1- Arthrodiatasis for the Treatment of Perthes Disease

1-Arthrodiatasis for the Treatment of Perthes’Disease

TAREK A. ALY, OSAMA A. AMIN.

Orthopedic department, Tanta university school of medicine

ORTHOPEDICS, NOVEMBER 2009 | Volume 32 • Number 11

Abstract:It is hypothesized that the interruption of the blood supply is an important factor causingfemoral head osteonecrosis in the early stages of Legg-Calvé-Perthes disease. Currently,treatment by containment is recommended to direct and guide remodeling of

the softened femoral head as it evolves from fragmentation through ossifi cation. Thegoal of this study was to show the results of arthrodiatasis to induce height recovery ofthe femoral head and to achieve true ambulatory nonweight-bearing containment.Forty-two patients younger than 8 years with a diagnosis of Perthes’ disease were studied.Twenty-three patients (9 class B and 14 class C) were treated with an articulateddistraction technique and 19 patients (11 class B and 8 class C) were treated conservativelyas a control group. Arthrodiatasis or articulated distraction of the hip combinesoff-loading of muscles and body forces with distraction of the joint space by meansof an external fi xator that crosses the hip joint. Radiologically, 21 patients (91%) had

satisfactory results and 2 (9%) had unsatisfactory results. Clinically, the results weregood in 21 patients (92%), fair in 1 (4%), and poor in 1 (4%). In patients treated conservatively,14 patients (72%) had satisfactory results and 5 (28%) had unsatisfactoryresults. Clinically, 71% had good results, 17% had fair, and 12% had poor.We conclude that hip joint containment by articulated arthrodiatasis (plus adductorsand psoas minimal surgery) is an effective method in the management of Perthes’ diseasein patients younger than 8 years, classifi ed B and C, and associated with a highlyreduced range of abduction. Restoration of clinical abnormalities and satisfactory radiological parameters are achieved in high percentages.

2-SURGICAL MANAGEMENT OF CHRONIC BOUTONNIERE DEFORMITY

Sameh El-Sallakh, Tarek Aly, Osama Amin and Mostafa Hegazi.

Orthopedic department, Tanta university school of medicine

Hand Surgery, Vol. 17, No. 3 (2012) 1_6.

ABSTRACT

Purpose: Boutonniere deformity is caused by damage to the central slip of the extensor tendon hood with secondary palmer migration of the lateral bands. Accordingly, patients complain of disfigurement and impairment of function due to hyperextension of their DIP. The aim of this study is to evaluate the results of surgical treatment of chronic boutonniere deformity by using a modified technique.

Patients and methods: Twelve patients with posttraumatic boutonniere deformity were available for follow up as aretrospective study. They were treated by release of the extensor expansion proximal to the distal insertion of the oblique retinacular ligaments with proximal recession of the extensor tendon and lifting the lateral bands dorsally onto the PIP joint after separation of the transverse retinacular ligaments from their insertion volarly. All patients had closed injury. The mean age was 32 years (range: 16_48 years). The average follow-up period was 33 months (range: 26_38 months). We included only cases with deformities that were totally correctable passively with or without joint osteoarthritic changes.Results: Preoperatively the average PIP joint extension deficit was 60_ and postoperatively the average is reduced to 7_,preoperative the average DIP motion was 10_ of hyperextension, post-surgery the average DIP active flexion was 75_. The final outcomes were 58.3% excellent, 33.3% good, and 8.3% poor.Discussion: This modified technique gave (91.6%) excellent and good results. The extensor tendon acted mainly on the PIP joint and allowing the DIP joint to flex freely. The procedure is simple and provides long-term good results.

3- Surgical Management of Unstable Thoracolumbar Burst Fractures: Anterior Versus Posterior Surgery

Tarek Aly,Mohamed El-Sayed, Waleed Ewais.

Orthopedic department, Tanta university school of medicine

J Spine Neurosurg 2013, 2:5

Abstract

Study background: Surgical treatment in the case of thoracolumbar burst fractures is very controversial. Posterior instrumentation is most frequently used technique. However, the number of levels to be instrumented remains a matter of debate.

Objective: The purpose of this study was to compare the results of anterior approach versus posterior approach in the treatment of unstable thoracolumbar fractures.

Patients and methods: Seventy-four patients who sustained thoracolumbar burst fractures in the period from June 2003 to August 2007 were recruited in this study. Two treatment groups were studied: the first group of 32 patients underwent anterior decompression and fusion with instrumentation; the second group of 42 patients underwent posterior decompression and fusion with instrumentation. Prior to surgery, the two groups were compared and found to be similar in demographic, radiologic, and neurologic parameters. All patients were followed for an average of 45 months.

