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Article
Managementt o f non traumatic A vascular Necrosis off Femoral Head at precollapse stage with Core Decompression and tibial Bone Grafting

Author: Baqer Kadhim Kraidi Senior orthopedic surgeon (F. I. C. M. S. – M. B. Ch. B)a Alwan Hussein Keetan (M. B. Ch. B).b
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2014 Volume: 10 Issue: 1 Pages: 44-47
Publisher: Baghdad University جامعة بغداد

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Abstract

B aa cc kk gg r oo uunn dd : Avascular necrosis have always presented great challenges to orthopedic surgeons and patients, remain in many ways today the unsolved dilemma. Varieties of non-vascularized bone grafting techniques preceded by core decompression have been proposed with varying degrees of success. O bb j ee cc t i vv ee ss : The aim of this study is to review the the value of core decompression and non-vascularized tibial bone strip graft treatment for early stages of non-traumatic osteonecrosis stage II & III according to stein burg staging . M ee t hh oo dd ss : prospectively reviewed 26 patients (32 hips) with osteonecrosis of the femoral head between June 2006 and December 2013 at Imam Ali hospital in Sader city & Al-Wasity teaching hospital. Inclusion criteria were all patients ages 19 years to 50 years and in Stein burg stages II and III . Mean follow-up for 3 year. Exclusion criteria were stage I, IV, V and VI .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 cortico-cancelloustibial bone strip graft. This study was taking into account ethical evaluation and approval by scientific committee of Arab board. R ee ss uu l t ss: The reported results of treatment for femoral head avascular necrosis was (87.6%) success rate of hips in our cohort of patients with core decompression &non-vascularized tibial bone strip C oo nn cc l uu ss i oo nn ss : None vascularized tibial bone graft effectively reduce donor site morbidity and may defer jointarthroplasty in selected patient stein burg staging


Article
Managements of Type 2 Tibial Hemimelia; Short Review on Treatment of Tibial Defects and The Results of Four Patient Treated Using a Modified Brown Procedure

Authors: Mohammed H. Salal --- Isam H.Ali
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 4 Pages: 454-465
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRUCT:BACKGROUND:Tibial hemimelia is a very rare deformity and problematic syndrome usually associated with variable visceral and skeletal deformities. The treatment is always difficult and challenging. Amputation was the preferred treatment option specially in complete tibial absence, however, a conservative management sometimes used in other types of the deformity or in cases of amputation refusal. OBJECTIVE: To review the methods of management of chronic tibial defects and to study the results of operative treatment of 4 patients with type ii congenital tibial hemimelia.PATIENT AND METHOD:All along thirty-two months period and after a proper clinical and radiological assessment we treated four male children with a mean age of 8.5 years who were all right sided type 2 tibial hemimelia according to Jones and Kalamchi with absence of the distal tibia. Treatment consisted of proximal fibula transfer to the lower end of the tibial stump (brown's operation) followed by Syme's amputation and prosthetic fitting.RESULTS:In all cases the transferred fibular shaft to the distal end of the tibial remnant was united within two to three months. The fibulae grew in length and the size to be tibialized and the leg increased in length as we preserved the distal fibular epiphysis.CONCLUSION:The results were acceptable as we saved and reconstructed the limb, we gained an acceptable knee function and stable prosthetic fitting that aided proper rehabilitation.


