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Shapovalov VM, Gubochkin NG, Mikitiuk SI. [Formation of vascularized bone grafts and their use for treatment of pseudoarthroses and bone defects]. VESTNIK KHIRURGII IMENI I. I. GREKOVA 2013; 172:63-67. [PMID: 24341248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
An analysis of 135 transplant surgeries of vascularised bone grafts in treatment of pseudoarthroses and defects of the clavicle, humerous, ulnar, radial, metacarpal,wrist and fingers bones was made. The fusion was noticed in 130 operated patients. The earlier removal of immobilization (in 2), the repeated trauma (in 2) and osteomyelitis of the transplanted graft, which required its removal in 1 patient, were the causes of failure in 5 (3.7%) patients.
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Burnei G, Vlad C, Gavriliu S, Georgescu I, Hodorogea D, Pârvan A, Burnei C, El Nayef T, Drăghici I. Upper and lower limb length equalization: diagnosis, limb lengthening and curtailment, epiphysiodesis. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2012; 50:43-59. [PMID: 22788093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION This article contains notions and guidelines derived from the current therapeutic approach used in the Pediatric Orthopedics Clinic of "M.S. Curie" Hospital, Bucharest. The purpose of this work is to illustrate the clinic's experience theoretically and by means of images. METHODS This article is based on 25 years of clinical experience (1986-2011), gained at Mangalia Regional Hospital and the Pediatric Orthopedics Clinic of "M.S. Curie" Hospital in Bucharest, having treated more than 250 such cases. In post-traumatic shortenings with associated soft tissue injuries we used double leveled corticotomies and lengthening. The lengthening rarely exceeded 10 cm, especially for congenital deformities and repeated lengthening. From 2001 onwards, all lengthening operations included the intramedullary implantation of one or two TEN rods, with the purpose of reducing the time to fixator removal and to shrink the healing index. In the last five years we frequently used minimally invasive osteotomies after the placement of TEN implants, achieving the separation of a small fragment that sites itself between the major fragments. The lengthening rate was 1 mm per day, broken down in four steps (0.25 mm every 6 hours). For difficult cases, such as congenital pseudarthroses or the presence of scar tissue around the osteotomy site, we recommended 0.75 mm of lengthening per day (0.25 mm every 8 hours). For congenital pseudarthroses we used controlled epiphysiolysis and bone transport. For inequalities ranging 3 to 5 cm we used temporary epiphysiodesis, initially with staples, and subsequently with "8", "H" and "I" plates. Limb shortening followed by locked intramedullary fixation was reserved for those patients who did not follow through with the evaluation program and who could not benefit from temporary epiphysiodesis. RESULTS The amount of lengthening per segment varied between 3 and 17 cm. The longest staged lengthening measured 20 cm, in two stages, and the greatest overall lengthening was 25 cm for an entire lower limb. An appropriate stabilization, followed by the adequate choice of osteotomy site and the postoperative weight loading of the limb ensured a quick and qualitative healing process. COMPLICATIONS Less than half of the patients suffered complications, most of them being minor ones. Pseudarthroses have been treated by compaction of the site, followed by distraction, and/or the injection of BMP (Bone Morphogenic Protein). We saw no complications after epiphysiodesis or limb shortening. CONCLUSIONS Limb lengthening procedures up to 5 cm lead to rapid consolidation and minimal complications. Lengthenings exceeding 5 cm require a good psychological preparation and careful monitoring. In lengthenings more than 10 cm, a faster rate of consolidation requires a double corticotomy, the use of intramedullary fixation and the immobilization of adjacent joints. In Lobstein's disease, good results can be obtained by the use of an Ilizarov external fixator. Restoring limb length equality by temporary epiphysiodesis, around the age of 10-12, is the least aggressive method and is very effective. Limb shortening by segmental resection should become obsolete.
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Wedemeyer C, Peppmüller R, Bredendiek T. [Therapy-resistant, atrophic and septic femoral pseudarthrosis]. DER ORTHOPADE 2010; 40:440-3. [PMID: 21052628 DOI: 10.1007/s00132-010-1698-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Non-union is a common and serious complication in orthopaedic surgery with high socioeconomic importance. In addition to conventional methods for the treatment of non-unions bone morphogenetic protein (BMP)-7 for the induction of bone tissue is available. The case report demonstrates successful treatment of a septic and atrophic femoral non-union by combination therapy with BMP-7 and autologous spongiosa graft after multiple revision surgeries.
