Amr A Abdelgawad

Maimonides Medical Center · Orthopedic department

Case: Three male patients, 8-, 13-, and 18-year-old, all developed posttraumatic cubitus varus elbow deformity after distal humerus supracondylar fractures. Each underwent a distal humerus osteotomy with application of a hexapod external fixator to gradually correct the deformity. Conclusion: In patients with cubitus varus malunion, the stabilit...

Background: Obstetrical brachial plexus palsy (OBPP) is a relatively common stretch injury of the brachial plexus sustained during delivery. Tendon transfers are commonly performed to improve shoulder function among patients with OBPP. Although several techniques for the surgical management of OBPP exist, it is unclear whether tendon transfers to...

The timing of definitive fixation of open ankle malleolar fractures is still controversial. This study intended to evaluate the outcome of patients who were managed by immediate definitive fixation in comparison to delayed definitive fixation following open ankle malleolar fractures. This was an IRB approved retrospective case control study of 32 p...

The PRECICE® intramedullary rod (NuVasive, San Diego, CA) utilizes multiple telescopic components to magnetically drive limb lengthening. These devices are routinely explanted after desired growth correction is met. To the author’s knowledge, this is the first description of an osteotomy assisted extraction of a disassociated tibial magnetic length...

Back Ground: Lisfranc injuries are a rare injury in the adolescent age group and can be easily missed. This study aimed to report pathological pattern of Lisfranc injury in adolescent patient and if it was different from the common adult patients and assess results of surgical treatment of these injuries. Materials: This is a retrospective study of...

Introduction: Various factors including patient demographics, fracture types, and fixation methods can affect the outcomes of distal femur fractures. This study aimed to analyze the risk factors for reoperation after operative fixation of these fractures. Methods: This was an institutional review board (IRB) approved retrospective study of extra-ar...

Introduction: Studies evaluating utilization and trends of total ankle arthroplasty (TAA) and ankle fusion (AF) are sparse. The purpose of this study was to use a nationwide administrative claims database to compare baseline demographics between TAA and ankle arthrodesis and to determine whether patients who had a TAA have increased rates of: (1) u...

Introduction Sleep Apnea (SA) is a common sleep disorder that increases postoperative morbidity. There is limited research on how SA influences outcomes following operative fixation of ankle fractures. Therefore, the aim of this study was to determine whether patients who undergo surgical fixation for bimalleolar ankle fractures have higher rates o...

Introduction Contemporary studies evaluating utilization and trends of total ankle arthroplasty (TAA) and ankle fusion (AF) for tibiotalar osteoarthritis are sparse. Therefore, the purpose of this study was to utilize a nationwide administrative claims database from 2010 to 2019 to compare: (1) baseline demographics; (2) utilization, (3) in-hospita...

Introduction:. The objectives for this study were to identify whether diagnostic or procedural errors more commonly resulted in lawsuit, as well as to elucidate how specific variables affected mean indemnity. Methods:. Systematic review of English-language articles in the PubMed and Google Scholar databases (through 2020) using Preferred Reporting...

Category Midfoot/Forefoot; Trauma Introduction/Purpose Lisfranc injuries are rare injuries in the adolescent age group and can be easily missed. Ligamentous Lisfranc injuries have been classically descried as disruption of the Lisfranc ligament (between medial cuneiform and second metatarsus) and ligamentous disruption of the first metatarso-phala...

Arthroereisis is a surgical procedure primarily used to treat flexible pes planus (flatfoot) in pediatric and young adult patients. The principal goal of subtalar arthroereisis is to relieve pain and restore function. This is primarily done by restoring the medial foot arch without fusing the subtalar joint and without requiring a long recovery per...

Background: Tibial shaft fractures are common injuries in the adolescent age group. The optimal method of treatment in this age group is still controversial. It relies on several factors including patient's age, fracture pattern, fracture location, and the condition of the soft tissue envelope. The purpose of this study was to report the clinical a...

Introduction: Chronic patella alta after chronic patellar tendon rupture or patella fracture non-union is a challenging condition to treat. Case report: In this report, we present the case of a 50-year-old male with inferior patellar pole fracture with non-union and chronic patella alta from a chain saw accident 12 years before presentation. An...

