** PhD Thesis protocol submitted for partial fulfillment of PhD Degree in orthopedic surgery.
**By:
Abdallah Ibrahim Jomaa El Azanki MD, MSc
Faculty of Medicine -- Mansoura University
** Supervisors
Prof. Brakat Sayed Elalfy
Professor of orthopedic surgery
Faculty of Medicine - Mansoura University
Prof. Nabil Ahmed Elmoghazy
Professor of orthopedic surgery
Faculty of Medicine - Mansoura University
Dr. Sallam Ibrahim Fawzy
Assistant Professor of orthopedic surgery
Faculty of Medicine - Mansoura University
Chondral Injuries - Current Concepts in Management & Cartilage RegenerationVaibhav Bagaria
Chondral Injuries are one of the technically challenging cases for sports injury surgeons. There are various techniques described including lavage, abrasion chondroplasty, micro fracture, Mosaicplasty, ACI - various generations and newly developed Bioprinting
Chondral Injuries - Current Concepts in Management & Cartilage RegenerationVaibhav Bagaria
Chondral Injuries are one of the technically challenging cases for sports injury surgeons. There are various techniques described including lavage, abrasion chondroplasty, micro fracture, Mosaicplasty, ACI - various generations and newly developed Bioprinting
Newer implants for geriatric hip fracturesArjun Viegas
PFNA2 from AO Synthes, Intertan Nail from Smith and Nephew, Gamma3 nail from Stryker, Natural Nail from Zimmer are all newer implants which have changed the way we treat comminuted and osteoporotic hip fractures. This presentation focuses on these newer implants with literature review.
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Newer implants for geriatric hip fracturesArjun Viegas
PFNA2 from AO Synthes, Intertan Nail from Smith and Nephew, Gamma3 nail from Stryker, Natural Nail from Zimmer are all newer implants which have changed the way we treat comminuted and osteoporotic hip fractures. This presentation focuses on these newer implants with literature review.
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
The role of radiation diagnostic methods in pathological changes of the hip j...SubmissionResearchpa
Endoprosthesis replacement-operational treatment of diseases and damages of hip joint. The problem of prevention of complications and their negative effects is extremely actual today. However the role of different beam techniques in identification of adverse effects and complications of endoprosthesis replacement of joints is studied insufficiently. Results of clinic and diagnostic and beam researches of 40 patients with pathology of hip joint are analyzed. The used beam methods of research - roentgenography, multispiral computed tomography. At presurgical stage the main objective was detection of pathology of joint, definition of indications and planning of operative measure. Situation and relationship of components of endoprosthesis, condition of bone tissue, and also bone cement round cup and leg of prosthesis were key parameters of radiological assessment of outcomes of endoprosthesis replacement. Complex use of radiological techniques (roentgenography and spiral computed tomography) allows to specify and add semiotics of changes of bone tissue at the level of acetabular hollow and proximal department of femur after endoprosthesis replacement. by Janibekov J. J 2020. The role of radiation diagnostic methods in pathological changes of the hip joint before and after endoprosthetics. International Journal on Integrated Education. 3, 11 (Dec. 2020), 203-205. DOI:https://doi.org/10.31149/ijie.v3i12.918. https://journals.researchparks.org/index.php/IJIE/article/view/918/866 https://journals.researchparks.org/index.php/IJIE/article/view/918
Outcome of Mitchell's procedure in the treatment of hallux valgusAbdulla Kamal
Presentation of my thesis in IBFMS committee under supervision of pro. Dr. Omer Barawi.
Hallux valgus is a complex deformity of medial ray that often coexist with deformities and symptoms within the other toes.
commonest foot and all musculoskeletal deformities.
worldwide prevalence = 23% (18- 65 years) 35% > 65 years
Onset (46% up to 92%) before skeletal maturation
Female predominance up to 90%
Bilateral HV up to 84%
A 31-years old male went through a complex scenario of a simple middle third fracture Femur through infection and multiple unwise unplanned decisions.
https://www.instagram.com/p/Cq8OAwRI7lV/
WHAT TO DO AS AN FLL PROJECT JUDGE!!!
#FIRST #LEGO #LEAGUE #FLL #JUDGES #PROJECT #PROBLEM #SOLUTION #INNOVATION #TEAMWORK #PRESENTATION #SHARING #SCIENCE #ROBOTICS #INNOVATION #DR_AZANKI
ROAD TO MEDICAL RESIDENCY ( Germany ,UK and North America) #dr_azanki #WSIG-LUAbdallah El-Azanki
Brief explanation for medical residency needs in the mentioned countries .
Where & How to start?
How much each exam will cost?
Time needed to prepare for exams?
Residency duration in Germany, UK, USA, Canada?
Salaries per year while residency !!
