This is a comparative study to evaluate the outcome of forty patients with bone loss in tibia using conventional external fixation device for group A while for group B using Ilizarov external fixator device each group consists of 20 patients, based on principles of distractive osteogenesis. Patients and methods: Forty patients with bone loss of 4 to 14 centimeters in tibia between April 2011 and April 2016 were treated, ages (15-65 years); female to male ratio was 6:34. The cause of defects in tibia was fracture due to road traffic accident (20 cases), bullet injury to leg (8 cases), gap nonunion (8 cases) and infected non unions(4 cases). They were divided into two groups each consists of 20 patients, conventional external fixator used for group A while for group B Ilizarov external fixator device was used with performing transverse corticotomy proximal or distal to the gap for both groups. Results: Evaluation of results was done according to Association for Study and Application of Methods of Ilizarov (A.S.A.M.I.) scoring system and it revealed that both functional and bony results were better in group B than group A. Conclusions: Fixation of the bone by Ilizarov frame gives more rapid union of the bone, less chance of pin tract infection and cosmetically more preferable because of smaller scar tissue of entry of K wires than Schanz pins. Prevention and treatment of equinus deformity and clawing of the toes can be done by extending the Ilizarov frame to correct them. In cases of severe soft tissue loss it is better to apply conventional external fixator as a provisional fixator till the soft tissue loss and swelling will be diminished.

Background: Cerebral palsy (CP) is a heterogenous permanent neurological disorder that is caused by a non-progressive damage to the developing brain. In this disorder, injury or malformation occurs in the growing central nervous system which eventually will affect the development of motor function and body posture before, during, or shortly after birth. Objective: To estimate and highlight the status of demographic and clinical characteristics of cerebral palsy in children at Sulaymaniyah province which has significant walking disorders. Patients and Methods: In this study (118) ambulatory patients with cerebral palsy who attended the health care and consultation clinic at Children Rehabilitation Center (CRC) in Sulaymaniyah province. The primary data were studied according to: gender distribution, patient age, types of delivery, and age of presentation of the CP disorder. Additionally, the conditions at birth such as asphyxia, kernicterus, types of cerebral palsy, full -term, and preterm were studied. Finally, the Gross Motor Function Classification System (GMFCS) of cerebral palsied children was identified. Results: Our data showed that females tend to be more affected by CP than males with a ratio of (65:53). The range of ages was between half a year and 12 years (mean of 7.5 years). The highest range appearance of cerebral palsy was between the ages of (12-24) months with a percentage of (58.47%). A delayed milestone was the most common presenting among CP types (41.53%). In comparison to the other CP types, the spastic type was the most common (59.32%). The most prevalent subtype of CP was the spastic hemiplegia (40%). 66.10% of patients were born with vaginal delivery. The majority of the patients were born with asphyxia (31.36%) followed by kernicterus direct antepartum. Sixty-seven (56.78%) mothers were using medications during pregnancy. Forty-eight of parents were consanguine marriage. According to the GMFCS results, most of the CP patients were in the level III and level IV with 27.12%, 25.42% respectively; the major motor disability in children with spastic hemiplegia varied from level I to III. Conclusion:We deduced that it is difficult to estimate and clarify the exact cause and risk factors associated with the cerebral palsy disorder. However; we found spastic hemiplegia is the most common clinical pattern of CP due to its high prevalence of birth asphyxia. Using medicine during pregnancy will increase a chance of CP to occurs, for further investigation, the case-control study should be employed within the cohort study.

Worldwide children’s walking disabilities that are caused mainly by cerebral palsy display multiple conditions of both permanent and non-developing motor dysfunction that in turn upsets posture, mobility, or muscle tone in general. In order to estimate the influence of instrumented gait analysis on the walking ability in cerebral palsied children the Dynaport Minimod, based on a triaxial accelerometer was employed. A Dynaport Minimod was used for collecting the spatial and temporal gait data. An evaluation of the gait data carried out via online services application for 80 children with cerebral palsies from April 1 st , 2018 to October 30 th , 2019. The Dynaport Minimod is capable of capturing most of the spatiotemporal gait parameters which indicate that this technique is quite cooperative and objective in the detection of gait changes and the evaluation of consequences, respectively. The most useful practice for the managing of children with cerebral palsy is a gait analysis system in which its clinical utilization is considered to be a developing technology especially in providing guidance to service planning centres and hospitals.

Split tibialis anterior tendon transfer to treat ambulatory children with spastic cerebral palsy