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Background: The objectives of this comprehensive quantitative review of the treatment of calcific supraspinatus tendinitis were to investigate if there is a sustainable positive effect on outcomes after treatment with extracorporeal shockwave therapy (ESWT) or ultrasound (US)-guided needling and to compare these results with those of treatment with arthroscopic surgery. Method: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to conduct this review. A systematic literature search was conducted in December 2019 to identify relevant clinical articles in peer-reviewed journals with at least 3 months’ follow-up. Each article was scored using the Coleman Methodology Score. The primary endpoints were functional outcome and radiologic change in the size of the calcific deposit. Results: Twenty-four studies were included (1,509 shoulders). The mean Coleman Methodology Score for the included studies was 77.1± 9.1. Overall, good to excellent clinical outcomes were achieved after treatment with either ESWT, US-guided needling, or arthroscopic surgery, with an improvement in the Constant-Murley score ranging between 26.3 and 41.5 points after 1 year. No severe side effects or long-term complications were encountered. Conclusions: Patients can achieve good to excellent clinical outcomes after ESWT, US-guided needling, and arthroscopy for calcific tendinopathy of the shoulder. Side effects and posttreatment complications should be taken into account when a decision is being made for each individual patient. Physicians should consider ESWT and US-guided needling as minimally invasive treatment options when primary conservative treatment fails. Arthroscopy can safely be used as a very effective but more invasive secondary option, although the extent of deposit removal and the additional benefit of subacromial decompression remain unclear. Keywords: Calcific Tendinitis, Treatment, ESWT, US-PICT, Arthroscopy, supraspinatus Management UGN.

Background: Ankle arthritis is a highly frequent condition and treatment choice in young individuals may be a difficulty. Fifty percent of older people get some sort of foot or ankle arthrosis. The most prevalent cause is post-traumatic arthritis, comprising 70 percent of people with osteoarthritis. Ankle fusion gives a solid foot that is painless, plantigrade. Several various procedures for ankle fusion were documented, although, including external fixators, internal binding and intramedullary nailing, this is a rescue treatment that leads to lasting abnormalities in gait and there is a danger of worsening owing to the danger of developing ipsilateral hind foot arthritis. There are several operational procedures including open or arthroscopic methods for ankle arthrodesis. Following both techniques, successful clinical outcomes may be attained. The major purpose of this research was to assess the clinical impact of arthrodesis of the knee with transfibular fastening. Methods: Methods: This is a study of 20 patients operated on a transfibular basis at university hospitals Benha and El helal. Results and findings: Compared to the pre-operative values, the post-operative AOFAS rear foot score has been significantly improved. In 20 patients, 95% bone union was accomplished which demonstrates that ankle arthrodesis with transfibular fixation results in good clinical results. This method guarantees high bone union rate and strong stability, removes ankle discomfort, corrects deformation and enhances the ankle function substantially.

Consolidated foremost cruciate tendon remaking and average opening wedge high tibial osteotomy can create solid re-visitation of donning action. This system permits patients to recapture a steady knee at right around 10-year follow-up, with a re-visitation of wearing exercises in about 80%. A critical decline in brandishing level is not out of the ordinary, and patient guiding is significant as the preinjury movement level in the objective patient segment is high. The point of this examination was to play out a precise audit of ACL remaking and high tibial valgus osteotomy in the administration of ACL insufficient with varus knee. This survey was finished utilizing standard approach sketched out in the Cochrane Handbook and detailed the discoveries as per the Preferred Reporting Items for Systematic Reviews and Meta-examinations (PRISMA) articulation rules. The writing search were performed utilizing the accompanying hunt terms: ACL reproduction with valgus osteotomy in administration of ACL inadequacy with varus knee. Watchwords: ACL recreation, and Varus knee. This precise survey included 6 examinations Only one investigation was and the others were single armed.We inferred that consolidated front cruciate tendon recreation and average opening wedge high tibial osteotomy is a feasible choice in youthful patients influenced by foremost shakiness, with great midterm results if a right sign, preoperative arranging, and careful method are applied. Also, The bone-patella ligament bone join has a more grounded obsession With the least re tear rate. This joined system gives palatable emotional, unbiased and radiological outcomes, improves the capacity and diminishes the agony.

Metacarpal fractures comprise between 18–44 % of all hand fractures. Non-thumb metacarpals account for around 88 % of all metacarpal fractures, with the fifth finger most commonly involved. This is a comparative study between Kirschner wires and mini-set plate in management of unstable metacarpal shaft fractures. This is a review article, The search was performed in MEDLINE, Embase, Pubmed and CINAHL Plus in the same date range with the following mediacl terms: “Kirschner wires; mini-set plate; unstable; metacarpal shaft; fractures.”, including articles from 2000 to 2019, K-wire fixation is simple to manipulate and without or with little damage on fracture blood supply, and has been used extensively. Since in the K-wire fixation there is no compression on the fracture, it is difficult to control the motions of the fingers. Stiffness resulting from tendon adhesions and joint contractures is the most common complication associated with hand fractures. Conversely, fractures that require mini-plate fixation but are treated without fixation or with inadequate fixation still lead to stiffness and are associated with an increased rate of nonunion and malunion. Kirschner wires are almost always used for temporary fixation and are removed after the early appearance of fracture callus on radiographs. Despite the availability of many options for fixation, percutaneous fixation using Kirschner wires is a good method for treatment of unstable ulnar four metacarpal fractures. We recommended this technique, which is more biological, technically easier, safe, cheap and rapid to perform with good functional outcome.

