Sohag UniversityEgyptian Journal of Orthopedic Research2682-47441220201101CLINICAL, MRI, AND ARTHROSCOPIC CORRELATION INMENISCAL INJURIES OF THE KNEE475216193610.21608/ejor.2020.161936ENKhalid AbougabalOrthopedic Surgery dept., Faculty of Medicine, Sohag Univ., Sohag, EgyptMoustafa ElsayedOrthopedic Surgery dept., Faculty of Medicine, Sohag Univ., Sohag, EgyptAbdelrahman KhalifaOrthopedic Surgery dept., Faculty of Medicine, Sohag Univ., Sohag, EgyptAshraf MarzoukOrthopedic Surgery dept., Faculty of Medicine, Sohag Univ., Sohag, EgyptJournal Article20200618<span>The aim of this study is to compare and correlate the clinical, magnetic resonance imaging (MRI), and arthroscopy findings in meniscal injuries of the knee. This was a prospective study of 30 cases of meniscal injuries of the knee admitted in Sohag University Hospital between January 2015 and June 2019, who underwent clinical examination, MRI, and arthroscopy of the knee. In our study of 30 cases, there were 24 male and six female patients with age ranging from 20 years to 39 years. Clinical examination had sensitivity of 86.9%, specificity of 85.7%, and accuracy of 86.6% for medial meniscus, and sensitivity of 57.2%, specificity of 95.6%, and accuracy of 86.6% for lateral meniscus. MRI had sensitivity of 95.6%, specificity of 85.7%, and accuracy of 93.33% for medial meniscus, and sensitivity of 85.7%, specificity of 69.56%, and accuracy of 73.33% for lateral meniscus. Clinical and MRI evaluations have no differences in the diagnosis of medial meniscus injuries. A trained radiologist obtained better sensitivity, specificity and accuracy in the diagnosis of lateral meniscus. Clinical diagnosis is of primary necessity. MRI is an additional diagnosing tool for meniscal injuries of the knee and can be used to exclude pathology, as the negative predictive value is high for all the lesions.</span>https://ejor.journals.ekb.eg/article_161936_f1a6fd18dad3003860e910aa679c5aee.pdfSohag UniversityEgyptian Journal of Orthopedic Research2682-47441220201101EVALUATION OF PERCUTANEOUS REPAIR OF THETENDON ACHILLES535716194210.21608/ejor.2020.161942ENMostafa HemaidTauma and Orthopedic Surgery dept., Faculty of Medicine, Sohag Univ., Sohag, EgyptAbd-El-Rahman HafezTauma and Orthopedic Surgery dept., Faculty of Medicine, Sohag Univ., Sohag, EgyptAhmad AddosokiTauma and Orthopedic Surgery dept., Faculty of Medicine, Sohag Univ., Sohag, EgyptHossam ElazabTauma and Orthopedic Surgery dept., Faculty of Medicine, Sohag Univ., Sohag, EgyptJournal Article20200712<span>The Achilles tendon is the largest and strongest tendon in the body. When the calf muscles flex, the Achilles tendon pulls on the heel. Percutaneous method gives the chance to do sufficient repair of tendon Achilles with minimal slit incisions .Achilles tendon rupture surgery is now routine and well established. Surgery is suggested for young, healthy and active individuals. Percutaneous repair of the Achilles tendon allows accurate opposition of the tendon ends minimizing surgical incision thus protecting against wound breakdown. It is a prospective study of 20 adolescent patients with cut tendon Achilles treated Percutaneous repair using Esipond 5 and Mayo needle, admitted in Orthopedics and traumatology department Sohag university hospital, between 12 / 2017 and 12 / 2018.The patients were followed up for 12 months according to the Achilles tendon rupture score (ATRS) from all patients and by checking wound complications. Limitation due to decrease in the strength of calf/Achilles tendon/foot, the mean score was 8.1. Limitation due to progressive tiredness in the calf/Achilles tendon/foot, the mean score was 8.1. Limitation due to stiffness in the calf/Achilles tendon/foot, the mean score was 8. Limitation due to pain in the calf/Achilles tendon/foot, the mean score was 8. Limitation during activities of daily living, the mean score was 7.7 Limitation when walking on uneven ground The mean score was 7.9 Limitation when walking quickly up stairs or uphill The mean score was 7.95. Limitation during activities that including running, the mean score was 7.9. Limitation during activities that including jumping, the mean score was 7.9. Limitation in performing heavy physical work, the mean score was 8.1</span>https://ejor.journals.ekb.eg/article_161942_67dbd2cfc4438b103ceec762fb8653ea.pdfSohag UniversityEgyptian Journal of Orthopedic Research2682-47441220201101CONSERVATIVE VERSUS K-WIRE PINNING OF ACUTE MALLET