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Jia LS. [Treatment and influencing factor of non-fusion after cervical surgery]. ZHONGHUA WAI KE ZA ZHI [CHINESE JOURNAL OF SURGERY] 2010; 48:801-802. [PMID: 21163044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Idrissi KK, Galiua F. [Non-vascularized fibular graft as salvage technique for forearm reconstruction]. CHIRURGIE DE LA MAIN 2010; 29:118-20. [PMID: 20303313 DOI: 10.1016/j.main.2010.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 09/15/2009] [Accepted: 01/31/2010] [Indexed: 11/18/2022]
Abstract
Authors report a case of a reconstruction of a large bone defect in the forearm with a free fibular graft occurring a good incorporation of the graft. Authors discuss the interest of fibula graft in reconstruction of large bone defect of the forearm.
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Cebrián JL, Gallego P, Francés A, Sánchez P, Manrique E, Marco F, López-Durán L. Comparative study of the use of electromagnetic fields in patients with pseudoarthrosis of tibia treated by intramedullary nailing. INTERNATIONAL ORTHOPAEDICS 2010; 34:437-40. [PMID: 19462169 PMCID: PMC2899307 DOI: 10.1007/s00264-009-0806-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 05/04/2009] [Accepted: 05/05/2009] [Indexed: 10/20/2022]
Abstract
We made a comparative cohort study in patients suffering from tibial pseudoarthrosis, all of whom were treated by intramedullary nailing. We divided patients into two groups: one treated by intramedullary nailing only (control group) and the other by intramedullary nailing combined with pulsed electromagnetic fields (PEMFs). The study included 57 cases of tibial pseudoarthrosis in 57 patients from February 1987 to February 2002. Pseudoarthrosis was treated surgically in all cases (Grosse-Kempf dynamic intramedullary nailing). This was combined with PEMFs in 22 cases. The average age was 38.3 years (range 14-89 years) and the average duration of follow-up was 27.2 months (range 12-48 months). Forty-nine fractures (86%) healed and eight (14%) did not. Of the group treated with PEMFs, 20 (91%) healed and two (9%) did not; from the group that did not receive PEMF (35), 29 (83%) healed compared to six (17%) that did not. The relationship between union and use of PEMFs, and between time to union and use of PEMFs was clinically relevant. PEMFs are useful when treating tibial pseudoarthrosis. Its noninvasive nature means that there are more complication-free unions.
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Haque MA, Akanda NI, Hossain MB. A neglected case of congenital pseudarthrosis of tibia. Mymensingh Med J 2010; 19:123-126. [PMID: 20046185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Congenital pseudarthrosis of the tibia (CPT) is a rare malformation. It was first described by Hatzoecher in 1708. Treatment options of the congenital pseudarthrosis of tibia are variable and challenging. Various forms of bone grafts such as autologous iliac bone graft or free vascularised fibular graft, bracing, electrical stimulation, external fixators including Ilizarov technique and internal fixation with rods and plates are used. Here we represent a case of congenital pseudarthrosis of the tibia (CPT) of a 15 year-old boy, a shopkeeper hailing from Barhatta, Netrokona and diagnosed by history, clinical examination and x-ray. He was treated by Ilizarov technique and follow up was done for a period of 1 year. Complete union was achieved with correction of angulation and shortening.