Case: The Ganz periacetabular osteotomy (PAO) is widely used to correct developmental hip dysplasia in the adolescent and young adult population. The aim of this case study was to examine the novel utility and safety of Stoppa approach for the Ganz PAO in a 15-year-old girl and 25-year-old man. The Stoppa approach is traditionally used for acetabu...

Background: Flexible intramedullary nails (FNs) are successfully used to treat pediatric forearm fractures, especially midshaft fractures. Distal forearm fractures have been described as "difficult to manage" with FN insertion. The purpose of this study was to report the clinical and radiographic outcomes of using flexible nails in pediatric forea...

Background Management of children with snakebites may vary based on subjective criteria, geographic, and climatic factors. We reviewed the incidence and management of snakebite injuries in children at two tertiary referral centers in separate geographic and climatic location to assess differences in management and outcomes of these patients. Metho...

Monteggia fracture dislocation include ulnar fracture and radial head dislocation. In most cases of Monteggia fracture dislocation, the radial head will reduce spontaneously with reduction of the ulnar fracture. In some cases, the radial head will not reduce with ulnar fracture reduction and these cases were classically reduced by open reduction wh...

Background: Successful surgical management of pelvic ring and acetabular fractures requires technical expertise to achieve an accurate reduction and stable fixation. The use of 3-dimensional (3D) intraoperative imaging (3DIOI) as an assessment tool has led to improved reduction and placement of implants. The purpose of this study was to assess the...

The treatment algorithm for tibial plateau fractures continues to evolve as surgeon experience increases. Initial surgical procedures have been fine- tuned over time. This is a retrospective chart review of 132 patients with low-energy tibial plateau fractures (Schatzker I–IV) treated at a level-1 academic trauma center between January 2008 and Fe...

Background: Open tibial plafond fractures (Orthopaedic Trauma Association and AO Foundation [OTA/AO] 43) are associated with severe complications, including deep infection (closed fractures, 20%; open fractures, 30%), amputation (3%-14%), and nonunion (up to 25%). Circular external fixators (CEFs) can minimize soft tissue injury. This study aimed...

Methods to achieve external immobilization of the extremity.

This chapter describes musculoskeletal infections, including bone infection (osteomyelitis) and joint infection (septic arthritis). It also describes management of different types of bites (human, cat, and dog).

The “limping child” is a common complaint in the pediatric clinic. Various pathologies can cause limping in children.

Bone fractures and dislocations are common injuries in children and adolescent; some need immediate referral and others can wait. This chapter explains the general management of the fractures and dislocations as well as the management of specific fractures and dislocations of the upper and lower extremities.

This chapter describes common foot presentations to primary care, e.g., intoeing, metatarsus adductus, and flat foot. Most of these cases are self-limited conditions and need only observation. You will learn how to identify the conditions that need treatment or surgical correction. On the other hand, some other conditions always need careful histor...

Hip joint is formed by the acetabulum on one side and the head of the femur on the other side. Various pathologoical process can affect the hip joint in children. Hip pain is a common complaint in the offices of the pediatricians and in the emergency departments. Knowledge of the different pathologies affecting the hip joint in children will help t...

Hand development follows very complex pattern. Many genes control the process of hand formation. Defiency of any of the genes can cause abnormal development of the hand. The hand is also exposed to variuos forms of trauma including soft tissue, bones, tendons and nerve injuries. Primary care physicians should be aware of the basic pathology involvi...

This chapter describes various imaging modalities that can be used in pediatric musculoskeletal imaging. It also explains the characteristic findings that can be seen in radiographs of the pediatric skeleton.

The knee joint is the largest synovial joint in the body. Examination of the knee joint requires proper examination skills. Many condition can affect the knee joint. Most of these conditions are part of normal development in which spontaneous improvment can be expected. This chapter will describe examination technique of the knee and explain the ph...

Bone tumors can be divided into primary and secondary tumors. Many bone tumors can affect the pediatric skeleton. Some of them are benign and some are malignant. The primary care physician should be aware with the common pediatic orthopedic tumors. This chapter will explain these tumors in simple method.

There has been a dramatic increase in adolescent sports participation over the last two decades. This increase has led to primary care physicians seeing and caring for athletic injuries more regularly. It is imperative that these physicians have a strong understanding of lower extremity injuries for proper initial management and necessary follow-up...

