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Popelka V, Popelka V. [Predictive Factors and Treatment of Aseptic Pseudoarthrosis of the Humeral Shaft]. Acta Chir Orthop Traumatol Cech 2022; 89:360-369. [PMID: 36322037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE OF THE STUDY Aseptic pseudoarthrosis (nonunion, PSA) of the humeral shaft is one of the serious complications in the treatment of fractures in this area. In a retrospective study, the authors described different methods of treating patients with this complication using predictive factors. MATERIAL AND METHODS Based on the definition of nonunion and the criteria, 14 patients (N=14) with the mean age of 56 years (32-78), namely 8 men and 6 women were included in the study. All patients were followed up clinically and radiologically at 1, 3, 6, 9, 12 months and every 3 months until the condition stabilized. The follow-up period was 11-72 months, with the average of 22 months. According to the AO classification, the fractures were classified as: 4-A1, 1-A2, 4-A3, 1-B1, 3-B2 and 1-C2. Based on the Weber-Čech classification, 2 cases of pseudoarthrosis were hypertrophic, 4 oligotrophic and 8 atrophic. According to the Non-Union Scoring System (NUSS), 5 patients reached the score under 25 points, 3 patients received 25-50 points, 4 patients 51-75 points and two patients over 76 points. In five cases, the fracture displacement index (FDI) was above 100%. In 11 patients, PSA was in the proximal and middle third and in three patients in the distal third of the humerus. METHODS Of the whole group (N=14), the nail was used in 5 cases (36%) - in 3 cases NUSS of up to 50 points and in 2 cases over 76 points. The plate was used in 9 cases (64%). In patients with NUSS of up to 50 points - in 1 case after conservative treatment, in 1 case for augmentation of nail, in 3 cases for augmentation of Prévot nails. In 4 cases with NUSS of 51-75 points a plate was replaced. Osteosynthesis was always supplemented by Judet's decortication or resection of atrophic bone and spongioplasty by autologous graft. RESULTS Shoulder function measured by the Constant Murley score (C-M) improved from 53 to 89 points (from the range of 36-76 points to the range of 75-100 points). The function of the elbow joint also improved, namely from the Mayo Elbow Performance Score (MEPS) of 65 points to 90 points (from the range of 45-70 points to the range of 80-100 points). In 11 cases (79%) the nonunion was healed and in 3 cases (21%) the failure to heal was reported. In the group with unhealed nonunions, in one case with NUSS of 51-75 points a thermoplastic casting was used and in two patients with NUSS above 76 points a palliative surgery was performed using a 12mm interlocking intramedullary nail. DISCUSSION The results of our study focused on the treatment of aseptic nonunion of the humeral shaft confirm the conclusions arrived at by other authors. As to the osteosynthesis materials, the plate remains the gold standard and provides sufficient stability for bone healing. For unhealed treatment-resistant PSA, we offer a stable intramedullary nail instead of prosthetic replacement or amputation, which provides good stability required for limb function. CONCLUSIONS When planning the treatment of aseptic pseudoarthrosis of the humeral shaft, it is necessary to have a thorough knowledge of etiopathogenesis with all predictive factors. The NUSS classification provides good guidance in treating this complication. Key words: aseptic nonunion, NUSS classification, predictive factors.
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Affiliation(s)
- V Popelka
- Ortopedicko-traumatologické oddelenie, Nemocnica Galanta
| | - V Popelka
- Klinika úrazovej chirurgie a ortopédie, Fakultná nemocnica Nitra, Fakulta sociálnych vied a zdravotníctva, Univerzita Konstantina Filozofa v Nitre
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Kocaoğlu M, Eralp L, Bilen FE, Civan M. Congenital pseudarthrosis of the tibia: Results of circular external fixation treatment with intramedullary rodding and periosteal grafting technique. Acta Orthop Traumatol Turc 2020; 54:245-254. [PMID: 32442122 DOI: 10.5152/j.aott.2020.03.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study investigated the clinical and functional results of treating congenital pseudarthrosis of the tibia (CPT) using the combined techniques of hamartoma resection, periosteal grafting, circular external fixator application, and intramedullary rodding. METHODS The clinical and radiological data of 17 patients (mean age at the treatment time: 7.6 months (range: 4.6-9.7 months) with CPT, treated by a single surgeon between 1997 and 2017, were retrospectively analyzed. All data regarding surgical interventions, complications, deformity analysis parameters, limb length discrepancy (LLD), ankle joint range of motion, and residual deformities were reviewed. All the patients were followed up at least two years after the last surgical intervention. The mean follow-up time was 8.5 years (range: 2.2 to 15.7 years). RESULTS Union was achieved with the index treatment in 15 of the 17 cases (88.2%). The mean age of the patients at the last follow-up visit was 14.2 years (range: 7.6 to 22.1). The mean LLD was 2.1 cm. Nine patients had radiological ankle valgus at the last follow-up. In the entire series, eight patients did not display any complications, four cases reported minor complications, and five cases were complicated by refractures. CONCLUSION Circular external fixator application combined with periosteal grafting is a superior method of CPT treatment. This method provides a healthy biological healing environment while correcting the mechanical problems. The combination of periosteal and cancellous bone grafts with intramedullary rods and an external fixator addresses issues that complicate obtaining and maintaining a union during the CPT treatment. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