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Leliefeld K, Van Der Sluijs H, Van Der Haven I. Isolated congenital anterolateral bowing of the fibula: a case report with 24 years follow-up. Acta Orthop Belg 2009; 75:842-846. [PMID: 20166370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Only very few cases of congenital anterolateral bowing of the fibula have been described in literature. We report a girl with congenital anterolateral bowing of the fibula with a 24 year follow-up. Asymptomatic bowing of her left leg below the knee was noted at the age of three years. Radiographs showed an isolated anterolateral bowing of the fibula with a normal ipsilateral tibia. Supervised neglect was advised. A spontaneous fracture occurred one year later. A shortening osteotomy resulted in solid consolidation of the fracture. At the age of 27 years the deformity had progressed into a two-level fracture of the fibular diaphysis with pseudoarthrosis. The segment in-between the fractures was resected. Following this, the patient returned to a normal level of activities in just a matter of weeks. She could even participate in recreational tennis six weeks after surgery and was then discharged from the outpatient clinic. Isolated congenital anterolateral bowing of the fibula is a very rare condition and there is no consensus on its treatment. In this case, removal of the painful pseudarthrotic fragment of the fibula led to a good result.
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Cueva-Del Castillo JF, Valdés-Gutiérrez GA, Elizondo-Vázquez F, Pérez-Ortiz O, Piña Barba MC, León-Mancilla BH. Bone loss treatment, pseudoarthrosis, arthrodesis and benign tumors using xenoimplant: clinical study. CIR CIR 2009; 77:287-271. [PMID: 19919790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Bone loss as a result of arthrodesis, pseudarthrosis, benign tumors and bone defects was treated using a xenoimplant (Nukbone). METHODS The effectiveness of the material was evaluated through a longitudinal and observational study at the Hospital Regional "General Ignacio Zaragoza" (HRGIZ) ISSSTE. The Mexican xenoimplant is a patent of the National Autonomous University of Mexico (UNAM). RESULTS Fifty two patients were considered regardless of age or gender. Of these patients, 28 were male and 24 female. Average age of the patients was 47.7 years (9-84 years). Twenty eight patients had arthrodesis, 16 were treated with pseudarthrosis, three patients had benign tumors and five patients presented bone defects, which were implanted with Nukbone at the site and was the correct treatment for the problem. The xenoimplant is fully integrated during a period of 3-18 months, depending on the size of the pathology and the region where it was placed. Fracture healing was evaluated radiographically according to the classification of Montoya. No patient had clinical signs of rejection. CONCLUSIONS In Mexico, bony xenoimplants (osseous) have been used, all of foreign origin due to the high degree of technological dependence in this country. In this study we describe the use, for the first time, of a Mexican xenoimplant with a patent from the Universidad Nacional Autónoma de México (UNAM). The Mexican xenoimplant is biocompatible and can be adapted to treat pathologies where bony (osseous) material is needed.
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Vargas-Soto HA, Mehbod A, Mullaney KJ, Dykes D, Schwender J, Transfeldt E, Akesen B, Wroblewski J. Salvage procedures for pseudarthrosis after transforaminal lumbar interbody fusion (TLIF)-anterior-only versus anterior-posterior surgery: a clinical and radiological outcome study. J Surg Orthop Adv 2009; 18:200-204. [PMID: 19995500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A retrospective review was performed to analyze the radiographic and functional outcomes of two different surgeries to repair a pseudarthrosis following a transforaminal lumbar interbody fusion (TLIF) procedure. Although there are several published reports on the results of the TLIF procedure, there are no reports on how to salvage a failed TLIF. A total of 38 consecutive patients with failed TLIF procedures (at 50 levels) were repaired by either a direct anterior approach only (21 patients) or by a combined direct anterior approach coupled with a posterior exploration and pseudarthrosis repair (17 patients). The minimum follow-up after revision was 24 months. Clinical outcome was measured by Oswestry Disability Index, Roland Morris Questionnaire, SF-36, and the authors' own centers' satisfaction questionnaire in 17 of the 38 patients. The fusion rate for the anterior-alone group was 81% (17/21) and 88% (15/17) for the anterior-posterior group, not a statistically significant difference. The Oswestry scores averaged 56.4 for the anterior lumbar interbody fusion (ALIF) group and 51.4 for the anterior-posterior fusion (APF) group. The Roland-Morris scores averaged 18.9 for the ALIF group and 20.0 for the APF group. The SF-36 showed similar outcomes in both groups. The authors' center's satisfaction questionnaire also showed similar results. The outcomes, both radiologic and functional, were equal in both groups. There was very little improvement in functional outcomes comparing prerepair to postrepair based on the authors' questionnaire.
