Papers by dr mohamed ashraf ,orthopaedic surgeon
International Journal of Research in Orthopaedics, 2016
Background: Osteonecrosis of femoral head (AVN) is a disabling condition with ill-defined etiolog... more Background: Osteonecrosis of femoral head (AVN) is a disabling condition with ill-defined etiology and pathogenesis. In more than 60% it leads to osteoarthritis of hip joint. Treatment for this condition includes both operative and non-operative methods with variable success rates. Surgical options being aimed at both conservation of femoral head and arthroplasty of hip joint. Aim of our study was to evaluate the efficacy of tensor fascia lata muscle pedicle grafting in the management of osteonecrosis of femoral head. Methods: 27 cases with a mean age of 38.7 years (range from 24 to 52) who underwent tensor fascia lata muscle pedicle grafting in the management of osteonecrosis of femoral head were prospectively evaluated with a mean follow up period of 7.3 years (range from 3 to 12 years). Watson-Jones approach was used in all patients. Average hospital stay was 12 days. Harris hip score was used for the evaluation of clinical outcome. Results: In our series of 27 cases, the Harris hip score was excellent (90-100) in 19, good (80-89) in 5, fair (70-79) in 2 and poor (<70) in 1 case at final follow up. Conclusions: Tensor fascia lata muscle pedicle grafting is an effective, technically easier, pain relieving headpreserving procedure and will improve outcome in properly selected patients with osteonecrosis of femoral head.
Journal of Orthopedics, Traumatology and Rehabilitation, 2021
IntRoductIon Avascular necrosis (AVN)/osteonecrosis of the femoral head is a debilitating conditi... more IntRoductIon Avascular necrosis (AVN)/osteonecrosis of the femoral head is a debilitating condition affecting the hip joint, especially in the younger population and is one of the most common causes of total hip replacement (THR) in this age group. [1,2] The average age of presentation in the Asian population ranges from 20 to 60 years. [3] Even though exact etiology is still unclear, the risk factors have been well documented in the literature and they are chronic corticosteroid administration, chronic alcohol ingestion, smoking, and various chronic diseases (renal disease, hematological disease, inflammatory bowel disease, postorgan transplantation, hypertension, and gout). [3-6] Clinically early stages of AVN are painless which on progression will result in severe groin associated with the limitation of hip movement and collapse of femoral head ultimately leading to end-stage degeneration. [3,6,7] Hence, early detection and interference are needed to prevent disease progression which is also one of the main treatment goals. In the treatment of AVN hip, there is no gold standard. The available treatments include pharmacological and surgical options which are mainly based on categorization into precollapse or early collapse and advanced collapse or osteoarthritis stage. [8-10] It is documented in the literature that hip preservation surgery in late stages is met with poor outcomes. [11] Background: Avascular Necrosis / Osteonecrosis of the femoral head is a debilitating condition affecting the hip joint and is one of the most common causes of total hip replacement. The available treatments include pharmacological and surgical options with Total hip arthroplasty (THA) being the mainstay of treatment. We here is studying a novel technique of combining micro core decompression with intra-lesional bisphosphonate as a treatment for osteonecrosis of the hip. Materials and Methods: A prospective study of 19 hips was done. There were 11 males and 4 females ranging 42-63 years. Four hips were stage I, ten hips were stage IIA, three hips were stage IIb and two hips were stage III. 16 hips (40%) had stage IIb and 24 hips (60%) had stage III ONFH. The minimum period of follow up was 24 months. All patients were assessed according to the Harris Hip Score (HHS). The operative procedure include decompressing the avascular area with drilling then injecting the zoledronic acid locally. Results: The mean preoperative modified Harris Hip Score in stage I (n=4), stage IIa (n=10), stage IIb (n=3) and Stage III (n=2) were 81.9, 72.7, 68.8 and 59.2 respectively. The mean postoperative modified Harris Hip Score at two years in stage I, stage IIa, stage IIb and Stage III were 97.3, 91.1, 88.4 and 82.5 respectively. Conclusion: We found that the use of micro core-decompression with intra-lesional bisphosphonate will provide higher chances towards hip preservation especially in late cases or cases with larger lesions where core decompression may not be successful.
indian journal of applied research, 2016
Introduction : Intramedullary nailing of distal tibial metaphyseal fracture may be result in defo... more Introduction : Intramedullary nailing of distal tibial metaphyseal fracture may be result in deformity secondary to instability and ambulation after fixation. Our aim was to evaluate the use of poller screws(blocking screws) as a supplement to stability along with statically locked intramedullary nail for distal tibial meta-physeal fractures. Materials and methods :We prospectively evaluated 15 patients of distal tibial fractures treated with poller screws along with interlocking nails for a period of 12 months Result : all fractures are united with a mean varus valgus alignment of-1° (-5-3) and mean antecurvatum recurvatum alignment of 1.4(-6-10). There was no complications related to poller screw. clinical outcome was assessed using the karstrom-olerud scorescope Conclusion : Poller screws, placed adjacent to the nail and perpendicular to the interlocking screw holes, usually in an anteroposterior direction, have been suggested as one possible method for improving the stability of metaphyseal fractures,and have been described as a reduction tool used to overcome the displacing forces at the time of introduction of the intramedullary nail.