Results: All patients in this study achieved solid fusion, with significant neurological improvement. Radiographic results (kyphotic angle, bony fusion, and instrumentation failure) and neurological improvement were compared between the two groups. The operation time was shorter in the posterior approach group than in the anterior approach group (median 171 min, range 122-205 min vs median 242 min, range 210-286 min, respectively, p<0.001). The blood loss was smaller in the posterior approach group (median 550 ml, range 420-850, vs median 1,120 ml, range 800-1350, in the anterior approach group; p<0.001). The average correction angle after surgery was larger in the posterior group than in the anterior group, but not at final follow-up (P>0.05). The average loss of correction was also higher in the posterior group than in the anterior group (P>0.05). There was no significant difference in neurological outcomes between anterior and posterior approaches (P>0.05).

Conclusion: Posterior surgery was found to be as effective as anterior surgery in treatment of thoracolumbar burst fractures with less complication.

4-Management of Valgus Extra-articular Calcaneus Fracture Malunions

with a Lateral Opening Wedge Osteotomy

Tarek Aly.

Orthopedic department, Tanta university school of medicine

The Journal of Foot & Ankle Surgery 2011Nov-Dec;50(6):703-6.

Ab s t r a c t

A total of 34 cases of symptomatic valgus deformity of the hindfoot secondary to a malunited extra-articularcalcaneal fracture were corrected with laterally based open wedge calcaneal osteotomy. The pre- and postoperativeradiographic parameters were compared, and a postoperative clinical evaluation was performedusing the American Orthopedic Foot and Ankle Society ankle and hindfoot scoring system. The mean follow-upperiod was 56.2 months (range 24.1 to 97). The most significant radiographic changes were improvement inthe talonavicular coverage angle (mean 17.3_) on the anteroposterior view. The mean postoperative AmericanOrthopedic Foot and Ankle Society hindfoot and ankle score was 90, with 23 excellent, 8 good, and 3 poorresults. Laterally based opening wedge osteotomy of the calcaneus is effective in the management of a valgusheel resulting from malunited extra-articular calcaneal fractures. Lateral decompression of the peronealtendons and the sural nerve was achieved indirectly through opening wedge lateral calcaneal osteotomy that shifted the weight-bearing axis laterally.

5-Medial superior cluneal nerve entrapment neuropathy in teenagers: a report of two cases.

Aly TA*, Tanaka Y, Aizawa T, Ozawa H, Kokubun S.

Tohoku J Exp Med. 2002 Aug;197(4):229-31.

*Orthopedic department, Tanta university school of medicine

6-The effect of Dega acetabuloplasty and Salter innominate osteotomy on acetabular remodeling monitored by the acetabular index in walking DDH patients between 2 and 6 years of age: short- to middle-term follow-up

Mohamed El-Sayed*, Tarek Ahmed*, Sameh Fathy & Hosam Zyton.

*Orthopedic department, Tanta university school of medicine

J Child Orthop (2012) 6:471-477

Abstract

Introduction The surgical management of neglected developmental dysplasia of the hip (DDH) in walking children has always been a challenge to orthopedic surgeons. The aim of this study was to evaluate the short- to middle-term clinical and radiographic results of the management of DDH.Patients and methods Patients less than 6 years old using two of the most commonly used osteotomies, namely, Salter innominate osteotomy and the Dega acetabuloplasty. Special attention was paid to acetabular remodeling after concentric reduction, which was monitored by the acetabular index, that, in turn, was measured preoperatively, immediately postoperatively, every 6 months, and at the final follow-up examination. Results The final overall clinical end results were favorable (excellent or good) in 93 hips (85.3 %). There was a marked improvement of the acetabular coverage during the follow-up period, which proved the good remodeling potential of the acetabulum for this particular age groupafter concentric reduction was achieved and maintained. Conclusion Both osteotomy types were found to be adequate for the management of neglected walking DDH patients under the age of 6 years.

7- Efficacy of Delayed Decompression of Lumbar Disk Herniation Causing Cauda Equina Syndrome

Tarek A. Aly, MohamedOsama AboRamadan.

Orthopedic department, Tanta university school of medicine

ORTHOPEDICS,

FEBRUARY 2014 | Volume 37 • Number 2: e153 – e 156.

