Total hip arthroplasty after renal transplantation

This study was performed on 31 cemented total hip arthroplasty in 25 renal transplant recipients. The average follow up was 48 months [range 6-66 months]. Total hip arthroplasty relieved pain and improved function in all patients. The average preoperative Harris hip score was 34 +/- 9.46 points which improved to 94 +/- 4.32 points after surgery. At the end of follow up, there were 64.52% excellent and 35.48% good results, there were no fair or poor results in this study. One case had dislocation, one case with grade II myositis ossificans and two cases with suspected cup loosening. The overall complications rate of this group were parallel to those in young patients who had hip arthroplasty for osteoarthritis. There were no reported complications with the renal allograft either intra or postoperatively

Staged management of commiunted intra-articular pilon fracture

Seventeen patients with 18 intra-articular pilon fractures associated with severe soft tissue swelling were managed by two-staged protocol of treatment. The first step composed of the reduction and stabilization of the fibular fracture, immediate calcaneal pin traction to maintain length and axial alignment, ice packing and elevation of the affected limb, blisters were left intact, nonsteroidal anti- inflammatory drugs and I.V. antibiotics. The second step was done 10-15 days post-trauma, which composed of open reduction, anatomical restoration of articular surface and stable internal fixation using low-profile plate screws. On the quantitative assessment by three scoring systems [clinical, anatomical and arthritis scores], there were 78% satisfactory results. The fractures healed at an average of 17.9 weeks. No patients had nonunion. There was a statistical significant effect of the type of fracture on the duration of healing and on the final results. All unsatisfactory results were among C3 and C2 fractures and non among the less comminuted fractures [AO classification]. The degree of soft tissue swelling significantly affected the final results. No unsatisfactory results among grade I soft tissue swelling was detected. The average follow up period was 25.5 months [14-42 months]. Delayed open reduction and internal fixation after the period of traction and soft tissue care gave satisfactory results for such severe intra-articular fractures

Ankle arthrodesis using full thickness iliac bone graft and screw fixation

Ten patients had ankle arthrodesis for post traumatic ankle arthritis. Full thickness iliac bone graft with cancellous screw fixation was used. There were seven male and three females. The mean age at the time of surgery was 32.2 years [range 18-46 years]. The right ankle was involved in six patients. The mean duration from trauma to surgery was 15.7 months [range 8-28 months], with a mean follow-up duration of 24.6 months [range 15-36 months]. All ankles had fused in an average time of 12.3 weeks with improvement of Mazur score [1979] from a mean preoperative score of 57.9 points to a mean postoperative score of 82.4 points. The functional results at end of follow-up were excellent in seven patients and good in three. The mean talotibial angle was 6.5 degrees of plantarflexion with no ankle placed in calceneus. The hind foot was placed in neutral to valgus in all patients but one. The mean leg length discrepancy as measured by scanogram was 5.5 millimeters [range 4-8 millimeters].No complications had been reported through this study apart from pain over the head of a medial screw in one patient that necessitated its removal after fusion. The use of full thickness iliac bone graft with screws fixation was found to give a satisfactory clinical outcome regarding the rate of union, the improvement of pain and the minimal leg length discrepancy