bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the Different Methods of Optic Disc Examination in Glaucomatous Patients
Authors: Shabaan Yasmine M , Abd-Elshafik Mohamed A , Gharib Hesham M , Hefny Mostafa M
Published: November 2024

Background

Glaucoma is the second leading cause of irreversible blindness worldwide. It affects the nerve fiber layer which forms the optic nerve. Many patients discover glaucoma accidently when they’re doing regular checkups. Glaucoma may have no specific symptoms until the advanced stages and it can be diagnosed by measuring intra ocular pressure, optic disc evaluation and visual field examination. The present work aims at evaluation of different methods in optic disc examination in glaucoma patients to detect their efficacy in diagnosis and follow up.

Purpose

To evaluate the agreement among slit lamp biomicroscopy, stereoscopic fundus photography and OCT in glaucomatous patients regarding Disc area, Cup area and vertical cup disc ratio (VCDR).

Material and Methods

14 known glaucomatous patients were included in this cross-sectional observational descriptive. All patients under went slit lamp biomicroscopy examination by using +90 lens, stereoscopic fundus photography to obtain 3D image for optic disc and using computerized program to measure the optic disc parameters and Optical Coherence Tomography for the optic disc.

Results

Comparing each examiner values measured on stereoscopic fundus image in comparison with OCT. Examiner one have a moderate reliability regarding disc area, cup area and VCDR with ICC 0.67, 0.67 and 0.50 and P values 0.68, 0.61 and 0.01 respectively and examiner two have a moderate reliability regarding disc area, cup area and VCDR with ICC 0.66, 0.63 and 0.54 and P values 0.16, 0.69 and 0.03 respectively and examiner 3 has a moderate reliability regarding disc area and VCDR with ICC 0.65, 0.71 and P value 0.69, 0.07 respectively while a good reliability for cup area with ICC 0.82 and P value 0.02. Comparing values obtained by slit lamp using +90 lens and stereoscopic fundus photography regarding VCDR there is a moderate reliability with ICC 0.50 and P value 0.06 for examiner one only.

Conclusion

The results of the present study showed that there is an moderate agreement between stereoscopic fundus photography and OCT and slit lamp values regarding disc area, cup area and CD ratio.
Modified Stoppa Approach versus Ilioinguinal Approach in Pelvi-Acetabular Fracture
Authors: Diab Abdelrahman Ahmed Elsayed , Elganzory Ibrahim Mostafa , Sallam Haitham Emad Elden Hafez
Published: November 2024

Background

Various epidemiological studies have revealed that the incidence of acetabular fracture is increasing rapidly. The most critical step in the treatment of displaced acetabular fracture is the anatomical reduction of the articular surface and stable fixation as well as the use of appropriate surgical approach to achieve good clinical outcomes.

Aim of the Work

to perform a systematic review to compare between modified Stoppa approach and ilioinguinal approach regarding Blood loss, Operative time and Complications in pelvi-acetablar fractures

Patients and Methods

On June 2022, we systematically searched the PubMed, the Web of Science, and the Cochrane Library electronic databases for relevant articles. The following terms were used for our search: acetabular fracture, approach and (comparison or versus Stoppa Approach, Ilioinguinal Approach, Pelvic fractures, Acetabular fractures and Pelvi- Acetabular Fractures.). We also checked the reference lists in the retrieved articles in order to include additional studies that met the criteria but had not been identified by the electronic search. All studies identified were individually assessed for inclusion in our study.

Results

That operative time was significantly shorter with the MS approach than with the IL approach and this was statistically significant. The main result of our results was post operative outcome was significantly better with the MS approach than the IL approach. In our study, there was no significant difference between the two approaches as regards postoperative complications except in nerve injury.

Conclusion

Our findings reveal that both the Modified Stoppa Approach and the Ilioinguinal Approach are viable options for the surgical management of pelvi-acetabular fractures. The choice between these two approaches should be tailored to individual patient factors, specific fracture patterns, and surgeon expertise. While the Modified Stoppa Approach may be associated with a lower incidence of certain complications, such as neurovascular injuries, the Ilioinguinal Approach provides better access to specific fracture types and may be favored in cases of associated anterior column or anterior wall involvement. Additionally, functional outcomes and long-term patient satisfaction appear to be comparable between the two approaches.
Functional Outcomes of PFN Fixation and Hemiarthroplasty of Unstable Intertrochanteric Fractures in Elderly A Comparative Study
Authors: Al-Gizawy Abdelrahman Ayman Farouk , Kamal Asal Mohamed , Sallam Haitham Emad Eldin Hafez
Published: November 2024

Background

Unstable Intertrochanteric Fracture of femur in elderly forms a great challenge to orthopedic surgeons, the aim of the management is early ambulation and good functional outcome also avoiding complications as the elderly patients often have several comorbidities.

Aim of the Work

To compare Functional hip outcome between active elderly patient who receive either a bipolar hemiarthroplasty or fixation via proximal femoral nail, after an unstable intertrochanteric femoral fractures through HHS.

