Publications

Some of our recent staff members' publications

2004

 

 

J Pediatr Orthop B. 2004 Mar;13(2):127-38.

 

Characteristics of patients with hypoplastic thumb: a prospective study of 51 patients with the results of surgical treatment.

 

Abdel-Ghani H, Amro S.

 

Abstract: The aim of this study was to characterize a group of patients with hypoplasia of the thumb, classifying them, describing the associated anomalies and to evaluate the results of surgical treatment of such cases. Thumb hypoplasia is a complex and heterogeneous congenital disorder that is detrimental to hand functions. The characteristics of patients with these anomalies are not well described in the literature. A prospective study on 51 patients with 82 hypoplastic thumbs was done. All the patients' data regarding their personal, family, pregnancy and developmental histories were recorded. All the patients were exposed to thorough clinical examination with genetic assessment and radiological examination including abdominal ultrasonography and echocardiography when requested by the paediatrician. The cases were classified using the modified Blauth classification into five types and we added the five-fingered hand. Surgical treatment was performed for 26 hands in 18 patients and the postoperative results were recorded with an average duration of follow-up of 38.6 months. Of the 51 patients, there was a positive consanguinity in 23.5%. Eighty-six per cent were found to have associated anomalies. Type V thumb hypoplasia was the most common type followed by type IV, with type I being the least common. All the patients' parents were

satisfied with the results of surgical treatment and noticed improvement of the performance of the operated hands in the daily activities. We detected some anomalies that have never been described before or described as case reports only; such as lacunar skull, congenital facial palsy and toe amputation; we also  described familial radial side dysplasia with variable presentation of congenital anomalies of the thumb in the families. In addition, we think that the

five-fingered hand should be added to the classification of thumb hypoplasia. Our study agrees with the literature regarding the distribution of different types of hypoplasia of the thumb, the incidence of associated anomalies and the results of surgical treatment.

 

 

Int Orthop. (SICOT) 2004 Jun;28(3):183-6. Epub 2004 Feb 5.

 

Correction of relapsed or neglected clubfoot using a simple Ilizarov frame.

 

El Barbary H, Abdel Ghani H, Hegazy M.

 

Abstract: We present the results of using a simple Ilizarov fixator frame in treatment of 66 feet in 52 patients (mean age 8.5 years) of 58 relapsed and eight neglected clubfeet with grade III or IV severity with a mean follow-up of 40 (26-58) months. Our frame, in spite of being simple and easy for surgeons and patients to handle, achieved satisfactory correction comparable to the literature.

 

 

The Egyptian Orthopaedic Journal 2004; 39(1):7-15.

 

Two Staged Surgical Correction of Scheuermann’s Disease.

 

ElMiligui Y, Koptan W, ElSebaie H

 

 

The Pan Arab Journal of Orthopaedics and Trauma 2004; 8(2):215-219.

 

Surgical Management of Traumatic Spondylolisthesis of the Axis.

 

Koptan W, ElMiligui Y, ElSebaie H

 

 

The Egyptian Orthopaedic Journal 2004; 39(2):283-289.

 

Single Stage Osteotomy for Congenital Lumbar Spine Deformities.

 

ElSebaie H, ElMiligui Y, Koptan W

 

 

The Egyptian Orthopaedic Journal 2004; 39(2):297-304.

 

Multiple Osteotomies and Segmental Instrumentation for Revision Surgery in Scoliosis. 

 

ElMiligui Y, Koptan W, ElSebaie H

 

 

The Pan Arab Journal of Orthopaedics and Trauma 2005; 9(1):1-9.

 

Indirect Spinal Decompression in Burst Thoracolumbar Fractures.

 

Koptan W

 

 

2005

 

 

Int Orthop. (SICOT) 2005 Jun;29(3):182-5. Epub 2005 Mar 9.

 

Complex tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation.

 

El Barbary H, Abdel Ghani H, Misbah H, Salem K.

 

Abstract:  We treated 30 tibial plateau fractures (Schatzker Type VI) in 29 patients, with a mean age of 41.4 (20-76) years, with the Ilizarov fixator. In 18 fractures, we combined the treatment with minimal internal fixation. All fractures were the result of high-energy trauma, and 20 patients had associated injuries.

Twenty-eight fractures were available for follow-up after 27 (16-36) months.

Using The Knee Society clinical rating system, 18 knees were rated as excellent, seven as good, one as fair, and two as poor. There was a direct correlation between the presence of associated injuries and the final outcome. The most significant concomitant injuries were distal femoral fractures and extensive soft-tissue injury. This study emphasizes the clinical success and low morbidity associated with the use of external fixation and minimal internal fixation.

 

 

Egyptian orthopaedic journal, 2005, Vol. 40. Nol 1: 59 – 63.

 

Arthroscopic management of discoid lateral meniscus tears.

 

Mohamed Shewy, Wisam Gaber and Hisham Abdel-Ghani.

 

 

The Medical Journal of Cairo University vol 73, no.4, 12/2005

 

Outcome of internal fixation for unstable pelvic fractures. A series of 30 cases.

 

Sherif Khaled, Sherif Amr, and Kamal Sami

 

 

Egyptian Medical Journal 6/2005

 

Percutaneous screw fixation for undisplaced and minimally displaced scaphoid fractures using free hand technique

 

Dr. Yasser A. Radwan, M. D., Dr. Ali M. Reda, M. D., & Dr. Sherif A. Khaled, M. D.

 

 

Pan Arab Journal of Orthopedic and trauma Vol. (9) No.2/ July 2005.

 

The role of Arthroscopic Acromioplasty in the treatment of chronic impingement syndrome in elderly age group.

 

Khaled Moh Abd El Halim Hafez, Hatem Ahmed Kotb and Sherif Ahmed Khaled

 

 

Cairo University Scientific Publications. December  2005

 

Meniscal Allograft Transplantation

 

Haleem AM, Atteya AM, El-Singergy AA, Azzam A

 

 

The Pan Arab Journal of Orthopaedics and Trauma 2005; 9(1):41-46.

 

Hemiprosthetic Replacement in Four-Part Fractures of the Proximal Humerus.

