Hegazy, M., H. Elbarbary, M. Hammoud, A. Arafa, M. T. Mohamed, A. S. Barakat, and A. Afifi, "The foot external rotation above-knee (FERAK) brace versus the Denis Browne brace for management of idiopathic clubfoot following Ponseti casting: a randomized controlled trial.", International orthopaedics, 2021. Abstract

PURPOSE: To compare the foot external rotation above-knee (FERAK) brace and the Denis Browne boot (DBB) brace in terms of relapse prevention and parents' compliance after successful correction with Ponseti casting.

METHODS: A single-centre, randomized controlled study was conducted between 2016 and 2020. A total of 60 feet in 38 patients with idiopathic clubfoot initially corrected with the Ponseti method were included. They were randomized into two equal groups: the FERAK group and the DBB group. The primary outcome was the efficacy in maintaining correction measured by the Pirani score. The secondary outcomes were parents' compliance and complications (e.g., relapses, skin complications).

RESULTS: The follow-up period was 24 months for each patient. The mean final Pirani score was 0.42 ± 0.76 in the FERAK group and 0.57 ± 0.82 in the DBB group. This difference was statistically insignificant (p-value = 0.411). Regarding parents' compliance in the FERAK group, 86.7% of parents had good and intermediate compliance while 13.3% had bad compliance. In the DBB group, 66.7% had good and intermediate compliance while 33.3% had bad compliance. This difference was also statistically insignificant (p-value = 0.118).

CONCLUSION: Both braces achieved good comparable outcomes after Ponseti casting. However, the FERAK brace yielded slightly better parents' compliance with a less recurrence rate.

Afifi, A., A. M. Lymona, and S. Galal, "Radial Head Fixation vs Replacement in Terrible Triad: Preliminary Results of a Prospective Cohort Study with Patient Reported Outcome.", Indian journal of orthopaedics, vol. 54, issue Suppl 2, pp. 254-259, 2020. Abstract

Introduction: The combination of posterior elbow dislocation, radial head fracture, and coronoid fracture has been named "terrible triad" as this injury is difficult to treat and yield poor outcomes. Some studies compared the results of radial head fixation to replacement in isolated radial head fractures, very few reports have tried to compare both treatment modalities in the setting of a terrible triad injury.The aim of this study was to compare the functional outcome of radial head fixation vs replacement in terrible triad injuries of the elbow.

Methods: A single-center, prospective cohort study was conducted at an academic Level 1 Trauma Center from April 2016 to April 2019.A total of 30 patients with terrible triad injury of the elbow were enrolled. The primary outcome was the Quick Disability of Arm, Shoulder and Hand (Quick-DASH) at 1 year. The secondary outcomes were to report the Mayo Elbow Performance Score (MEPS) at 1 year and elbow range of motion.

Results: At final follow up for each patient (13.4 ± 1.2 months) The Quick-DASH score at 1 year for fixation group was 5 ± 2.3, for the replacement group it was 7.1 ± 7.1. The MEPS at 1 year for fixation group was 93.6 ± 8.4, for the replacement group it was 90.9 ± 9.4.Loss of elbow extension at 1 year for fixation group was 17.1° ± 10.7°, for replacement group it was 18.75° ± 11.5°.

Conclusion: A systematic approach to address the bony and soft tissue components of terrible triad elbow injury is crucial to obtain satisfactory outcome. Our study shows that radial head repair and replacement, in the setting of terrible triad injury, yields comparable results.

Level of evidence: Level II, Therapeutic study.

Afifi, A., and I. Khaled, "Internal Fixation of Scapular Body Fractures: Short‑Term Results of a Prospective Study", Journal of Musculoskeletal Surgery and Research, vol. 4, issue 4, pp. 194-198, 2020.
Zein, A. B., A. S. Elhalawany, M. Nagy, A. Kholeif, H. Elbarbary, M. Hegazy, and A. Afifi, "Three-Dimensional Correction of Hallux Valgus Deformity: A Novel Technique", Techniques in Orthopaedics, 2020.
Afifi, A., H. M. Dobal, M. Mahmoud, and A. N. Moharram, "90/90 Bicortical, double-loop, interosseous wiring for fixation of transverse and short oblique metacarpal shaft fractures", Current Orthopaedic Practice, vol. 30, issue 2, pp. 164–169, 2019. 90_90_bicortical_double_loop_interosseous_wiring.15.pdf
Elhalawany, A. S., A. Afifi, A. Anbar, and S. Galal, "Hybrid fixation for adolescent both-bones diaphyseal forearm fractures: Preliminary results of a prospective cohort study.", Journal of clinical orthopaedics and trauma, vol. 11, issue Suppl 1, pp. S46-S50, 2020. Abstracthybrid_fixation_final.pdf

Introduction: Both-bone forearm fractures account for 3.4% of all pediatric fractures and 26% of all pediatric upper extremity fractures. Although non-operative management remains a feasible treatment option for children older than 10 years, they have a higher incidence for malunion due to their limited bone remodelling potential. Therefore, surgical intervention could be advocated for this age group, however the optimal method of surgical fixation in this age group remains controversial.Authors wanted to evaluate hybrid fixation (plating of ulna & elastic nail for radius) of adolescent both-bone forearm fractures in a large single-institution cohort of patients.

Methods: A single-center, prospective cohort study was conducted at an academic Level 1 Trauma Center from February 2016 to February 2019.A total of 60 patients (age 10-16 years) with both-bones forearm fracture were enrolled. Patients were assessed radiographically for union as well as clinically using the "Outcome Grading System" developed by Martus et al. for functional assessment of surgical management of pediatric forearm fractures using forearm rotation range of motion & complications rate.

Results: At final follow up for each patient (24 months) was achieved in all cases. occurred in 4 patients (2 radii & 2 ulnae) with no case of combined radius & ulnar delayed union. At final follow up, the mean supination was 81.27° ± 4.1°, while the mean pronation range was 68.17° ± 3.03°. The "" results were: 48 cases (80%) scored excellent, 10 cases (16.7%) scored good & 2 cases (3.3%) scored fair.

Conclusion: Hybrid fixation method in adolescent both-bones forearm fracture could be a viable option in managing these injuries & may reduce the problem of ulnar non-union encountered when using elastic stable intramedullary nail (ESIN) in that age group.

Level of evidence: Level II, Therapeutic study.

Afifi, A., and A. Farghaly, "Anteromedial Plate Osteosynthesis of Midshaft Humeral Fractures- Is It Safe?", Egyptian Orthopedic Journal, vol. 53 (supplement 1), pp. 40-44, 2018.