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Article
Open Tibial Shaft Fractures Treated By Primary External Fixation And Bone Graft

Author: Ghadeer H. Majeed
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2012 Volume: 5 no 1 Issue: 11 Pages: 1306-1313
Publisher: Kerbala University جامعة كربلاء

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Abstract

Eprospective study undertaken between January 2007 and January 2011, 58 consecutive cases with compound tibial shaft fractures. All fractures were stabilized by external fixator device AO/ASIF type after failed the manipulation under anesthesia (MUA) to restore the osseous alignment. In 32 patients cancellous bone graft were used from the upper part of the tibia to enhance healing process, all these patients were followed for an average of 8 – 12 months.Our findings showed that stabilization of the fracture shaft tibia by external fixation with cancellous bone graft had significantly better result, than external fixation alone.We conclude that unilateral, uniplanar external fixation with early bone grafting from upper part of the tibia is considered the best method of management for unstable tibial shaft fracture in our community. The frame offered sufficient stability even in segmental fractures; application time is very short in the hands of the experienced surgeon. dynamization of the fixator must not be forgotten, and lastly we recommended that the external fixation is not only used as temporary form of immobilization but can be used as a definitive stabilizing procedure until consolidation of the fracture. It is safe, effective, cheap and available in almost all orthopedics units in Iraq.

Keywords


Article
Non Traumatic Hip Osteonecrosis Treated By Non Vascularised Bone Graft Versus Core Decompression

Author: *Dhary F. hassan; ** Ghadeer H. Majeed, *Abed Falih Al-Sudani
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2016 Volume: 12 Issue: 2 Pages: 49-55
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Avascular necrosis (AVN) is defined as cellular death of bone components due to interruption of the blood supply; the bone structures then collapse, resulting in bone destruction, pain, and loss of joint function. AVN is associated with numerous conditions and usually involves the epiphysis of long bones, such as the femoral head. In clinical practice, AVN is most commonly encountered in the hip. Early diagnosis and appropriate intervention can delay the need for joint replacement. However, most patients present late in the disease course. Without treatment, the process is almost always progressive, leading to joint destruction within 5 years.Treatment of a vascular necrosis depends mainly on early diagnosis which mainly based on clinical findings, x-ray finding & MRI.A variety of non vascularized bone grafting techniques have been proposed with varying degrees of success as treatment alternatives for osteonecrosis of the femoral head. The success of these procedures may be enhanced using ancillary growth and differentiation factors. Objectives: To treat non traumatic hip osteonecrosis by non vascularized bone graft versus core decompression.Type of the study: A retrospective study. Methods: We retrospectively reviewed 72 patients (88 hips) with osteonecrosis of the femoral head between May 2009, and March 2014,divided into two groups . Group A include 34 patients (44 hips) with osteonecrosis of the femoral head who had non vascularized bone grafting procedures done for them . Minimum follow-up was 12 months. We compared the outcomes in this cohort to similar hip number (44 hips) in 40 patients treated with core decompression only (group B). We used Phemister technique to make a window at the posterior aspect of greater trochanter to remove necrotic bone and packed the excavated area with autogenous cancellous bone graft taken from ipsilateral iliac crest or leave it without bone graft (decompression only). Results: We report the result of treatment for femoral head avascular necrosis depending on Ficat classification stage I, II, & III. The minimum follow up was 12 months (12m-36m). The success percentage of hips in our cohort of patients with non vascularized bone grafting group A are 86% (38 of 44 hips), which is higher than group B 63% (28 of 44 hips) with core decompression alone. Conclusions: These procedures core decompression and autogenous cancellous bone graft may defer joint arthroplasty in selected patients & it is more effective than core decompression alone in treating early stages of femoral head osteonecrosis.


Article
Operative Treatment by Plate and Screws Versus Conservative Treatment of Closed Displaced Fracture of the Mid Third of Clavicle in Adults: Comparative Study

Author: Mohammed Rageeb *, Ghadeer H. Majeed **, Mohammed S. Al- Edanni **, Sadik A. Al-Muktar
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 2 Pages: 145-151
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Clavicle fractures are common injuries in young active individuals, the mid third of the clavicle is most commonly fractured part(80% of clavicle fracture)OBJECTIVE:To compare the outcomes of operative and non operative management of displaced and or comminuted closed fracture of the mid third of clavicle in young adultsPATIENTS AND METHODS: This prospective observational study of 24 patients of fracture of the mid third of the clavicle was conducted in Alkindy teaching hospital from July 2015 to January 2017 and divided into two groups; one managed by operative treatment with plate and screws and the other by non operative sling immobilization after taking the consent and the patients were seen at 2, 4, 6 weeks,3, 6, and 9 monthsRESULTS: The mean time of functional recovery in the operative group was 3.75 weeks while in the non operative group was 8.09(P value=0.005) which is highly significant, the mean time of fracture healing(radiological union) in the operative group was 14.25 while in the non operative group was 28.72 with P value 0.005 which is statistically highly significant, there was no significant differences between the two groups in the range of movements although the adduction was better in the operative group but not significant P value=0.120, the DASH score was 11.25, 22.25 in the operative and non operative group respectively which is highly significant P value=0.005.CONCLUSION:Operative fixation of the clavicle results in improvement in the functional outcome, shorter time of union, lower complication rate in 9 month follow up ..