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Singaraju VM, Lubahn JD. Pseudoarthrosis in a hypertrophic nonunion of the humerus: a case report. J Surg Orthop Adv 2009; 18:39-41. [PMID: 19327265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Nonunion of humerus fractures is an extensively reviewed topic in orthopedic literature. The current case describes the successful outcome of a hypertrophic nonunion in a patient who chose not to undergo any intervention when the nonunion was identified and the treatment options were discussed with him. Hence this case report is a good example of the transition of the medical world to the concept of patient-centered decision making having a successful outcome.
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Park DK, An HS. Problems related to cervical fusion: malalignment and nonunion. Instr Course Lect 2009; 58:737-745. [PMID: 19385582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Two common complications associated with cervical surgery are malalignment, particularly after multilevel laminectomies, and nonunion. In both situations, prevention and early recognition are critical in clinical management. In postlaminectomy kyphosis, the prevailing cause is an alteration in the normal spinal biomechanics. The exact incidence is unknown; however, this malalignment can cause significant morbidity. Surgical treatment is used once a patient becomes symptomatic. Anterior cervical procedures are frequently used to correct the deformity. Like postlaminectomy kyphosis, most nonunions can be prevented. The reported incidence of pseudarthrosis has ranged from 0% to 50%. With advances in instrumentation and attention to surgical detail, the frequency of this complication has decreased. Fortunately, not all nonunions are symptomatic or require treatment. For symptomatic nonunions, surgical options include anterior, posterior, and combined cervical procedures depending on the pathology. As the frequency of cervical procedures continues to increase, it is paramount for spine surgeons to be aware of these complications and the various methods to treat them.
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Orihovac Z, Aljinović-Ratković N, Varga S. [Surgical treatment of lower jaw pseudoarthrosis as a result of fracture non-treatment following tooth extraction]. ACTA MEDICA CROATICA : CASOPIS HRAVATSKE AKADEMIJE MEDICINSKIH ZNANOSTI 2008; 62:301-303. [PMID: 18843851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Fracture of the lower jaw following tooth extraction is a rare and severe complication, occurring most often in the preangular region following third molar extraction. When left untreated, pseudoarthrosis can occur. Symptoms show a wide variance, including pathologic mobility, pain and infection, as well as sometimes trismus before and following surgical treatment. The possible complications of pseudoarthrosis may be malnutrition, jaw deformity and long-term disability. Treatment options range from prescription of a soft diet in case of simple fracture to surgical treatment by open reduction and internal fixation. A case is presented where a 47-year-old male suffered from painful perimandibular swelling and complained of "instability" of the lower jaw as well as hypoesthesia in the area of the left mental nerve. Case history revealed that he had had extraction of the lower left second molar (tooth 37) four months before. Following clinical and radiographic examination he was diagnosed with non-diagnosed and/or non-treated lower jaw fracture. The patient was surgically treated using an oseosynthetic plate to ensure stability. The postoperative protocol showed satisfactory results. Bone growth in the fracture line was recorded in the follow up. However, due to the four-month period of pseudoarthrosis and infection, the plate was removed much later than it would have been the case if surgical treatment had been performed immediately following the fracture. The delayed diagnosis of this fracture demonstrates the necessity of radiologic control when a fracture is suspected following tooth extraction. When a patient shows symptoms inconsistent with those following tooth extraction, surgical consultation is recommended.
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Meznik F, Pflüger G, Plenk H, Fischerleitner F, Grundschober F, Machacek F. [Experimental investigations on the growth of the vertebral column after dorsal spondylodesis (author's transl)]. ZEITSCHRIFT FUR ORTHOPADIE UND IHRE GRENZGEBIETE 2008; 118:28-40. [PMID: 7424104 DOI: 10.1055/s-2008-1051468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To investigate the question which growth processes take place in dorsally stiffened vertebral regions, 4 vertebral segments each were dorsally fused in twenty-one pigs, using Harrington's distraction system in 20 cases. X-ray examination and histological measurements conducted with the aid of fluorochromosequential markings showed a more or less pronounced growth of the vertebral bodies and of the fusion mass in all animals. As a rule, the sequence of vertebral bodies overgrows the fusion mass in longitudinal direction, which always results in lordosis of the stiffened region. The longitudinal growth of the vertebral bodies, and even more so of the fusion mass, decreases with increasing postoperative observation time. The fusion mass shows actual internal growth which proceeds partly in diffuse manner in all directions, in the region of the clefts, i.e. as spondyloschisis, in some cases also in the same direction as with enchondral ossification associated with columnar chondrification. The growth of the fused mass does not depend on the formation of a pseudoarthrosis, although it is probably quantitatively promoted by pseudarthroses. The stimulus to longitudinal growth of the fused mass originates from the growing vertebral bodies, with probably varying influence of tensile and compressive forces.