indian journal of applied research, 2017
INDIAN JOURNAL OF APPLIED RESEARCH X 45 Volume -7 | Issue -2 | February -2017 | ISSN -2249-555X |... more INDIAN JOURNAL OF APPLIED RESEARCH X 45 Volume -7 | Issue -2 | February -2017 | ISSN -2249-555X | IF : 3.919 | IC Value : 79.96
journal of evidence based medicine and healthcare, 2016
INTRODUCTION Intertrochanteric fractures in osteoporotic bones which are grossly comminuted are h... more INTRODUCTION Intertrochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Conservative treatment with traction and prolonged immobilisation lands up with many complications and often fatality. Rate of failure with internal fixation has been found to be high, especially in osteoporotic bones. Revision osteosynthesis is technically demanding and it leads to complications, a second surgical procedure for revision synthesis, arthroplasty or removal of a symptomatic implant is again a risky procedure in elderly patients with lot of comorbidities. The aim of this study was to assess the efficacy of a cemented bipolar hemiarthroplasty with calcar preserving intracapsular osteotomy in the management of unstable trochanteric fractures in elderly patients with osteoporosis. Hemiarthroplasty in unstable trochanteric fractures have been described in the past with varying outcome. The reasons for poor outcome were shortening, varus positioning and abductor insufficiency. This was mainly due to the deficient medial support due to the removal of lesser trochanter and calcar. Recently, free calcar grafting excised from the removed neck for medial support was reported, but in our technique we are preserving the calcar and lesser trochanter with all its soft tissue and muscle attachments.
international journal of orthopaedics sciences, 2017
Background: This study was performed to evaluate the results of vaccum assisted wound therapy in ... more Background: This study was performed to evaluate the results of vaccum assisted wound therapy in patients with open musculoskeletal injuries or infected or exposed implant in situ (excluding arthroplasty) or traumatic wounds after debridement, infections after debridement at a tertiary care hospital, from 2013 to 2015.
journal of trauma &orthopaedic surgery, 2020
This study evaluates the clinical and radiological outcome of varus derotation osteotomy (VDRO) i... more This study evaluates the clinical and radiological outcome of varus derotation osteotomy (VDRO) in late onset and early healed Perthes with extruded femoral head with remaining growth potential. (1)Extruded femoral head Results: The evaluation was done using caput index (CI) and epiphyseal quotient (EQ) radiologically, range of motion and Harris Hip Score for clinical outcome.Our minimum follow up was 3yrs and maximum follow up of 10years. We studied Radiological and clinical parameters on 3rd year follow up. All measurement was done on pre-op , post op x-rays at 3rd year follow up and also compared with the contralateral hip. We noted improvement in the clinical outcome and radiologically femoral head attained more spherical contour after containment. Materials and Methods: 30 children (19 males and 11 females) falling in the group of 10-16 years ,belonging to modified Elizabethtown classification Stage 4-healed stage / Waldenstrom's stage 4-residual stage , radiologically-reossified,extruded,deformed femoral head are treated with open wedge VDRO, between 2009 and 2017 were included in this study. 21(70%) are between 10-14yrs, rest are 14-16yrs, mean age of osteotomy is 12.37yrs. All patients had limitation of abduction and internal rotation. 14 patients (46.67%) had pain at the hip and 26 patients (86.7%) had limp. Mean time between diagnosis and corrective surgery was 3 weeks. In our studies 21 children (70%) had good result with Spherical head and fully contained by acetabulum, 6 children (21%) had fair result with congruent head and acetabulum covering>4/5th of femoral head. Rest 3 children had poor result with clinically symptomatic and extruded deformed head. There was a significant change (P = 0.000) in CI among all the patients after surgery. The final EQ after 3 years of VDRO was 0.685 and was significant (P = 0.0000). (2)Deformed head leads to early onset of osteoarthritis Background: Role of surgical containment in late onset and healed perthes is still controversial and ill defined. Untreated and partially treated Perthes disease can progress to osteoarthritis by the fourth decade. The main complication is femoral head deformation. Two important factors contributing to complication:
international journal of orthopaedics sciences, 2016
Background: The incidence of closed Achilles rupture is on rise year after year reflecting the in... more Background: The incidence of closed Achilles rupture is on rise year after year reflecting the increased sports and recreational activites and life style diseases. The disability both long term and short term are profound if not promptly diagnosed and properly treated. The complications of non-operative treatment and conventional open surgical procedures are well known and documented. Materials & Methods: Thirty patients with acute closed rupture of Achilles tendon were treated between 2010 and 2015 using a new technique of percutaneous repair using cannula. Twenty four patients were males and six patients were females. 20 patients were between 40 and 50 years of age. 8 patients were between 30 and 40 years of age while 2 patients were above 50 years of age. The mean time between injury and index surgery was 8 days (range 5 to 14 days). Results: The average range of ankle plantar flexion was 130° (range, 120°-140°) on the repaired side and 143° (range, 120°-155°) on the non-injured side. The average range of ankle dorsiflexion was 17° (range, 16°-21°) on the operated side and 19° (range, 18°-22°) on the non-injured side. The mean calf diameter was 40.5 cm (range, 37-44 cm) on the operated side and 42.5 cm (range, 39-45 cm) on the non-injured side. The interval between injury and return to regular work was 13 weeks (range 10-16 weeks). The mean AOFAS score was 90 (80-98) at the most recent follow-up and 80% of patients' results were considered excellent while 20% were good. There was no re-rupture, skin necrosis or sural nerve injury in our series Conclusions: Percutaneous "cannula" technic repair of closed tendo Achilles rupture is an excellent and simple outpatient technic without much possibility of soft tissue complications. The only drawback of this technique is the possibility of sural nerve injury. This can be eliminated by close puncture of the tendon on lateral side.