Article
Comparison between dome and wedge osteotomy in management of hallux valgus deformity

Authors: Haider Amin Mirza --- Mohammed Sh. Al- Iedani --- Ahmed Latteef Al-Shamari --- Ghadeer H. Majeed
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2016 Volume: 12 Issue: 22 Pages: 49-58
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Background: the condition of hallux valgus is considered as the most common deformities affecting females more than males, characteristically manifested as lateral deviation of the big toe and widening of first and second inter -metatarsal angle with a deformity of second toe in some severe cases.Objective: to make a radiological and clinical assessment of two surgical methods of osteotomy used in treatment of hallux valgu and to compare between them: first one is the distal dome osteotomy, and second one is a distal wedge metatarsal osteotomy.Patients and methods: a total of 36 feet of 28 patients suffer from hallux valgus, with mean age of 50.3 years were included in this study, followed for 6- 30 months ( mean follow-up of 8.8 months). Nineteen feet treated by dome osteotomy and seventeen feet treated by wedge osteotomy. All the cases were evaluated by the american orthopedics foot and ankle society (aofas) score, also, through the hallux valgus angle and intermetatarsal angle, both before and after surgery. Results: by dome osteotomy, the preoperative mean result of aofas score was about 45.7, with hallux valgus angle (hva) of 33.2o and intermetatarsal angle (IMA) of 11.7º. Postoperatively, the mean result of AOFAS score was 82.8, with HVA of 14.3º and IMA of 7º, with about 94.7% satisfactory results. In the other hand, the method of wedge osteotomy showed a preoperative mean result for AOFAS score of 45.2, with HVA of 34º and IMA of 12.8º , compared with postoperative mean result of AOFAS score of about 80.7, with HVA of 15.8º and IMA of 7.7º, with about 82.8 % satisfactory results.Conclusions: the two methods of osteotomy were used with very good outcome in radiological and clinical treatment of hallux valgus.

المقارنه بين طريقه القبه والإيقاع في علاج ابهام القدم الاروحالطريقةتم دراسه 36 قدم ل 28 مريض معدل اعمارهم 50.3سنه مصابون بإبهام القدم الاروح.معدل وقت المتابعه 8 اشهر 19 قدم تم معالجتها بواسطة القبه و 17 بواسطة الايقاع.ثم تم دراسة النتائج حسب مقياس AOFAS الامريكي.الذي يعتمد على ثماني عوامل منها حساب الزوايا حسب الرقائق الشعاعيه.الاستنتاجكلا الطريقتين متساوية الفعالية سريريا وشعاعيا في النتائج

Keywords

Hallux valgus --- osteotomy --- dome --- wedge.


Article
Scaphoid Fracture Non Union Treated by Bone

Author: *Ghadeer H. Majeed, F.I.C.M.S. *; Mohammed S. Al- Iedani, F.I.C.M.S.
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2012 Volume: 8 Issue: 1 Pages: 36-40
Publisher: Baghdad University جامعة بغداد

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Abstract

Objective: to evaluate the results of (Modification of Russe method) in treatment of nonunion fracture scaphoid bone by bone graft with external splintage (plaster of paris cast (pop ).Methods:Prospective study done on 26 patients (24 male, 2 female), age range between 25-42 years (mean age 34 years), fracture site at middle 1/3 with minimal displacements with no carpal bone or radial bone injury, technique of Matte- Russe method (explore the bone through volar approach using bone graft from iliac crest (cortico-cancellous peg plus cancellus bone) with thumb spica for 90 days with period of follow up 12-18 months.Results: out of 26 patients treated by this method , 23 patients (88.5%) union was achieved radiologically by the end of 3rd month &progressed over the next 3 months, range of motion of the wrist & power of grip increased gradually became almost comparable to the normal side by the end of sixth month , 5-7 degrees loss of dorsiflexion was residual in 6 patients . Three patients (11.5%) did not show union radiolgically after sixth postoperative month, their local symptoms were better than before surgery ,they were not keen to have another operation .No complications were noticed, wound healed well ,patient tolerance was goodConclusion: the use of cancellous bone graft with plaster of paris (p.o.p.) splint is less demanding surgically& less coasty and resulted in good results(88.5% healed well ).we recommend this treatment as a method for treating nonunion of carpal scaphoid bone .Key wards: nonunion, scaphoid , bone graft , plaster of paris


Article
The Role of Tibialis Posterior Tendon Transfer in Correction of Foot Drop Deformity
نقل العضله الضنمبوبية الخلفيه في علاج سقوط القدم

