains controversial. Some authors advocate the use of open reduction and internal fixation (ORIF) to avoid articular incongruence. Others advocate the use of bridging external fixation with limited internal fixation (EFLIF) to reduce soft tissue complications. Literature reports of prospective studies comparing the radioclinical outcomes of ORIF and EFLIF in high-energy fractures are scarce. Retrospective studies have their limitations because of insufficient randomisation. The objective of this randomised prospective study is to compare the clinical, radiologic and functional outcomes of displaced and comminuted closed pilon fractures, Rüedi and Allgöwer type II and III, treated by either ORIF or EFLIF. Materials and Methods Forty-two patients were selected for the study. Twenty-two patients were subjected to ORIF and 20 patients were subjected to EFLIF. We used the American Orthopaedic Foot and Ankle Society score as a standard method of reporting clinical status of the ankle. Patients were followed-up clinically and radiologically for over 2 years after the surgical treatment. Results The results of ORIF and EFLIF in treatment of high-energy pilon fractures are equally effective in terms of functional outcomes and complication rates on the short term. Conclusion Soft tissue integrity and fracture comminution seem to have a significant influence on outcomes of intervention. A prospective multicentre study with a larger sample size that controls for other associated variables and comorbidities is warranted. Level of evidence Level II.

Flexion deformities of the wrist and fingers in spastic cerebral palsy: A protocol of management

Background: Literature is confusing regarding grading and treatment of flexion deformities of wrist and fingers in spastic cerebral palsy (CP). The most established classification is that described by Zancolli; unfortunately, it has its shortcomings which we experienced in the beginning of our approach to manage this rather difficult deformity. We thus modified Zancollis classification and developed a classification system and treatment protocol. Materials and Methods: Thirty patients with spastic CP were operated upon due to flexion deformity of the wrist and fingers and were included in this study. Age ranged from 4 to 14 years, average 7 years. There were twenty boys and ten girls. Results: The average followup was 18 months (range 9 months - 3 years). The power of wrist dorsiflexion, the “Houses classification of upper extremity functional use” and the clinical assessment of hand function were used for evaluation; they improved in all patients and this improvement was statistically significant. In all patients, cosmetic appearance improved without any residual flexion deformity. Conclusion: This study introduces a new grading system for flexion deformity of wrist and fingers in spastic CP that correlates with severity of the condition and allows a treatment protocol to be established.

Spasticity and Gait

Cerebral Palsy is the most common pediatric neurologic disorder, with an incidence of 3.6 per 1,000 live births.

Online orthopaedic surgical anatomical study using the visible human server

Practicing orthopaedic surgeons may face day to day challenge in planning certain operations that require a special study of the anatomical part on which a complicated or rare surgical procedure is required. The standard options to obtain such special surgical anatomical data has been traditionally the reference of anatomical text books, special surgical exposure literature and books, or a special arrangement to visit the morgue and perform a post-mortem hands-on anatomical research. The new era of electronic data manipulation used over broadband internet connection, human volunteers who were executed for murder and accepted to give their body for the sake of science, and ingenious software created by dedicated scientists to build an engine for controlled real-time rendering of 2D, 3D, slices, surfaces, and animations of the human body opens a novel methodology to supplement the previously mentioned options. This work aims at exploring. The Visible Human Slice Server (http://www.visiblehuman.epfl.ch) as a tool for orthopaedic surgeons that they may use whenever the need for real-time special anatomical-surgical study is required, as well as for education and training of surgical anatomy.