Fracture Surgery Internal fixationLocked plate a b s t r a c t Background: The ideal surgical fixation for displaced distal clavicle fractures should not

Background: Many surgical options for treating lumbar degenerative disorders have been used to improve health related outcome of those patients. The aim of the study is to compare the functional and radiological outcome of the two techniques in management of Lumbar spinal stenosis (LSS). Methods: Sixty patients with Lumbar spinal stenosis were included in a retrospective cohort study at zagazig university hospital. The inclusion criteria were patients with single level LSS with back and /or leg pain with instability on dynamic radiology not responding to medical treatment. We excluded patients with pathological fracture, high grade spondylolisthesis and infection. Patients were divided into two groups according to the method of treatment done. Group one included patients with sublaminar trimming Laminoplasty with instrumented fusion. The second group included patients with sublaminar decompression with instrumented fusion. Patients were assessed clinically using visual analogue scale (VAS) for back and leg pain and the Owestry Disability Index (ODI) for the disability. Plain x-ray, CT and MRI was done for all patients preoperative and we measured AP-thecal sac area, foraminal height and the thecal sac area for all patients (pre- and post-operative). Results: comparing both groups there were no difference in relation to demographic data nor in the diagnosis of the spinal stenosis. Group-2 had longer hospital stay. Both groups improved clinically post-operatively with no statistical difference between them. However, the rate of improvement in group-2 in relation to leg pain was better. Both groups improved radiologically, but AP-thecal sac area, foraminal height and the thecal sac area were much improved in group-2 (p-value<0.001) in comparison to group-1. Conclusion: Sublaminar decompression can particularly achieve better central, foraminal and lateral recess decompression together with a better fusion rate and hence, can be used as alternative to different laminotomy decompression techniques for treating different lumbar degenerative disorders.

Background: Social costs are reduced by using percutaneous fixation rather than cast immobilization for acute nondisplaced fractures of the scaphoid's mid-waist. Objective: The purpose of this study was to evaluate the clinical and radiographic outcomes of Herbert screw versus non-operative treatment for acute, non-displaced waist scaphoid fractures. Patients and methods: A randomized controlled clinical trial was conducted on 18 adult patients with acute non-displaced waist scaphoid fractures attended at the Emergency Unit, Orthopedic Surgery Department, Zagazig University. Nine patients were treated conservatively with a scaphoid cast (Group 1), and the remaining nine were treated surgically with a Herbert screw (Group 2). Results: The mean union duration was 9.8 (SD 4.8) weeks and 7.9 (SD 3.3) weeks among group 1 and 2 respectively. The median was 10 and ranging from 8 to 16 weeks among group 1 and was 8 and ranging from 8 to 12 weeks among group 2. About 11.1% had non-union wrist in groups 1 and 2. Union duration did not differ significantly between both groups. The pain score was 18.9 (SD 7.9) among the participants, and the satisfaction score was 18.6 (SD 8.4) among the participants. The mean range of motion was 20.3 (SD 6.3) among the participants, and the mean grip strength was 17.2 (SD 5.5) among the participants. The mean total score was 75.6 (SD 23.5) among the participants and there were 16.7% had poor results, 11.1% had fair results, 38.9% had good results and 33.3% had excellent results. Conclusion: Cast immobilization is the standard of care for treating acute non-displaced scaphoid waist fractures however percutaneous fixation with a Herbert screw has some advantages.

Background: Proximal humeral fracture pattern varies based on the mechanism of injury and the patient's age at the time of the injury. The purpose of this study was to prove short-term clinical and radiographic results of closed reduction and percutaneous pinning in displaced proximal humeral fractures in pediatric by K-wire. Subjects and Methods: This was clinical trial study included 18 children with proximal humeral fracture; their age ranged from 8 to 15 years with mean age 11.88 ± 2.08 with closed proximal humeral fracture between November 2019 and June 2020 at Zagazig University Hospital by closed reduction and percutaneous pinning under image intensifier using Kirschner-wires. Results: This study showed that 12 cases had no complication (66.7%), 3 cases had stiffness (16.7%), 2 cases had superficial infection (11.1%) and 1 case had loss of reduction (5.6%) and treated by K-wire removal, arm sling stabilizer. Two cases of superficial infection did not necessitate early removal of K-wires. All of them were treated with oral antibiotics. Conclusions: Additional K-wires through the lateral cortex give more stability for the severely displaced fractures with rotational or angular instability mainly type 4 fractures.

Background: Metacarpal fractures represent about 1/3 of hand fracture, which represent 10% of all fractures, mostly in the second and third decades of life. The purpose of this study was to evaluate the functional, radiological outcomes and reducing rate of complications in patients suffering of metacarpal fractures, treated by closed reduction and internal fixation by using headless compression screws. Patients and methods: This prospective one-arm clinical trial included 18 patients presented by a total of 20 metacarpal shaft fractures, who were managed surgically at Zagazig University Hospital (ZUH), Egypt. They were managed by intra medullary headless compression screws (IMHS). Results: No cases had malunion and 3 cases had superficial skin infection by 16.6%. Regarding Total Active Motion (TAM) score, 83.4% of cases had satisfactory level, and 16.6% had unsatisfactory level. Conclusion: Intramedullary screw fixation of metacarpal fractures is an efficient and safe procedure with a low incidence of complications. The IMH screws appeared to require less casting and provide a quicker return to work.