 

Soliman O, Ossman N, Koptan W

 

 

The Pan Arab Journal of Orthopaedics and Trauma 2005; 9(2):146-151.

 

Anterior Cervical Interbody Fusion with PEEK Cages.

 

Koptan W

 

 

 

2006

 

 

The Medical Journal of Cairo University vol 74, No. 1, 3/2006

 

The effect of biplane symphyseal plate on rigid anterior segment fixation of the pelvic ring (a biomechanical study).

 

Sherif Khaled, Sherif Amr, and Kamal Sami

 

 

Journal of the Egyptian Orthopedic Association

 

THE USE OF DELTA FRAME IN THE MANAGEMENT OF COMPLEX PILON FRACTURES: A case series.

 

Sherif A. Khaled, M. D, Ali M. Reda Mansour, M. D, Yasser A. Radwan, M. D.

 

 

Journal of hand surgery (british and european volume) 2006, 31b: 2: 226–229.

 

Modified dorsal rotation advancement flap for release of the thumb web space.

 

H. Abdel ghani

 

 

 

2007

 

 

Int Orthop. 2008 Oct;32(5):671-7. Epub 2007 Jun 6.

 

Resistant tennis elbow: shock-wave therapy versus percutaneous tenotomy.

 

Radwan YA, ElSobhi G, Badawy WS, Reda A, Khalid S.

 

 

Abstract: Fifty-six patients who suffered from chronic persistent tennis elbow of more than six months duration were randomly assigned to two active treatment groups. Group  1 (n = 29) received high-energy extracorporeal shock wave treatment (ESWT; 1,500  shocks) at 18 kV (0.22 mJ/mm(2)) without local anaesthesia; group 2 (n = 27) underwent percutaneous tenotomy of the common extensor origin. Both groups achieved improvement from the base line at three weeks, six weeks, 12 weeks and 12 months post-intervention. The success rate (Roles and Maudsley score: excellent and good) at three months in the ESWT group was 65.5% and in the tenotomy group was 74.1%. ESWT appeared to be a useful noninvasive treatment method that reduced the necessity for surgical procedures.

 

 

 

The Pan Arab Journal of Orthopaedics and Trauma 2007; 11 (1):96-101.

 

Carpal Tunnel Decompression: A Randomized Controlled Trial of Endoscopic Versus Open Release.

 

Moharram A, Koptan W, Hegazi M, Kamal T

 

 

2008

 

 

Int Orthop. 2009 Aug;33(4):961-7. doi: 10.1007/s00264-008-0580-5. Epub 2008 May

28.

 

Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee: comparison with arthroscopy.

 

Behairy NH, Dorgham MA, Khaled SA.

 

Abstract: The aim of this study was to detect the accuracy of routine magnetic resonance imaging (MRI) done in different centres and its agreement with arthroscopy in meniscal and ligamentous injuries of the knee. We prospectively examined 70 patients ranging in age between 22 and 59 years. History taking, plain X-ray, clinical examination, routine MRI and arthroscopy were done for all patients. Sensitivity, specificity, accuracy, positive and negative predictive values, P value and kappa agreement measures were calculated. We found a sensitivity of 47

and 100%, specificity of 95 and 75% and accuracy of 73 and 78.5%, respectively, for the medial and lateral meniscus. A sensitivity of 77.8%, specificity of 100%  and accuracy of 94% was noted for the anterior cruciate ligament (ACL). We found  good kappa agreements (0.43 and 0.45) for both menisci and excellent agreement (0.84) for the ACL. MRI shows high accuracy and should be used as the primary diagnostic tool for selection of candidates for arthroscopy. Level of evidence: 4.

 

 

American Journal of Sports Medicine, 2008

 

Open Reduction and Posterior Capsular Shift for Cases of Neglected Unreduced Posterior Shoulder Dislocation.

 

Mohamed Taha El Shewy, MD, Hassan Magdy El Barbary, MD, Yasser Hassan El Meligy, MD, and Sherif Ahmed Khaled, MD

 

 

Pan Arab Journal of Orthopedics and trauma 7/2008

 

Percutaneous Iliosacral Screw Fixation for Unstable Posterior Pelvic Fractures

A series of 32 cases.

 

Sherif Khaled

 

 

The Pan Arab Journal of Orthopaedics and Trauma 2008; 12(2):233-237.

 

Closed Reduction and Percutaneous Pinning in Three-Part Fractures of

the Proximal Humerus.

 

Soliman O, Koptan W, Shohayeb K

 

 

 

2009

 

 

J Pediatr Orthop B. 2009 Mar;18(2):76-8. doi: 10.1097/BPB.0b013e32832988a1.

 

Results of treatment of idiopathic clubfoot in older infants using the Ponseti

method: a preliminary report.

 

Hegazy M, Nasef NM, Abdel-Ghani H.

 

Abstract: The Ponseti method has become a well-established technique for the treatment of clubfoot presenting in the neonatal period. A few reports have discussed the result of this method in older age group. The purpose of this study is to present the results and clinical experience of using the Ponseti method in the treatment  of idiopathic congenital talipes equinovarus in infants presented between 4 and 13 months of age with a history of failed manipulations. Thirty-two feet in 20 infants (12 males; eight females) with idiopathic congenital clubfeet were treated using the Ponseti method with minor modifications. The average age at

presentation was 7 months (range from 4 to 13 months). We used the Pirani scoring system to assess the feet. After an average follow-up of 19 months, the ultimate  overall results were satisfactory in 31 feet. The Pirani score improved from an average of 4.3 (range: 3-6) at presentation to a final follow-up average of 0.5 (range: 0-1). One foot had unsatisfactory result with a pretreatment score of 5.5 and a final score of 3. The results were also presented in terms of the number of casts applied, the need for tenotomy of tendo Achillis, recurrence of the deformity and the ultimate requirement for surgical release. The use of the Ponseti method in older-aged infants with idiopathic congenital clubfoot seems to be an effective method of treatment, obviating the need for extensive surgery.

 

 

Am J Sports Med. 2009 Aug;37(8):1570-7. doi: 10.1177/0363546509333009. Epub 2009  Jun 11.

