Background: relapsed Clubfoot has been a clinical challenge for the orthopedic surgeons. There is no single modality of treatment till date. Tibialis anterior tendon transfer was described as a good procedure in restoring muscle balance and correcting this deformity. Aim of the work: to evaluate the results of tibialis anterior tendon transfer after walking age in children with residual dynamic supination after correction of congenital clubfoot with ponseti technique. Patients and methods: The current study is an interventional study that was conducted between 2016 and 2019 at Benha University hospitals, Zagazig general hospital, and Zagazig university hospitals. About (30 feet) in 22 patients with residual dynamic clubfoot deformity underwent transfer of the anterior tibial tendon were enrolled in the study. The follow up period ranged from 12 months to 19 months. Results: The patients' age ranged from 2.5 years to 6.5 years old at the time of the operation with mean age was (4.22±1.26) and the majority of them were males (60%). About 9 feet (30%) required further preoperative recasting and tendoachilles lengthening. There was statistically significant improvement between pre and post operative results regarding observational gate analysis, range of motion, foot posture index, X ray measured angles, eversion muscles power and parents satisfaction (p value <0.05). Conclusion: Tibialis anterior tendon transfer has been shown to be an effective procedure in dynamic supination deformity correction. Ankle and foot range of motion and muscle function of the children definitely improved with the procedure.
Careful adjustment of the intertrochanteric cracks and early activation of the patients are the ideal treatment to forestall the confusions of delayed immobilization, aside from in patients with clinical issues in whom medical procedure is contraindicated. The Dynamic hip screw (DHS) has been the norm and the best archived embed in rewarding intertrochanteric breaks and in a few randomized preliminaries it has been related with lower difficulties and reoperation rates. Also, it is a more affordable embed, however hypothetically it has a biomechanical drawback in view of a more extensive separation between the weight bearing pivot and the embed A sum of 20 instances of shaky proximal femoral breaks were incorporated, and they were partitioned into two equivalent gatherings; the principal bunch experienced PFN, while the other one experienced LP. Follow up visits was at 1st,3rd,6th weeks and third and sixth months in outpatient facility and results were recorded. Altered Harris Hip Score had a middle of 88 and 85 in the femoral nail and bolted plate bunches separately (p = 0.114). Postponed association was experienced uniquely in one case in the bolted plate gathering, while it was not experienced in the other gathering (p = 0.345). Radiological assessment uncovered a middle score of 3 in both examination gatherings. all the inserts in their own privilege are magnificent modalities in the administration of unsteady proximal cracks of the femur. Precarious proximal femoral cracks with rotational mal-arrangement issues were dealt with best by PFN. Precarious proximal femoral cracks particularly with expanded comminution do give a choice to be fixed by LP.
Premature patients are more likely to suffer from flexible flat feet. This disease may be treated using a variety of methods. It may be treated with ease and simplicity using the calcaneal stop. According to our findings, this method is a worthwhile one. Methods and Subjects: A calcaneal-stop surgery was conducted on 20 feet in 12 individuals, seven men and five females, with flexible flat feet. They used the following criteria to determine who should be included: (a) skeletal immaturity; (b) symptomatic flexible flatfoot deformity (pain, function, and activity limits) that is not amenable to conservative therapy. AOFAS Ankle-Hindfoot score and Hindfoot valgus angle were used in the clinical examination. The results were reported back to the patient. Calcaneal pitch angles, Kite's angle, talar declination angle, lateral Meary's angle, and talonavicular coverage angle were used for radiological examination. All patients' clinical and functional results were assessed before, three and six months after surgery, respectively. A total of 88.4 SD 7.4 AOFAS scores were recorded at the conclusion of the trial, an increase from 70.6 SD 4.8 at the beginning. During the course of the research, the patient's heel valgus went from an average of 11.45 (SD 3.02) to a median of 2.7 (SD 1.3). Ending the investigation, the angle of the calcaneal pitch rose from 13.4 to 16.1 (SD 1.1). Kite angle decreased from 29.6° (SD 3.1°) to 26.7° (SD 2.7°) after surgery. A decrease from 22.4 to 11.2 (SD 5.68) was seen in the final talonavicular coverage angle. At six months following surgery, the lateral Meary talocalcaneal angle dropped from 20.55 6.9 to 14.3 4.73. Eleven patients (91.6 percent) were quite satisfied, and the one patient who had some discomfort at the location of the procedure did not need the removal of the screw. All clinical and radiological markers improved significantly (p .00001). After surgery, most of the alterations occurred. Although the progress was steady, it was not statistically significant. It is the patient's discontent that is the most pressing issue with flat feet. For the treatment of flexible flat feet, the calcaneal stop operation is a simple and straightforward surgery with little risks.
Formative Dysplasia of the hip is a typical hip condition that effects around 1-3% of recently conceived kids. In addition, it is the principle reason representing around 29% of essential hip replace¬ments up to the sixties old enough. The administration of formative dysplasia of the hip principally attempts to early analyze, to begin the treatment. Concentric decrease of the hip, and sufficient inclusion of the acetabular rooftop are the determinants of treatment whether the hip is set up, subluxated, or profoundly disjoined. Open decrease alone may give industrious decrease to quite a long while; nonetheless, the absence of sufficient bony rooftop over the femoral head would cause biomechanical issues in adulthood. Conversely, Dega osteotomy gives much better inclusion and the endproduct would be more anatomical, which may keep the youngster from growing further joint issues later on. This investigation was completed at Benha University Hospital on two gatherings as follows: Group A: 10 patients went through open decrease with DEGA, Group B: 10 patients went through open decrease without DEGA. Mean age of the investigation populace was 21 months in bunch A, 19 months in bunch B. The influenced side was correct side (50.0%) while left side was 50.0%. The IHDI middle of the two gatherings was grade 1 in bunch, some time it was grade 3 in bunch B. At a half year, acetabular record was essentially higher in bunch B (49) contrasted with bunch A (38). P esteem was <0.001. There was no critical distinction between the two gatherings pre-operatively. Concerning, Dislocation was fundamentally higher in bunch B (50.0%) contrasted with bunch A (0.0). P esteem was 0.033.
Fractures of the proximal or distal thirds of the tibia are one of the most challenging injuries in orthopedic. A few strategies have been portrayed m the decision of procedure relies upon numerous elements including crack arrangement, bone quality, delicate tissue injury and accessible equipment.Intramedullary nailing might be powerful in dealing with these breaks even with straightforward articular augmentation, yet care should be taken with decrease and sufficient screws locking to forestall malalignment and ceaseless knee agony may likewise be an issue. This investigation included 20 patients with distal and proximal tibial breaks rewarded with intramedullary nail with multidirectional proximal and distal locking screws (Expert tibial nail). The time of follow up was up to 6months utilizing certain scoring frameworks. The suggestive and useful assessment results were reviewed by the models by Johner and Wruh's Criteria According to Johner and Wruh's measures, 45.0% of patients indicated great rules, 30.0% were brilliant, 15.0% were reasonable and just 10.0% were poor. Two cases created deferred association (10%), two cases built up Sudeck's decay (10%), one case created malunion (5%), one case created nonunion(5%) and foremost knee torment was found in four cases (20%). So front knee torment spoke to the most widely recognized intricacy in this study.Treatment of proximal and distal thirds tibial cracks utilizing master tibial intramedullary nail (with multidirectional locking screws) is a protected and acknowledged strategy option in contrast to customary nail and plating procedure. This structure of the embed helps in accomplishing stable obsession and improved securing most extraarticular tibial cracks.
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