Patients and Methods

prospective Cohort study was conducted at Ain Shams university hospitals recruiting 48 active patients aged from 60 and above with unstable intertrochanteric fracture femur starting from November 2022 till January 2024. We excluded patients with pathological fractures, revision cases and patients unfit for surgery. Patients were in 2 groups each group 24 patients, one group for PFN fixation and the other for Bipolar Hemiarthroplasty (BHA). The mean follow-up period was 1 year.

Results

In this study, we found that there is statistically significant difference between PFN and BHA regarding the functional outcomes towards the PFN

Conclusion

For the healthy elderly with Unstable intertrochanteric Femoral Fractures. Fixation with PFN appeared to be superior with respect to HHs as indicator to Functional outcomes.
Acetabular Reconstruction after Periacetabular Tumor Resection: A Systematic Review and Meta-Analysis
Authors: Al Masry Ayman Mohammed , El Mowafi Mohamed Ahmed , Mohammed Abdelrahman Gamal
Published: November 2024

Background

Periacetabular oncological lesions may present in various areas of the acetabulum and be of varying size. Many types of reconstruction are available for their treatment to deal with defects after tumor resection but which technique is optimal remains controversial.

Objective

To evaluate different methods and approaches of acetabular metallergic reconstruction after periacetabular tumor resection as regards surgical techniques, clinical, functional, oncological outcomes and possible complications.

Methods

This systematic review and meta-analysis study included twenty five studies with a total of 846 cases to evaluate different methods of acetabular reconstruction after periacetabular tumor resection as regards surgical techniques, clinical, functional, oncological outcomes and possible complications. We conducted a systematic review of literature in different databases and with pre-specified eligibility criteria and according to Cochrane’s handbook of systematic review guidelines in screening, we concluded sixteen different studies to be included in our study. Data were obtained from text, tables, figures, and supplementary data. We focused on the following outcome measures: operative time, blood loss, postoperative complication, MSTS score, and implant survival rate. Risk of bias assessment was done according to GRADE guidelines to every study using Cochrane’s risk of bias tool.

Results

Regarding implant survival analysis, the current study detected that first year survival rate was as following; constrained-type hip tumor prosthesis was 91%, ice-cream cone prosthesis was 72% and for Iliac Stem prosthesis first year survival rate was 90%. 3-year survival rate, the present study pooled result for the odds of three year survival for hemipelvic endoprosthesis (OR = 0.78, 95%CI = [0.71, 0.88], I 2 = 59.7%, P value=0.04), three year survival rate for the rest was as following; constrained-type hip tumor prosthesis was 62%, ice-cream cone prosthesis was 58% and for Iliac Stem prosthesis first year survival rate was 70%. 5 year survival, best results were achieved by Compound osteosynthesis 93.3 % followed by LUMiC ndoprosthetic 83%.

Conclusion

The choice of the best method of reconstruction after periacetabular tumor resection should be tailored according to each case, depending on many factors such as, age, daily activity, general condition, tumor type and human size. However, hemipelvic endoprothesis and ice cream cone prothesis may be the treatment of choice in young active patients, while in elderly with multiple comorbidities 3D printing represent the best option according to its availability
Femoral versus Acetabular Containment Procedures in Perthes Disease: A Systematic Review and Meta-analysis
Authors: Ahmed Adel Alaa Refai , Mahran Mahmoud A , Baraka Mostafa M
Published: November 2024

Background

Perthes disease is a rare childhood condition that affects the hip. It occurs when the blood supply to the rounded head of femur is temporarily disrupted. Without an adequate blood supply, the bone cells die, a process called avascular necrosis. There is limited data about surgical options in treatment of Perthes disease. The authors conducted this systematic review and meta-analysis to compare between femoral versus acetabular containment in the management of Perthes disease in terms of efficacy and complications, however there is a debate about the ideal way of treatment in Perthes disease.

Objective

To compare between femoral varus and acetabular containment osteotomies in children with Perthes disease, regarding the efficacy, long-term outcomes and complications.

Methods

This systematic review and meta-analysis examined studies that compared FVO and Pelvic Osteotomy. The authors searched the Medline database via PubMed, EMBASE, and Cochrane Library for studies published between 2012 and 2022.

Results

A total of 1051 patients were analyzed for different procedures, including 429 patients in the pelvic arm, 459 patients in FVO arm, and 163 patients in the combined arm. The number of hips included in the current analysis was 1069 hips, including 437 in pelvic arm, 469 in FVO arm, and 163 in the combined arm. The mean age for the included patients was 9.5±7.74 years, with 859 (81.8%) males and 192 (18.2%) females. There was an apparent predominance in males vs. females in all arms. The mean follow-up of the included studies was 8.6±8.32 years. We compared between the three procedures clinically, radiographic and complications. (FVO: Femoral varus osteotomy).

