tarek ABDEL KHALEK

One of the most common injuries treated by orthopedic surgeons is the ankle injuries. Syndesmosis injuries account for 1%–18% of ankle sprains and much more in athletes 32%. The proper classification of syndesmosis injuries and the proper management depends mainly on the clinical and radiological assessment. Objectives to compare between the suprasyndesmotic and syndesmotic technique in management of syndesmotic injury regarding the functional outcome and time to weight bearing and to assess factors affecting the outcome of syndesmotic injuries management. Methods This prospective case series study was conducted on thirty patients attending to Kasr Alainy orthopedic surgery department with ankle fractures, they were divided into two groups each contains fifteen patients: Group 1:underwent and supra-syndesmotic screw fixation. Group 2: underwent syndesmotic screw fixation. Radiological evaluation of fixations using AP, lateral and mortise X-ray. Assessment of post-operative range of motion. Evaluation of functional outcome using FAOS (Foot and ankle outcome score). Patients were followed up for 24 months, with an average of 22 months. Results Patients scored 80–100% on the foot & ankle outcome score, with an average of 91.6 ± 5.4; (63.3%) had FAOS of 90% or above. Regaining weight bearing took 6–12 with an average of 8.2 ± 1.8 weeks; in (70%) wt bearing occurred within 6–8 weeks. Only one patient (3.3%) had post-operative infection, while no other patient (96.7%) had any postoperative complications. The mean FAOS score in supra-syndesmotic fixation was 92.5 and in the syndesmotic is 90 with an insignificant difference between the two groups (P = 0.4). The mean time to weight bearing was 8.1 and 8.3 weeks (P = 0.84) in supra-syndesmotic and syndesmotic fixation respectively. Conclusion there were no significant difference in terms of functional score and time to weight between syndesmotic and suprasyndesmotic techniques however; the functional score was significantly affected by the presence of associated injury and patient age while time to weight bearing was prolonged by the presence of associated injury and comorbidities, patient age as well as operative time.

The rationale for minimally invasive surgery (MIS) is to minimize tissue damage in order to reduce blood loss, decrease postoperative pain, shorten hospital stay, and allow for faster rehabilitation. Objectives This study compares the short-term clinical and radiographic outcome between conventional and minimally invasive posterior approaches in total hip arthroplasty. Study Design & Methods We conducted a prospective, comparative pilot study containing 30 patients who underwent primary total hip arthroplasty between January 2017 and May 2017, 15 of them were operated through a conventional posterior approach and the other 15 were operated upon using a minimally invasive posterior approach. The exclusion criteria were severe protrusio or acetabular dysplasia as well as severe obesity (more than 120 kg body weight or a body mass index (BMI) > 40). For all patients, age, gender, indication, body mass index (BMI), preoperative hemoglobin and preoperative assessment using radiology, WOMAC and Harris hip scores were recorded. The patients were informed about the type of their operation. Results:There was a significant difference in the mean operative time (p < 0.001),rehabilitation and early return to workand usual activities (p < 0.001) in favour of the minimally invasive approach. Furthermore, there was no need for blood transfusion in the MIS group compared to 20% in the conventional group, better cosmetic results in the MIS group (mean scar length was 9.07 compared to 21.67 in the conventional approach) and more incidence of complications with the conventional approach (13.33% as compared to 0% in the MIS group). These differences were statistically highly significant (p < 0.0001). No significant differences were seen as regards the clinical outcome at 6 months post-operative (using the WOMAC and Harris hip scores) and the radiological results between in both groups. Conclusions:The minimally invasive posterior approach allows reduced blood loss, reduced operative time, decreased incidence of blood transfusion, faster rehabilitation and earlier return to workin total hip arthroplasty.