Article
LOCKING INTRAMEDULLARY NAIL VERSUS PLATE AND SCREWS FOR FIXATION IN TIBIAL DIAPHYSEAL FRACTURE

Authors: Ali A Alwan Al-Tamimi --- Aram Abdullah Rasheed
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2016 Volume: 22 Issue: 2 Pages: 77-83
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract Diaphyseal tibial fracture is the most common fractured long bone because of it is subcutaneous position anteromedially and thinner diaphysis distally. Tibial diaphysis has poor blood supply and poor soft tissue envelope around it so it is more susceptible to infection, delay union, and non-union. For these reasons many modalities including cast and brace, external fixation, plate and screws, and locking intramedullary nail were used for treating diaphyseal tibial fracture. The aim of this study is to compare the outcome of locking intramedullary nail(LIMN) fixation versus plate and screws fixation in treating diaphyseal tibial fracture in term of operation time, early weight bearing, time to union, and complications. The study was carried out in Sulaimaniyah Teaching Hospital, Department of Orthopedics prospectively from May 2010 to July 2014 on 74 patients, 40 of them underwent surgical fixation by locking intramedullary nail (26 close method and 14 by open method), and 34 of them underwent open reduction and internal fixation by plate and screws. The outcome was assessed by clinical and radiological evaluation. The results show that young male are more affected by trauma, and the main mechanism of injury was Road Traffic Accident. Operation time was shorter among plate and screws group with a mean of 51.4±4.9 minutes, than locking intramedullary nail group with a mean of 88.5±12.5 minutes. Weight bearing(WB) time achieved earlier in the locking intramedullary nail group with a mean of 2.6±0.8 weeks than the plate and screws group with a mean of 4.2±1.4 weeks. There were no significant difference between the two groups regarding time to full weight bearing(FWB), time to union, and complications. In conclusion, Locking intramedullary nail and plate fixation are ideal option for treatment of diaphyseal tibial fractures since there were no significant differences between them in time of union and the post-operative complications.

Keywords

INTRAMEDULLARY NAIL --- PLATE --- SCREWS --- TIBIAL --- DIAPHYSEAL --- FRACTURE


Article
THE TREATMENT OF OPEN & CLOSED TIBIAL ‎FRACTURES BY PRIMARY EXTERNAL FIXATION & ‎BONE GRAFT

Authors: Mohammad S Al-Edany --- Thamer A Hamdan
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2005 Volume: 11 Issue: 2 Pages: 38-44
Publisher: Basrah University جامعة البصرة

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Abstract

‎ We prospectively studied 64 patients with fracture shaft tibia, 23 patients with closed tibial fracture and ‎‎41 patients with open type. All fractures were stabilized by external fixation device AO/ASIF type after ‎failed manipulation under anesthesia (MUA) to restore the osseous alignment. In 28 patients cancellous ‎bone graft were used after 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 results, than external fixation alone.‎‎ The use of external fixation device with bone graft, is safe, effective, cheap and available in almost all ‎orthopaedic units n Iraq. ‎


Article
Assessment & Evaluation Of The Outcome For Closed And Open Method In The Treatment Of Closed Segmental Tibial Fracture By External Fixation
تقييم معالجة الكسور المتعددة المستويات لعظم القصبة للساق باستخدام الأسلوب الجــراحي المغلق والمفتــوح بواسطة التثبيت الخارجي

Author: Jamal Kadhim Shwayel AL-Saeedi جمال كاظم شويل السعيدي
Journal: JOURNAL OF THI-QAR SCIENCE مجلة علوم ذي قار ISSN: 19918690 Year: 2014 Volume: 5 Issue: 1 Pages: 22-31
Publisher: Thi-Qar University جامعة ذي قار

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Abstract

Segmental tibial fractures are considered to be a special type of injury associated with high complication rates. The aim of our study was to evaluate and assess the outcome of our policy on dealing with closed segmental fracture of the tibia treated by (closed or open) application of external tubular device fixator (AO group of ASIF) .Within the period between October 1, 1998 and September 30, 2010 we collect 38 patients. The minimally or undisplaced fractures were treated by closed method, while those with significantly displaced fractures, firstly managed by calcaneal traction for a few days, some of them were reduced and also treated closed, and some are remain significantly displaced, treated by open reposition and external fixation with the help of X-ray control for all cases. A range of motion exercise of ankle and knee joints post operatively were encouraged.The mean age was 38.81 years. We collect and study 38 closed segmental tibial fractures i.e. (two fractures focuses for one bone), so we are dealing with 76 fractures in 38 patients. All the patients were treated by AO unilateral external fixator arranged in multiplanar technique for more rigid fixation and regarded as a definitive procedure for holding the fractures until clinical& radiological union. Then the external fixation was removed and a partial weight bearing was continued with the help of the crutches until consolidation.Healing of the bone occurred in 52 fracture focuses (68.42%) patients, and 24 fractures (31.57%) patients reported significant complications in the course of treatment that required further surgical management, 18 of them delayed union (23.68%) patients and 6 of the fracture focuses(7.89)patients go to nonunion. The delayed union treated simply by dianamyzation with chips bone graft and sometimes rearrangement of the external fixator particularly the loose pines, all of them healed completely, while the nonunited were treated by (Revision procedure):- (revision of the external fixator with wider pins and extensive refreshment of the fracture ends and added a considerable amount of bone graft), so all of them were united successfully.We conclude that the external fixation is a suitable method for the treatment of segmental tibial fractures with an acceptable rate of complications.