FINGER IN ADULTS596316196010.21608/ejor.2020.161960ENIsaac PotrosOrthopedic Surgery dept., Faculty of Medicine, Sohag Univ., Sohag, EgyptWael Salama(*)Orthopedic Surgery dept., Faculty of Medicine, Sohag Univ., Sohag, EgyptYasser OthmanOrthopedic Surgery dept., Faculty of Medicine, Sohag Univ., Sohag, EgyptMohamed Abdel WanisOrthopedic Surgery dept., Faculty of Medicine, Sohag Univ., Sohag, EgyptJournal Article20200721Mallet finger lesions are common. The diagnosis of mallet finger is essentially clinical, the patient's recent history includes the mechanism of injury. A radiographic lateral and anteroposterior views of the DIPJ usually see bony avulsion of distal phalanx or it may be a ligamentous injury with normal bony anatomy, Wehbe and Schneider described a method to measure the size and displacement of the bony fragment. The aim of this study is to compare the results between of conservative and K-wire pinning management of acute mallet finger Doyle type I in adult patients. Patients were divided into two groups. Group (A) were treated with aluminum orthosis that immobilized the DIPJ in full extension for six weeks. And Group (B) were treated with percutaneous fixation of the distal interphalangeal joint using a smooth Kirschner wire. No external splint age was used and the wire was removed after six weeks. A total of 40 patients suffering from acute mallet finger type I Doyle's classification admitted in orthopedics and traumatology department of Sohag university hospital from February 2019 to November 2019. All patients had Follow up radiographs taken of the affected finger at one week, four weeks, and eight weeks. Functional outcomes were determined using Crawford’s evaluation criteria. The final extensor lag was significantly better in the pin group (12.3 vs 6.6°). The amount of improvement between the groups was statistically significant and in favor of percutaneous pinning (16.15 vs 20.55°), also the flexion loss was lesser in pin group (5.4 vs 4.1°). The optimal treatment for mallet finger injuries remains controversial in the literature. Many orthotic devices for conservative management and surgical techniques have been described in the past. This study shows that closed reduction by use of K-wires provide functionally better result in acute mallet finger cases. Surgical treatment by a single k-wire is better than conservative treatment as regard clinical and radiological results. Conservative technique may have less complications, but the difference in final clinical results is in favor of surgical treatmenthttps://ejor.journals.ekb.eg/article_161960_daa8a4995ee859dc307f2709cf031835.pdfSohag UniversityEgyptian Journal of Orthopedic Research2682-47441220201101EARLY CHANGES IN SHOULDER BALANCE AFTER SELECTIVE ANTERIOR CORRECTION AND FUSION FOR LUMBAR SCOLIOSIS657316199710.21608/ejor.2020.161997ENAhmed AbdelaalOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptKei MiyamotoSpine Center, Gifu Municipal Hospital, Gifu, JapanTetsuya ShimokawaOrthopedic Surgery dept., Graduate School of Medicine, Gifu University, JapanTakahiro MasudaOrthopedic Surgery dept., Graduate School of Medicine, Gifu University, JapanAkira HiokiOrthopedic Surgery dept., Graduate School of Medicine, Gifu University, JapanKatsuji ShimizuOrthopedic Surgery dept., Graduate School of Medicine, Gifu University, JapanHaruhiko AkiyamaOrthopedic Surgery dept., Graduate School of Medicine, Gifu University, JapanJournal Article20200730<span>Some patients developed shoulder imbalance after selective anterior correction of lumbar scoliosis with spontaneous rebalances later on. We conducted this retrospective radiographic analysis study to study the effect of selective anterior correction of thoracolumbar and lumbar scoliosis on shoulder balance. Standing X-ray films of 15 patients with lumbar scoliosis operated by anterior correction at preoperative, 3, 6 & 12 months postoperative were used. Spine and shoulder balance parameters were measured. Correlations between changes in shoulder balance and spine parameters were evaluated. Shoulder height parameters showed early postoperative change from positive or neutral to negative shoulder balance, Lumbar and thoracic Cobb angles showed immediate postoperative improvement with a slight later increase contributing to shoulder rebalance mechanisms. Changes in T1 tilt was correlated to change in thoracic Cobb angle at 3 months post op. (r= 0.515 p =.049), CRCI was correlated to difference