 

Repair of chronic rupture of the achilles tendon using 2 intratendinous flaps from the proximal gastrocnemius-soleus complex.

 

El Shewy MT, El Barbary HM, Abdel-Ghani H.

 

Abstract: BACKGROUND: Chronic rupture of the Achilles tendon is a surgical challenge, owing to the presence of a gap between the retracted ends, which renders direct repair almost impossible.

PURPOSE: In this study, 2 intratendinous distally based flaps fashioned from the  proximal gastrocnemiussoleus complex are used to bridge the gap between the retracted edges of the ruptured Achilles tendon. The flaps are placed in the same line of pull of the ruptured tendon, in an effort to make the graft mimic the original biomechanics as much as possible. STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Eleven patients (9 male and 2 female) with neglected rupture of the Achilles tendon with retracted ends were included in this study. Two flaps fashioned from the proximal gastrocnemiussoleus complex were rotated over themselves, passed through the proximal stump, and then securely inserted into a  previously prepared bed in the distal stump.

RESULTS: The patients were followed up for a period of 6 to 9 years. At the final follow-up, all patients were able to return to their preinjury level of activity  within a period of 6 to 9 months. The mean preoperative American Orthopedic Foot  and Ankle Society score was 42.27, whereas it was 98.91 at the final follow-up, with a range of 88 (in 1 patient) to 100 points (in 10 patients). All 11 patients showed statistically significant improvement according to the Holz rating system. CONCLUSION: This technique allows for a bridging of the defect present in chronic ruptures of Achilles tendons, with a minimum of complications and a good final outcome.

 

 

The Egyptian Journal of Basic Sciences. Oct 2009; 111-119.

 

Combined bony procedure and ligament reconstruction for management of recurrent peroneal tendon subluxation.

 

Mahmoud M, Kholeif A, Nassef M, Abou Senna W.

 

 

Spine J. 2009 Apr;9(4):296-302. doi: 10.1016/j.spinee.2008.05.011. Epub 2008 Jul  21.

 

All pedicle screw instrumentation for Scheuermann's kyphosis correction: is it worth it?

 

Koptan WM, Elmiligui YH, Elsebaie HB.

 

Abstract: BACKGROUND CONTEXT: Scheuermann's kyphosis has long been treated by a two-staged  fusion and instrumentation with a hybrid construct using hooks, pedicle screws, and sublaminar wires. Recent interest in all pedicle screw constructs led to its  use in the treatment of Scheuermann's kyphosis. Evaluation of this newly described application is needed.

PURPOSE: To compare the results of segmental all pedicle screw constructs versus two-staged hybrid instrumentation in patients with Scheuermann's kyphosis analyzing the amount of correction and incidence of complications.

STUDY DESIGN: Retrospective case series reporting on two groups of patients with  Scheuermann's kyphosis treated with single-staged all pedicle screws technique versus two-staged anterior release and posterior hybrid instrumentation followed-up for a minimum of 2 years.

PATIENT SAMPLE: The study included 33 patients divided into two groups. The average age was 15 years+9 months and 16 years+8 months, respectively. The average preoperative dorsal kyphosis was 85.5 degrees (Group 1) and 79.8 degrees  (Group 2).

OUTCOME MEASURES: The deformity was measured by Cobb's method preoperatively, postoperatively, and at final follow-up. Operative time and blood loss were also  measured and recorded. The results of the Scoliosis Research Society (SRS)-30 questionnaire were also reviewed.

METHODS: The study included 16 patients who underwent a single-staged correction  by segmental all pedicle screw constructs and multiple-level posterior osteotomies (Group 1) and 17 who underwent a two-staged fusion and instrumentation with a hybrid construct (Group 2).

RESULTS: Both groups were followed for a minimum of 2 years. The deformity

correction of Group 1 had an average of 52.2% postoperatively with 2.4% loss at final follow-up in comparison to Group 2 where the correction was 48.7%

postoperatively with 3.1% loss at final follow-up. The operative time was

considerably less in Group 1 with an average of 215 minutes than Group 2 with an  average of 315 minutes. The average blood loss was 620cc in Group 1 and 910cc in  Group 2. The SRS-30 questionnaire in Group 1 averaged 134 and in Group 2 averaged 120.

CONCLUSIONS: The use of multiple-level all pedicle screws technique allowed a rigid anchor for posterior correction of the deformity with less operative time,

blood loss, and hospital stay without the need for anterior release. A better

correction was achieved and preserved with the use of all pedicle screw

constructs. This technique is a useful modality in the treatment of Scheuermann's kyphosis.

 

 

 

2010

 

 

J Bone Joint Surg Br. 2010 Feb;92(2):267-72. doi: 10.1302/0301-620X.92B2.22758.

 

Management of combined nonunion and limb-length discrepancy after vascularised

fibular grafting.

 

Abdel-Ghani H, Ebeid W, El-Barbary H.

 

Abstract: We describe the management of nonunion combined with limb-length discrepancy following vascularised fibular grafting for the reconstruction of long-bone defects in the lower limb after resection of a tumour in skeletally immature patients. We operated on nine patients with a mean age of 13.1 years (10.5 to 14.5) who presented with a mean limb-length discrepancy of 7 cm (4 to 9) and nonunion at one end of a vascularised fibular graft, which had been performed previously, to reconstruct a bone defect after resection of an osteosarcoma. Reconstruction was carried out using a ring fixator secured with correction by half pins of any malalignment, compression of the site of nonunion and lengthening through a metaphyseal parafocal osteotomy without bone grafting. The  expected limb-length discrepancy at maturity was calculated using the arithmetic  method. Solid union and the intended leg length were achieved in all the patients. Excessive scarring and the distorted anatomy from previous surgery in these patients required other procedures to be performed with minimal exposures and dissection in order to avoid further compromise to the vascularity of the graft or damage to neurovascular structures. The methods which we chose were simple and effective in addressing these complex problems.

 

 

J Hand Surg Am. 2010 May;35(5):813-8. doi: 10.1016/j.jhsa.2010.02.012.

 

Congenital cleft scapula with type V ulnar longitudinal deficiency: case report.

 

Abdel-Ghani H.