This chapter describes the characteristics of musculoskeletal injuries in cases of non-accidental trauma. It also explains the general management of children with suspected non-accidental trauma.

Children can suffer from different neurological conditions that can affect their musculoskeletal system. These conditions commonly need orthopedic interventions. These neurological conditions are best treated by multi-dispensary approach which includes pediatricians, pediatric orthopods, physiatrists, neurologists or neurosurgeons, and possibly uro...

Pediatric spinal pathology encompasses many different types of disease processes. Pathologies of the pediatric spine can effect the cervical, thoracic, or lumbar spines. Cervical pathologies can include disease processes such as torticollis or atlantoaxial instability. Thoracic pathologies can include scoliosis or kyphosis which can be congenital o...

This chapter explains the definitions used in orthopedics and the names of different parts of the bone, and movements. This will help the clinician to understand the pathology of the musculoskeletal diseases, and the definitions of the different deformities, malformations, and common orthopedic procedures.

This chapter describes the musculoskeletal injuries presented at birth, mostly due to macrosomia and difficult labour. most commonly Erb’s palsy and clavicular fracture. It is focused on clinical presentations, management and indications for orthopedic referral.

The revised and the expanded second edition of this concise and targeted handbook presents the “need-to-know” musculoskeletal conditions and injuries required for all health care providers dealing with pediatric patients, including primary care physicians, emergency medicine physicians, radiologists, residents, students, nurses, and therapists, to...

In recent years, there has been a significant increase in the incidence and severity of ankle fractures in the elderly. We present a case of an elderly patient with significant medical comorbidities and social issues who sustained an unstable ankle fracture that led to a severe malunion secondary to refusal for surgery and noncompliance with weight...

Background The purpose of this study was to analyze a comprehensive database to 1) compare patient demographic profiles; and 2) identify patient-related risk factors for surgical site infections (SSIs) following open reduction and internal fixation (ORIF) for lateral malleolar ankle fractures. Methods Patients treated with ORIF for lateral malleol...

Background: Gluteal compartment syndrome is an uncommon condition and can be difficult to diagnose. It has been diagnosed after trauma, vascular injury, infection, surgical positioning, and prolonged immobilization from drug or alcohol intoxication. The diagnosis is based on clinical findings and, in most cases, recognizing these symptoms and maki...

Pediatric tibial nonunion following corrective osteotomy is a rare complication that is not well understood. While adult nonunions have been linked to endocrine and metabolic aberrations, this has not been established in a pediatric population. Pediatric tibial nonunion has been shown to respond to debridement with revision fixation using dynamic c...

This study sought to determine the diagnostic accuracy, consultation appropriateness, and effectiveness of management of orthopaedic conditions in an emergency setting. A prospective, blinded analysis of all orthopaedic consults by emergency medicine providers at our institutional level I trauma center was conducted between May 1, 2016 and Jun 30,...

This chapter gives a brief description of the most common pediatric musculoskeletal disorders (congenital, developmental, and acquired). Clinical pictures and radiographs are provided to help explain the pathology of these conditions.

Fifty-seven years old female presented with resistant nonunion and limb length discrepancy (LLD) following distal periprosthetic fracture. The report described the experiences treating these conditions and literature review about the topic. Nonunion in periprosthetic distal femoral fractures can be challenging to the orthopedic surgeon and can resu...

Background: The purpose of this study was to describe the incidence and variables contributing to valgus distraction following cephalomedullary fixation of intertrochanteric femoral fractures with the helical blade system and to determine whether the resulting valgus reduction affected outcomes. Methods: We performed a retrospective case review of...

The aim of proximal femoral osteotomies in pediatrics is to restore normal anatomy and obtain joint congruency to prevent long-term degenerative hip problems. These osteotomies play an important role in the management of hip dislocations or subluxations due to neurological and other conditions that affect the hip. Femoral derotational osteotomy is...

Procedure Video

Open reduction internal fixation is the gold standard for unstable ankle fracture fixation; however, complications in patients with multiple medical comorbidities are common. Intramedullary nail fixation of the fibula can help to mitigate these difficulties. A retrospective chart review was performed on all patients who underwent fixation for unsta...