Neck of femur and Distal end radius fracture case... evidence based #dr_azankiAbdallah El-Azanki
a 46 years old patient with ipsilateral neck femur and distal end radius fracture, the aim of this lecture is to highlight the deficit of evidence base or literature for such combined cases and to stimulate orthopedic surgeons in reporting how did they manage their cases.
#dr_azanki
Distal End Radius Fracture are quiet frequent, but some are complex fracture which requires a special care in diagnosis and management (according to certain algorithm )...this is a presentation transforming the review article by the american academy of orthopedic surgery into a simple and useful presentation. #dr_azanki
WALANT -Wide Awake Local Anesthesia No Tourniquet Surgery Technique Abdallah El-Azanki
Local anesthesia mixed with epinephrine and sodium bicarbonate , this mixture is called WIDE AWAKE , and it got an injection technique ...this is in brief called "WALANT" (wide awake local anesthesia no tourniquet) #dr_azanki
Wide Awake Technique for hand surgery--introduction #dr_azankiAbdallah El-Azanki
local anesthesia mixed with epinephrine and sodium bicarbonate , this mixture is called WIDE AWAKE , and it got an injection technique ...this is in brief called "WALANT" (wide awake local anesthesia no tourniquet) #dr_azanki
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ilizarov Methods versus Masquelet’s Technique in Management of Segmental Skeletal Defects of the Femur
1. Ilizarov Methods versus Masquelet’s Technique in
Management of Segmental Skeletal Defects of the Femur
PhD Thesis protocol submitted for partial fulfillment of PhD Degree in orthopedic surgery
By
Abdallah Ibrahim Jomaa El Azanki
MBBCh
Faculty of Medicine -- Kursk State Medical University
MSc
Faculty of Medicine -- Mansoura University
2020
2. Supervisors
Prof. Brakat Sayed Elalfy
Professor of orthopedic surgery
Faculty of Medicine - Mansoura University
Prof. Nabil Ahmed Elmoghazy
Professor of orthopedic surgery
Faculty of Medicine - Mansoura University
Dr. Sallam Ibrahim Fawzy
Assistant Professor of orthopedic surgery
Faculty of Medicine - Mansoura University
( Principal Supervisor)
4. Reconstruction of long tubular bone defects is always one of the most difficult
problems in orthopaedic surgery
Segmental Skeletal Defects (SSD) may result from
High-energy trauma
Debridement of osteomyelitis
Tumor resection
Congenital anomalies
Some defects are accompanied by major soft tissue injuries that limit the
functional outcome (independent of the actual bone loss )
(Mauffrey et al., 2015; Paley and Maar, 2000)
SSD Causes
5. Free bone graft was the hallmark in management of segmental skeletal defects.
high failure rate rejection or sequestration result of purulent infection
Amount of autograft available for filing big SSD is limited.
Reconstruction of large SSD with vascularized bone graft.
Useful in the upper limb
Lower limb : fibula or iliac crest
• takes years to hypertrophy
• fracture once or more before remodeling.
Microvascular bone graft often fails to unite to the recipient bone at one or both ends
(Green, 1994;Ilizarov and Ledyaev, 1992; Pederson and Person, 2007)
Grafting Hx
6. All these treatment protocols have variable rates of success
or failure and are limited in their ability to reestablish extremity
length and correct the deformity.
It is common to have :
• Persistent infection
• Soft-tissue contracture
• Prolonged fracture disease
• Residual deformity
• Eventual amputation
(Cattaneo et al., 1992; Lowenberg and Githens, 2015)
7. In 1956 Ilizarov has developed the technique of distraction osteogenesis.
Stimulus of pure distraction applied to a special cortecotomy site to induce new
bone formation at the distraction gap.
Corticotomy is made through a healthy bone segment at some distance from the
defect site.
Components of the frame are attached with wires and half pins to the segment of
bone between the corticotomy and the defect.
Steady traction is applied to the intercalary bone segment to elongate the
corticotomy region while closing the original skeletal defect in the same time.
Ilizarov
(Ilizarov, 1989; Murray and Fitch, 1996)
8. In Ilizarov Methods:
Limb length is maintained
Deformity is corrected
Limb shortening is gradually overcome
SSD are eliminated
Reported variable Tx results:
• Good results
• High complication rate
(ChADDhA et al., 2010; Cierny and Zorn, 1994; Dahl et al., 1994; Lowenberg and Githens, 2015)
Pros & Cons
9. In the early 21th century a two-stage technique for reconstruction of SSD was
described.
First stage a cement spacer fills the defect.
This induces the formation of specialized tissue or membrane around it.
During the second stage the cement spacer is removed, and bone graft is
placed within he induced membrane.
Masquelet
(Masquelet et al., 2000; Masquelet and Begue, 2010; Pelissier et al., 2002)
10. This membrane was found to be:
Impermeable
hypervascular
biologically active, it secretes GF :
• Vascular endothelial growth factor and transforming growth factor-beta-1 (VEGF, TGF-_1)
• Osteoinductive factors as bone morphogenetic protein-2 (BMP- 2).