تعتبر الكسور المتعددة المستويات من المعضلات المهمة في جراحة العظام وخاصة لعظمة القصبة للساق حيث عادة يكون مصحوب بأضرار واصابات للأنسجة المحيطة للعظم وخاصة سمحاق العظم مما يؤثر سلبا على عملية التئام الكسور وابطاء في عملية الالتحام والاندماج العظمي. انها دراسة استرجاعية اجريت على 38 حالة مرضية للفترة من شهر اكتوبر عام 1998 الى شهر سبتمبر 2010. تم التعامل معها معالجتها من قبلي في مستشفى الناصرية العسكري ومستشفى العمارة العسكري ومستشفى الحسين التعليمي في الناصرية وذلك باستخدام جهاز التثبيت الخارجي ( النوع السويسري) لمجموعة (A.O - ASIF) حيث يتم تثبيت العظم المكسور الغير متباعد مباشرة دون فتح داخلي، اما الكسور المتباعدة فيتم تمهيديا اجراء عملية سحب عظمي مستمر من خلال عظمة الكعب لحين حصول حالة تعديل الكسر المتباعد ثم يتم بعد ذلك تثبيت الكسر دون فتح على العظم، اما الكسور التي تبقى متباعدة فيتم تعديلها داخليا وذلك بإجراء عملية فتح جراحي على موضع الكسر وتعديله ثم يتم تثبيت الجهاز الخارجي، ان هذه العمليات كلها اجريت بمساعدة بمساعدة الاشعة السينية. يتم مراقبة المريض في المستشفى بعد العملية لمدة 3 ايام حيث يتم اعطاءه المضادات الحيوية المناسبة ورفع الساق للأعلى لمنع حدوث الوذمة ثم بعد ذلك يتم اخراجه من المستشفى و المشي بمساعدة العكازات دون الضغط او المشي على الساق المكسورة (مجرد ملامسة الارض) لحين ظهور بوادر سريرية وشعاعية جيدة لالتئام العظم حيث يتم في حينها بدء الضغط الخفيف على العظم المكسور بعد اجراء ترخية وشد بسيطة للجهاز حيث تستمر عملية الضغط التدريجي على العظم لحين اكتمال الالتئام العظمي ثم بعد ذلك يتم رفع الجهاز تماما والى جانب ذلك يستمر المشي والضغط التدريجي على العظم المكسور لحين اكتمال الاندماج التام.النتائج التي تم الحصول عليها جيدة حيث تم التئام واندماج طبيعي للكسور بدون مضاعفات لحوالي 68.42% من الحالات، في حين حدث تأخير في الالتئام لحوالي 23.68% من الحالات وتم معالجتهم بنجاح بواسطة تطعيم عضمي بسيط مع ترتيب بسيط للجهاز او تغيير في بعض المسامير. في حين تم تسجيل 7.89% من الحالات لعدم الالتئام والذي هو الاخر تم معالجته بنجاح وذلك بإعادة تثبيت جهاز جديد بمسامير اوسع مع اضافة كمية كبيرة من تطعيم عظمي وتنظيف واسع لنهايات الكسر الغير ملتئم حيث تم بعدها الشفاء التام . نستخلص من دراستنا هذه ان استخدام جهاز التثبيت الخارجي لحالات الكسور المتعددة المستويات لعظم قصبة الساق تعتبر طريقة جيدة ومعتبرة وبمضاعفات مقبولة ومن الممكن السيطرة عليها.


Article
Non cannulated intramedullary nailing in treatment of nonunited tibial fractures
تسمير باطني غير مقنطر في علاج كسور الظنبوب غير الملتحمة