Tibial plateau fractures present an important entity in orthopaedic fractures. They may be associated with other knee injuries such as meniscal tears, cruciate ligaments injuries and collateral ligaments damage. The purpose of this study was to reach the latest advances in the different methods of management of tibial plateau fractures using arthroscope and evaluate the results of arthroscopically assisted reduction and internal fixation of tibial plateau fractures on a series of patients clinicaly and radiologicaly. Our study was a prospective case series study that involved 20 patients with tibial plateau fractures presenting to Benha University Hospitals between the period of September 2017 and November 2019.All fractures were evaluated according to the Schatzker classification and there were 2 type I, 7 type II, 7 type III, 2 type IV and 2 type V. According to the clinical Rasmussen score, 15 patients [75%] had excellent results, [2 type I, 5 types II, 7 types III and 1 type IV], and 5 patients [25%] had good results [ 2 types II, 1 type IV and 2 types V]. Radiologic results were excellent in 14 cases [70 %] and good in 6 cases [30%]. There were no patients who had fair or poor results. ARIF of selected tibial plateau fractures allows anatomic reduction and rigid internal fixation with less morbidity than with ORIF, and has the advantage of superior visualization of the entire joint.

AimsTo investigate the use of PCS fixation for acetabular fractures including indications, preoperative planning, operative technique, and complications during the study period. Setting and designA retrospective and prospective study of PCS fixations of several types of acetabular fractures nondisplaced and minimally displaced guided by fluoroscopy.Patients and methodsThe study included 20 patients after obtaining informed consent they were operated and studied for acetabular fixation by anterior column, posterior column, supra-acetabular screws, combination of all and combination of plate and screw between 2015 and 2019.Statistical analysis used The software for statistical package for social sciences for windows 10 was used for all statistical calculations. Each variable was tested for its normal value using the Mann-Whitney Test and exact P values were calculated. Significance was set at the P value of less than 0.05 level.ResultsAll cases had good to excellent functional results according to the modified Merle d’Aubigne Hip Score. We managed to mobilize all patients out of bed from the 2nd day of surgery and managed to avoid double approaches for transverse fractures.ConclusionOur results show that PCS under fluoroscopic control is a safe technique to treat some patterns of acetabular fractures and with some tips and tricks surgical and fluoroscopy time can be minimized.Key-wordsAcetabular fracture - Minimally invasive technique - Percutaneous fixation.Key MessagesPCS fixation of acetabular fractures using fluoroscopic guidance is a safe and relatively easy surgical procedure to treat minimally displaced fractures with several advantages.

The crossing internal suture augmentation technique is an all-inside technique of anterior cruciate ligament reconstruction with augmentation of the hamstring tendon autograft with a braided ultrahigh-molecular-weight polyester–polyethylene suture tape resting on the adjustable cortical buttons on both the femoral and tibial sides. The internal suture augmentation acts as a backbone supporting and protecting the graft until the process of healing and ligamentization of the graft is completed. The ends of the suture tape are tied on the tibial button and additionally fixed to the tibia with a knotless anchor as a backup fixation with the knee in full extension. The technique has the advantages of being minimally invasive with small incisions and allowing preservation of the bone stock through the use of sockets. It also allows early return to activity thanks to the more secure rehabilitation and prevents early failure and stretching of the graft.

Purpose To assess the clinical results of using mesh plate in management of displaced comminuted fracture patella. Patients and methods Between January 2014 and October 2015, nine patients with closed displaced comminuted fracture patella were fixed using mesh plate and 2 mm mini screws. Results All fractures united after an average of 10 weeks. At final follow-up of an average 19.6 months, average postoperative Lysholm score was 89.1 ± 4.9, and average Postoperative Bostman scale was 27.2 ± 3.1. No hardware related complications were recorded. Conclusion Low profile mesh plate is a good option in management of comminuted fracture patella with good clinical outcome. This new surgical technique may be particularly useful in comminuted fractures when patellectomy would otherwise be considered.

It has been proved by many researchers in the last few years that arthroscopic capsulolabral repair is an efficient method for surgical management of anteroinferior shoulder instability. Different arthroscopic techniques using different fixation devices and constructs have been described in the literature, but the suture anchors were the most used implants to shift the inferiorly displaced capsulolabral complex and fix it to the glenoid. In the majority of these techniques, the anchors concentrate the load at specific points (e.g., at 3 or 4 interrupted points over the glenoid directly opposite the anchors) without putting direct pressure on the area of the labral footprint that is between the anchors. We describe here a technique using 2 standard suture anchors inferiorly in conjunction with a knotless suture anchor (e.g., 3.5 mm PushLock, Arthrex, Naples, FL) superiorly. No additional separate sutures or suture tapes are required other than those already loaded in the inferior 2 anchors, which are used to compress the capsulolabral complex to the glenoid in the areas between the suture anchors, producing a uniform pressure that may contribute to better healing.