between changes in lumbar Cobb angle and changes in thoracic Cobb angle (r= 0.56 p= 0.030), close correlation between Correction change ratio and T1 tilt, FRA, CA and CPH was shown (p=0.008, 0.016, 0.011 & 0.012). Spontaneous Correction of shoulder balance after anterior correction of lumbar scoliosis is likely to occur during the first postoperative year. Flexibility of the thoracic curve was a major determinant in the shoulder re-balance, ratio between correction of lumbar curve and correction of thoracic curve may have a prognostic value in shoulder rebalance after anterior correction surgery. Clavicle angle has the best predictor for postoperative shoulder balance improvement.</span>https://ejor.journals.ekb.eg/article_161997_c01226c186d2f7e0824dfdfb96fdd08d.pdfSohag UniversityEgyptian Journal of Orthopedic Research2682-47441220201101EFFECT OF TOPICAL USE OF TRANEXAMIC ACID IN PATIENTS WITH THORACOLUMBAR FRACTURE UNDERGOING POSTERIOR SPINAL FIXATION AND FUSION758216200210.21608/ejor.2020.162002ENMohamed Abdel WanisOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptAhmed SleemOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptMostafa Abdel-allOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptJournal Article20200809<span>Thoracic and lumbar spine trauma (TLST) is frequently associated with chest and abdominal injuries. Multilevel spinal fusions require a longer operative time, with significant soft tissue stripping as well as blood loss, which frequently leads to allogenic blood transfusion. Topical TXA might enhance patient safety, reducing excessive postoperative bleeding. To evaluate effect of topically applied 1 g TXA on postoperative whole blood transfusion and blood loss in neurologically intact patients with thoracolumbar spine fracture. A clinical prospective randomized study is done on 30 patients with thoracolumbar fracture, undergoing primary posterior instrumented fixation and fusion. Patients were randomized to 2 groups, first group (15 patients) was injected with saline only and second group (15 patients) was injected with mixture of tranexamic acid and saline. Patients were operated under general anesthesia, using a standard midline incision. Wounds are closed in layers over a 16 gauge suction drain; injection cocktail was delivered retrograde into the drain which was then closed for 2 hours. There was a highly significant decrease in blood loss in Group 2. The decrease in Hb level is less in the 2nd group than in the 1st group, indicating less postoperative anemia in the blood count (highly significant). Use of topically administered 1 g of TXA (20 mL) in thoracic and lumbar spinal trauma cases undergoing posterior instrumented fixation and fusion effectively decreased postoperative transfusion requirements. Treatment also reduced total drainage volume, time until drain removal, and length of postoperative hospital stay.</span>https://ejor.journals.ekb.eg/article_162002_49bb72044ab56311e7ae7af094daf0d4.pdfSohag UniversityEgyptian Journal of Orthopedic Research2682-47441220201101FEMORAL LENGTHENING USING MODIFIED LOW PROFILE ILIZAROV FIXATOR IN ADOLESCENTS: DESCRIPTION OF THE TECHNIQUE AND EARLY EXPERIENCE839016200910.21608/ejor.2020.162009ENAbdel Rahman HafezOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptAshraf MarzoukOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptWael SalamaOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptMohamed AliOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptMohamed KenaweyOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptJournal Article20200828<span>We modified the original Ilizarov frame described for femoral lengthening and used two full rings fixed by 3 tensioned wires for each with an osteotomy in the distal metaphyseal area. Four femoral lengthenings were performed and followed up for at least 30 months. Average age of our patients was 15 years and length gain was 74±18mm with one patient had concomitant correction of valgus deformity. The planned lengthening was achieved in all patients with healing index 19±2 days/cm. Advantages for this low profile frame are mainly less bulky external fixator and fewer transosseous elements and therefore pin site problems.