Mohamed F. Mostafa

Distal soft tissue realignment and proximal metatarsal countersinking osteotomy for moderate to severe hallux valgus.

BACKGROUND Hallux valgus is a common condition and surgical correction has remained a challenge. OBJECTIVE To evaluate the results of distal soft tissue realignment and proximal 1st metatarsal countersinking osteotomy for the treatment of moderate to severe hallux valgus deformity. MATERIALS AND METHODS This prospective study included 33 ft in 28 patients. The deformity was moderate in 27 ft (23 patients), severe in six ft (five patients) and bilateral in five patients. All operations were performed as a primary procedure with an average duration of follow-up of 28.2 months (range 10-45 months). RESULTS The average hallux valgus angle was improved from 32.5° to 8° and the first intermetatarsal angle from 16.5° to 7.7°. According to the symptomatic score of Broughton and Winson, 22 ft (18 patients) were rated excellent, nine good and two poor. The average American Orthopedic Foot Ankle Society score at the final follow-up was 89.3 (range 65-100). Recurrence of the valgus deformity was seen in three patients and hallux varus in two patients. CONCLUSIONS The current procedure proved to be effective to correct all components of hallux valgus deformity regardless of its severity.

Shaped graft for aneurysmal bone cyst of upper-limb bones

Background and purpose The optimal treatment of aneurysmal bone cyst (ABC) remains challenging. The aim of this study was to evaluate the results of using bone grafts shaped to the defects caused by ABCs of upper-limb bones. Patients and methods Totally, 15 patients (12 male and three female) with an average age of 12 years (range: 6–16 years) were treated for ABCs of upper-limb bones by intralesional resection, argon beam coagulation, and shaped bone graft. The grafts were harvested from 14 patients (11 fibulas and three iliac bones) and from the mother of one patient (proximal fibula). Osteosynthesis was required to stabilize the graft in four cases. The modified Enneking’s scoring system was used for functional evaluation. Results One patient developed partial recurrence at 6 months and required reoperation. Superficial wound infection was encountered in one patient. Shortening of the humeral segment was seen in two patients (1 and 1.5 cm) but without angular deformity. After a mean follow-up of 45 months (range: 24–68 months), the mean functional score was 97.3%. Conclusion This technique is reliable to obtain a well-reconstructed and growing bone with no or minimal deformity and good function.

Modified Metaizeau technique for displaced radial neck fracture in adults

Background and purpose Few studies have been reported about closed treatment of the radial neck fractures in adults, which most often are found in children. A prospective study was conducted to evaluate the results of modified Metaizeau technique in the management of displaced radial neck fracture in adults. Patients and methods A total of 12 adults with displaced radial neck fractures were selected after excluding patients with combined neck and head fractures and patients younger than 16 years. After closed reduction, two or more K-wires were inserted from the midshaft of radius in a retrograde direction to stabilize the reduced head. The Mayo elbow performance score was used for final clinical assessment. A proposed scale by authors was used for radiological evaluation. Results Using the modified Masson classification, there were nine type IIb and three type IIIb fractures. After a mean follow-up of 38 months (range: 22–60 months), 10 patients were clinically rated excellent and two were good. Two patients had skin irritation and painful bursitis at the buried ends of K-wires; otherwise, no cases of superficial or deep infection, K-wire breakage or migration, and tendon or nerve injury were indicated. Asymptomatic nonunion was detected in two patients. According to the proposed radiological scale, six patients were excellent, four good, and two poor. Conclusion Closed manipulation and retrograde intramedullary pinning is a minimally invasive technique allowing stable fixation of displaced radial neck fractures in adults, with excellent to good outcomes and low complication rate.

Sling reconstruction of acromioclavicular joint dislocation: is screw fixation necessary?

Background Acromioclavicular joint injuries have been in much controversy with regard to the ideal method of treatment. The loop technique has been successfully used to stabilize this joint with variable success. Adding a Bosworth screw to the loop fixation may improve its efficacy and decrease the incidence of postoperative subluxation. This comparative study evaluates the efficacy of loop fixation for both acromioclavicular and coracoclavicular ligament reconstruction versus a loop combined with Bosworth screw with regard to function, radiology, and fixation-related complications. Patient and methods Over a 5-year period, we treated 50 patients with acute acromioclavicular joint dislocations with two methods of fixation. Only 47 patients continued follow-up. Group I (N=24) was managed with reconstruction of the coracoclavicular and acromioclavicular ligaments by means of loop fixation. In group II (N=23), a Bosworth screw was added to the loop fixation. Results The mean follow-up period was 24.2±5.9 months (range: 15–34 months) for the first group and 23.3±6.5 months (range: 13–36 months) for the second group. The mean postoperative pain score (visual analog scale) was 1.38±1.7 for group I and 1.35±1.27 for group II. The mean Constant score was 90.2±8.1 for group I and 92.2±5.5 for group II. The mean Taft score was 10.6±1.4 and 10.9±1.3 in the first and second groups, respectively. Recurrence was detected in four patients, two in each group. There was no statistically significant difference in results between the two groups. Conclusion Sling technique was found efficient enough to maintain stability of the acutely dislocated acromioclavicular joint without the need to augment this reconstruction with a screw.