Conclusion

Femoral varus osteotomy and Pelvic osteotomy have shown comparable clinical and radiological improvement in treatment of perthes disease. The FVO group has shown higher rate than pelvic or combined osteotomies regarding post-operative arthritis and decrease range of motion. The pelvic group has shown higher rate than FVO and combined osteotomies regarding post-operative impingement and leg length discrepancy. There was no significant difference between the pelvic, femoral and combined osteotomies regarding range of motion, Trendelenberg, limping, post-operative pain and secondary knee deformity. In summary, this review provides evidence that femoral and pelvic osteotomies are safe, effective methods in treatment.
Management of Intra-Articular Tibial Plafond Fracture Using Ring Fixator
Authors: Abou Seif Salah Abdel Gawad , Beshry Shady Samir El , Mounir Ayman Fathy , Galhoum Ahmed El Sayed Yosef
Published: November 2024

Background

Intraarticular fractures of the distal tibia is a challenging condition that requires surgical intervention in the majority of cases. Due to the nature of the injury and the vulnerable soft tissue envelope around the ankle and distal tibia, skin necrosis and soft tissue devitalization is a major concern. Open reduction and internal fixation offers a reliable method to restore the anatomy and to maintain the length of the limb, however, in many cases this approach might not be ideal and get complicated with skin sloughing and necrosis.

Aim of the Work

To evaluate the role of ring external fixator in the management of intra articular fractures of the tibial plafond and to assess the functional outcome and patient satisfaction following this procedure.

Patients and Methods

Ring External fixation with minimally invasive AO screws offer another reliable alternative that achieves the reduction and allows for soft tissue healing. In this study we prospectively treated 30 patients who presented with distal tibia intraarticular fractures using Ilizarov frames in combination of minimally invasive AO screws. The minimum follow up was 4 years and the outcome was assessed radiologically and functionally using AOFAS scores.

Results

The results showed that 96% of the patients achieved bony union and satisfactory functional scores. There was no incidence of skin or soft tissue necrosis apart from superficial pin tract infection that was treated successfully. Three patients developed ankle OA four years post operatively that was managed later with ankle fusion. One patient experienced non union and was managed with pantalar ankle fusion. The Mean AOFAS scores at 12 months and 48 months were 76.2±8 Range (59-89) and 75.1±11 Range (37-91) respectively. In addition, we found that smokers within the study group had significantly lower AOFAS scores than non-smokers.

Conclusion

Ilizarov external fixation with minimally invasive AO screws is considered a reliable and safe way to manage intraarticular fractures of the distal tibia that respects the soft tissues and produce good functional results.
Superior Capsular Reconstruction Versus Reversed Total Shoulder Arthroplasty in Management of Massive Irreparable Rotator Cuff Tear: A Systematic Review and Meta-analysis
Authors: Mahmoud Ali Gamal Ali , Ghazaly Sherif Ahmed El , Kotb Ahmed Mostafa
Published: November 2024

Background

rotator cuff pathology is one of the most common sources of shoulder disability and among the prevalent conditions treated by orthopaedic surgeons. Irreparable rotator cuff tear is generally large tear (in both anterior-posterior and medial-lateral dimensions) and retracted with poor attenuated tissue quality, muscular atrophy and fatty infiltiration.

Aim of the Work

to conduct a systematic review about superior capsular reconstruction Versus reversed total shoulder arthroplasty in treatment of massive irreparable rotator cuff tears aiming to reach a conclusion regarding superiority of one technique over the other. We may then present recommendations to orthopaedic surgeons to facilitate decision-making when approaching such cases.

Patients and Methods

this systematic review will be performed following the preferred reporting items for systematic reviews meta-analysis (Prisma). Six guided items and check list to answer the question of: comparison study between superior capsular reconstruction and reversed total shoulder arthroplasty in treatment of massive irreparable rotator cuff tears. Patients with irreparable rotator cuff tear of both gender and patients older than 18 years.

Results

all outcomes showed improvement in all studies either clinically and radiologically, also all studies had low complications rate as the following with variation of significance and heterogenicity between each group of studies. The mean age of patients underwent SCR was 64.7 ± 5.89 years, while for patients underwent RTSA; the mean age was 68.1 ± 22.18 years with metanalysis between the two groups; showing significant difference between them (p- value:0.0001) as the SCR operation was decided for age group younger than patients underwent RTSA with mean difference 5.24 (95% CI [ 2.57, 7.9]) years. Both SCR and RTSA showed significant improvement post operatively with functional scores and in active range of motion with no significant difference between the two operations except with JOA score and Constant score; both showed difference between the two groups favoring SCR over RTSA, (p-value:0.001) with JOA and (p-value:0.04) with constant score.

Conclusion

based on the evidence presented, both SCR and RTSA showed significant improvement in post-operative outcome measures in management of MIRCTs. All outcome measures showed comparable results with both SCR and RTSA except in JOA score and constant score, both showed significant improvement favoring RTSA. RTSA was the preferred choice for elderly patients with higher grade of glenohumeral arthritis and it was the most common revision surgery after failed SCR. It is preferred to mention SCR as the joint preserving surgical technique and that is why it would be the preferred technique in young age patients with relative lower grades of glenohumeral arthritis.
Eight Plate & Single Screw for Temporary Epiphysiodesis for Genu Varum and Genu Valgum Systematic Review and Meta-Analysis
Authors: Ragheb David G , Fayyad Tamer A , Nageeb Ahmed M
Published: November 2024

Angular deformities of lower limbs are a common finding in children. Although most of these correspond to physiological conditions that resolve spontaneously without intervention, some deformities persist through preadolescence and will not correct spontaneously. This review providing the best evidence for correction of genu varum and genu valgum by hemiepiphysiodesis. The literature extraction process yielded 38 articles for inclusion in this review.

