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Article
Comparison between dome and wedge osteotomy in management of hallux valgus deformity
مقارنة بين بضع العظم والقبة إسفين في إدارة تشوه أروح الإبهام

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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
Using the Ilizarov technique for the correction of coxa vara

Authors: Dhulfikar I. Saeed --- Zaineb Abdul-wahab Mohamad
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2019 Volume: 23 Issue: 1 Pages: 11-18
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Coxa vara was treated previously by subtrochanteric and inter-trochanteric valgus osteotomies with internal fixation. Recently; more attention was paid for achieving corrections of limb deformities and length discrepancies through less invasive means using external fixator systems including Ilizarov fixation. This study aimed to describe the performance of Ilizarov fixation technique in the surgical correction of coxa vara of different etiologies and limb lengthening. Methods: In this case series study, nine patients (11 hips) with coxa vara of different etiologies were treated surgically by sub-trochanteric osteotomy done percutaneously with the use of Ilizarov fixation device, in 15 months at Erbil teaching hospital. Patients between four and ten years of age with coxa vara with neck – shaft angle less than 120° or Hilgenreiner epiphyseal angle of more than 40° were included in this study. Results: All osteotomies achieved the targeted correction in the Hilgenreiner –epiphyseal angle and the neck-shaft angle with a P value <0.001. All osteotomies healed primarily and on follow-up, no intra-operative complications developed, and no patient needed the post-operative blood transfusion. Three patients needed limb lengthening, one patient needed shelf osteotomy, and two patients had superficial pin tract infection. Four patients had postoperative knee stiffness which resolved completely. Radiological analysis revealed a maintained improvement in the Hilgenreiner-epiphyseal angle and neck-shaft angle.Conclusion: Ilizarov technique is a safe and less invasive technique for the surgical management of coxa vara of different etiologies and limb length discrepancy.


Article
Open Osteotomy of ulna as a ModelFor Fracture Healing Studies in Rabbits

Author: Mahmood A. Aljumaily
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2010 Volume: 52 Issue: 3 Pages: 258-261
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Bone healing of fractures is still an open field for research due to its biological complexity. Adequately adapted experimental model is essential for understanding the factors influencing the biological process of bone healing. Rabbits provide a good animal model for bone healing studies; its bone had Haversian system similar to human.
Material and Methods: Six young locally breaded New Zeeland male rabbits were used in this study, the study conducted in animal house in college of medicine at November and December 2009. Surgical fracture (osteotomy) induced operatively in right ulna under general anesthesia by a hand saw. At the end of fifth weeks, the animals' scarified and the specimens taken for radiological, computerized tomography (CT) scan densimetry and histological examination carried out for bone healing in site of osteotomy
Results: All bone osteotomy united at end of fifth weeks macroscopically and radiologically. There was no significant difference in serum calcium, serum phosphate, and serum alkaline phosphatase preoperatively and at end of fifth weeks. The callus density was measured in site of osteotomy by CT scan densimetry and its mean was 302 ± 142. The histological examination of the bone at site of osteotomy show healing with woven bone predominantly with some lamellar bone and cartilage. Conclusion: The present study demonstrated that the ulnar osteotomy without use of external splintage or internal fixation model is a new, easy to perform and can be used as a model for fractures healing studies.

Keywords

rabbit --- ulna --- osteotomy --- and bone healing.


Article
The use of the three sided flab in the maxillary anterior segmental osteotomy

Authors: Ne`am F. Yasen --- Ayad M. Isma`el --- Bassam F. Yasen
Journal: Al-Rafidain Dental Journal مجلة الرافدين لطب الأسنان ISSN: 18121217 Year: 2011 Volume: 11 Issue: SpIss Pages: S259-S264
Publisher: Mosul University جامعة الموصل

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Abstract

Aims:Evaluation of new surgical approach to anterior maxillary segmental osteotomy (AMSO). Materials and Methods: Twenty five jaws operated on for AMSO with the use of three sided flap, using sulcular type of incision of the soft tissues to access the bone to be osteotomized. Patients underwent surgical correction under general anesthesia and follow up extended postoperatively till complete healing process occurred nearly six months later. Results: From the total number of cases, twenty four jaws healed properly; and only one jaw (premaxilla) was lost due to necrosis of bone with loss of the associated teeth due to accidental and complete detachment of bone from the overlying soft tissues during surgery, although this procedure offers the avoidance of loss of any part of the soft tissue envelope. Conclusion: The three sided sulcular incision doesn’t interfere with blood supply of both hard & soft tissues, with many advantages over other types of access flaps