Background: Deltoid ligament injuries are typically caused by supination-external rotation or pronation injury. Numerous ligament reconstruction techniques have been proposed; however, clear indications for operative repair have not yet been well established in the literature. Methods: We reviewed primary research articles comparing ORIF treatme...

Background: A radial incision with radial plate fixation for distal radius fracture has historically been avoided due to its risk to the superficial branch of the radial nerve (SBRN). With careful technique, it is possible to avoid injury to the SBRN, thereby minimizing the soft tissue injury associated with other approaches. We compare subjective...

Category Ankle, Basic Sciences/Biologics Introduction/Purpose Ankle arthrodesis is performed in a variety of methods.We propose a new technique for tibiotalar arthrodesis using a newly designed intramedullary nail Methods We proposed the development of an intramedullary device for ankle arthrodesis which spared the subtalar joint using a sinus ta...

Gunshot wounds to the upper extremity in pediatric patients are an uncommon injury, but their impact on the patient can be severe. They can be accompanied by nerve damage, bone fracture, or tendon rupture. The most common cause of these pediatric gun injuries is unintentional firearm discharge. The most common type of firearm involved overall is a...

Despite timely and appropriate management, displaced femoral neck fractures are often devastating injuries for the young patient. The risk of negative sequelae is further amplified with increasing displacement and vertical fracture patterns. Open anatomic reduction with rigid internal fixation is essential to maximize the healing potential in displ...

Introduction Premature growth arrest can pose a challenge to the orthopedic surgeon. Various options for treating physeal arrest exist. Methods Systematic searches were conducted on PubMed/Medline, ScienceDirect, OVID, and Cochrane Library. Secondary searching was performed, where certain articles from reference lists of the selected studies were...

Background: Acute compartment syndrome (ACS) is often associated with tibial plateau fractures and is a limb-threatening injury. Staged management through fasciotomy with delayed definitive fixation can prevent muscle necrosis and increase limb salvage rates. This procedure opens a large area for potential contamination and infection in the lower...

Patients who undergo open reduction and internal fixation of distal clavicle fractures have a high rate of hardware removal and persistence of symptoms, particularly when attempting to return to high-demand activities. This study evaluated the outcomes of military servicemembers after surgical treatment of distal clavicle fractures. The authors per...

Introduction Clavicle fractures are common injuries in adolescent patients. In this study we present our technique and results for treating non-comminuted displaced midshaft clavicle fractures using flexible intra medullary nails. Methods A retrospective review of prospectively collected data using the electronic medical record was performed. Adol...

Objectives: Evaluate the Taylor spatial frame (TSF) for primary and definitive fixation of open supracondylar-intracondylar femoral (SIF) fractures. Design: Retrospective. Setting: Level I trauma center. Patients: Subset of 20 SIF open fractures treated with TSF extracted from a consecutive series of 80 SIF fractures treated between 2007 and...

Introduction: The purpose of this investigation was to evaluate the outcomes following reamer-irrigator-aspirator (RIA) autogenous bone grafting (ABG) of high-grade open tibia fracture nonunions stabilized via multiplanar external fixation. Methods: We retrospectively reviewed all patients with Gustilo-Anderson type III open tibia fractures treate...

Fracture of the calcaneal tuberosity with a concomitant Achilles tendon rupture presents a difficult challenge for the treating surgeon. The ultimate goal of treatment is to restore function of both the gastrocnemius-soleus complex and the Achilles tendon. This particular subset of fractures occurs often in diabetics and elderly patients with osteo...

Autogenous iliac crest bone grating has been the gold standard. Recently, intramedullary bone graft harvest using a reamer-irrigator-aspirator (RIA) had been gaining more interest among orthopedic surgeons. Twenty-four RIA bone graft harvesting procedures in 23 consecutive patients with nonunions were included. The mean age was 37.8 years. Rates of...

Operative fixation of medial malleolar fractures, whether isolated or in the setting of bi- or trimalleolar fractures, remains controversial. Increasingly, anatomic reduction and internal fixation is used to treat medial malleolar fractures to avoid long-term sequelae of symptomatic nonunion and posttraumatic osteoarthritis. However, outcomes have...