Purpose: Aim of this review to compare, through the available literature and comparing between 8 plate & single screw for temporary epiphysiodesis for genu varum and genu valgum. Various techniques for epiphysiodesis involving screws, staples and wires have been trialled and described. However, good success rates, complications such as material fractures and implant loosening as well as damage to growth plates have frequently been reported.
Outcomes of Figure of Eight Graft Reconstruction of Anterior Sternoclavicular Joint Dislocation: A Systematic Review and Meta-Analysis
Authors: Abdullah Islam Abdullah Ahmed , Atiyya Ahmed Naeem , Ghazaly Sherif Ahmed El
Published: November 2024

Background

A sternoclavicular (SC) joint dislocation is a rare injury, accounting for 1% of all traumatic joint dislocations. Dislocation of the SCJ is a rare injury and typically requires high- energy forces applied directly or indirectly to the joint. Although anterior sternoclavicular dislocations are more common because of the strength of the posterior joint capsule, posterior sternoclavicular dislocations tend to be more morbid because of the risk of tracheal, esophageal, or neurovascular compression. Even after appropriate treatment of the initial dislocation, patients can occasionally have persistent SCJ instability that may present as pain and scapular dyskinesia.

Objective

To perform a systematic review on results of reconstruction of anterior sternoclavicular joint dislocation via figure of eight graft, aiming at highlighting clinical and functional outcomes of this technique.

Patients and Methods

This is a systematic review study and meta-analysis on human subjects studied in different literatures collected from different medical websites up to December 2022 that dealing with the reconstruction of anterior sternoclavicular joint dislocation via figure of eight graft, aiming at highlighting clinical and functional outcomes of this technique. The study was performed in the Orthopedic Surgery Department, Faculty of Medicine, Ain Shams University along the period from August 2022 to January 2023.

Results

The meta-analysis for postoperative complications showed non-significant difference (P = 0.068). This indicated that this technique had low risk of complications. Forest plot and pooling of data using random-effects method (REM) with 95% CI found minor heterogeneity (I2 = 38.4%) non- significant difference (p > 0.05) in complications of this operative technique. The funnel plot for postoperative complications found no evidence of publication bias with symmetrical funnel plot. Rank correlation test and regression analysis for funnel plot asymmetry was insignificant (r = 0.0852, p = 0.068) for postoperative complication of anterior sternoclavicular joint dislocation operated by 8-shaped autologous graft.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2020.

Conclusion

SC joint reconstruction, using a gracilis graft, results in a prolonged improvement in shoulder function in most patients with symptomatic chronic anterior SC instability. The technique aims at reducing the risk of serious vascular and functional complications, but extreme care is still needed during the procedure.
Functional Outcomes after Total Hip Arthroplasty versus Hemiarthroplasty for the Treatment of Displaced Femoral Neck Fracture in Active Elderly Patients
Authors: Ramzy Awad Kirollos Hany , Zaher El Zaher Hassan El , Nagy Amr Mohammed
Published: November 2024

Background

Fracture neck of femur has always been a great challenge to orthopedic surgeons, the aim of the management is early ambulation and good functional outcome also avoiding complications and reoperation as the elderly patients often have several comorbidities.

Aim of the Work

To analyse Functional hip outcome as the primary end-point, after a displaced fracture of the femoral neck in a relatively healthy, active elderly patient who receive either a bipolar hemiarthroplasty or a Total Hip Arthroplasty.

Patients and Methods

Retrospective Cohort study was conducted at Ain Shams university hospitals recruiting 20 active patients aged from 60 to 80 years old with fracture neck of femur starting from January 2021 till January 2022. We excluded patients with grade 3 hip osteoarthritis (Tonnis classification), acetabular dysplasia and with previous ipsilateral hip surgeries. Patients were in 2 groups each 10 patients one for THA and the other for BHA. The follow up period was 1 year.

Results

In this study, we found that the duration of surgery, blood loss, and amount of blood transfusion were considerably less in the BHA group. These findings corroborate with the results of multiple studies and reviews on the topic conducted in the past both in the western and Indian populations. In elderly patients, the treatment outcome is significantly affected by the duration of surgery and the amount of blood loss.

Conclusion

For the healthy elderly with displaced FNFs. None of these treatment options (THA, BHA) appeared to be superior with respect to mHHs as indicator to Functional outcomes. BHA led to better outcomes regarding dislocation rate, while THA was more favorable regarding reoperation rate.
Open versus Percutaneous Repair of Acute Achilles Tendon Rupture A Systematic Review
Authors: Ahmed Mahmoud Gamal , Saeed Diab Hossam , Haroun Yahia Mohamed
Published: November 2024

Background

The optimal treatment of acute Achilles tendon ruptures (AATR) is still under debate. It is most frequently ruptured in the 3rd and 4th decade of age.

Objective

The aim of this study was to compare open repair and minimally invasive repair in acute Achilles tendon rupture in adults regarding operative techniques, functional outcome and complications.

