Percutaneous cannulated screw fixation in the treatment for diabetic ankle fractures.

BACKGROUND: Diabetic ankle fractures were usually treated by open reduction and internal fixation (ORIF) which may lead to Charcot joint, or conservative which may lead to pressure sores. For better results, minimally invasive procedures have been developed, which decrease complications and enable early mobilization and rapid rehabilitation. MATERIALS AND METHODS: This is a retrospective study of a total of 26 uncontrolled diabetic patients: 8 males [30.8%] and 18 females [69.2%]. The mean age of the patients was 67.4 (range 60 to 75) years. We include only Weber A and B where 10 patients suffered from lateral malleolus only (38.5%), 11 patients with bi-malleolar ankle fracture (42.3%) and 5 patients with tri-malleolar fracture (19.2%). RESULTS: The mean time to union was 6.92 weeks (range of 6 to 12 weeks). Weight-bearing has begun from the first day in 19 patients (73.1%), while 7 patients began weight-bearing 4 weeks after the operation (26.9%). Mean follow-up ranged from 2 to 5 years. Mean AOFAS was 96.12 (range of 60 to 99). Only 3 patients suffered from complication: One patient suffered from Charcot joint, one suffered from fracture displacement and needed revision, and one suffered from mal-reduction. Thus, the complication rate was 11.5%. CONCLUSION: We believe that percutaneous cannulated screws technique is a simple and effective method that can be applied safely in uncontrolled DM patients with ankle fractures.

Percutaneous low-energy osteotomy in treatment of pathological coronal knee deformities in pediatrics.

The aim of this study was to assess the safety and efficacy of percutaneous low-energy osteotomy and casting in treatment of pathological coronal knee deformities in children equal or younger than 6 years. A prospective nonrandomized case series study was conducted. A total of 62 (109 limbs) patients with pathological coronal knee deformities were treated by percutaneous low-energy osteotomy and casting and observed over 3-10 years. The pathological nature was variable (rickets, Blount disease, dysplasia, after trauma, or after infection). The average age at the time of surgery was 4.5 years (range: 3-6 years). Clinical and radiological outcomes were evaluated annually and at the end of follow-up period. There was a statistically significant improvement of the clinical appearance and the radiological parameters regarding mechanical axis deviation and tibiofemoral angle at the end of follow-up period. The total complication rate was 6.4%, with only four limbs with overcorrection and three limbs with recurrence. Percutaneous osteotomy is a simple, safe, and effective option in the treatment of children with coronal knee deformities equal or younger than 6 years.

Bifocal Compression-Distraction for Combined Bone and Soft-Tissue Defects in Post-traumatic Tibial Nonunion.

OBJECTIVE: To compare 2 distraction osteogenesis techniques in post-traumatic tibial nonunion patients with composite bone and soft-tissue defects. DESIGN: Nonrandomized prospective, case series, single-center study. SETTING: Department of Orthopaedics and Traumatology, Limb Reconstruction Unit, El-Helal hospital, Cairo, Egypt. PARTICIPANTS: Fifty post-traumatic tibial nonunion patients with composite bone and soft-tissue defects. INTERVENTION: Twenty-five patients were treated using bone transport (BT) technique, and 25 patients were treated using acute shortening (AS) and distraction technique. OUTCOME MEASUREMENTS: The external fixation index (EFI); functional and bone results; and complication rates. RESULTS: All patients were followed for a minimum of 18 months after removal of their Ilizarov frame. AS and BT groups were followed up for a mean of 19.7 and 20.3 months, respectively. The mean bone gap after resection and debridement was 4 cm in AS group and 5.9 cm in BT group (P = 0.06). The mean EFI was statistically significant and lower in the AS group compared with BT group (P = 0.03). There were no other statistically significant differences between either intervention groups. CONCLUSIONS: Both techniques achieved comparable good to excellent results, and the differences in number of complications and ASAMI scores for bone or function were not statistically significant. Yet, it appears that the AS technique may be superior because it has a significantly lower EFI. This may not be feasible in all cases, however, because the AS technique is limited by the defect size and the condition of the surrounding soft tissues. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.