 

Abstract: A rare case of malformation of the scapula, a cleft scapula, has been

encountered. This case is associated with type V ulnar longitudinal deficiency of the ipsilateral upper limb. The scapular malformation has been treated with

fusion of the 2 parts, with good aesthetic and functional outcome. In this

report, the clinical, radiological, and surgical findings, as well as the

surgical technique, are described. Four cases of similar malformation have been reported in the literature, and they were described as complete scapular

duplication. According to the current findings and reinterpretation of the

previous reports, this malformation is better called cleft scapula rather than

scapular duplication.

 

 

J Bone Joint Surg Br. 2010 Feb;92(2):267-72. doi: 10.1302/0301-620X.92B2.22758.

 

Management of combined nonunion and limb-length discrepancy after vascularized fibular grafting.

 

Abdel-Ghani H, Ebeid W, El-Barbary H.

 

Abstract: We describe the management of nonunion combined with limb-length discrepancy following vascularised fibular grafting for the reconstruction of long-bone defects in the lower limb after resection of a tumour in skeletally immature patients. We operated on nine patients with a mean age of 13.1 years (10.5 to 14.5) who presented with a mean limb-length discrepancy of 7 cm (4 to 9) and nonunion at one end of a vascularised fibular graft, which had been performed previously, to reconstruct a bone defect after resection of an osteosarcoma. Reconstruction was carried out using a ring fixator secured with correction by half pins of any malalignment, compression of the site of nonunion and lengthening through a metaphyseal parafocal osteotomy without bone grafting. The  expected limb-length discrepancy at maturity was calculated using the arithmetic  method. Solid union and the intended leg length were achieved in all the patients. Excessive scarring and the distorted anatomy from previous surgery in these patients required other procedures to be performed with minimal exposures and dissection in order to avoid further compromise to the vascularity of the graft or damage to neurovascular structures. The methods which we chose were simple and effective in addressing these complex problems.

 

 

Cartilage. 2010 April. 1; 4: 253-261

 

The Clinical Use of Human Culture-Expanded Autologous Bone Marrow Mesenchymal Stem Cells Transplanted on Platelet-Rich Fibrin Glue in the Treatment of Articular Cartilage Defects – A Pilot Study and Preliminary Results

 

Haleem AM, El Singergy AA, Sabry D, Atta H, Rashed  LA, Chu CR, El Shewy MT, Azzam A and Abdel Aziz MT.

 

 

Operative Techniques in Orthopaedics. 2010 June. 202:76-89.

 

Advances in Tissue Engineering for Articular Cartilage Repair. 

 

Haleem AM, Chu CR.  

 

 

Pittsburgh Othopaedic Journal. 2010. 21;134.

 

Bone Marrow Concentrate Versus Microfracture in the Treatment of Full Thickness Chondral Defects in Equine Stifle Joints. 

 

Haleem AM, Fortier LA, McCarrel T, Novakofski K, Chu CR.

 

 

Pittsburgh Othopaedic Journal. 2010. 21;138.

 

Effect of Exercise on Cartilage Integrity in the Rat Anterior Cruciate Ligament Transection Model. 

 

Henry SE, Haleem AM, Coyle CH, Rankin KK, Mulkeen ML, Chu CR.

 

 

The Egyptian Orthopaedic Journal 2010; 45(4):391-398

 

Transforaminal Lumbar Interbody Fusion (TLIF) for Degenerative and Low Grade Isthmic Spondylolisthesis.

 

Koptan W, ElMiligui Y, Maher A

 

 

The Egyptian Orthopaedic Journal 2010; 45(4):399-404.

 

Circumferential Resection of Aggressive Osteoblastoma of the Cervical Spine.

 

ElMiligui Y, Koptan W

 

 

Spine (Phila Pa 1976). 2010 Feb 26.

 

Anterior Instrumentation and Correction of Congenital Spinal Deformities Under Age of Four Without Hemivertebrectomy: A New Alternative.

 

Elsebaie HB, Kaptan W, El Miligui Y, El Masry MA, Salaheldine M, Noordeen HM, Akbarnia BA.

 

Abstract: STUDY DESIGN.: Retrospective clinical and radiologic evaluation of a single-stage

partial corpectomy of the hemivertebra with anterior instrumentation and

simultaneous posterior noninstrumented fusion. OBJECTIVE.: To determine the

safety and efficacy of a new technique in the management of progressive

congenital spinal deformities due to failure of formation in the very young age.

SUMMARY OF BACKGROUND DATA.: Several techniques have been reported for the

surgical treatment of young children with congenital spinal deformities. There

have been concerns regarding epidural bleeding, neurologic complications, pedicle

screws placement, implant failure, and prominence of posterior constructs in this

very young age group. A single-stage partial corpectomy of the hemivertebra with

anterior instrumentation and simultaneous posterior noninstrumented fusion can

offer a new alternative which can avoid these concerns. METHODS.: Twelve patients

with progressive congenital spinal deformities due to failure of formation were

retrospectively reviewed after adopting the above mentioned technique. All

patients included in the study presented with a single hemivertebra. The mean age

at time of surgery was 2 years 7 months (range, 1 year and 9 months to 3 years

and 10 months). The average follow-up period was 3 years and 1 month (range, 2

years to 4 years and 5 months). RESULTS.: There were no cases of intra or

postoperative neurologic or implant related complications. There was 1

superficial infection. All patients showed solid radiologic fusion. The mean

scoliosis angle improved from 48.3 degrees (range, 34 degrees -58 degrees )

preoperative to 17.2 degrees (range, 11 degrees -25 degrees ). The mean angle of

kyphosis improved from 23.2 degrees (range, 16 degrees -57 degrees ) before

surgery to 11.7 degrees (range, 4 degrees -16 degrees ). CONCLUSION.: A

single-stage partial corpectomy of the hemivertebra with anterior instrumentation

and simultaneous posterior noninstrumented fusion offers a safe alternative

method in treating patients with congenital hemivertebra under the age of 4

years.

 

 

 

Eur Spine J. 2010 Sep;19(9):1569-75. doi: 10.1007/s00586-010-1464-0. Epub 2010 May 27.