Abstract:

Cauda equina syndrome (CES) is a rare but serious neurosurgical emergency that can have devastating long-lasting neurologic consequences. Compression of the cauda equina can result in paralysis of bowel and bladder function. Such compression has been considered the only absolute indication for surgery in cases of lumbar disk disease. Therefore, it is extremely important that physicians be aware of the condition so that a surgeon is consulted before neurological damage becomes permanent. This article reports the results of delayed surgical decompression in cases of lumbar disk herniation with CES.

The study group comprised 14 patients (11 men and 3 women) with a mean age of 48 years (range, 36-57 years). Clinical presentation was chronic low back pain, sciatica, and impaired sphincter function. All patients had a fenestration at the affected level and site, and the disk fragments were excised and the disk space cleared. The surgeries were performed 1 to 3 months after onset of sphinctric disturbance. Postoperatively, all patients were relieved of back and/or leg pain and showed sensory improvement. Twelve patients regained full control of urination and defecation. Lower extremity strength improved in 9 patients.

The classical presentation of CES is not obvious. Even if surgery is performed late due to delayed presentation, significant improvement in neurologic and bladder function can still be expected.

8- Realignment-lengthening osteotomy for malunited distal fibular fracture.

Mahmoud El-Rosasy & Tarek Ali.

Orthopedic department, Tanta university school of medicine

International Orthopaedics, 2013 Jul;37(7):1285-90.

Abstract

Purpose Persistent displacement of ankle fractures increases the stresses on the articular cartilage and leads to degenerative arthritis. Correction of the ankle mortise restores the normal ankle biomechanics and should prevent the development of degenerative joint disease. Methods Seventeen patients were treated for symptomatic ankle joint due to malunited distal fibular fracture. There were eleven male and six female patients. Their ages ranged from 23 to 54 years (median 34 years). The procedure included transverse fibular osteotomy for restoration of the lateral malleolar alignment, acute distraction of the

osteotomy to restore the fibular length with interpositional graft and reduction of subluxation of the distal tibio-fibular articulation. Internal fixation of the osteotomy was performed with plate and screws and trans-syndesmotic screws. Results Fibular lengthening was performed in all cases and ranged from six to 12 mm (median eight millimetres). The American Orthopaedic Foot and Ankle Society score preoperatively ranged from 40 to 74 (median 60) and at follow up ranged from 50 to 95 (median79). Progression of ankles arthrosis occurred in one patient leading to ankle arthrodesis as a secondary procedure. Results were satisfactory in 12 cases (70.6 %), and unsatisfactory in five cases (29.4 %) due to stiffness and pain in the ankle joint. The follow-up ranged from 24 to 45 months (median 31 months). Conclusion Corrective osteotomy of fibular malunion produces considerable improvement provided that the patient does not have significant degenerative changes before surgery. The use of athrodiastasis of the ankle as a secondary procedure may be of value to improve the outcome.

9- Evaluation of Scarf Osteotomy for Management of Hallux Valgus Deformity

Tarek Aly, Weam Mousa, Sameh Elsallakh.

Orthopedic department, Tanta university school of medicine

Orthopedics. 2011 Jan 1;34(2):95.

Abstract

Hallux valgus is a complex progressive deformity affecting the forefoot. The main pathologic anatomy concerns the first metatarsophalangeal joint, including a varus or medial deviation of the first metatarsal and pronation deformity in the longitudinal axis. The goal of this study was to evaluate a series of consecutive patients over a 2-year period after a scarf osteotomy of the first metatarsal. A scarf osteotomy was performed on 31 consecutive patients with moderate to severe hallux valgus deformity (intermetatarsal angle, 13-22°; hallux valgus angle, 20-44°). Twenty-nine women and 2 men had an average age of 57 years (range, 21-71 years) at the time of surgery. Preoperative and postoperative evaluations included standing anteroposterior and lateral radiographs, American Orthopaedic Foot and Ankle Score (AOFAS) score, physical examination, and foot pressure analysis by weight-bearing ink prints. Patients were evaluated radiographically and clinically in the initial postoperative period (≤1 month), intermediate postoperative period (2-6 months), and final follow-up (12-36 months). Twenty-eight feet were available for analysis. Five of the 28 feet had concurrent surgeries on the lesser toes for hammer-toe correction or preoperative metatarsalgia. Paired Student t test on the 28 feet showed a statistically significant improvement (P<.0001) between pre- and postoperative intermetatarsal angle, hallux valgus angle, and AOFAS score. One foot had recurrence of the hallux valgus deformity. Paired analysis of variance of the 27 feet without recurrence showed a statistically significant improvement in the pre- and postoperative parameters (P<.0001). From this subset, the multiple-comparison Student-Newman-Keuis post hoc test showed a statistically significant (P<.0001) preservation of the correction in the intermediate follow-up period to final follow-up at an average 28 months.