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Abstract

اجريت الدراسة على تسعة مرضى كانوا يعانون من سقوط القدم نتيجة اسباب متعددة وكانت اعمار المرضى مختلفة عولجوا بواسطة عملية نقل العضلة الضنبوبية الخلفية الى ظاهر القدم وتم متابعة المرضى لفترة متوسطها سنة في مستشفى الكندي التعليمي .العمليات الجراحية و المتابعة بعد العملية تمت بأشراف نفس الجراح .تم استخدام اسلوبين مختلفين في عملية نقل الوتر, في الاسلوب الاول تم نقل الوتر من خلال الغشاء البين العظمي (بين عظمي الظنبوب والشظية) لأربعة مرضى وفي الاسلوب الثاني تم نقل الوتر من خلال النسيج تحت الجلدي امام عظم الظنبوب لخمسة مرضى.من خلال متابعة المرضى لاحظنا تحسن في الحركة الارادية القابضة لمفصل الكاحل بصورة ممتازة في مريضين وبصورة جيدة في خمسة مرضى وبصورة مقبولة في مريضين.لا يوجد فرق بين اسلوبي عملية نقل وتر العضلة الظنبوبية من حيث تحسن الحركة الارادية القابضة لمفصل الكاحل في النتيجة النهائية للعملية.

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Article
Ultrasound of the Rotator Cuff: A Comparison of Ultrasonographic and

Author: Mohammed S. Al- Iedani, F.I.C.M.S. * Ghadeer H. Majeed, F.I.C.M.S. ** Tamer M. Assim, M.B.Ch.B.
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2012 Volume: 8 Issue: 1 Pages: 63-68
Publisher: Baghdad University جامعة بغداد

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Abstract

Al – Kindy Col Med J 2012; Vol. 8 No. 1 P: 63AbstractBackground : Shoulder pain is a common problem that can pose difficult diagnostic and therapeutic challenges for the family physician It is the third most common musculoskeletal complaint in the general population, and account for 5% of all general practitioners musculoskeletal consultsObjective: To determine the diagnostic performance of ultrasonography compared with the physical examination for detection of rotator cuff tears in painful shoulder syndrome.Method: Prospective study was done on seventy patients (48 male, 22 female), age ranged between 30-70 years (mean age 50 years), From February 2007 to July 2011, were subjected to comparative study in Al-Kindy teaching hospital with rotator cuff tears, including physical and ultrasonographic examination.Result: Ultrasound examination confirmed the presence of rotator cuff tear in 58 patients (82.8%), about two third of them below age 40 (65.7%) and male gender (68.6%).Conclusion: Ultrasonography which is non-invasive, safe; cheap with no known risk like radiation is a sensitive and accurate method of identifying patients with rotator cuff tears, and should be used wherever possible to improve diagnosis and treatment of painful shoulder disorders.Keyword: rotator cuff tear, physical examination and ultrasound


Article
Limping in twenty years old male A Case Report

Author: Mohammed S. Al- Iedani, F.I.C.M.S.; *,Ghadeer H. Majeed F.I.C.M.S. *; Tarek K. Al-Assadi, F.I.C.M.S..**
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2014 Volume: 10 Issue: 2 Pages: 100-103
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Osteoid osteoma(OO) is a relatively common benign skeletal neoplasm of unknown etiology that is composed of osteoid and woven bone, usually seen in adolescent and young males Although, the clinical, radiological and scintigraphic features of OO have been well described, these features may be misleading or altered in the cases of lesser trochanter of the femur which is relatively uncommon location for OO with a few number of cases reported up to date.Case Presentation: We report a case of a 20-year-old man who presented with painful limpThe pain had begun six months earlier and was made worse by walking and by exercise., with normal initial X-rays .The diagnosis was made after six months when typical Computed tomography, magnetic resonance imaging findings appeared , showing the nidus.Treatment: Acompleteen block resection accomplished successfully and the whole tumor with lesser trochanter of the femur in one mass was removed.Outcome and Follow-up: the post-operative period was uneventful. The pathological examination is consistent withosteoid osteoma. The patient was asymptomatic at one year follow up.Conclusions: lesser trochanter OO can mimic lots of pathologic entities related to the affected area, and presents a diagnostic challenge and cause a delay in the diagnosis. The delays in the diagnosis and treatment can be avoided with a high index of suspicion. Treatment should be individualized according to the surgeon’s preference and the characteristics of the case.Key words: Osteoid osteoma OO, lesser trochanter, enblock excision


Article
Aneurysmal bone cyst of the lateral end of clavicle in a twelfth year old girl Case study

Author: Mohammed S. Al- Iedani, F.I.C.M.S. *; Ghadeer H. Majeed, F.I.C.M.S. *; Basher A. Rashid, F.I.C.M.S. **
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2015 Volume: 11 Issue: 1 Pages: 84-87
Publisher: Baghdad University جامعة بغداد

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Abstract

Introduction: An aneurysmal bone cyst are enigmatic lesionof unknown cause and presentation and are difficult todistinguish from other lesions, it is a benign, but expansibletumor like lesion that generally occurs in the long bones. Ananeurysmal bone cyst arising from the flat bone like clavicleis rare .Case presentation: We report a 12-year-old girl child with ananeurysmal bone cyst of the lateral third of left clavicletreated with enblock resection. The pathologic findingsconfirmed the diagnosis of aneurysmal bone cyst. Thepatient has been followed up for one year with no evidenceof recurrence .Conclusion: En bloc resection can be curative and provide good results for this rare type of clavicle tumour.

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