 

Surgical correction of severe dystrophic neurofibromatosis scoliosis: an

experience of 32 cases.

 

Koptan W, ElMiligui Y.

 

Abstract: The surgical management of severe rigid dystrophic neurofibromatosis curves is a

demanding procedure with uncertain results. Several difficulties are present in

such patients including a poor bone stock, sharp angulation of these dystrophic

curves and dural thinning or ectasia. The aim of this work was to review the

clinical and radiographic outcomes of three-dimensional correction of severe

rigid neurofibromatosis curves analyzing its efficacy, safety and possible

complications. Thirty-two patients were followed up for an average of 6.5 years

(range 3-9 years). The average age at surgery was 14 years (range 11-19 years). All patients had typical dystrophic curves, and the apex of the deformity was thoracic (n = 13), thoracolumbar (n = 14) and lumbar (n = 5). All patients had a  two-staged procedure; an anterior release followed latter by posterior hybrid instrumentation augmented by sublaminar wires. Two wires were usually placed immediately below the proximal anchor, and several sublaminar wires were always passed at the apex of the deformity. There were a total of 142 wires with an average of 6.5 wires/patient (range 5-8 wires). The mean preoperative Cobb angle  of the scoliotic curve was 102.2 degrees (range 71 degrees-114 degrees) corrected to an average of 39 degrees (range 16 degrees-49 degrees), and the loss of correction had an average of 4 degrees. The mean preoperative sagittal plane deformity was 49 degrees corrected by an average of 61%, and rotation was corrected by an average of 34%. There were no dural tears during passage of the sublaminar wires, no implant-related complications and no permanent neurologic deficits. The use of extensive and vigorous anterior release with posterior hybrid instrumentation has proved useful and effective in the treatment of these  severe deformities; sublaminar wires allow safe gradual correction and even distribution of forces over multiple anchor points improving the correction achieved and decreasing implant-related complications.

 

 

 

2011

 

 

J Bone Joint Surg Br. 2011 Jul;93(7):932-6. doi: 10.1302/0301-620X.93B7.25418.

 

Percutaneous screw fixation without bone grafting for established scaphoid nonunion with substantial bone loss.

 

Mahmoud M, Koptan W.

 

Abstract: Ununited fractures of the scaphoid with extensive bone resorption are usually treated by bone grafting and internal fixation, using either an open or a minimally invasive technique. We studied the feasibility of percutaneous fixation without bone grafting in a consecutive series of 27 patients with established nonunion of an undisplaced fracture of the scaphoid and extensive local resorption of bone. They were treated by a single surgeon with rigid fixation alone, using a headless cannulated screw inserted through a volar percutaneous technique. Clinical examination, standard radiographs and CT confirmed that the fracture had united in all patients at a mean of 11.6 weeks (8 to 16), and that their functional scores had improved. We concluded that extensive resorption at the fracture site is not an absolute indication for bone grafting, and that percutaneous fixation alone will eventually produce healing of ununited undisplaced fractures of the scaphoid regardless of the size of the gap.

 

 

Osteoarthritis Cartilage. 2011 Aug;19(8):1058-65. doi:

10.1016/j.joca.2011.04.009. Epub 2011 Apr 28.

 

Single intra-articular injection of adeno-associated virus results in stable and  controllable in vivo transgene expression in normal rat knees.

 

Payne KA, Lee HH, Haleem AM, Martins C, Yuan Z, Qiao C, Xiao X, Chu CR.

 

Abstract: OBJECTIVE: To test the hypothesis that in vivo transgene expression mediated by single intra-articular injection of adeno-associated virus serotype 2 (AAV2) persists within intra-articular tissues 1 year post-injection and can be externally controlled using an AAV2-based tetracycline-inducible gene regulation  system containing the tetracycline response element (TRE) promoter. METHODS: Sprague Dawley rats received intra-articular injections of AAV2-cytomegalovirus (CMV)-enhanced green fluorescent protein (GFP) and AAV2-CMV-luciferase (Luc) into their right and left knees, respectively. Luciferase expression was evaluated over 1 year using bioluminescence imaging.

After sacrifice, tissues were analyzed for GFP+ cells by fluorescent microscopy.

To study external control of intra-articular AAV-transgene expression, another set of rats was co-injected with AAV2-TRE-Luc and

AAV2-CMV-reverse-tetracycline-controlled transactivator (rtTA) into the right knees, and AAV2-CMV-Luc and AAV2-CMV-rtTA into the left knees. Rats received oral doxycycline (Dox), an analog of tetracycline, for 7 days. Luciferase expression was assessed by bioluminescence imaging.

RESULTS: Luciferase expression was localized to the injected joint and persisted  throughout the 1-year study period. Abundant GFP+ cells were observed within intra-articular soft tissues. Transgene expression in AAV2-TRE-Luc injected joints was upregulated by oral administration of Dox, and downregulated following its removal, at 14 days and 13 months post-AAV injection. CONCLUSIONS: This longitudinal in vivo study shows that sustained and stableAAV-mediated intra-articular transgene expression can be achieved through a

single intra-articular injection and can be controlled using atetracycline-controlled inducible AAV system in a normal rat knee model. Highly

regulatable long-term intra-articular transgene expression is of potential

clinical utility for development of treatment strategies for chronic

intra-articular disease processes such as inflammatory and degenerative

arthritis.

 

 

Tissue Eng Part A. 2011 Aug;17(15-16):1969-78. doi: 10.1089/ten.TEA.2010.0586. Epub 2011 May 11.

 

Release of bioactive adeno-associated virus from fibrin scaffolds: effects of fibrin glue concentrations.

 

Lee HH, Haleem AM, Yao V, Li J, Xiao X, Chu CR.

 

Abstract: Fibrin glue (FG) is used in a variety of clinical applications and in the

laboratory for localized and sustained release of factors potentially important

for tissue engineering. However, the effect of different fibrinogen

concentrations on FG scaffold delivery of bioactive adeno-associated viruses

(AAVs) has not been established. This study was performed to test the hypothesis  that FG concentration alters AAV release profiles, which affect AAV

bioavailability. Gene transfer efficiency of AAV-GFP released from FG was

measured using HEK-293 cells. Bioactivity of AAV transforming growth factor-beta1 (TGF-β(1)) released from FG was assessed using the mink lung cell assay, and by measuring induction of cartilage-specific gene expression in human mesenchymal stem cells (hMSCs). Nondiluted FG had longer clotting times, smaller pore sizes,  thicker fibers, and slower dissolution rate, resulting in reduced release of AAV.