Author: Yousif Rashid Mohammad
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2012 Volume: 16 Issue: 2 Pages: 129-132
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objectives: Nonunion following diaphyseal tibial fractures is still a challenging problem facing orthopaedic practice , different approaches used to tackle this problem , the aim of this study was to evaluate the outcome of treatment by non cannulated intramedullary nailing as regards union and complicationsMethod: Eighteen patients with non-united diaphyseal tibial fractures their age ranged between 19 –60 years (mean of 33.5 years) were studied and treated by non cannulated intramedullary nailing between 2005 to 2010. Initially all these patients underwent multiple surgeries including wound excisions , revision of fixation and bone grafting All underwent fixation by non cannulated intramedullary nailing , in 14 patients , the site of the non-union wasexplored to correct alignment by osteotomy, while closed intramedullary nailing were performed in the remaining 4 patientsResults: In seventeen cases (94.4%) union was achieved between 5 – 9 months with an average of 7.5 months , complications included refracture and failure of fixation in 1 patient (5.6%) and superficial wound infection occurred in 3 cases (16.6%)Patients with nonunited diaphyseal fractures were followed post-operatively for 1–6 year (average 4 years), eventually healing was successful with full weight bearing without support and pain , fracture line was not visible on radiographsConclusion: Non-cannulated intra-medullary nailing appears to be very helpful procedure to promote union in these cases with relatively less significant complications.


Article
Primary Below Knee Amputation in the Management of Compound Comminuted Fracture Lower Tibia and Fibula Due to High Velocity Missile Injury Associated with Bone Loss and Tibial Nerve Injury

Author: Ali Bakir Al-Hilli
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2008 Volume: 7 Issue: 4 Pages: 290-294
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Compound comminuted fractures of lower tibia and fibula are very common in Iraq these days due to missile injuries (bullets and blasts), it could be associated with bone loss and neurovascular injury this will interfere with the patients rehabilitation and leads to major social and economic burden on the patient, , his family and the community.OBJECTIVE:To prove that primary below knee amputation in management of compound comminuted fracture lower tibia and fibula due to high velocity missile injury and complete tibial nerve injury is superior to limb salvage.PATIENT AND METHODS:This is a prospective comparative study including 25 patients age 30-60 years presented to the emergency department in Medical City with a history of missile injury during the period 2005-2007 they had compound comminuted fractures of lower tibia and fibula (Gustilo grade II, III) all of them had different degrees of bone loss (more than 5 cm) and all of them had complete tibial nerve injury and 10 of them had associated posterior tibial artery injury which is irreparable. We divided our patients in to two groups the first one (9 patients four of them had also associated vascular injury) we did primary below knee amputation, while the second group (16 patients six of them had vascular injury) who refused amputation we did wound exsion and application of external fixation. Both groups followed up clinically and radiologically for one year.RESULTS:Group I the patients rehabilitated early and a prosthesis were used after one and a half month and the patients return to their original work or changing their work and have almost normal life, group II all of them had prolonged course of treatment with economic and social problems.CONCLUSION:Primary below knee amputation is a very good option for patients with history of compound comminuted fractures of lower tibia and fibula (grade II and III) associated with bone loss and tibial nerve injury. Decreasing rehabilitation time and early return back to work also less cost and less social problems.


Article
Management of Tibial Fracture due to High Velocity Speed War Injuries

Author: Zaid Wajeeh Al-Shahwanii د. زيد وجية الشهواني
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2010 Volume: 23 Issue: 1 Pages: 64-68
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract:Background: Fractures of tibia are very common in patients with war trauma, because the only expose part remain of the body are the limbsObjective: To evaluate the use of external fixation device as the initial and definitive method of treatment of these fracturesMethods: Fifty-nine high-velocity tibial war injuries fractures (11 closed and 48 open) in 51 patients were treated with the external fixation devices of different varieties (mainly AO, Orthofix, Strayker), in al Yarmouk teaching hospital between 2005 and 2006. Open wounds were debried and tension free primary closure using interrupted nylon sutures was attempted wherever appropriate. In others, either split thickness skin grafting or local gastrocnemius flaps were used. Early weight bearing with range of motion exercises of ankle and knee joints were encouraged.Results: Average fracture healing time was 6.25 months (range 4–8.5 months). Based on Johner and Wruh's Criteria, there were (37 excellent 62.7%), (18 good 30%), (2 fair 3.3%), and (2 poor results 3.3%). Complications included pin tract infection (17 case 28.8%), knee joint stiffness (9 cases 15%), shortening (7 cases 11.8%), and ankle joint stiffness (4 cases 6.7%).Conclusion: External fixation provided early and definitive fixation for high-velocity speed tibial fractures with good results.Keywords: External fixation, tibial fractures, war injuries