Patients and Methods

This systematic review included 6 articles with 329 patients. There were 165 patients had open repair and 164 patients by percutaneous repair with a mean follow-up of 23 months (range 20–24 months). Variables of each article were recorded and analyzed with respect to age, sex, follow-up, complications, and final outcomes.

Results

Percutaneous technique was much faster than open repair but regarding time to return to work, open repair patients had fewer weeks than the percutaneous. Complications were less in percutaneous repair except sural nerve injury.

Conclusion

The review has showed out that minimally invasive techniques clinically and biomechanically suitable alternatives to open repair based on both clinical outcomes and complication.
Comparison of Clinical Outcomes of Arthroscopic Versus Mini-Open Rotator Cuff Repair
Authors: AbdElhady Amr Mohamed , Ebied Wessam Eldin Fakhry , Farag Makarious Mousa
Published: November 2024

Background

The treatment of rotator cuff pathology has evolved with an improved understanding of rotator cuff anatomy, more sophisticated instrumentation, and advances in surgical technique. The most effective method of surgical repair is controversial given that both arthroscopic and mini-open rotator cuff repairs have been shown to produce satisfactory clinical results.

Aim of the Work

Compare between the outcomes of two techniques arthroscopic versus mini-open rotator cuff repair regarding functional outcome, postoperative complications.

Patients and Methods

This study is a Randomized control trials (RCT), and studies with level evidence 1 and Duration of follow up equal or more than 6 months. The systematic literature review was performed following the preferred items for systematic reviews meta-analysis (PRISMA) guided items and check list.

Results

Studies was pooled and reported ASES score showed insignificant difference between the two groups. We revealed that the pooled results showed statistically significant difference regarding clinical outcomes ROM (External Rotation) between groups. The pooled results showed no statistically significant difference regarding clinical outcomes forward flexion and pain score between groups and studies were pooled to compare complication between arthroscopic repair with mini open repair. Results showed insignificant difference between the two groups.

Conclusion

The effects of arthroscopic compared to mini-open rotator cuff repair, on function, pain and range of motion are too small to be clinically important at 3-, 6- and 12-month follow up, So the surgical choice should depend on the surgeon experience, and how much the aesthetic factor means to the patient.
Clinical and Radiographic Outcome of Anatomical Locked Plates in the Management of Proximal Tibial Fractures (A Case Series Study)
Authors: Morsi Ahmed Mohamed , Mohseb Ahmed Mohamed , Rezk Michael Refaat Shafik
Published: November 2024

Background

Intra-articular proximal tibial fractures account approximately for 1 % of all fractures in the general population and about 8 % of fractures in the elderly. Extra-articular proximal tibial fractures are estimated to be 5-10 % of all tibial fractures. Several fracture classifications exist, and the most widely used is the Anatomical AO/OTA classification. The goal of treatment for intra-articular fractures is to restore joint mobility, joint stability, articular surface congruence, and axial alignment, and to avoid posttraumatic osteoarthritis.

Objective

To assess the Clinical and Radiographic Outcome of Anatomical Locked Plates in the Management of Proximal Tibial Fractures.

Methods

This case series study was done at Orthopedic Surgery department of Ain Shams University Hospital from January 2023 and ended in January 2024 on 20 Patients who are skeletally mature, aged 18 and above of either sex, suffering from closed proximal tibial fracture.

Results

The radiological and functional results are promising. The functional results were all good or excellent according to (KSS). The KSS ranges from 70 to100 the mean was 90.25 points. 90% of cases were excellent and 10% were good. The Total Flexion range was between 115 and 132 degrees. The Total Flexion range mean was 123.1 degrees. There was no significant loss of knee ROM at the last follow-up.

Conclusion

Anatomical reduction is the most important factor in fixation of proximal tibial fractures. Fixation using an Anatomical Locked plate for proximal tibial fractures without using bone graft or bone substitutes is a viable option, helps surgeons achieve and preserve the anatomic joint line and normal mechanical axis, with superior functional results in the short term.
External Fixation versus Internal Fixation in the Treatment of Severe Grade of Blount’s Disease. A Systemic Review & Meta Analysis
Authors: Someel Mina Saad , Thakeb Moaatz Fouaad , Ahmed Ahmed Rayan
Published: November 2024

Background

Blount disease is a developmental condition characterized by a failure of endochondral ossification localized at the medial aspect of the proximal tibial physeal plate with consequent angular and rotational deformities of the lower limb.

Objective

To review systemically studies about External fixation versus internal fixation in the treatment of severe grade of blount’s disease.

Patients and Methods

This is a systematic review study and meta-analysis on human subjects studied in different literatures collected from different medical websites from 2011 till 2021 that dealing with external and internal fixation in Severe Blount’s disease, aiming at highlighting clinical and functional outcomes of both techniques.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021.

Data Extraction

If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.