AAV release and gene transfer efficiency was higher with 25% and 50% FG than with the 75% and 100% FG. AAV-TGF-β(1) released from dilute-FG transduced hMSCs, resulting in higher concentrations of bioactive TGF-β(1) and greater upregulation of cartilage-specific gene expression compared with hMSC from undiluted FG. This  study, showing improved release, transduction efficiency, and chondrogenic effect on hMSC of bioactive AAV-TGF-β(1) released from diluted FG, provides information  important to optimization of this clinically available scaffold for therapeutic gene delivery, both in cartilage regeneration and for other tissue engineering

applications.

 

 

Eur Spine J. 2011 Feb;20(2):308-13. doi: 10.1007/s00586-010-1537-0. Epub 2010 Jul

30.

 

Single stage anterior reconstruction using titanium mesh cages in neglected kyphotic tuberculous spondylodiscitis of the cervical spine.

 

Koptan W, Elmiligui Y, Elsharkawi M.

 

Abstarct: Cervical tuberculous spondylodiscitis is a serious, hazardous disorder and to our

knowledge, hardly any reports focused on the use of titanium mesh cages in its

treatment. The aim of this work is to evaluate the efficacy of using a titanium

mesh cage compared to iliac crest grafting regarding correction of the deformity,

fusion rate and to report the incidence of complications. A prospective,

non-randomized multicentre study of 30 patients with cervical tuberculous

spondylodiscitis presenting with a neglected kyphotic deformity. The average age

was 44.5 years; 18 had neurological deficits. All patients had a single stage

radical debridement, decompression, and instrumentation. The anterior column was

reconstructed with a titanium mesh cage in 16 patients (Group 1) and an

autogenous iliac bone strut graft in 14 (Group 2). Both groups were followed for

a minimum of 2 years. Group 1 showed a better sagittal profile and local kyphosis

was corrected from an average of 36° (10°-62°) to an average of -6° (+4° to -16°)

compared to Group 2 corrected from an average of 30° (6°-48°) to an average of

-1° (+2° to -13°). Group 1 patients showed a solid bony fusion without any

recurrence of infection while Group 2 showed a higher incidence of nonunion and

of persistent donor site morbidity. The use of titanium mesh cages effectively

restores the sagittal profile while adding immediate stability. There is no donor

site morbidity, recurrence, or persistence of infection associated with their

implantation.

 

 

Spine J. 2011 Feb;11(2):133-8. doi: 10.1016/j.spinee.2011.01.012.

 

Direct repair of spondylolysis presenting after correction of adolescent

idiopathic scoliosis.

 

Koptan WM, ElMiligui YH, ElSharkawi MM.

 

Abstract: BACKGROUND CONTEXT: Although spondylolysis is found in 6% of idiopathic scoliosis

patients, very little was reported on management of pars defects in this group.

These patients with painful spondylolysis are most eligible for direct repair of

the defect rather than lumbosacral fusion in an attempt to save motion segments.

PURPOSE: The aim of this work was to analyze the clinical and radiologic outcome

of pars repair in a group of adolescents who presented after surgical correction

of their idiopathic scoliosis.

STUDY DESIGN: A prospective nonrandomized study.

PATIENT SAMPLE: Ten consecutive patients with spondylolysis presenting after an

average of 3 months (range, 2-7 months) from correction of their idiopathic

scoliosis with low back pain not responding to conservative therapy and

interfering with everyday activities. The mean age at operation was 16 years

(range, 14-19 years).

OUTCOME MEASURES: Total blood loss, operative time, and hospital stay were

recorded. Clinical outcome was assessed by the Oswestry Disability Index (ODI),

visual analog scale (VAS), and Scoliosis Research Society (SRS)-22 questionnaire.

Fusion of the pars interarticularis was assessed using plain, lateral, and

oblique radiographs and a computed tomography (CT) scan.

METHODS: The surgical technique consisted of thorough debridement of the defect,

impacting the gap created with a tricortical iliac crest graft, and rigid

fixation by either pedicle screws and a V-shaped rod (five patients) or a

cable-screw construct (five patients).

RESULTS: Patients were followed up for an average of 4.5 years (range, 2-7

years). Nine patients had a good-to-excellent result, returned to normal everyday

life, and participated in sports when desired. The mean ODI, VAS, and SRS total

scores were 11 (range, 0-34), 1.1 (range, 0-2), and 92 (range, 61-108),

respectively. Follow-up radiographs and CT scans revealed healing of all defects

in nine cases, no signs of disc degeneration in any, and no implant-related

complications.

CONCLUSIONS: The results of direct repair of spondylolysis in idiopathic

scoliosis patients were very satisfactory both clinically and radiologically.

Direct repair appears to be a logical alternative to spinal fusion; lumbar spine

mobility was preserved, and precocious motion segments were saved with a

relatively simple operation.

 

 

Eur Spine J. 2011 Sep;20(9):1434-40. doi: 10.1007/s00586-011-1720-y. Epub 2011 Feb 19.

 

Comparison between pedicle subtraction osteotomy and anterior corpectomy and plating for correcting post-traumatic kyphosis: a multicenter study.

 

El-Sharkawi MM, Koptan WM, El-Miligui YH, Said GZ.

 

Abstract: Kyphosis is a common sequel of inadequately managed thoracolumbar fractures. This

study compares between pedicle subtraction osteotomy (PSO) and anterior

corpectomy and plating (ACP) for correcting post-traumatic kyphosis. Forty-three

patients with symptomatic post-traumatic kyphosis of the thoracolumbar spine were

treated with PSO and prospectively followed for a minimum of 2 years. Visual

Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess

clinical improvement and radiographs were obtained at 2, 6, 12 and 24 months. The

recorded clinical and radiological outcomes were compared to a control group of

37 patients, who were treated earlier by the same authors with ACP. The mean

correction of the kyphotic angle was 29.8° for the PSO group and 22° for the ACP

group (P = 0.001). PSO group showed significantly better improvement in the VAS

score and the ODI. At final follow-up, patients reported very good satisfaction

(93% in PSO vs. 81% in ACP) and good function (90% in PSO vs. 73% in ACP).