Article
The Direction Of Distal Segment Relapses After Mandibular Setback Surgery Vertical Ramus Versus Bilateral Sagittal Split Osteotomies

Authors: Ra'ed Mohammed Ayoub Al-Delayme --- Qutabah Abdul Razak --- Hassan Ali Hamzah
Journal: Journal of University of Babylon مجلة جامعة بابل ISSN: 19920652 23128135 Year: 2013 Volume: 21 Issue: 3 Pages: 1076-1085
Publisher: Babylon University جامعة بابل

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Abstract

The present study evaluates the direction of postoperative horizontal and vertical changes (relapse) that occur at B point and pogonion after vertical ramus osteotomy (VRO) without fixation and bilateral sagital split osteotomy (BSSO) with semirigid internal fixation in mandibular setback operation in eleven patients with mandibular setback operation B.S.SO (n=6), V.R.O(n=5) .Postoperative changes (relapse) of B-point and Pogonion in horizontal and vertical axis from 1 week post operatively (T0) to 1 year post operatively (T2) were assessed and compared with initial direction of set back. In all VRO cases, distal segments moved posteriorly and inferiorly immediately after the release of MMF.As for in BSSO cases, distal segments moved anteriorly and supereriorly immediately after the release of MMF

إن الهدف من هذه الدراسة هو تقيم اتجاه النكس الحاصل بعد عمليات ارجاع الفك السفلي في الاتجاهين الأفقي و العامودي عند النقطة (ب) و النقطة (بوكونيون) عند اجراءعمليات النشر العمودي للشعبة الصاعدة بدون استعمال أي تثبيت مع النشر القسمي للشعبة الصاعدة وباستعمال تثبيت شبه صلب لدى احد عشر مريضا يعانون من سوء إطباق هيكلي من الصنف الثالث .حيث تبين انه في كل حالات النشر العمودي تحركت القطعة البعيدة بالاتجاه الخلفي و السفلي بعد إزالة التثبيت بين الفكين إما حالات النشر ألقسمي ثنائي الجانب 0تحركت بالاتجاه الأمامي و العلوي بعد إزالة التثبيت بين الفكين


Article
Clinical Implications In Pyle`s Disease, (Familial Metapyseal Dysplasia), Report Of Five Cases with Review Of The Literature.
التقديمات السريرية للمرضى المصابين بتشوه نهايات العظام الطويلة العائلي (( مرض بايلز)) خمس حالات مسجلة مع مراجعة العلوم الطبية ذات العلاقة

Author: Sameer A. Kitab سمير عبد الامير كتاب
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2011 Volume: 53 Issue: 4 Pages: 381-385
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Pyle`s disease is a distinct skeletal dysplasia with defective metaphyseal modeling and Erlenmeyer-flask deformity of tubular bones. Objectives: Clinical implications in five reported cases with mechanical bone properties different from normal bones were presented. One patient with Genu-valgum deformity had corrective osteotomy done with internal fixation showing osteotomy healing and sustained deformity correction with more than twelve years of follow up. Two patients presented with fractures and angular malalignment with abundant callus .The other two had insufficiency fractures due to repetitive low energy activities.Results: Patients with Pyle`s disease have less than normal mechanical bone properties, insufficiency fracture or gross fractures may develop after low energy or repetitive trauma. Internal fixation can be used and healing may progress with abundant callus.Conclusions: Pyle`s disease stands as a distinct type of metapyseal dysplasia with characteristic clinical-radiological criteria.Genu valgum deformity may warrant osteotomy correction, Internal Fixation can be used and osteotomy may be rapid to heal with the widened bone surfaces. Protection against potential angular malalignment is important until there is sound healing of the fractured bone. Because of increased fragility of bone, a word of caution may be appropriate in the young patient indulged with sports activity.