Conclusion

Comparison of both preoperative and postoperative results of both internal and external fixation methods showed statistically non-significant difference.
A Systematic Review and Meta-Analysis Study in Functional Outcome between Olecranon Osteotomy and Triceps Anconeous Pedicle Elevation in Intercondylar and Supracondylar Humerus Fracture
Authors: Atiyya Ahmed Naeem , Soliman Ramy Ahmed Aly , Abdel-Nabi Seif Mohamed Abdel-Aal
Published: November 2024

Background

Approximately, 7% of all adult fractures involve the elbow, of these one third (2%) are distal humeral fractures. Articular fractures of elbow are the most difficult one to treat. Because of their complex anatomy, proximity to vital structures, injury patterns, associated osteoporosis in elderly patients and limited space for instrumentation. As far as we know, no previous meta-analysis study has investigated the privilege between olecranon osteotomy and triceps-reflacting anconeous pedicle (TRAP) regarding functional outcome and complications in the treatment of suprachondylar and interchondylar humerus fractures. Therefore, we performed this systematic review and meta-analysis study of this issue.

Methods

This meta-analysis study included all studies which comparing between TRAP and OO in the treatment of suprachondylar and interchondylar humerus fractures. The literature search was in the Web of Science, PubMed, Scopus, and Cochrane databases using advanced search strategy. The search results was screened using titles and abstracts then full paper. The following data were extracted: country, study design, sample size, baseline characters of included patients, intervention, outcomes, parameters measuring functional outcome as incidence of excellent and good elbow performance, Mayo elbow performance score, duration of operation, blood loss and, complications. The quality assessment was operated by ROBINS-I tool for assessment of risk of bias for non-randomized studies, cohort studies and the Cochrane RoB tool for randomized trials.

Results

This meta-analysis study included 10 studies. The result of meta-analysis study may be summarized as follow no statistically significant difference between operative time and blood loss during both approaches. No statistically significant difference between both approaches regarding MEPS score, DASH Score, incidence of excellent/good elbow function, supination and pronation. A significant increase in union time, extension deficit (degrees) and incidence of complications after OO approach comparing with TRAP approach. A significant decrease in ROM after OO approach comparing with TRAP approach.

Conclusion

TRAP approach is a better alternative to olecranon osteotomy approach in the treatment of inter-condylar and supracondylar humeral fracture. TRAP approach has privileges over olecranon osteotomy approach regarding post-operative union time, extension deficit, range of motion and incidence of complications.
Morbidity and Mortality of Surgical Management of Proximal Femur Fracture in COVID Positive Patients A Systematic Review and Meta-Analysis
Authors: EL-redi Mohamed Arafat Ahmed , Kamel Mohamed El-Sayed , El Hawi Ezzat Mohamed
Published: November 2024

Background

Corona virus disease 2019 (covid-19) which is caused by the novel severe acute respiratory inflammatory syndrome corona virus (SARS-CoV-2) lead to 21st century first pandemic crisis. First emerged in December, 2019 in China, and has since rapidly spread to become a world-wide pandemic. It affects healthcare system and patient’s morbidity and mortality rate. Orthopaedic surgery suffered a significant decline in the volume of surgical cases, while Emergency operations for proximal femur fractures (PFF) in the elderly population assumed levels comparable to before the pandemic, with the 1-year mortality rate ranging from 14% to 36%.

Objectives

To determine whether patients with proximal femur fractures and concomitant COVID-19 infection have a higher risk of postoperative mortality through a systematic review and meta-analysis.

Patients and Methods

The present systematic review will be performed in accordance with the preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search for all evidence published articles using the online databases MEDLINE, PubMed and Cochrane will be performed. The purpose of this search is to identify all eligible studies featuring co-morbidities and mortality in PFFS patient treated surgically.

Results

among 159 articles that came from the search query and hand-search, 24 studies included, 24 articles were eligible after applying inclusion and exclusion criteria. 15 comparative studies reported mortality for both covid +ve and non covid +ve pts underwent surgical management with total number of 78,486 patients, 569 /2744 covid +ve compared to 3567/75742 non covid +ve pts managed surgically had died. The overall mortality among covid +ve was 20.7% compared to 4.7% non covid +ve. Covid +ve pts had a significant higher mortality rate than non covid +ve pts. (Odds ratio 5.22, 95% CI (3.88-4.9), P value < .00001), and I2 = 27%. Sensitivity test was done without Egol et al., 2020 and show decreased heterogeneity I2 from 27% to 14%. 8 case series studies reported 27.9% mortality for covid +ve pts. The weighted mean of hospital length stay for covid +ve pts was 15.9 compared to 9.2 days for non covid +ve with Total WMD 5.99 days.

Conclusion

there is significant increase In 30 day mortality in covid +ve patients 4 Folds compared to non-covid patients. covid +ve patients underwent hip fracture surgery had a significant longer hospital length stay compared to non-covid patients with a weighted mean difference of 6 days, IMN usage show tendency to increased usage In studies with a higher mortality rates. ORIF associated with increased mortality rate than Arthroplasty.
Use of Cemented Standard Stem Arthroplasty for Unstable Inter Trochanteric Fractures in Elderly Patients
Authors: Elrahman Mohamed Abd , Bassiony Ayman Abdelaziz , Elmasry Ayman , Eshak Sherif , Elashmawy Mohamed Ibrahim Ibrahim
Published: November 2024

Background

The treatment of unstable intertrochanteric fracture in the elderly patient is still controversial. Traditionally, internal fixation using a dynamic hip screw was of choice. Recently, some authors advocated the use of cemented arthroplasty which results in better functional outcome.

