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Club Foot Deformity Conservative Versus
مرض القفد الفحجي (دراسة مقارنة بين العلاج التتحفظي والجراحي)

Author: Sadeq A . Al-Mukhtar
Journal: KUFA MEDICAL JOURNAL مجلة الكوفة الطبية ISSN: 1993517X Year: 2009 Volume: 12 Issue: 2 Pages: 245-256
Publisher: University of Kufa جامعة الكوفة

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Abstract

Background: Congenital talipes equinovarus is a complex deformity of foot .It is a collection of different abnormalities, with different etiologies. Consequently, Severity varies with difficulties in evaluating treatment strategies with outcome results.Clubfoot deformity consists of adduction of the forefoot, inversion and varus of the hind foot, and equines at the ankle and subtalar joints, some cases are complicated by an additional cavus deformity. The severity of clubfoot varies widely from case to case, ranging from deformed but flexible to extremely rigid and difficult to move.The treatment of congenital club foot remains controversial. The results of any form of treatment vary according to the severity of the deformity. Usually, the orthopaedist"s goal is to obtain anatomically and functionally normal feet in all patients, but this is not realistic because in many club feet the deformities of the bone , joint, and ligaments of the foot and ankle are too severe to be fully corrected. Before 1950 extensive posteromedial soft-tissue releases were done commonly in different clinics to achieve an anatomical correction of the deformity. These operations often resulted in considerable stiffness of the foot and ankle, and recurrences or over-corrections of the deformity were observed.In this study which was done in three hospitals in Baghdad in the period between 5th of April 1995 and 20th of May 2004, we depended mainly on conservative methods of the treatment of clubfeet.Aim: Validity of early conservative treatment in clubfeetPatients and Methods: The number of patients involved in this study were 470(745 feet),323 were male and 147 were female. It involved only patients with age less than six months.Each patient in this study filled out a questionnaire that provides information. Full Examination, general and local, full neurological examination. Radiological assessment also done for every patient. The protocol of treatment was modified Ponseti method.Follow up of patients for four years. The patients were divided into two groups. Group A, included patients age less than one month, while group B, included patients age between One to six months.Results: The male to female ratio was 2.2:1. Group A- patients were 315, while group B, were 155 patients. Bilateral was 51.7%. Simple clubfoot was 77%.%.Radiologicl assessment; before starting the treatment, 85% of patients, their talo-calcaneal indices were 0-40 degrees and 15% were 40-50 degrees and after 9 months of treatment, we found that 80% of uncorrected patients their indices were 34-40 degrees and 205 with indices of 40-50 degrees . . After 6 weeks of conservative treatment in group A 83.8% got correction, while in group B, 56% only. After 9 weeks of conservative, in group A 91.4%were corrected, while in group B only 58.7% were corrected. Percutaneous tenotomy of T.A. was done in8.3% of group A , while in group B in 18.7%. Soft tissue release with or with out tendon transfer was done in 3.2% in group A and in group B was 25.8%. Follow up for 4 years,14 patients(4%) developed relapse in group A, while in group B, 22 patients(14.2%). The results, using rating system the result in both groups were excellent in 42% , good in 24%,fair in 8.4%, and poor in 25.6% (7.9% in group A, and 43.2% in group B). Conclusions: 1-Understanding the main pathology of club foot, and the ideal method of conservative methods of correction of the deformities systematically before starting the treatment.2- In all types of club foot, we must start conservative treatment.3- Starting the treatment from the first day of life give good results.4- In assessment of the patients, we must depend on clinical, radiological, and functional outcome.5- Follow up is important in long-term treatment, but not more than two years6- Parental compliance is very important in the treatment of clubfoot.

ان مرض القفد الفحجي هو تشوه مقعد القدم حيث يشمل تغيرات متعددة نتيجة لأسباب مختلفة وهذا بالضرورة ينعكس على اسلوب العلاج .ان هذا التشوه يتكون من كون الجهة الامامية للقدم مقربة الى الداخل ، انقلاب داخلي مع فحج الجهة الخلفية من القدم ،مع مفصل الكاحل ومفصل تحت العقب وفي بعض الحالات تكون الأكثر تعقيداً نلاحظ وجود تشوه اضافي وذلك في تجويف القدم (تقوس) .ان علاج هذا التشوه مختلف بأختلاف المدارس ونتيجة هذا العلاج ايضاًمختلفة وتعتمد على شدة التشوهوان هدف المعالج هو للحصول على قدم ذات شكل صحيح تشريحياً ووظيفياً وفي بعض الحالات لا يمكن الوصول الى هذا الهدف لكون التشوه شديد .في هذه الدراسة التي اجريت في ثلاث مستشفيات في بغداد للفترة ما بين شهر نيسان 1995 ولغاية مايس 2004 اعتمدت الدراسة على المعالجة بالطريقة التحفظية.ان الهدف من الدراسة هو لتقييم دور العلاج التحفظي منذ ولادة المريض ومقارنة مع العلاج في فترات اخرى من حياة الطفل.اجريت الدراسة على 470 مريض (745 قدم). (223)ذكر و(147) انثى لمرضى اعمارهمتقل عن ستة أشهر واجراء الفحوصات الشعاعية لتقييم الحالات وتمت معالجتهم تحفظياً الا في بعض الحالات يكون جراحياً وتمت المتابعة لأربع سنوات وكانت نتائج الدراسة مشجعة حيث انه كلما عولج المريض في الايام الاولى من الولادة كلما كانت النتائج ممتازة (91.4%) ونستنتج من هذه الدراسة بأن معالحة هذه التشوهات تحتاج الى معالج متفهم للتغيرات التشريحية والوظيفية الحاصلة في القدم. وطريقة العلاج التحفظي مبينة على اسس علمية بخطوات متتالية بالاضافة الى أهمية التعاون بين المعالج وذوي المريض للحصول على الهدف .


Article
Compound fractures of the hand metacarpals and phalanges treated by using mini-external fixator

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Abstract

Background: A review of articles of method in treating compound phalangeal fractures by using mini-external fixator, elaborating the anatomy, mechanics, modalities of treatment, and complications of these types of fractures. Also, it compares between different studies regarding the functional results and final outcome. External fixation of phalangeal fractures is a good method for osteo synthesis in certain situations. The simplicity of the surgical procedure and the minimal disruption of the normal bone architecture also make it appealing.Objectives: Evaluating the functional results of the use of mini-external fixator for the treatment of compound fractures of phalangeal bones of the hand.Method: Our study consists of 15 patients, 12 were male and 3 was female, treated with external fixator for sever open hand fractures at Al-Kindy teaching hospital during the period from June 2011 – June 2013, using 2 K-wires bonded by IV needle cover, or 2 K-wires bonded by bone cement.Results: In comparison between different studies, external fixation offers several advantages. It allows preservation of the bone architecture, union of the fracture, facilitatinghealing of the disrupted area, and good functional results. External fixation is versatile, adapting to a wide range of clinical situations. This method of fixation provides good stability and adequate control of comminuted fractures, allowing not only anatomic restoration but also early active motion.Conclusion: External fixators are appropriate in cases of open, comminuted, unstable fractures. Other appropriate settings for external fixation include temporal management of fractures and length preservation of a functional digit.

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