Bone grafting is one of the most common orthopedic procedures. We conducted a study to assess the possibility of passing a Reamer/Irrigator/Aspirator (RIA; DePuy Synthes) retrograde through the nonunion site in distal femur cases. This technique would avoid the complications and discomfort associated with a separate entry site for RIA. All patients...

Introduction . Ankle arthrodesis is performed in a variety of methods. We propose a new technique for tibiotalar arthrodesis using a newly designed intramedullary nail. Methods . We proposed development of an intramedullary device for ankle arthrodesis which spared the subtalar joint using a sinus tarsi approach. Standard saw bones models and compu...

Pelvic pyomyositis is an infection of the skeletal muscles around the hip joint. Fever, hip pain, limp, and leukocytosis are common; however, the clinical picture is often vague. MRI is the current gold-standard imaging for pyomyositis. No studies in the current literature have reported an unremarkable initial MRI in a patient with symptomatic pyom...

Objectives: The purpose of this study was to describe our experience in treatment of pediatric patient presenting with pedal puncture wound to our level I trauma center and describe our results for the need for hospitalization and/or surgery for these patients. Methods: Children and adolescents 18 years and younger presenting with pedal puncture...

Fractures of the lateral end of the clavicle are common in pediatric patients; most of these fractures occur at the physeal level representing Salter Harris injuries. The vast majority of fractures of the lateral end of the clavicle are managed nonoperatively. In this report, we describe a unique type of fracture of the distal end of the clavicle i...

Introduction: Femoral fracture after lengthening of congenital femoral deficiency (CFD) is a common complication with a high incidence, up to 50%. The purpose of this study is to determine whether prophylactic intramedullary Rush rodding after lengthening for CFD is an effective method to prevent femoral fracture and to assess any complications th...

Dog bites are common injuries in children. A large percentage of these dog bites affect the upper extremity. There is little information describing the results of treatment of upper extremity injuries in children. We retrospectively reviewed the medical records for all children less than 19 years old who presented to the emergency department in our...

Introduction: Trochanteric fractures are a leading cause of disability among the elderly. Internal fixation is the gold standard treatment. However, it may be challenging in the high-risk population. We present our results using external fixator in trochanteric fractures in the elderly. Patients and methods: During 2005-2012, twenty-three high-r...

The optimal management of displaced intra-articular calcaneal fractures remains a topic of debate among trauma surgeons. The purpose of this study was to assess the safety of the sinus tarsi approach in regard to the incidence of deep infection and amputation following open reduction and internal fixation intra-articular calcaneal fractures. We con...

Last minute review tables designed for a quick review before the exam; it helps the learner self-test their ability to the correct or most likely diagnosis and patient management in a very short time. Pediatric board study guide will offer further clarifications and additional information related to the topics on the last minute review section.

This chapter gives brief description of the most common pediatric musculoskeletal disorders. Clinical pictures and radiographs are provided to help explaining the pathology of these conditions.

Treatment of sacral fractures and sacroiliac joint (SIJ) disruption with percutaneous ilio-sacral (IS) screw fixation had become a more popular treatment option. There has been no study that specifically assessed IS fixation in children. The purpose of this study is present our results with fixation of the sacral fractures and SIJ disruption using...

We report a case of a 10-year-old boy presenting with radial nerve palsy due to injury during a tug-of-war game. Patient was managed nonoperatively and regained radial nerve function. Tug-of-war is a globally popular noncontact sport. Injuries during this game are inevitable and may range from simple sprains to life and limb threatening trauma. Com...

Calcaneus fractures in children differ from those in adults. Most calcaneus fractures in children can be managed nonoperatively, with good long-term results expected. The width and height of the calcaneus can remodel with time in children. Recently, there has been a trend toward operative treatment of displaced intra-articular fractures of the calc...

The knee joint is a hinge joint. It is the largest synovial joint in the body. The main motion in the knee joint is flexion–extension. Mild internal rotation-external rotation and adduction-abduction can occur.

Affection of the bony skeleton with deformity and shortness. Can affect the epiphysis, the metaphysis or the diaphysis. Can sometimes affect the spine (spondylodysplasia).

Methods to achieve immobilization of the extremity.

Children can suffer from different neurological conditions that can affect their musculoskeletal system.