Aim and Objectives

to assess use cemented standard stem arthroplasty for treatment of unstable intertrochnteric fractures in elderly patients to detect functional outcomes and complications.

Subjects and Methods

This was single arm clinical trial, was conducted in Ain Shams University Hospitals and Dar El-shefa hospital on 20 patients with unstable inter-trochanteric fractures in12 months.

Result

There was high statistically significant difference between Harris hip score at different periods.

Conclusion

Primary cemented arthroplasty is an effective treatment option for the unstable intertrochanteric femur fractures in the elderly when compared to open reduction and internal fixation. Cemented fixation is recommended in the elderly patients with osteopenic bone. Results of cemented arthroplasty in the treatment of unstable intertrochanteric femur fractures are affected by the age and sex of the patients, and medical comorbidities. Long term evaluation of the results of cemented arthroplasty in the treatment of unstable intertrochanteric fractures in elderly is recommended to assess the survivorship of the prosthesis and to evaluate the patient response to the cemented arthroplasty.
Efficacy of Peri-Operative Intra-Articular Compared with Intravenous Tranexamic Acid in Reducing Blood Loss after Primary Total Knee Arthroplasty
Authors: Aly Mohammad Ashraf Farouk , El-Beltagy Atef Mohamed Fathy , Zakaria Zeiad M
Published: November 2024

Background

Total knee arthroplasty (TKA) is an established and reliable surgical procedure but it is associated with substantial perioperative blood loss. Tranexamic acid (TXA) reduces blood loss in this type of surgery.

Aim of the Work

The main primary outcome of this study is to investigate and compare the clinical effectiveness of intra-articular (IA) topical TXA with intravenous (IV) TXA in patients undergoing primary TKA regarding the efficacy in reducing blood loss. The other secondary targets for this study is to compare and discuss the efficacy of both regimens regarding the level of hemoglobin drop, reducing the need of blood transfusion, checking the safety of both interventions regarding the patient population and possible accompanying comorbidities, and the reduction of length of hospital stay and costs.

Materials and Method

The electronic search strategy included the following databases: PubMed, and Cochrane Library from January 2010 to January 2020. Published accessible completed studies on the use of tranexamic acid TXA via the intra-articular IA route or the intravenous IV route in patients undergoing primary total knee arthroplasty TKA were identified through searching PubMed, and Cochrane Library using this specific set of keywords: (((((total knee arthroplasty) AND (tranexamic acid)) AND (intravenous)) OR (intraarticular)) AND (primary)) AND (tourniquet).

Results

This meta-analysis demonstrates the statistically significant favoring of IA-TXA over IV-TXA in reducing blood loss and it demonstrates the statistically significant favoring of IV-TXA over IA-TXA in postoperative hemoglobin level drop.

Conclusion

Both IV-TXA and IA-TXA are equivalent effectively in reducing the need for postoperative blood transfusion and consequently helps reduce the possible accompanying complications of blood transfusion.
Functional Outcomes of Arthroscopic Frozen Shoulder Release in Diabetic and Non-Diabetic Patients: A Comparative Study
Authors: Hany Ezzat Mohammed Ahmed , AbdelHady Amr Mohamed , Haroun Yahia Mohammed , AbdelAziz El Dessokey Haitham Adel Ahmed
Published: November 2024

Background

Adhesive capsulitis (frozen shoulder) is a disorder that has been poorly understood in terms of pathology and optimal treatment. It is well established that frozen shoulder is a common condition among diabetic patients, with diabetes being a significant risk factor. However, literature has shown that finding an optimal intervention for this condition has been quite challenging.

Aim of the Work

To compare functional outcomes of arthroscopic capsular release (ACR) in diabetic versus non-diabetic patients with idiopathic frozen shoulder.

Patients and Methods

A prospective Cohort study was conducted at Ain Shams University Hospitals starting from September 2022 to September 2023. The study recruited 20 Patients with idiopathic frozen shoulder, who were categorized into two groups: diabetics and non-diabetics. All patients underwent arthroscopic 360° capsular release (ACR) and biceps tenotomy. Patients who had pre-existing glenohumeral pathology other than adhesive capsulitis (AC) were excluded. The follow-up period was 6 months.

Results

This study showed that both diabetics and non-diabetics with adhesive capsulitis showed significant improvement in pain, range of motion and functional outcomes after the index procedure. However, there is no statistically significant difference after ACR between both groups.

Conclusion

Arthroscopic 360° capsular release and biceps tenotomy significantly improved outcomes in both diabetics and non-diabetics with no significant difference between the two groups.
A Systematic Review of Unilateral Biportal Endoscopic Spinal Surgery versus Uniportal Endoscopic Spinal Surgery in Lumbar Canal Stenosis: Clinical Results and Complications
Authors: Youssef Magdy Gamal Abdelkader , Zaki Mina Sameh , Rafek Omar , Alghazawy Mohamed Foad
Published: November 2024

Background

Lumbar spinal stenosis is an important cause of pain and disability in the aging population. The true prevalence of symptomatic spinal stenosis is unknown because radiographic evidence of the condition does not always lead to clinical symptoms. Boden performed a cross-sectional analysis of MRI findings in a population of asymptomatic individuals and found that 30% to 90% of asymptomatic adults had a major spinal abnormality, including disc herniation, disc degeneration, and spinal stenosis.