10- Geometrical dimensions and morphological study of the lumbar spinal canal in the normal Egyptian population.

Aly T, Amin O.

Orthopedic department, Tanta university school of medicine

Orthopedics. 2013 Feb;36(2):e229-34.

Abstract

Information regarding the precise dimensions of the lumbar vertebrae is essential for spinal surgery and instrumentation. When stenosis of the vertebral canal or the intervertebral foramen exists, the neural structures in them can be affected and cause symptoms such as low back or radicular pain. Accurate and comprehensive spinal canal measurements in the lumbar vertebrae are incomplete. The purpose of this study was to collect data on the dimensions of the lumbar spinal canal from computed tomography scans. Three hundred patients (162 men and 138 women) were studied. Computed tomography scans were obtained to determine the normal values of the midsagittal diameter, interpedicular distance, and lateral recess depth in the normal Egyptian population. The narrowest level was L3. The range of the midsagittal diameter was 11.07 to 26.07 mm at all levels. The range of the interpedicular distance was 17.00 to 43.41 mm at all levels. In all patients at all levels, mean lateral recess depth was 6.7 mm (range, 4-14 mm). The narrowest lateral recess depth was at L5. Few patients (3.3%) had a statistically stenotic midsagittal diameter measurement. The canal shape was not uniform along the 5 lumbar vertebrae; it ranged from being circular or rounded in the upper lumbar vertebrae to triangular in the midlumbar vertebrae to trefoil in the lower lumbar vertebrae, especially at L5. Trefoil canals existed mainly in the lower lumbar vertebrae at L5, followed by L4. Data from computed tomography scans combined with accurate measurements are the basis for anatomical studies, clinical research, and the development of implants suitable for a group of patients with measurements different from the population standard.

11- HIP MORPHOLOGY. COMPARATIVE STUDY BETWEEN

EGYPTIANS AND JAPANESE ADULTS.

Tarek Aly*, Gengi Fujii.

*Orthopedic department, Tanta university school of medicine

Journal of Musculoskeletal Research, Vol. 16, No. 3 (2013).

ABSTRACT

The prevalence of osteoarthritis appears to vary widely among ethinic groups. Many studies had beenpublished describing the acetabular morphology of Chinese, Nigerians, Singaporeans and Japanese.

No previous studies comparing Egyptian Arabs and Japanese Orientals work available. Purpose: Theaim of this study was to determine the ethnic variations of acetabular morphology between Egyptian

and Japanese populations. Patients and Methods: A total of 844 Egyptian and 757 Japanese consecutivepatients with no clinical evidence of hip osteoarthritis and who underwent pelvic radiography

in the supine position for hip trauma or a routine health check were analyzed for the relationshipsbetween the center-edge (CE) angle, Sharp angle, acetabular head index, as well as the relationships of

the above-mentioned variables with age, gender, body height. Results: Comparing the measurementsof those three parameters in both populations showed statistically significant values (all Egyptianversus Japanese, all female versus male are significant). Conclusion: Our data confirm the presence ofethnic variations in acetabular morphology which predispose to various pathologies of the hip joint.

12- Hip morphologic measurements in an Egyptian population.

Aly TA.

Orthopedic department, Tanta university school of medicine

Orthopedics. 2011 Apr 11;34(4).

Abstract

The study of acetabular morphology has shown that there are geographic differences in the morphology and prevalence of acetabular dysplasia among different ethnic groups. However, few data exist on the shape of the acetabulum in various populations around the world. In this study, we examined samples of pelvic radiographs from Egyptian adults. Acetabular dysplasia in adults is characterized by a shallow and relatively vertical acetabulum.The aim of this study was to examine acetabular morphology to determine the prevalence of hip dysplasia in adult Egyptians. This included 244 adults, 134 men and 110 women between 18 and 60 years, who were used to measure center edge angle, acetabular Sharp angle, acetabular head index on anteroposterior radiographic views of the hip joints, and vertical center anterior margin angle on false profile views. The radiographs were taken of patients with no hip complaints at Tanta University Hospital.The results were statistically studied according to the age, height, and weight of patients. The prevalence of acetabular dysplasia was 2.25% for Egyptian men and 3.6% for women with respect to center edge angles, vertical center anterior margin angle, and acetabular head index.We concluded that gender variations in the morphology of the acetabulum and sex influences geometrical measurements of the acetabulum. Egyptian women were more dysplastic than men using the 4 parameters of hip measurements. There are also racial variations in hip morphology.