معالجة كسور القصبة الناتجة عن أصابات الحرب الفائقة السرعةد. زيد الشهوانيالملخصخلفية البحث: تعتبر كسور القصبة من الكسور الكثير الحدوث في أصابات الحروب لان الاطراف هي الوحيدة التي تكون غير محميه من اجزاء الجسم عند المصابالأهداف : هدف البحث هو لتققيم استعمال جهاز التثبيت الخارجي في تثبيت والمعالجة الأولية والنهائيه الكسوراعلاهزطرق البحث: تسعة وخمسون حالة كسور قصبة ناتجه عن اصابة حرب عالية السرعة عولجت بجهاز التثبيت الخارجي من مختلف الانواع (الاكثر ِأي او..اورثوفكس..سترايكر ) في مستشفى اليرموك التعليمي بين عامي 2005 و عام 2006.الجوح المفتوحه تم تنظيفها مع محاولت خياطتها تحت الضغط باستعمال خيوط النايلون المتقطعة العقد كلما أمكن .وفي أخر اما ترقيع جلدي رقيق التثخن او بأستخدام غطاء موضعي من العضله الخلفيه الساق تم استخدامها.مع التشجيع على تمارين تحريك مفصل الكاحل والركبه و السير بكل ثقل وزن الجسم .النتائج : معدل الوقت لالتئام الكسورهو 6.25شهر (تتراوح بين 4-8.5شهر)ز اعتمادا على تصنيف جونر و روث, كان هناك (37 ممتازه 63.7%) و(18 جيدة 30%) و(2 مقبول 3.3%) و (2 ضعيف 3.3%).المضاعفات وتشمل التهاب قناة المسمار (17حالات 28.8%), تصلب حركة الركبه (9حالات 15%) ,تصلب حركة الكاحل ( 4 حالات 6.7%).ألاستنتاجات: التثبيت الخارجي يوفر المعالجة الأوليه والنهائيه لأصابات القصبه العالية السرعة بنتائج جيدة مفاتيح البحث التثبيت الخارجي وكسور القصبه واصابات الحروب


Article
Comparison of Plate VS. Nail Fixation for the Treatment of Distal Tibial Shaft Fractures in a Sample of Trauma Patients

Author: Ali A. Ali
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 2 Pages: 172-178
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: Fractures of the distal third of the tibia are the major cause of morbidity in patients with lower extremity injuries. Most fractures are sustained in young adults during high velocity injuries.PATIENTS AND METHODS: Forty patients with closed fractures of distal third of the tibia were treated in Al-Yarmouk Teaching hospital between May 2012 and April 2014. 20 patients had been treated with open reduction and internal fixation by heavy-duty plate and screws and were matched to 20 patients treated with closed reduction and intramedullary nailing fixation, with regard to gender, age, and the AO classification of the fracture.RESULTS: There were no significant differences in regard to: time of surgical procedures, non-union, hardware failure or deep infections between plate fixation and intramedullary nailing. Open reduction and plate fixation was associated with higher risk of: delayed union, osteopenia, ankle joint stiffness and algodystrophy. Closed reduction with intramedullary nailing was associated with higher rates of rotational malalignment and knee joint pain/stiffness. The limb length difference was of no clinical significance in all patients.CONCLUSION: Intramedullary nailing is the preferred method for treating closed distal tibial fractures but open reduction and plate fixation may provide superior results in terms of optimal alignment.


Article
Intramedullary Versus Extramedullary Alignment Guide for the Accurate Sagital Tibial Prosthesis Alignment in Total Knee Replacement Arthroplasty.
مقارنة بين استخدام دليل الاستقامة خارج نخاع العظم وداخل نخاع العظم في دقة الوضع الجانبي للجزء القصبي الاصطناعي في عمليات تبديل مفصل الركبة الكامل.