Objective

To compare the clinical outcomes and complications of uniportal endoscopic spine decompression versus unilateral biportal endoscopic spine decompression in management of lumbar spinal stenosis.

Methods

This study was Randomized control trials, We included 197 patients from 3 studies; 92 in uniportal group and 105 in biportal. We compared VAS score for back pain and leg pain immediate postoperative and after 12 months.

Results

There was highly statistically significant difference found between the two studied groups regarding operative time (minutes) with p-value <0.003. That there was no statistically significant difference found between the two studied groups regarding complications as dural tears as well as length of hospital stay.

Conclusion

Our study show that Biportal and uniportal endoscopic spine surgery are both safe and effective technique in treating LSS as well as the new Biportal endoscopic technique proves to be superior method to shorten the operation time as well as learning curve. However, more randomized controlled trials with larger sample sizes are needed to strengthen the demonstration of the current conclusions.
Percutaneous Epiphysiodesis Using Transphyseal Screws in Management of Coronal Plane Knee Deformities. A Prospective Case Series
Authors: Gendy Poula Gad Shenouda Gad , Abdelaziz Tarek Hassan , Ghaly Nabil AbdEl-Moneem , Fayyad Tamer Abdelmaguid Mohamed , Elbeshry Shady Samir
Published: November 2024

Background

Although many studies reported the efficacy of using percutaneous epiphsiodesis using transphyseal screws (PETS) in correction of coronal plane knee deformities, a lot of them refrained from using this technique because of lack of objective evidence of its reversibility.

Methods

Twenty-three patient aged from 8 years to 13 years old (40 lower limbs) with coronal plane knee deformity were enrolled into this prospective case series from September 2019 to June 2023. Rate of correction of Mechanical axis deviation MAD, mechanical lateral distal femoral angle mLDFA and medial proximal tibial angle MPTA were measured to prove PETS efficacy. Lower limb length, mLDFA, MPTA were recorded preoperatively and 6 months after screw removal in addition to CT scan of the treated physis to investigate physis behavior and reversibility of the technique.

Results

The mean MAD correction rate was 3.3 mm/month and 1.78 mm/month for genu valgum and genu varum patients respectively. mLDFA mean correction rate was 1.07 degree/month for genu valgum patients while MPTA mean correction rate was 0.81 degree/month for genu varum patient. No physeal bony bars could be detected 6 months after screw removal for all patients.

Conclusion

PETS is a highly effective method of hemiepiphysiodesis with rate of correction faster than the other methods of epiphysiodesis. Moreover, it is reliable, reproducible, easy, cheap, more cosmetic, safe and completely reversible when used in juvenile and early adolescent pediatric population
Assessment of Local Complications with Preoperative versus Postoperative Radiotherapy in Patients with Soft Tissue Sarcoma in Extremities: A Randomized Comparative Clinical Trial
Authors: Abdallah Ziad Khaled , EL Masry Ayman Mohammad , Azmy Sherif Ishak , El Mowafi Mohamed Ahmed , Rahman Mustafa Mohamed Abdel
Published: November 2024

Background

Radiotherapy is considered a cornerstone as adjuvant or neo adjuvant to surgery in extremity soft tissue sarcoma (ESTS). Wound complications are the most agonizing complication that may have an impact on patient’s functional outcome following radiotherapy. The best care for ESTS is by combining extensive surgical excision with safety margin and radiotherapy either preoperative (neoadjuvant) or postoperative. Preoperative radiotherapy allows for lower dose of radiation over smaller fields which is supposed to decrease long-term complications. However, several studies have shown that early complications which include wound dehiscence, infection, seroma and burn may be more frequent with preoperative radiotherapy than with postoperative radiotherapy. Most of these studies were retrospective. This study aims to prospectively assess and compare the early complications associated with radiotherapy in both techniques.

Hypothesis

Preoperative radiotherapy is not inferior to postoperative radiotherapy regarding early wound complications.

Patients and Methods

Between January 2021 and June 2022, we prospectively studied 22 patients and categorized them into two groups, group A (preoperative radiotherapy) and group B (postoperative radiotherapy). We included patients with extremity soft tissue sarcoma in skeletally mature patients who were randomized into two groups with follow up 9 – 12 months. Wound complications, local complications, recurrence, time for wound healing and survival rate were recorded and analysed using SPSS 25.

Results

22 patients were included, 10 in group A and 12 in group B, their mean age was 46.4 years with mean follow up 9 months. The major wound complications were higher in group A (preoperative radiotherapy). in comparison with group B (postoperative radiotherapy), however, this was not statistically significant. While other local complications were higher in group B, it was also statistically insignificant. Time for wound healing was higher in group A more than group B and was statistically significant (p value = 0.011)

Conclusion

No increase in the wound complications rate with preoperative radiotherapy by using low fractionated doses of radiotherapy and increasing interval before surgery to six weeks, although there is increased risk of delayed wound healing time after surgery. The size and site of the tumor may increase the risk of wound complications unrelated to the type of radiotherapy.