Infected unstable Charcot ankle neuroarthropathy, any hope before amputation? A prospective study.

BACKGROUND: Charcot neuroarthropathy is a destructive disease characterized by progressive bony fragmentation as a result of the isolated or accumulative trauma in patients with decreased sensation that manifests as dislocation, periarticular fractures, and instability. In this study, we present the results of salvage procedure of the ankle Charcot neuroarthropathy using aggressive debridement and Ilizarov frame fusion with early weight bearing. METHODS: Twenty-three patients with severely infected ulcerated and unstable Charcot neuroarthropathy of the ankle were treated between 2013 and 2018. The mean age was 63.5 ± 7.9 years; 16 males and seven females. Aggressive open debridement of ulcers and joint surfaces, with talectomy in some cases, was performed followed by external fixation with an Ilizarov frame along with early weight-bearing. The primary outcome was a stable plantigrade infection-free foot and ankle that allows weight-bearing in accommodative footwear. RESULTS: Limb salvage was achieved in 91.3% of cases at the end of a mean follow-up time of 19 months (range: 17-29). Fifteen (71.4%) solid bony unions evident clinically and radiographically were achieved, while six (28.5%) patients developed stable painless pseudarthrosis. Two patients had below-knee amputations due to uncontrolled infection. CONCLUSION: Aggressive debridement and arthrodesis using ring external fixation can be used successfully to salvage severely infected Charcot arthropathy of the ankle. Pin tract infection, delayed wound healing, and stress fracture may complicate the procedure but can be easily managed. Amputation may be the last resort in uncontrolled infection.

Direct vertebral rotation versus simple rod derotation techniques in correction of adolescent idiopathic scoliosis.

BACKGROUND: One method for treating adolescent idiopathic scoliosis (AIS), which is characterized by abnormal spinal alignment in the coronal, sagittal, and rotational planes, is surgical correction. The two surgical techniques most typically used to correct spine alignment are simple rod derotation (SRD) and direct vertebral derotation (DVR). AIM: The study's goal was to assess the effectiveness of two treatment methods for adolescent idiopathic scoliosis: simple rod derotation and direct vertebral rotation. SUBJECTS AND METHODS: A randomized controlled research involving 36 adolescents with idiopathic scoliosis was done. Patients were randomly split into one of two groups: 18 patients in group A had DVR treatment, while 18 patients in group B received SRD with a 2-year follow-up. RESULTS: Apical Vertebral Rotation measured from CT scans in DVR group was 24.4° ± 8.38° preoperatively and it decreased significantly postoperatively to 14.4° ± 4.61° with (42.22%) correction rate, while in SRD group, it was 25.03° ± 7.99° preoperatively and it also decreased significantly postoperatively to a mean value of 21.41° ± 7.01° with (14.65%) correction rate. There were statistically significant differences between both groups post-operative (P < 0.001). CONCLUSION: The apical vertebral rotation was greatly enhanced in both procedures, with direct vertebral rotation being better. Both Simple rod derotation and direct vertebral rotation reduce the rib hump, although the improvement is much greater with direct vertebral rotation.

The Reliability of an Arabic Version of the Modified Japanese Orthopaedic Association Score for Cervical Myelopathy.

INTRODUCTION: The modified Japanese Orthopaedic Association (mJOA) score is considered to be among the most comprehensive scores in the assessment of patients with cervical myelopathy. Hence, providing reliable, translated, and cross-culturally adapted versions in different languages is required to standardize the evaluation of patients. This study aimed to translate a reliable Arabic version of the mJOA score. METHODS: A total of 65 patients of variable age and with etiologies for compressive cervical myelopathy were recruited. Both forward and backward translations were performed. Then, intraobserver and interobserver reliabilities were measured using the intraclass correlation coefficient and Cronbach's alpha coefficient. RESULTS: The mean age of the patients was 58.08 years, and most of them were male (69.2%). The intraobserver and interobserver reliabilities were almost in perfect agreement for the different sections and the total score, which were 96.8% and 97.4%, respectively. CONCLUSIONS: In this study, a reliable, cross-culturally adapted Arabic version of the mJOA score for patients with cervical myelopathy is provided. Although the study was conducted on Egyptian patients, we believe that it could be implemented in majority of the Arabic-speaking population.