Forty-five limb lengthening procedures are carried out in the Orthopedic department in Alkhadra Hospital in Tripoli the period between April 2006 and December 2010A retrograde study done Subjects and Methods A scanogram was used for measurement. All our cases

operated under general anesthesia. One bone at a time, for the tibia, we used the tourniquet. Distal or midshaft fibular osteotomy: If it was distal, we fix the distal segment to the tibia by a single screw for ankle stability. Two Schanz screws were inserted in the metaphyseal region above the proposed corticotomy site, another two screws just below it. As all our cases had proximal metaphyseal osteotomy, one skin incision was used, and two parallel periosteal incisions were performed. Gigli saw was used with or without drill holes, safeguarding the medulla. The Wagner apparatus was then installed. The wound was closed in layers over the drain. An antibiotic was given postoperatively; check if an x-ray was taken. On the second postoperative day, lengthening started and was recorded on the chart. In the other group the corticotomy was kept compressed for two weeks, and lengthening started in the same manner. We lengthen 1 mm per day, monitoring the patient's response. Some patients were taught how to use the apparatus on themselves, though most of the patients remained in the hospital until full length was achieved. Control x-ray prior to discharge unless complications were detected. Once the target length had been achieved, the frame was locked until a good quality of bone was seen radiologically; then the fixator was removed. All patients underwent vigorous physiotherapy from the first postoperative day Results from 45 patients include 10 males (22%) and 35 females (78%). Twenty-seven tibiae (60%), seventeen femora (37%), and one humerus were lengthened (3%). Lengthening ranged between 3 cm (18%) and 11 cm (3%). The cause of lengthening was residual poliomyelitis in 38 patients (84%), trauma in 4 patients (9%), and congenital shortening in 3 patients (7%). Complication: Only 5 cases (11%) had pin tract infection; malalignment of the longitudinal axis more than 5 degrees was noticed in 12 cases (27%); equinus deformity was noticed in 9 cases (20%) of tibial lengthening; and knee stiffness was observed in 11 cases (24%) of both femoral and tibial lengthening. There was neither serious infection nor deep venous thrombosis. With such an extended course of treatment, most of the patients had some problems that resolved with nonoperative intervention. Most patients experienced pain or discomfort during The course of treatment was managed by analgesics or by stopping the length for 1-2 days. Conclusion: In all patients the desired length was gained without any serious mechanical problems.

Abstract— Private cars are important for most household

activities in Libyan societies. They give comfort and

convenience to the users to go to different destinations without

affecting other users. However, the total number of private car

and private transport namely taxi and micro buses on the road

increases and causes many problems such as traffic congestion,

accidents, air and noise pollution. This study aims to identify

the factors to support private car drivers shifting to public

transport system (PT) and to develop model shift from private

car to public transport in order to formulate policies to achieve

this. The study has been carried out in Tripoli city authority

areas among private car users who live in the areas with lack

of private transport and no public transport (PT) services. A

questionnaire survey was carried out to study the potential

reduction of private cars on road through optimal use of

suitable public transportation system in order to reduce traffic

problems. The probability of policy car drivers shifting to

public transport was examined based on scenario several

options such as reduce and improve in public transport travel

time, travel cost and car parking. This study has recommended

shift level of level 113 (it means that parking cost will be

increased by Libyan Dinar (LYD) 0.5 as level 1 (low level),

travel time to be improved by 10% as level 1 (low level) and

travel cost to be reduced by at least 50% as level 3 (middle

level)) to be implemented if the targeted PT shift around 60%

to be achieved. The result has shown a logical implementation

to both of the travellers and operators. Statistical Package for

Social Science (SPSS) and Excel 2007 software were used to

descriptive and analysis the questionnaire in this study