خلفية الدراسة : مرض بايلز تشوه نمو نهايات العظام العائلي هو مرض يصيب نهايات العظام الطويلة مع تشوه يشبه شكل قدح الاختبار المختبري.المرضى وطرق العمل : العلامات السريرية لخمس حالات مسجلة من مرض بايلز (بايلز) تميزت بصفات ميكانيكا حياتية تختلف عن صفات العظام الطبيعية قدمت في البحث. المريض الاول كان لديه انحراف الركبتين الى الجهة الوحشية اجريت لها عملية قص وتعديل العظم مع تثبيت داخلي . تم التئام العظم وتمت متابعة الحالة لمدة اثنى عشر سنة.مريضان اخران لديهما كسر اجهادي في العظم بسبب ضعف العظام في مثل هذه الحالة. ومريضان اخران كان لديهما كسر في العظم مع انحراف وعلامات التئام تختلف عن علامات التئام العظام الطبيعية.النتائج: تتميز عظام المرضى المصابين بمرض بايلز بصفات ميكانيكا حياتية تختلف عن العظام الطبيعية ، ومن الممكن ان يصابوا بكسور اجهادية مع قابلية انحراف الكسر وعلامت التئام تختلف عن علامات التئام العظام العادية . من الممكن استخدام التثبيت الداخلي لحللات الكسور في مرض( بايلز).الاستنتاج: يتميز مرض بايلز بخصائص ميكانيكا حياتية متميزة عن خصائص العظام الطبيعية مما يجعلها عرضة للكسور الاعتيادية والاجهادية مع علامات التئام خاصة . كما يجعلها عرضة للانحراف والتشوه بسبب ضعف العظام. ينصح هولاء المرضى باجراءات الحماية في حالات الاجهاد والرياضة العنيفة. ومن الممكن استخدام التثبيت الداخلي في علاج كسور العظام مع حماية كافية لحين التئام العظم بصورة مستقرة.


Article
Management of DDH in children between age of (1-2.5) years old by open reduction & derotation osteotomy without pelvic osteotomy

Authors: Raed Abbas Saadoon --- Mohammed Jafer Jawad
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2016 Volume: 15 Issue: 2 Pages: 1-8
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background; Developmental dysplasia of the hip (DDH) means femoral head subluxation or dislocation and/or acetabular dysplasia. Management of neglected (DDH) in children after the walking age is challenging to the orthopedic surgeons. It is usually surgically demanding procedures at this age group. There will be always children who reach walking age with DDH, either secondary to failed treatment or delayed diagnosis. Aims: To evaluate the results of open reduction & derotation osteotomy in treatment of DDH in children without pelvic osteotomy. Methods: At the Orthopedic Department in AL-Yarmook hospital from the period of December 2010 to November 2015. Twenty-three patients (3 patients had bilateral DDH) [26 hip joints] with DDH, the age of patients at time of the operation ranged from (12-30) months, treatment done in two stages open reduction (1st stage) and derotation osteotomy of femur (2nd stage), except Five cases, we did open reduction, shortening & derotation osteotomy in one session because of difficulty in reduction. Final functional & clinical evaluation of patients were done according to a combination of modified MacKay criteria and modified Harris hip score. Radiological evaluation at the end of follow-up was done according to the modified Severin radiographic criteria. Results: - The overall final clinical results were excellent in 8 hips (30.8%), good in 16 hips (61.6%), fair in one hip (3.8%) and poor in one (3.8%), satisfactory (excellent and good) in 24hips (92.3%) and unsatisfactory (fair and poor) in 2 hips (7.7%).The radiological end result was Class I (excellent) in 15 hipss (57.7%), Class II (good) in 10 (38.5%), Class III (fair) in one (3.8%). The results were satisfactory in 25 (96%) hips and unsatisfactory in one (4%) hip. Conclusion: We concluded that operative treatment of neglected DDH ( after the age of walking ) is a surgically demanding procedure but when it performed properly by an open reduction & derotation osteotomy with spending good time for cleaning of acetabulum & excise part of capsule with secure capsulorraphy without need for pelvic osteotomy for those children below age of 2.5 years old.