Background Recurrent lateral instability of the patella after traumatic patellar dislocation always involves injury to the medial patellar soft tissue restraints. The purpose of the study was to assess the results of double-bundle medial patellofemoral ligament (MPFL) reconstruction in the management of recurrent lateral patellar dislocations. Patients and methods Between January 2012 and November 2014, MPFL reconstruction was performed in 25 knees in 19 patients (12 females and seven males) at Benha University Hospital. The inclusion criteria included patients with recurrent dislocations of the patella (more than two times) with deficient medial retinacula. Autogenous gracilis graft was used as double bundle. Graft was fixed at the femoral side using interference screws and at the patellar side using incomplete tunnels and bone groove in the medial half of the patella. Results Average follow-up period was 32.16±5.8 months. At the final follow-up, average postoperative Lysholm score improved significantly from 58.88±5.87 to 90.68±2.77 (P Conclusion Anatomical double-bundle MPFL reconstruction is a simple and cheap technique used in the current case series that provides accurate femoral and patellar anatomical insertion points at the insertion sites and allows proper tensioning of the graft maintaining normal patellar glide, with overall favorable outcome results.

Background Surgical treatment of bony avulsions of the posterior cruciate ligament (PCL) through a classic posterior approach carries a high risk of neurovascular compromise, and arthroscopic techniques are demanding. The purpose of this study is to report results of safe, minimal invasive surgical approach using pull-out suture fixation technique.

Several reconstructive procedures have been used in management of large tibial bone defects including bone graft, bone transport (distraction osteogenesis) using various external fixators, and vascularized bone graft. Each of these procedures has its limitations and complications. The study describes gradual medial fibular transfer using Ilizarov external fixators in management of patients with large tibial defect, either following infection or trauma. Between May 2011 and June 2013, 14 patients were prospectively included in the current study. The inclusion criteria were large tibial defect due to trauma or infection with severe soft tissue compromise, and small or poor tibial bone remnants making bone lengthening difficult. Exclusion criteria were patients with vascular or nerve injuries. The average age of the patients was 31.64 (± 6.5) years. Medial fibular transfer was done for all patients using Ilizarov at a rate of 0.5 mm twice daily. Iliac bone graft was used in all patients after the transfer. The average segmental bone defect of the tibia was (13.2 ± 2.6), ranging between 8 and 18.6 cm. Union was achieved in all patients with average fixator time was 32.42 (± 4.32) weeks. Average follow-up after removal of the fixator was 40.5 (± 6.9) months. Gradual fibular transfer by Ilizarov external fixator is a reliable technique in management of post-traumatic and post-infection large tibial bone defects with good clinical outcome, and with few complications.

Background: Infected re-ruptured patellar tendon after avulsed distal patellar pole usually difficult to manage especially if there is bad tissue quality, patella small in size besides atrophy and adhesions of retinacula. Case presentation: Egyptian male patient 20 years old with re-ruptured repaired patellar tendon after 3 months from management by distal patellar pole excision and repair, (two months in cast and one month physiotherapy) get infected in the ligament site, the infection is treated and reconstruction of the ligament was done using semitendinosus in a figure-of-eight fashion, fixed by sutures and bone tunnels in the patella and tibial tuberosity. Conclusion: The patient get improved and regain near normal extensor mechanism function besides patellar stability and strength.

Radiographs of 110 patients who had undergone 120 high tibial osteotomies (60 closed-wedge, 60 open-wedge) were assessed for posterior tibial slope before and after operation, and before removal of the hardware. In the closed-wedge group the mean slope was 5.7 degrees (SD 3.8) before and 2.4 degrees (SD 3.9) immediately after operation, and 2.4 degrees (SD 3.4) before removal of the hardware. In the open-wedge group, these values were 5.0 degrees (SD 3.7), 7.7 degrees (SD 4.3) and 8.1 degrees (SD 3.9) respectively, when stabilised with a non-locking plate, and 7.7 degrees (SD 3.5), 9.4 degrees (SD 4.1) and 9.1 degrees (SD 3.8), when stabilised with a locking plate. The reduction in slope (-2.7 degrees (SD 4.1)) in the closed-wedge group and the increase (+2.5 degrees (SD 3.4), in the open-wedge group was significantly different before and after operation (p = 0.002, p = 0.003). In no group were the changes in slope directly after operation and before removal of the hardware significant (p0.05). There was no correlation between the amount of correction in the frontal plane and the post-operative change in slope. Posterior tibial slope decreases after closed-wedge high tibial osteotomy and increases after an open-wedge procedure because of the geometry of the proximal tibia. The changes in the slope are stable over time, emphasising the influence of the operative procedure rather than of the implant.