MANAGEMENT OF FIBULAR HEMIMELIA (CONGENITAL ABSENCE OF FIBULA) USING ILIZAROV METHOD IN SULAIMANI

Background: Fibular hemimelia is the most common congenital deficiency of long bones. Therefore, it is characterized by a wide spectrum of manifestations ranging from mild limb length inequality to sever shortening with foot and ankle deformities and associated anomalies. Objectives: To evaluate the results of ankle and foot reconstruction and limb length equalization in patients with Fibular Hemimelia. Patients and Methods: A prospective study was carried out on 40 limbs in 32 patients with fibular hemimelia during the periods of March 2010 to January 2014. Male to female ratio was 24:8. Their age ranged at an average between 2-16 years (9 years). The reconstruction of ankle and foot was done. Also, the equalization of the limb was done also using Ilizarov frame. Results: The result of this study was assessed using the Association for the Study of Applications of Methods of Ilizarov (ASAMI) scoring system. Therefore, the final results were: Failure rate with 2 limbs 5%, Poor with 2 limbs 5%, Fair with 2 limbs 5%, Good with 8 limbs 20%, and Excellent with 26 limbs 65%. Conclusion: In conclusion, the Ilizarov method is an attractive alternative method used for the management of selected fibular hemimelic patients having three or more toes who are refusing amputation

COMPARATIVE STUDY OF FLEXOR TENDON REPAIR BY MODIFIED KESSLER'S TECHNIQUE WITH OR WITHOUT USING VENOUS GRAFT AS A TENDON SHEATH SUBSTITUTE IN ZONE II

Background: Hands are frequently exposed to injuries during daily working hours which might affect its function. Flexor tendon injuries of the hand result in loss of function. The main goal of surgery is to restore function, and avoid the occurrence of postoperative adhesions. However, a better understanding of the process of tendon healing, and continuous evolution of operative technique helps in improving the result. The use of venous graft as a tendon sheath substitute following tendon repair, reduces the adhesion formation, improves tendon nourishment, decreases the need for intensive physiotherapy, restores the function, and improves the results. Despite this remarkable progress, flexor tendon lesions still continues to present difficulty. Objectives: To observe the effectiveness of using vein graft in tendon sheath reconstruction with the aim of decreasing adhesions and comparing it to the conventional method of tendon repair. Patients and Methods: Forty patients who were injured recently, had flexor tendon injuries of the hand involving zone II. They were divided into test and control groups (20 patients each). Modified Kessler technique for primary repair of acute flexor tendons injuries were used in both groups added by the cephalic vein as a tendon sheath substitute in the test group. Results: T h e evaluation of the results is based on TAM (Total Active Motion) score of the ASSH (American Society for Surgery of the Hand). The final results were 75% excellent, 25% good, with no fair or poor results concerning the test group, while in the control group, there was no excellent results; thus, 55% good, 45% fair, and the results obtained were not poor. Conclusion: Repair of the flexor tendon injuries using modified Kessler technique using a venous graft as a tendon sheath substitute and early active movement are recommended to provide effective results as a replacement for the conventional methods

COMPARATIVE STUDY OF FLEXOR TENDON REPAIR BY MODIFIED KESSLER'S TECHNIQUE WITH OR WITHOUT USING VENOUS GRAFT AS A TENDON SHEATH SUBSTITUTE IN ZONE II

Background: Hands are frequently exposed to injuries during daily working hours which might affect its function. Flexor tendon injuries of the hand result in loss of function. The main goal of surgery is to restore function, and avoid the occurrence of postoperative adhesions. However, a better understanding of the process of tendon healing, and continuous evolution of operative technique helps in improving the result. The use of venous graft as a tendon sheath substitute following tendon repair, reduces the adhesion formation, improves tendon nourishment, decreases the need for intensive physiotherapy, restores the function, and improves the results. Despite this remarkable progress, flexor tendon lesions still continues to present difficulty. Objectives: To observe the effectiveness of using vein graft in tendon sheath reconstruction with the aim of decreasing adhesions and comparing it to the conventional method of tendon repair. Patients and Methods: Forty patients who were injured recently, had flexor tendon injuries of the hand involving zone II. They were divided into test and control groups (20 patients each). Modified Kessler technique for primary repair of acute flexor tendons injuries were used in both groups added by the cephalic vein as a tendon sheath substitute in the test group. Results: T h e evaluation of the results is based on TAM (Total Active Motion) score of the ASSH (American Society for Surgery of the Hand). The final results were 75% excellent, 25% good, with no fair or poor results concerning the test group, while in the control group, there was no excellent results; thus, 55% good, 45% fair, and the results obtained were not poor. Conclusion: Repair of the flexor tendon injuries using modified Kessler technique using a venous graft as a tendon sheath substitute and early active movement are recommended to provide effective results as a replacement for the conventional methods

Bone Transport of Tibia

This is a comparative study to evaluate the outcome of forty patients with bone loss in tibia using conventional external fixation device for group A while for group B using Ilizarov external fixator device each group consists of 20 patients, based on principles of distractive osteogenesis. Patients and methods: Forty patients with bone loss of 4 to 14 centimeters in tibia between April 2011 and April 2016 were treated, ages (15-65 years); female to male ratio was 6:34. The cause of defects in tibia was fracture due to road traffic accident (20 cases), bullet injury to leg (8 cases), gap nonunion (8 cases) and infected non unions(4 cases). They were divided into two groups each consists of 20 patients, conventional external fixator used for group A while for group B Ilizarov external fixator device was used with performing transverse corticotomy proximal or distal to the gap for both groups. Results: Evaluation of results was done according to Association for Study and Application of Methods of Ilizarov (A.S.A.M.I.) scoring system and it revealed that both functional and bony results were better in group B than group A. Conclusions: Fixation of the bone by Ilizarov frame gives more rapid union of the bone, less chance of pin tract infection and cosmetically more preferable because of smaller scar tissue of entry of K wires than Schanz pins. Prevention and treatment of equinus deformity and clawing of the toes can be done by extending the Ilizarov frame to correct them. In cases of severe soft tissue loss it is better to apply conventional external fixator as a provisional fixator till the soft tissue loss and swelling will be diminished

GAIT ANALYSIS IN AMBULATORY CHILDREN WITH CEREBRAL PALSY USING A TRI-AXIAL ACCELEROMETER

Worldwide children’s walking disabilities that are caused mainly by cerebral palsy display multiple conditions of both permanent and non-developing motor dysfunction that in turn upsets posture, mobility, or muscle tone in general. In order to estimate the influence of instrumented gait analysis on the walking ability in cerebral palsied children the Dynaport Minimod, based on a triaxial accelerometer was employed. A Dynaport Minimod was used for collecting the spatial and temporal gait data. An evaluation of the gait data carried out via online services application for 80 children with cerebral palsies from April 1 st , 2018 to October 30 th , 2019. The Dynaport Minimod is capable of capturing most of the spatiotemporal gait parameters which indicate that this technique is quite cooperative and objective in the detection of gait changes and the evaluation of consequences, respectively. The most useful practice for the managing of children with cerebral palsy is a gait analysis system in which its clinical utilization is considered to be a developing technology especially in providing guidance to service planning centres and hospitals