Complications in the PSO group included pulling out of screws and recurrence of

deformity requiring revision and longer fixation (1 patient), and transient lower

limb paraesthesia (2 patients). Recorded complications in the ACP group included

an aortic injury (1 patient) that was successfully repaired, pseudarthrosis (1

patient), persistent graft donor site morbidity (3 patients), and incisional

hernia (1 patient). PSO and ACP are demanding procedures. PSO seems to be equally safe but more effective than ACP for correcting post-traumatic kyphosis.

 

 

 

2012

 

 

J Bone Joint Surg Br. 2012 Aug;94(8):1090-6. doi: 10.1302/0301-620X.94B8.28646.

 

Correction of dorsally-malunited extra-articular distal radial fractures using volar locked plates without bone grafting.

 

Mahmoud M, El Shafie S, Kamal M.

 

Abstract: Malunion is the most common complication of the distal radius with many modalities of treatment available for such a problem. The use of bone grafting after an osteotomy is still recommended by most authors. We hypothesised that bone grafting is not required; fixing the corrected construct with a volar locked plate helps maintain the alignment, while metaphyseal defect fills by itself.

Prospectively, we performed the procedure on 30 malunited dorsally-angulated

radii using fixed angle volar locked plates without bone grafting. At the final

follow-up, 22 wrists were available. Radiological evidence of union, correction

of the deformity, clinical and functional improvement was achieved in all cases.

Without the use of bone grafting, corrective open wedge osteotomy fixed by a

volar locked plate provides a high rate of union and satisfactory functional

outcomes.

 

 

J Hand Surg Eur Vol. 2012 Oct;37(8):781-6. doi: 10.1177/1753193412451401. Epub 2012 Jun 26.

 

Tendon transfer for treatment of internal rotation contracture of the shoulder in brachial plexus birth palsy.

 

Abdel-Ghani H, Hamdy KA, Basha N, Tarraf YN.

 

Abstract: We retrospectively analyzed 63 patients with internal rotation contracture of the

shoulder secondary to brachial plexus birth palsy treated with subscapularis

sliding combined with either latissimus dorsi transfer (group A: n = 18) or

latissimus dorsi and teres major transfer (group B: n = 45) to the rotator cuff.

The mean age at time of surgery was 43 months (SD 21 months; range 8 months to 9 years). We used a modification of the Gilbert shoulder grading system for

assessment. All patients showed statistically significant improvement of active

shoulder abduction and external rotation without significant differences between

the two groups. Significant external rotation contracture of the shoulder

(inability to touch the abdomen with the wrist extended) occurred in 42 of 63

patients, and there was a greater incidence of external rotation contracture in

group B. We conclude that surgery should be restricted to latissimus dorsi

transfer without teres major transfer to avoid external rotation contractures.

Our modification of the Gilbert grading system appears to be valid and

applicable.

 

 

The Egyptian orthopedic journal. (accepted on 15/6/2012).

 

Four corner fusion for management of scaphoid nonunion advanced collapse - A New technique.

 

Mostafa Mahmoud

 

 

The Egyptian orthopedic journal. (accepted on 20/6/2012)

 

The use of perforator based radial fascial forearm flap for management of recurrent carpal tunnel syndrome.

 

Mostafa Mahmoud

 

 

Sports Health. Accepted for publication. May 2012

 

Serum CTXii Correlates with Articular Cartilage Degeneration 1 After Anterior Cruciate Ligament Transection or Arthrotomy Followed by Standardized Exercise. 

 

Coyle CH, Henry SE, Haleem AM, O’Malley MJ, Chu CR. 

 

World J Orthop. 2012 Jul 18;3(7):101-8.

 

Establishing proof of concept: Platelet-rich plasma and bone marrow aspirate concentrate may improve cartilage repair following surgical treatment for osteochondral lesions of the talus.

 

 Smyth NA, Murawski CD, Haleem AM, Hannon CP, Savage-Elliot I, Kennedy JG.

 

 

Phys Sportsmed. 2012 Nov;40(4):66-72. doi: 10.3810/psm.2012.11.1989.

 

A review of synthetic playing surfaces, the shoe-surface interface, and lower extremity injuries in athletes.

 

Taylor SA, Fabricant PD, Khair MM, Haleem AM, Drakos MC.

 

Abstract: The evolution of synthetic playing surfaces began in the 1960s and has had an impact on field use, shoe-surface dynamics, and the incidence of sports-related injuries. Modern third-generation turfs are being installed in recreational facilities and professional stadiums worldwide. Currently, > two-thirds of

National Football League teams, > 100 National Collegiate Athletic Association

Division I football teams, and > 1000 high schools in the United States have

installed synthetic playing surfaces. Those in favor of such playing surfaces

note their unique combination of versatility and durability; they can be used in

both ideal and inclement weather conditions. However, the more widespread

installation and use of these surfaces have raised questions and concerns

regarding the impact of artificial turf on the type and severity of

sports-related injuries. There appears to be no question that the shoe-surface

interface has a significant impact on such injuries. Independent variables such

as weather conditions, contact versus noncontact sport, shoe design, and field

wear complicate many of the results reported in the literature, thereby

preventing an accurate assessment of the true risk(s) associated with certain

shoe-surface combinations. Historically, studies suggest that artificial turf is

associated with a higher incidence of injury. Furthermore, reliable biomechanical data suggest that both the torque and strain experienced by lower extremity joints generated by artificial surfaces may be more than those generated by natural grass fields. Recent data from the National Football League support this theory and suggest that elite athletes may sustain more injuries, even when playing on the newer artificial surfaces. By contrast, some reports based on data collected from lower-level athletes suggest that artificial turf may protect against injury. This review discusses the history of artificial surfaces, the biomechanics of the shoe-surface interface, and some common turf-related lower extremity injuries.