Such options prevents bone resorption and favors growth and maturation
of the bone graft
This is called Masquelet’s Technique, which is being widely used with
many promising results
Masquelet
(Chotel et al., 2012; Karger et al., 2012)
12. The aim of the present study is to compare the results of Ilizarov
methods versus Masquelet’s technique in management of
segmental skeletal defects (SSD) of the Femur.
13. Objectives
1. Reporting bone healing results in both techniques
2. Functional results while and after treatment.
3. Studying different factors such as body mass index (BMI), blood glucose level, life habits
recording and correlating it to clinical outcomes.
4. Attentive watching for transport time in accordance to the intraoperative SSD measure.
5. Patient’s satisfaction with the management
6. Different SSD correlations ( CT, Clinical, Long Film )
15. Type of the study:
Retrospective and prospective randomized comparative study (Panel Study)
Study locality:
Department of orthopedic surgery, Mansoura university and emergency hospitals.
Time:
During the period of April 2018- 2022 .
16. Patients:
Study will include patients with SSD of 4 cm or more:
Exclusion criteria:
Skeletally immature patients
SSD less than 4 cm
Patients with Osteomyelitis
Patients treated with:
Regular External Fixator
Oncological etiology Cases- post
resection SSD
Inclusion criteria:
Adult patients with SSD
Post traumatic bone loss
Post traumatic Non-union
Post traumatic Malunion
Post traumatic Infection sequalae
18. Patients to be included are those with post-traumatic SSD that present to Mansoura
University Emergency Hospital and “Limb Lengthening & Deformity Correction”
Out-patient Clinic at the department of orthopedic surgery, Mansoura university.
Patients will be examined clinically and radiologically
SSD will be measured twice : Preop. By CT scanogram and intraoperatively
Treatment option will be in accordance to patient’s randomization number and he/she will be
consented after surgical plan/approach explanation.
19. Clinical Examination :
• Pain
• Neuro-vascular status of the limb.
• Soft tissue condition (Gustilo classification)
• Deformity in the lower limb.
• Vital signs (Pulse, Blood pressure, Respiratory rate)
Preoperative Evaluation
Patient History :
• Age, Sex, Occupation, Residency
• Medical History (diseases or previous trauma)
• Medications (immunosuppressive drugs, steroids, or osteoporosis Tx)
• Nutritional status
• Alcoholism / Smoking / Addiction
20. Radiological investigations:
• Plain radiographs:
Antero-posterior, Lateral view of the Femur
• Computed Tomography:
CT scan with the four views (axial, coronal, sagittal and 3D) will be
ordered to better understand the osseous pattern.
CT Scanogram will be done to measure the SSD.
Laboratory investigations:
• CBC
• INR / PTT
• ABG if resuscitated
• HbA1C
21. Intraoperative and Postoperative Methods
• After debridement SSD will be measured
• SSD measured by CT scan will be compared to the intraoperative measure.
• In case of post traumatic infection sequalae , deep tissues for culture and
cytology will taken.
• Patients will know the estimated time needed for bone transport / second
stage timing and requirements for each method
22. In Masquelet’s technique patients, second stage will happen after 4-8 weeks in
ordinance with clinical, laboratory and radiological status.
Autograft will be harvested from the iliac bone minced around the fibular strut.
In Ilizarov method patients, distraction osteogenesis process will start according to age
and or bone and health quality (7-14 days).
Graft at the docking site will be done when needed.
Postoperative methods:
23. Patients will be followed up at the “Limb Lengthening and Deformity
Correction” OPC with interval of 2,4,8 weeks
Later, FU every 3 weeks till docking site flags or the same for Masquelet’s 2nd
stage patients.
Follow up AP and Lateral View X-rays will be done:
• Regenerate and healing status
• Confirm union/ consolidation
Long film standing lower limb x-ray anteroposterior and lateral views will be
used in both methods to study the mechanical axis of the limb and final LLD.
Postoperative methods:
24. Complications to be reported:
Mal-union
Non-union
Infection (superficial or deep)
Neurovascular status
Failure of fixation or transport
Soft tissue problems will noted and managed accordingly even
by flaps or by histogenesis.
25. Ethical consideration:
1. Study protocol will be submitted for approval by IRB.
2. Approval of mangers of hospital in which the study will be conducted.
3. Informed written consent will be obtained from each participant sharing the study.
4. Confidentiality and personal privacy will be respected in all the levels of the
study. Collected data will not be used for any other purpose.
26. Statistical analysis:
The collected data will be coded, processed and analyzed using SPSS
program (version17) for windows. The appropriate statistical tests will be used
when needed. P values less than 0.05 (5%) will be considered to be statistical
significant.