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Trieb K, Huber W, Kainberger F. A rare reason for the end of a career in competitive tennis. J Sports Med Phys Fitness 2008; 48:120-122. [PMID: 18212720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Stress fractures are reported in adolescents taking part in high standard sports and they are associated with specific sites for stress fractures. The first rib is also affected in rowers and ball throwing sports. This report describes the complications of such a case in a competitive tennis player at international level practicing 5 times a week with far-reaching consequences. Due to constant load dependent pain in the region of the right shoulder, standard diagnosis, X-ray, magnetic resonance imaging (MRI) and a computed tomography (CT) scan with 3-D reconstruction were done, showing a pseudoarthrosis of the first rib. Therefore, further treatment was conservative without pain relieve. At follow-up 5 years after onset of symptoms the patient did not play tennis, he did not complain pain, but control imaging still showed a pseudoarthrosis of the first rib. Our case shows that it is important, when treating shoulder pain in the overhead athlete, to think of the possibility of a stress fracture.
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Hładki W, Lorkowski J, Trybus M, Brongel L. [Results of autogenous bone marrow grafting in disorders of bone healing and bone defectives]. PRZEGLAD LEKARSKI 2008; 65:25-28. [PMID: 18669105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The aim of the study constituted a prospective assessment of efficacy of autogenous bone marrow grafting for the treatment of defective bone healing in patients with isolated and multiple injuries. Material comprised 3367 patients that were operated since June 1st 2004 to October 31st 2007 due to long bone fractures. Disorders of bone healing were diagnosed in 32 (0.95%) patients. 9 (28.1%) patients from the study group were treated due to multiple injuries (with severity of injuries assessed to be 33 points according to ISS; on the average 2.9 injured body regions). Multifragmental and comminutive fractures were note in 12 (37.5%), in this group 3 open fractures. The average time interval to achieve bone healing was 4.5 months, but was about twice longer in cases of pseudoarthrosis. The method was not effective in 7 (21.8%) patients. Defective bone healing was predominantly noted in cases of femoral, tibia and radial fractures. Bone marrow grafting proved the most effective in cases of delayed unions and non-infected pseudoarthrosis and non-union.
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Kuklo TR, Potter BK, Lenke LG, Polly DW, Sides B, Bridwell KH. Surgical revision rates of hooks versus hybrid versus screws versus combined anteroposterior spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2007; 32:2258-64. [PMID: 17873820 DOI: 10.1097/brs.0b013e31814b1ba6] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multi-institution retrospective review. OBJECTIVE To determine the surgical revision rates of hook, hybrid, anteroposterior, and total pedicle screw constructs for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Much debate continues on the safety, efficacy, and cost of thoracic pedicle screws. Nonetheless, there are no large series that have evaluated the revision rate of various constructs in AIS to determine the need for repeat surgery, and therefore, the added indirect costs and risks of additional procedures. METHODS We retrospectively reviewed the surgical case logs of 1428 patients with AIS at 2 institutions from 1990 to 2004, and the clinical records and radiographs of revision cases. Patients were classified into 1 of 4 groups: hook, hybrid hook and screw, all pedicle screw, and combined anteroposterior fusion constructs. Overall, there were 65 (4.6%) returns to the operating room, or 55 (3.9%) cases after excluding infections without concomitant pseudarthrosis. RESULTS Of the 65 revision cases, there were 52 females and 13 males, at an average age at first surgery of 13.9 years (range, 9-18 years), and an average age at revision of 14.7 years (range, 12-23 years). For the revision cases, the average initial Cobb was 61.9 degrees (range 44 degrees -110 degrees ), and this was not statistically different within the cohorts (P > 0.05). In terms of revision rate, all hook constructs had a higher revision rate secondary to instrumentation failure when compared with screws, while both hook and hybrid constructs had an overall higher surgical revision rate when compared with screw constructs or anteroposterior constructs (all P <or= 0.05). The pseudarthrosis rate trended toward, but did not meet, statistical significance between these same groups. CONCLUSION All pedicle screw and anteroposterior constructs have a lower surgical revision rate when compared with hook and hybrid constructs. The hidden patient and financial costs of these findings should be considered when evaluating overall instrumentation efficacy.