 

 

The Egyptian Spine Journal 2012; 1(1):48-54.

 

Unilateral Transforaminal Lumbar Interbody Fusion for High Grade Isthmic Spondylolisthesis.

 

Koptan W, ElMiligui Y, ElSharkawi, Ramadan M

 

 

? The Egyptian Spine Journal 2012; 1(2):5-13.

 

 

Multiple-Level Anterior Cervical Discectomy and Fusion Using PEEK Cages in Cervical Myelopathy. Is Anterior Platting Necessary

 

Fouad A, Koptan W, ElMiligui Y, , ElHadidi T, ElSharkawi M

 

 

The Egyptian Spine Journal 2012; 1(2):20-29.

 

Pedicle Subtraction Osteotomies for Correcting Sagittal Imbalance.

 

ElSharkawi M, Koptan W, ElMiligui Y, El-Sherif E

 

 

The Egyptian Spine Journal 2012; 1(2):38-46.

 

Transforaminal Lumbar Interbody Fusion (TLIF) for Revision of Failed Posterolateral Spinal Fusion.

 

ElSharkawi M, Koptan W, ElMiligui Y

 

 

Eur Spine J. 2012 Jun;21(6):1091-8. doi: 10.1007/s00586-011-2111-0. Epub 2011 Dec 13.

 

Three-staged correction of severe rigid idiopathic scoliosis using limited

halo-gravity traction.

 

Koptan W, ElMiligui Y.

 

Abstract: INTRODUCTION: Despite the advantages of modern instrumentation techniques, the

treatment of severe rigid idiopathic scoliosis could be very demanding. Traction

can provide better, safer correction and minimize complications related to

forceful intra-operative maneuvers; however, several side effects are associated

with prolonged periods of traction. The aim of this work is to review the

clinical and radiographic results of limited perioperative halo-gravity traction

in severe rigid curves analyzing its efficacy, advantages and possible

complications and comparing it to classic two staged corrections performed

without traction.

METHODS: A retrospective case control study including 47 adolescents with severe

rigid idiopathic scoliosis divided into two groups; a consecutive series of 21

patients who had a three-staged correction by an anterior release, 2 weeks of

halo-gravity traction then posterior instrumentation (TRN group); compared to an

earlier series of 26 consecutive patients treated without traction (SAP group).

The average age was 18 years + 1 month and 16 years + 2 months, respectively. The

average preoperative dorsal and lumbar curves for (TRN) group were 106.5° and

87°, respectively, and for (SAP) group were 102° and 81°, respectively.

RESULTS: Patients were followed up for an average of 6 years (range 3-8 years). A

significantly better correction was achieved in (TRN) group (average 59%)

compared to (SAP) group (average 47%). At final follow-up, the loss of correction had an average of 8° for (TRN) group and 11° for (SAP) group. A shorter hospital  stay was found in (SAP) group; a shorter operative time was found in (TRN) group  and there was no significant difference in blood loss, early or delayed

complications. CONCLUSIONS: Limited halo-gravity traction is an efficient, safe modality in the  treatment of severe rigid adolescent scoliosis. The application of gradual

traction over a limited period of 2 weeks led to better correction, shorter

operative time with no significant complications.

 

 

Injury. 2012 Sep 28. pii: S0020-1383(12)00389-0. doi:

10.1016/j.injury.2012.09.005.

 

Four-part fracture dislocations of the proximal humerus in young adults: Results  of fixation.

 

Soliman OA, Koptan WM.

 

Abstarct: INTRODUCTION: Four-part fracture dislocations of the proximal humerus occurring

in young age are extremely difficult fractures with a high incidence of

complications. The risk of avascular necrosis is high; hence, prosthetic

replacement is the treatment of choice in older patients with these complex fractures; on the other hand, the longevity of the prosthesis is the main concern in young age. Thus, every effort should be made to fix these fractures in the young. The purpose of this study is to evaluate the results of fixation in a series of young patients with four-part fracture dislocations; to support the trend to fix these fractures; and reserve prosthetic replacement to older patients. METHODS: In a prospective study, 39 patients younger than 40 years of

age with four-part fracture dislocations were treated with open reduction and fixation either with K-wires or with a proximal humerus plate. Ethibond sutures were used in all patients to supplement fixation of tuberosities. In 18 patients,

the dislocation was anterior and in 21 patients it was posterior. Twelve patients had an anatomic neck fracture and 27 had a surgical neck fracture. Surgery was performed within 1 week after the injury. Physiotherapy was initiated according

to the general condition of the patient and the stability of fixation; the

average time was 5 days after surgery. RESULTS: Patients were followed up for an  average of 26 months. Union was achieved in 36 patients and three patients had nonunion, all in anatomic neck fractures. Avascular necrosis developed in eight patients, seven of which were fractures of the anatomic neck and one was in the surgical neck. The average Constant score was 77; 26 patients were pain free, nine had mild pain and four had moderate pain. The mean active anterior elevation was 145°. Patients were divided into two groups based on the anatomic configuration of the fracture; in 12 patients (group 1), the head was fractured at the anatomical neck and in 27 patients (group 2), the head was fractured at the surgical neck. In group 2, the active anterior elevation was significantly better and the Constant score was higher. CONCLUSIONS: Anatomical reduction and rigid fixation with meticulous surgical technique can lead to satisfactory results. The results in surgical neck fractures are superior to anatomic neck fractures with significantly less complications.

 

 

 

Books

 

 

Co-author in 2010 IFSSH Hand Surgery book: Edited by Chung MS, Baek GH, Gong HS. By Koonja publishing, Inc. 149-50 and 481-2

 

Mostafa Mahmoud

 

 

Co-author; Animal Models of Orthopedic Implant Related Infection;

Biomaterials Associated Infection 2013, p273-304

http://link.springer.com/chapter/10.1007/978-1-4614-1031-7_12

 

Ahmed Fouad Seif Eldin

 

Update on Cartilage Regeneration and Clinical Applications of Tissue Engineering in the Management of Cartilage Defects. Orthopaedic Knowledge Update (OKU). Accepted for publication October 2012

 

Haleem AM