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ABSTRACT:BACKGROUND:Many methods used for treatment of proximal humerus fractures, in this study used the tension band wiring in treatment of proximal humerus surgical neck as figure of 8 in treatment of these fractures.OBJECTIVE:To prove the advantages of tension band wiring in treatment of proximal humerus fractures.Patients& Methods:From December 2003- December 2006, 16 patients with closed two part surgical Neck proximal humerus fractures Neer’s type III were admitted to the department of orthopaedic surgery and traumatology in Alkarama General Hospital &Sulaimania Teaching Hospital. All patients were males mean age 32 years, all patients were treated by figure –of- 8 tension band wiring techniques with minimal osteosynthesis in fixation, surgical deltoid splitting approach without disturbing the Vascularity of the humeral head, but with a stable secure fixation.RESULTS:The out come of this method of treatment was reviewed monthly for 12 months. The results were evaluated according to the Neer’s criteria and scores. The final follow up 13 patients out of 16 (81.25%) achieved excellent and satisfactory results, 3 patients (18.75%) was rated as unsatisfactory result. So the final outcome according to Neer’s scores was good and excellent result.CONCLUSION:Two parts displaced proximal humerus fractures in young adults patients Treated by open reduction with fixation by tension band wiring has improved the functional outcome results of these type fractures

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We studied the effect of combination of intra articular injection of hyaluronic acid plus oral glucosamine and chondroitin sulfate compared to intra articular injection of hyaluronic acid alone in treatment of knee osteoarthritis.In prospective comparative study 104 patients with knee osteoarthritis were randomized according to inclusion exclusion criteria into two groups to receive either, intra-articular injections of hyaluronic acid 25 mg plus oral combination of glucosamine 1500mg and chondroitin sulfate 645 mg daily for 1 year, or receive intra-articular injection of hyaluronic acid 25 mg alone. The patients were followed up for 12 months period. The primary outcome measurements were according to Lequesne's and WOMAC scores. In both group A and B significant reduction in the mean of both Lequesne's and WOMAC scores from baseline were seen at all follow up visit for 12 months. Also there were significant statistical differences at 12 months for both Lequesne's and WOMAC scores between group A and group B (p-value < 0.0001). No severe adverse events related to drugs were observed.We concluded that intra-articular injections of hyaluronic acid plus oral combination of glucosamine and chondroitin sulfate for 1 year are superior to intra-articular injections of hyaluronic acid alone.

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background: Epidural fibrosis and adhesion seen as common post lumbar syndrome phenomena which contribute to 50%-60% recurrent of the symptoms.Aim of study: We studied the effectiveness of percutaneous epiduroscopic adhesiolysis in management of fibrosis & adhesion resultant from failed backed lumbar spine surgery compared to second time surgical decompression with surgical excision of the fibrosis of lumbar spinal stenosis.Patients & Methods: In a prospective comparative study of 44 patients all of them with failed backed post laminectomy syndrome were diagnosed in Sulaimania city private clinic and private hospital, from June 2010 till May 2012 according to magnetic resonance imaging techniques, also according to inclusion exclusion criteria in diagnosis of adhesion with fibrosis, were randomized into two groups. Group A treated by lumbar spine surgery with second time surgical exploration, decompression and excision of fibrosis compared to the second group B were treated by percutaneous epiduroscopic adhesiolysis through sacral canal under fluoroscopic guide. The caudal epidurogram showed restriction in spread of contrast caused by fibrosis & adhesion then the canal open by irrigation through pressurized saline range from 40 to 80 ml according to the number of the level which were obstructed by fibrosis. Saline used intermittently until the spinal canal open were seen by fluoroscope until complete procedure with adequate adhesiolysis with visualization of the canal opening. At the end of the procedure solutions were used to decrease rate of adhesion. Depomedrol 80 mg 2ml , Hyaluronate 6ml, 1% 5ml lignocaine injected into canal space.Results & Discussion: In both group A by surgical procedure & B percutaneous epiduroscopic adhesiolysis were noticed significant improvement in the mean of Stanford score and ODI (Oswestry low back disability score) from baseline were at all follow up visit for 24 Months according to sciatica pain (short term less than 6 Months, long term more than 6 Months), Functional outcome, Return back to work, psychological status, Change in narcotic intake, with the general satisfaction rate. Also there were significant statistical differences at 12, 24 Months follow up for both Stanford and ODI Oswestry index between group A and group B revealed high outcome results for group B was treated by epiduroscopic adhesiolysis technique (P- value <0.0001) with minimal complications rate in group B compared to group A.Conclusion: We concluded that percutaneous epiduroscopic adhesiolysis for 2 years follow up specific for the patients of fibrosis with adhesion post laminectomy are superior to the surgical exploration with excision of fibrosis & second time decompression in treatment of failed back lumbar spinal surgery.

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Background: Cerebral palsy (CP) is a heterogenous permanent neurological disorder that is caused by a non-progressive damage to the developing brain. In this disorder, injury or malformation occurs in the growing central nervous system which eventually will affect the development of motor function and body posture before, during, or shortly after birth.Objective: To estimate and highlight the status of demographic and clinical characteristics of cerebral palsy in children at Sulaymaniyah province which has significant walking disorders. Patients and Methods: In this study (118) ambulatory patients with cerebral palsy who attended the health care and consultation clinic at Children Rehabilitation Center (CRC) in Sulaymaniyah province. The primary data were studied according to: gender distribution, patient age, types of delivery, and age of presentation of the CP disorder. Additionally, the conditions at birth such as asphyxia, kernicterus, types of cerebral palsy, full-term, and pre-term were studied. Finally, the Gross Motor Function Classification System (GMFCS) of cerebral palsied children was identified.Results: Our data showed that females tend to be more affected by CP than males with a ratio of (65:53). The range of ages was between half a year and 12 years (mean of 7.5 years). The highest range appearance of cerebral palsy was between the ages of (12-24) months with a percentage of (58.47%). A delayed milestone was the most common presenting among CP types (41.53%). In comparison to the other CP types, the spastic type was the most common (59.32%). The most prevalent subtype of CP was the spastic hemiplegia (40%). 66.10% of patients were born with vaginal delivery. The majority of the patients were born with asphyxia (31.36%) followed by kernicterus direct antepartum. Sixty-seven (56.78%) mothers were using medications during pregnancy. Forty-eight of parents were consanguine marriage. According to the GMFCS results, most of the CP patients were in the level III and level IV with 27.12%, 25.42% respectively; the major motor disability in children with spastic hemiplegia varied from level I to III. Conclusion: We deduced that it is difficult to estimate and clarify the exact cause and risk factors associated with the cerebral palsy disorder. However; we found spastic hemiplegia is the most common clinical pattern of CP due to its high prevalence of birth asphyxia. Using medicine during pregnancy will increase a chance of CP to occurs, for further investigation, the case-control study should be employed within the cohort study.

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