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Kim YJ, Bridwell KH, Lenke LG, Cheh G, Baldus C. Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976) 2007; 32:2189-97. [PMID: 17873810 DOI: 10.1097/brs.0b013e31814b8371] [Citation(s) in RCA: 241] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To report results at a minimum 5 years after pedicle subtraction osteotomy for fixed sagittal imbalance. SUMMARY OF BACKGROUND DATA No one has reported results of pedicle subtraction osteotomies with a 5- to 8-year follow-up. METHOD Thirty-five consecutive patients with sagittal imbalance (29 females/6 males, average age at surgery, 53.1 years) treated with lumbar pedicle subtraction osteotomies (1 at L1, 13 at L2, 20 at L3, and 1 at L4) at 1 institution were analyzed (average follow-up, 5.8 years; range, 5-7.6 years). Radiographic and clinical outcomes analysis was performed. RESULTS There were no significant regional radiographic changes between 2 years postoperative and the ultimate follow-up (proximal junctional change, P = 0.30; thoracic kyphosis, P = 0.38; and lumbar lordosis, P = 0.84), although many patients did demonstrate an increasingly anterior C7 sagittal plumb with time. Ten pseudarthroses (29%) occurred in 8 patients and were revised between 2 and 5 years postoperative. There were no pseudarthroses at the osteotomy level (9 at the thoracolumbar junction, 1 at the LS junction), but at the levels added to the previous fusions. There was no degradation in Oswestry and Scoliosis Research Society (SRS) outcome scores between 2 years postoperative and ultimate follow-up (P = 0.23 and 0.90, respectively). Patients reported very good satisfaction (87%), good self-image (76%), good function (69%), and fair pain subscales (66%) at ultimate follow-up. Sagittal vertical axis <8 cm at ultimate follow-up was significant for better SRS outcomes scores (P = 0.038). Eight patients with revised pseudarthroses did not demonstrate poorer SRS outcomes scores (P = 0.52). Those 8 patients were queried after their pseudarthrosis revision surgery. CONCLUSION Pedicle subtraction osteotomy can provide satisfactory clinical and radiographic outcomes for patients with a minimum 5-year follow-up despite needing pseudarthrosis revision and some component of increasingly positive sagittal vertical axis between 2 years and 5 to 8 years of follow-up. The level of patient satisfaction and self-image subscales were high after more than 5 years of follow-up. Restoration and maintenance of sagittal vertical axis <8 cm were important to the ultimate sagittal reconstruction.
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Hedequist D, Yeon H, Emans J. The use of allograft as a bone graft substitute in patients with congenital spine deformities. J Pediatr Orthop 2007; 27:686-9. [PMID: 17717472 DOI: 10.1097/bpo.0b013e318093f50d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to determine the safety and efficacy of using allograft bone as a substitute for iliac crest bone graft when treating pediatric patients with congenital spine deformities. We performed a retrospective review of 107 pediatric patients who underwent instrumentation and arthrodesis using allograft for congenital spine deformity between 1995 and 2002. Pseudoarthrosis was defined as implant failure, a clear radiographic pseudoarthrosis, or any loss of correction more than 10 degrees from the immediate postoperative radiographs to the final follow-up radiographs. The pseudoarthrosis rate in this series was 2.8%, and the infection rate was 0.9%. We conclude that freeze-dried corticocancellous allograft is a safe and effective alternative to iliac crest bone graft in this patient population.