</span>https://ejor.journals.ekb.eg/article_162009_d08ef9121cb1426f048e0ce2ff84f5ad.pdfSohag UniversityEgyptian Journal of Orthopedic Research2682-47441220201101MODIFIED SURAL FLAP TO COVER DISTAL LOWER LIMB SOFT TISSUE DEFECTS9110116201210.21608/ejor.2020.162012ENMohamed AbdellahOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptWael SalamaOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptAshraf RashadOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptHassan NoamanOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptJournal Article20200901<span>The purpose of this study was to evaluate the outcomes of coverage of soft tissue defects of leg and foot by sural flap with preserving a lane of skin over the pedicle (cutaneous pedicle) with open passage between donor and recipient sites. A proscriptive study including thirty-six patients with distal lower limb soft tissue defects was carried out in the period between June 2018 and June 2019 at Sohag University Hospital. All these 36 patients underwent modified sural flap with preserved lane of skin over the pedicle with open passage for the pedicle between donor and recipient sites. Evaluation of viability of the flap, resistance against infection, healing of the flap, donor site healing and weight bearing, postoperative follow up to nine months. Group of patients including thirty-six patients with distal lower limb soft tissue defects underwent modified sural flap, the indication for flap cover was Motor car accident in 26 cases (72.2%) and exposed plate was in 6 cases (16.7%) crushing trauma was in 4 cases (11.1%). Infection were the common complications encountered Six cases (16.7%) three cases (8.35%) complicated by distal ischemia and One case (2.8%) was totally lost with increase in the flap viability with modified sural flap. Modified sural flap by preserving alane of skin over the pedicle and open passage between donor and recipient site increase venous return of the flap and increase flap viability.</span>https://ejor.journals.ekb.eg/article_162012_4cc4a33062029c57c96113b01140fb5d.pdfSohag UniversityEgyptian Journal of Orthopedic Research2682-47441220201101BONE LENGTHENING IN CORRECTION OF HAND AND WRIST DEFORMITIES USING NEW MINI EXTERNAL FIXATOR10311016201710.21608/ejor.2020.162017ENHassan NoamanOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptAhmed AddosookiOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptMohamed AhmedOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptFouad AssalAl Razi Hospital, KuwaitAbdullah ElsayedOrthopedic Surgery dept., Faculty of Medicine, Sohag University, Sohag, EgyptJournal Article20200907<span>Bone elongation through callotasis is a relatively simple procedure from a surgical point of view. Bone elongation results are amazing and highly beneficial to the patients‘life quality. A good use of the external fixation leads us to meet various orthopaedic and surgical techniques which were unthinkable years ago and which nowadays are a standard practice in pediatric and adult orthopaedics units worldwide. External fixation entails the use of percutaneously placed transosseus pins and/or wires secured to external scaffolding to provide support to a limb. The benefits of external fixation are numerous. When compared with internal plates and intramedullary nails, external fixators cause less disruption of the soft tissues, osseous blood supply, and periosteumin. Our task is to restore the anatomy of the locomotor system mechanically and, which is even more important, biologically, since the whole future life of these bones and joints will depend on it using new mini external fixator device manufactured and developed by Kuwait institute of science and research (KISR). Our study is a short term prospective study of patients received in emergency unit and orthopedic department at Sohag university hospital. After taking of written consent from the patients and approval of the ethical committee, 22 patients with posttraumatic or congenital wrist or hand deformities were treated by the new mini ex.fix. All patients were admitted to orthopedic trauma unit with hand and wrist deformities either traumatic or congenital and placed on radiolucent operating table. General anesthesia had been given to all patients. The new mini external fix technique should be considered for bone lengthening for the surgical treatment of Madelung‘s and other hand and wrist deformities in patients suffering from persistent pain , deformity when gradual correction and lengthening is indicated as its easy for the patient and the operating surgeon with promising results.</span>https://ejor.journals.ekb.eg/article_162017_518b3df0af136ee18a106adef6fa5932.pdf