Scaphoid nonunion: a novel modification of Matti-Russe technique with enhanced recovery and full clinical and radiographic union.

BACKGROUND: A scaphoid fracture is a common injury affecting the wrist joint. A fracture of the carpus scaphoid can heal uneventfully or be complicated by non-union. Scaphoid non-union can result in persistent wrist pain, and with functional difficulties affecting all activities of daily living of the patients, this disability is expected to be significant since most of these patients are young active adults. HYPOTHESIS: Extensive removal of the bone from the scaphoid, with the application of a large amount of cancellous bone graft and fixation with two to three wires, could lead to a high union rate and a good functional outcome. METHODS: Eighteen patients with scaphoid fracture non-union were recruited during their visit to the upper limb clinic at our institute. Demographic data were collected, and data regarding comorbidities, smoking, manual work, and others were recorded. Data regarding the interval between injury and surgery, time to radiographic union, and functional wrist scores were reported as well. RESULTS: A cohort of 18 patients was included. The mean age of patients was 30 years; most of our patients were healthy (83.3%), and more than two-thirds were smokers (72.2%). The mean follow-up time was 18 months (1.5 years), 15 patients (83.3%) achieved radiographic unions by 2-3 months, and the remaining 3 patients (16.7%) achieved radiographic unions by (4-5) months, i.e., all patients achieved successful radiographic unions by 5 months at maximum. The mean Mayo score for our series was 83.6 (± 12.4), with 5 patients (27%) achieved ≥ 95% which indicates a significantly high functioning wrist in our cohort. CONCLUSION: Our modified technique with enhanced stability from using three k-wires can achieve full clinical and radiographic unions and result in enhanced recovery postoperatively with cast immobilization limited to 6 weeks total. LEVEL OF EVIDENCE: IV Case series study.

Clinical and radiological response and side effects of beta interferon in Iraqi patients with relapsing and remitting multiple sclerosis.

OBJECTIVE: To determine the efficacy and tolerability of subcutaneous Interferon beta 1a (IFNbeta-1a) among Iraqi patients with relapsing remitting multiple sclerosis (RRMS). METHODS: The study was held at the Multiple Sclerosis clinic at Baghdad Teaching Hospital, Baghdad, Iraq from January-October 2004. Thirty-seven patients with clinically definite RRMS and disability status scale below 6.5 were enrolled in this study. Patients received IFNbeta-1a, 22 ug subcutaneously 3 times a week. Clinical measures, including number of relapses and disability progression, with MRI measures including number, size activity of lesions, and brain atrophy were used for evaluation of response to treatment. Side effects were also looked for. RESULTS: Patient ages ranged between 17-60 years with a mean age of 34.85 years, with 20 female patients and 17 male patients. After 2 years of treatment, there was a significant reduction in relapse rate (54.1% were relapse free, and 21.6% had reduction in relapse rate). There was also a significant effect on disability progression (the mean expanded disability status scale (EDSS) before treatment was 3.22 and mean EDSS after treatment was 2.84). Significant effects on MRI measures were also shown, presented by a reduction in the number of lesions, which was seen in 64.9% of the patients, and a reduction in the size of lesions, which was seen in 64.9% of the patients. Also, significant effects on the activity of lesions was seen, as 67.6% of the patients had non-active lesions before treatment and remained non-active after treatment, and 29.7% of the patients had active lesions before treatment, which became non-active after 2 years of treatment. Mild adverse reactions were seen, mainly influenza like reactions and injection site reactions. CONCLUSION: Interferon beta-1a was effective in the treatment of RRMS with minimal side effects.