Author: Firas A. Naser فراس عبد الهادي ناصر
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2013 Volume: 55 Issue: 3 Pages: 210-213
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: long term survivorship in total knee arthroplasty is significantly dependant on prosthesis alignment, several studies have correlated poor outcome with malalignment of the components. The debate on the optimal system for femoral alignment is now largely resolved, but there is still controversy about whether intramedullary or extramedullary systems are better for the tibial side.Objecives : is to determine whether intramedullary or extramedullary tibial alignment guide is better for accurate sagital tibial prosthesis alignment in total knee replacement arthroplasty.Patients and methods: Of 65 patients recruited, only 48 patients (55 knees) were met the inclusion criteria of this study (32 female and 16 male) with an average age of 62.2 years ranging from 57 to 70 years who had attended the outpatient clinic in medical city-orthopedic and trauma consultation unit and private work, during the period from October 2010 till March 2012. All patients were diagnosed to have severe osteoarthritis of their knees and we performed total knee replacement arthroplasty for them. Patients were divided into two groups, group A, were 22 patients (25 knees) in which we used intramedullary alignment guide for the preparation of proximal tibia, and group B, were 26 patients (30 knees) in which we used extramedullary alignment guide for the preparation of the proximal tibia. Three months postoperatively, a standing long leg proper lateral plain X-ray (digital software) was taken and the sagital tibial slope was measured for each case.Results: Accurate alignment of sagital posterior slope of tibial prosthesis was found in 80% (20 out of 25 knees) in group A, and in 43.3% (13 out of 30 knees) in group B.By using Student t test, the P value was less than 0.001 which was very significant.Conclusion: we concluded that the intramedullary tibial alignment guide is statistically more accurate than extramedullary tibial alignment guide, in the sagital positioning of the tibial component.Key words: intramedullary, versus, extramedullary, tibial guide, total knee replacement.

الخلفية : ان بقاء مفصل الركبة الاصطناعي فعالا لفترة طويلة من الزمن يعتمد وبشكل كبير على دقة وضع اجزاء المفصل الاصطناعية.ان الجدل حول الجهاز المناسب لزرع الجزء الفخذي من مفصل الركبة الاصطناعي قد حل وبشكل كبير,لكن الجدل مازال حول استخدام جهاز دليل الاستقامة داخل او خارج نخاع العظم لغرض دقة الوضع الجانبي للجزء القصبي من مفصل الركبة الاصطناعي.الهدف : لغرض معرفة هل ان استخدام جهاز دليل الاستقامة داخل ام خارج نخاع العظم هو الادق للوضع الجانبي للجزء القصبي من مفصل الركبة الاصطناعي.المرضى والطرق : من 65 مريض تم تجميعهم, 48 مريض (55 ركبة ) فقط ادخلوا ضمن هذه الدراسة لملائمتهم الشروط المطلوبة لدخول البحث (32 امراة و16 رجل) بمعدل عمر 62,2 سنة وتتراوح اعمارهم بين 57 و70 سنة.تم استقبالهم في العيادة الاستشارية لجراحة العظام والكسور في مدينة الطب والعيادات الخاصة خلال الفترة مابين تشرين الاول عام 2010 واذار عام 2012. كل المرضى الداخلين بالبحث كانوا يعانون من سوفان متقدم في مفصل الركبة, وتم اجراء عمليات تبديل مفصل الركبة الكامل لهم.تم تقسيم المرضى الى مجموعتين, المجموعة الاولى ( ا ) وتتكون من 22 مريض (25 ركبة ) وتم استخدام دليل الاستقامة داخل نخاع العظم لوضع الجزء القصبي من مفصل الركبة الاصطناعي لهم. والمجموعة الثانية (ب) وتتكون من 26 مريض ( 30 ركبة ) وتم استخدام دليل الاستقامة خارج نخاع العظم لوضع الجزء القصبي من مفصل الركبة الاصطناعي لهم.وبعد ثلاثة اشهر من العملية تم اخذ الرقائق الشعاعية الجانبية لكل مريض في وضع الوقوف وعلى طول الطرف السفلي وتم قياس درجة الميلان الجانبي للجزء القصبي من المفصل الاصطناعي لكل مريض.النتائج : النتائج الدقيقة لدرجة الميلان الجنابي للجزء القصبي من المفصل الاصطناعي كانت تشكل 80 % ( 20 ركبة من اصل 25 ) في المجموعة ( ا ) , وكانت تشكل 43,3% ( 13 ركبة من اصل 30 ) في المجموعة ( ب ).الاستنتاج : ان استخدام دليل الاستقامة داخل نخاع العظم بالنسبة لدقة وضع الميلان الجانبي للجزء القصبي من مفصل الركبة الاصطناعي ادق احصائيا من استخدام دليل الاستقامة خارج نخاع العظم.الكلمات المفتاحية : داخل نخاع العظم ,ضد,خارج نخاع العظم ,دليل الاستقامة القصبي, تبديل مفصل الركبة الكامل.

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