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Valente L, Moura Gonçalves A, Sousa A, Almeida L. [Pseudarthrosis of the radius in a child with neurofibromatosis]. ACTA MEDICA PORT 2007; 20:453-456. [PMID: 18282443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In children, pseudarthrosis of the forearm is generally associated to neurofibromatosis. It results from a pathological fracture because it appears in a bone that is considered abnormal for the presence of deformity or cyst. The authors present the case of a child who developed pseudartrosis of the radio after fracture in a bone without structural alteration. Only four similar cases can be found in the literature. The authors discuss its treatment.
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Kim KT, Lee SH, Suk KS, Lee JH, Im YJ. Spinal pseudarthrosis in advanced ankylosing spondylitis with sagittal plane deformity: clinical characteristics and outcome analysis. Spine (Phila Pa 1976) 2007; 32:1641-7. [PMID: 17621212 DOI: 10.1097/brs.0b013e318074c3ce] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study of consecutive ankylosing spondylitis (AS) patients with spinal pseudarthrosis. OBJECTIVES To review the clinical characteristics and assess the outcomes of surgical treatment of spinal pseudarthrosis in advanced AS patients with sagittal plane deformity. SUMMARY OF BACKGROUND DATA There have been several reports describing the clinical findings of spinal pseudarthrosis in AS. However, few have studied the outcomes of surgical treatment of spinal pseudarthrosis with sagittal plane deformity in advanced AS patients. METHODS A total of 19 destructive vertebral lesions in 12 patients were reviewed. We performed Smith-Petersen osteotomy (SPO) at the same level for correction of sagittal plane deformity and anterior interbody fusion (AIF) for repair of pseudarthrosis. Pedicle subtraction osteotomy (PSO) was performed additionally at the lumbar spine in six severe kyphotic patients. Outcome variables included radiographic measurement from preoperative, immediate postoperative and follow-up films (mean, 51 months; range, 35-108 months), and clinical assessment using visual analog scale for back pain and the modified SRS outcome instruments satisfaction domain and the review of postoperative complications. RESULTS Clinical characteristics including trauma and inflammatory reaction were variable. The mean time for radiographic union of pseudarthrosis was 4.2 months (range, 2.5-6 months). Average correction of segmental kyphosis with SPO at the level of pseudarthrosis was 20.9 degrees (range, 5 degrees -34 degrees ) and 26.3 degrees (range, 20 degrees -32 degrees ) with lumbar PSO. Mean sagittal imbalance had improved 15.2 cm (range, 6.7-34.7 cm) at the last follow-up. All 12 patients had improvement of pain and neurologic deficit. The mean visual analog scale for pain had improved 4.8 (range, 4-7). The mean SRS score for patient satisfaction at the last follow-up was 4.6 of a possible 5. There were 7 cases of complications, including 3 cases of intraoperative dural tear, 2 cases of postoperative radiculopathy, and 1 case of wound infection. There was no permanent complication. CONCLUSIONS SPO at the level of pseudarthrosis was a safe and effective technique to correct sagittal imbalance without vascular complication. Surgical repair of pseudarthrosis with AIF provided successful fusion and good clinical results. For patients with lumbar hypolordosis, additional PSO was effective in restoration of sagittal balance.
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Morasiewicz L, Orzechowski W, Kulej M, Stepniewski M. The results of treatment of bone defects and non-union within the femoral shaft with shortening of femur using Ilizarov method. Ortop Traumatol Rehabil 2007; 9:366-76. [PMID: 17882116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND The non-union within the femur with shortening of the limb as a consequence of trauma is an indication to choose external stabilisation as a method of treatment for that reason, that healing of the bone and surrounded soft tissues is disordered. MATERIALS AND METHODS Authors discuss the results of treatment of 16 patients with post-traumatic bone defect and pseudarthroses with femur shortening. The injury was located in femur shaft in 8 cases, distal epiphysis in 5 cases and proximal epiphysis in 3 cases. 11 patients were treated in one stage, 4 patients were treated in two stages and 1 was held in three stages. First operation was made for achievement of union in place of bone loss or pseudarthrosis- the second and third- for elongation and correction of the axis of the femur. The follow-up consisted of 10 patients. In most cases subjective and objective improvement was achieved. RESULTS The bone union was reached in 15 patients and in 1 case pseudarthrosis was observed. Patients who were considered to have next procedures due to remaining femur shortening or other limb deformity didn't see necessity of following treatment. CONCLUSION The results of the current study indicated that Ilizarov's method can be successfully used in most patients with post-traumatic bone defect and pseudarthrosis with femur shortening. The method allows to reach the bone union, correct the deformity and lengthen the limb as well, what need mostly multi-stage treatment.