Article
Bladder exstrophy closure using anterior pelvic osteotomy of superior pubic rami
غلق المثانة المنقلبة باستخدام طريقة القطع الامامي للفروع العانية العليا لعظم الحوض

Author: Moaied A. Hassan مؤيد حسن
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2015 Volume: 57 Issue: 3 Pages: 201-204
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Bladder exstrophy is a rare and complex urogenital malformation. The current surgical approach consists of early closure followed by other procedures later on aiming for continence. Primary closure usually requires some form of osteotomy to facilitate successful bladder and abdominal wall repair. For decades, bilateral posterior iliac osteotomy has been the most commonly used technique. A new osteotomy technique, consisting of anterior pelvic ostecotomy of the superior pubic ramus, seems to be a safe and quick alternative method to obtain tension-free approximation of the symphysis pubisPatients and methods: A prospective study between 2006 and 2013, were 10 (9 males and 1 female) newborns underwent surgery for bladder exstrophy closure in the pediatric surgery department, using anterior pelvic osteotomy of superior pubic rami to achieve tension-free approximation of the symphysis pubis and successful repair.Results: Successful closure was achieved in 90% of the patients operated upon. Only 1 patient had wound dehiscence and failure of the repair. The procedure was safe, quick with minimal blood loss and was performed by the pediatric surgeon without the need to an orthopedic surgeon. Conclusion: Anterior pelvic osteotomy of superior pubic rami in an effective alternative measure to obtain tension-free approximation of the symphysis pubis, and hence successful bladder exstrophy repair. It provides further advantages namely, ease and rapidity, minimal blood loss, and no requirement for an extra skin incision or patient's repositioning.Keywords:-Bladder exstrophy, closure, pelvic osteotomy, superior pubic rami.

المقدمة :-تعد المثانة المنقلبة من التشوهات الخلقية النادرة والمعقدة التي تصيب المجمع البولي التناسلي. إن إسلوب العلاج الجراحي الحالي يتألف أساساً من الغلق المبكر متبوعاً بإجراءاتٍ أخرى في وقت لاحق تهدف إلى تحقيق السيطرة على التبول.إن الغلق الإبتدائي أو المبكر يحتاج عادة إلى أحد أشكال قطع عظم الحوض لتسهيل إصلاح المثانة وجدار البطن بنجاح. لعقود مضت كان القطع الخلفي المزدوج للعظم الحرقفي هو الطريقة المتبعة والأكثر شيوعاً. لقد تم تطوير طريقة جديدة تعتمد على القطع الامامي للفروع العانية العليا لعظم الحوض. لقد بدت هذه الطريقة بديلاً سريعاً وأميناً لتحقيق مقاربة خالية من الشد للإرتفاق العاني.المرضى والطرائق:-لقد تم إجراء دراسة إستباقية للفترة ما بين عامي 2006 و 2013 تضمنت 10 أطفال حديثي الولادة ( تسعة ذكور وأنثى واحدة) مصابين بمثانة منقلبة وقد تم إجراء الغلق الإبتدائي لهم بالإعتماد على طريقة القطع الامامي للفروع العانية العليا لعظم الحوض.النتائج :-لقد كان الغلق ناجحاً في 90% من المرضى الذين تمت معالجتهم. تم تسجيل حالة فشل الإصلاح وتفزر الجرح لدى مريض واحد فقط. لقد كانت هذه الطريقة أمينة وسريعة وكان معدل فقدان الدم متدنياً جداً وتم إجراؤها من قبل جراح الأطفال بدون الإستعانة بجراح العظام.الإستنتاج :-إن طريقة القطع الامامي للفروع العانية العليا لعظم الحوض تعد بديلاً فعالاً للطرق التقليدية الأخرى في تحقيق مقاربة خالية من الشد للإرتفاق العاني وبذلك تحقق الإصلاح الناجح للمثانة المنقلبة. إضافةً لذلك فإنّ هذه الطريقة توفر ميزات أخرى كونها بسيطة وسريعة ومعدل فقدان الدم متدني جداً مع عدم الحاجة لإعادة تموضع المريض وإجراء شق إضافي في الجلد.مفتاح الكلمات: بروز المثانة، غلق، تفويه القولون الحوضي، العظم الفرعي العاني العلوي

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