the lancet, 2020
Background Observational studies have suggested that accelerated surgery is associated with impro... more Background Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications.
international journal of research in orthopaedics, 2016
Background: Osteonecrosis of femoral head (AVN) is a disabling condition with ill-defined etiolog... more Background: Osteonecrosis of femoral head (AVN) is a disabling condition with ill-defined etiology and pathogenesis. In more than 60% it leads to osteoarthritis of hip joint. Treatment for this condition includes both operative and non-operative methods with variable success rates. Surgical options being aimed at both conservation of femoral head and arthroplasty of hip joint. Aim of our study was to evaluate the efficacy of tensor fascia lata muscle pedicle grafting in the management of osteonecrosis of femoral head. Methods: 27 cases with a mean age of 38.7 years (range from 24 to 52) who underwent tensor fascia lata muscle pedicle grafting in the management of osteonecrosis of femoral head were prospectively evaluated with a mean follow up period of 7.3 years (range from 3 to 12 years). Watson-Jones approach was used in all patients. Average hospital stay was 12 days. Harris hip score was used for the evaluation of clinical outcome. Results: In our series of 27 cases, the Harris hip score was excellent (90-100) in 19, good (80-89) in 5, fair (70-79) in 2 and poor (<70) in 1 case at final follow up. Conclusions: Tensor fascia lata muscle pedicle grafting is an effective, technically easier, pain relieving headpreserving procedure and will improve outcome in properly selected patients with osteonecrosis of femoral head.
journal of clinical orthopaedics, 2020
journal of evolution of medical and dental sciences jemds.com, 2016
AIM AND OBJECTIVES Aim and objective of this study is to assess role of synovectomy during TKR on... more AIM AND OBJECTIVES Aim and objective of this study is to assess role of synovectomy during TKR on joint effusion, haemarthrosis, patellar clunk, recurrent synovitis, and histopathological diagnosis in patients undergoing Total Knee Arthroplasty (TKA). MATERIAL AND METHODS We studied prospectively 30 patients with osteoarthritis of knee treated with total knee arthroplasty with near-total synovectomy. Patients were in the age group 55-70 years. The overall efficacy of both procedures was assessed postoperatively by determination of blood loss from the drain, pain, and Lysholm knee functional score. RESULTS All 30 patients have been followed up for an average of 3 years for assessment for postoperative pain, knee joint effusion, patellar clunk, range of movement, and stability of prosthesis. During the postoperative 48 hours, the mean blood loss was slightly higher. To conclude, supplementing near-total synovectomy along with TKA may provide complete pathological diagnosis, beneficial in inflammatory arthritis, and some special synovial pathology like pigmented villonodular synovitis, rheumatoid arthritis, tuberculous arthritis, and haemophilic arthritis. Better long-term pain relief and functional outcome due to the removal of pathological synovium have been observed after synovectomy along with total knee arthroplasty. CONCLUSION Performing synovectomy in TKA will give complete pathological diagnosis, avoiding persistence of synovial pathology along with long-term benefits of synovectomy in the form of minimal to no joint effusion, less pain, absence of synovial hypertrophy, patellar clunk, and good range of movement of knee.
Traumatic Extensor Carpi Ulnaris (ECU) sublaxation is often missed and undiagnosed or wrongly dia... more Traumatic Extensor Carpi Ulnaris (ECU) sublaxation is often missed and undiagnosed or wrongly diagnosed. ECU muscle plays a key role in active movement of wrist extension, ulnar deviation and also in providing suport to the ulnar side of wrist. Its position relative to the other structures in the wrist changes with forearm pronation and supination. As such it must be mobile yet stable. This structure can be injured in a variety of different athletic activity and following fall on outstretched hand. It lies subcutaneously and easily palpated and visualized, allowing early diagnosis and management. We in our study report a case of traumatic ECU sublaxation. An 18 year old female patient presented to our OPD with ulnar side wrist pain. MRI showed volar subluxed ECU tendon with ruptured ECU sheath. We had done open ECU sheath repair and excision of bursa. Very few literature shows traumatic ECU sublaxation report. The case is reported for the rarity of presentation and likely to misdiagnose in day to day clinical scenario.
Drafts by dr mohamed ashraf ,orthopaedic surgeon
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Papers by dr mohamed ashraf ,orthopaedic surgeon
Drafts by dr mohamed ashraf ,orthopaedic surgeon