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Goldberg G, Albert TJ, Vaccaro AR, Hilibrand AS, Anderson DG, Wharton N. Short-term comparison of cervical fusion with static and dynamic plating using computerized motion analysis. Spine (Phila Pa 1976) 2007; 32:E371-5. [PMID: 17545900 DOI: 10.1097/brs.0b013e318060cca9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This study is a retrospective review of fusion rates for cervical plates, analyzed by means of computerized analysis. OBJECTIVES This study compares the fusion rates for two-level anterior cervical discectomy and fusion between patients with static versus dynamic plates. SUMMARY OF BACKGROUND DATA Anterior cervical plating has been shown to decrease the pseudarthrosis rate. However, static plates, which have been successful in reducing nonunion rates, may be "too rigid" in certain situations, leading to pseudarthrosis in some patients. Recently, some surgeons have begun using dynamic plate constructs to avoid this problem. METHODS A retrospective review was performed of patients having a two-level anterior cervical discectomy and fusion performed either with a static or dynamic plate. A computerized method for evaluating the presence of a solid fusion was used with a criterion of <2 degrees of motion considered a solid fusion. RESULTS The follow-up time period averaged 10 months (range, 5.8-13 months) for the static plate group and 9.5 months (range, 5.8-13 months) for the dynamic plate group. Based on a motion threshold of 2 degrees, the rate of fusion per level for patients in the static plate/autograft group was 87.8%, resulting in an overall fusion rate of 76.2%. The rate for fusion per level for patients treated with a dynamic plate and allograft was 89.8%, with an overall fusion rate of 81.8%. There was no statistically significant difference between the two groups (P = 0.469). The fusion rate increased during the follow-up period: In the 6- to 9-month interval, the static plate/autograft group had a 62.5% fusion rate, versus 75% for the dynamic plate/allograft group. In the 10- to 13-month interval, the fusion rate had increased to 84.7% for the static plate/autograft group and 90% for the dynamic plate/allograft group. CONCLUSIONS Computerized evaluation of digitized films can improve the accuracy and reproducibility of the analysis of anterior cervical fusion. An angular threshold of 2 degrees was selected for this purpose. This study showed that the rate of fusion with a dynamic plate was similar to that of the static plate despite the use of allograft bone with the dynamic plate. In addition, this study found that successful fusions continued to evolve throughout the first year following surgery.
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Waast D, Touraine D, Wessely L, Ropars M, Coipeau P, Perrier C, Guillot P. [Pertrochanteric fractures in elderly subjects aged over 75]. REVUE DE CHIRURGIE ORTHOPEDIQUE ET REPARATRICE DE L'APPAREIL MOTEUR 2007; 93:2S33-46. [PMID: 17646827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Pertrochanteric fractures constitute a major public health concern. This retrospective multicentric study evaluated outcome after treatment in patients aged over 75 years hospitalized for pertrochanteric fractures over a one year period (May 2004-May 2005). Five University Hospitals in the cities of Angers, Brest, Rennes, Tours, Nantes participated in this evaluation. The quality of the reduction and the position of the osteosynthesis were the two main criteria for good outcome. The type of material implanted had little effect on outcome. The results emphasized the importance of preventing osteoporosis. Fracture prevention and treatment of osteoporosis are crucial, even after fracture.
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Witsberger TH, Cook JL, Cook CR. What is your diagnosis? Hip joint luxation with secondary osteoarthritis and pseudoarthrosis. J Am Vet Med Assoc 2007; 230:1631-2. [PMID: 17542727 DOI: 10.2460/javma.230.11.1631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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