| | - Levent Eralp
- Department of Orthopaedics and Traumatology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Fikri Erkal Bilen
- Department of Orthopaedics and Traumatology, Yeni Yüzyıl University, School of Medicine, İstanbul, Turkey
| | - Melih Civan
- Department of Orthopaedics and Traumatology, Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkey
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Yoshida Y, Ehara Y, Koga M, Imafuku S, Yamamoto O. Epidemiological Analysis of Major Complications Requiring Medical Intervention in Patients with Neurofibromatosis 1. Acta Derm Venereol 2018; 98:753-756. [PMID: 29796689 DOI: 10.2340/00015555-2975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Neurofibromatosis 1 has various complications. To elucidate the frequency of neurofibromatosis 1-related major complications requiring medical intervention, a nationwide retrospective study was conducted of 3,530 patients with neurofibromatosis 1 registered from 2001 to 2014 in Japan. The ratio of certified patients requiring medical intervention (>stage 3) was 82%. Patients classified in the most severe grade experienced dermatological complications (71.8% of patients), neurological complications (38.1%) and bone complications (33.3%). In patients with dermatological manifestations, medical treatment was needed for cutaneous neurofibromas (58%), diffuse plexiform neurofibromas (31%) and malignant peripheral nerve sheath tumours (10%). Patients with neurological manifestations needed medical treatment mainly for brain tumours (53%) and intellectual disability (26%). Patients with bone manifestations needed medical treatment for pseudoarthrosis (9%), scoliosis (55%) and bone defects (16%). It is necessary for physicians to be aware of neurofibromatosis 1-related complications requiring medical intervention in order to provide appropriate care for patients with neurofibromatosis 1.
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Affiliation(s)
- Yuichi Yoshida
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago-shi, Tottori 683-8503, Japan. ,
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Kim YH, Reoyan GN, Ha KY, Kim CK. Pseudarthrosis Repair Using Autologous Cultured Osteoblasts in Complex Type-1 Neurofibromatosis Spinal Deformity: A Case Report and Review of the Literature. Spine (Phila Pa 1976) 2016; 41:E1372-E1378. [PMID: 27831994 DOI: 10.1097/brs.0000000000001670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report and literature review. OBJECTIVE To report a late dislocation of the vertebra caused by progressive dural ectasia combined with type-1 neurofibromatosis (NF-1) and the clinical results of pseudarthrosis repairs using autologous cultured osteoblasts. SUMMARY OF BACKGROUND DATA NF-1 is a well-known genetic disorder that is commonly characterized by spinal deformities including kyphoscoliosis. Late dislocation of the vertebra resulting from progressive dural ectasia after surgical correction of NF-1 scoliosis is a very rare occurrence, and pseudarthrosis frequently develops after surgical intervention for this complex spinal deformity. METHODS A 32-year-old female patient with NF-1 scoliosis underwent surgical correction with posterior instrumented fusion. Seventeen years later, dislocation of the lumbar spine with implant failure resulting from massive progressive dural ectasia was observed. She underwent anterior interbody fusion three times and posterior instrumented fusion four times for pseudarthrosis followed by surgical deformity correction. For the last operation, autologous cultured osteoblasts were used as a therapeutic approach to repair the pseudarthrosis, and a three-dimensional printing technique was used to understand the surgical anatomy of the dislocated lumbar spine in detail. RESULTS After the final operation, bone union was achieved and confirmed by clinical and radiological examination. CONCLUSION Spine surgeons should be knowledgeable about the possibility of late destabilization of the spine, due to pulsatile dural ectasia, and a high rate of pseudarthrosis in neurofibromatosis. Autologous cultured osteoblasts may prove to be a modality that can be applied pseudarthrosis repair to treat complex spinal deformity. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Young-Hoon Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kutikov SA, Borzunov DY, D’Yachkova GV, Chevardin AY. TREATMENT OF CONGENITAL PSEUDARTHROSIS OF THE TIBIA. Vestn Khir Im I I Grek 2016; 175:53-58. [PMID: 30457265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The work is based on an analysis of treatment results of 47 patients with congenital pseudarthrosis of the tibia. The Ilizarov technique of unfree osteoplasty was applied on these patients. The authors considered an application of combined variants of exterior and external osteosynthesis as very perspective in rehabilitation of the patients with congenital pseudarthrosis.
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Peters M, Willems P, Weijers R, Wierts R, Jutten L, Urbach C, Arts C, van Rhijn L, Brans B. Pseudarthrosis after lumbar spinal fusion: the role of ¹⁸F-fluoride PET/CT. Eur J Nucl Med Mol Imaging 2015; 42:1891-8. [PMID: 26290422 PMCID: PMC4589546 DOI: 10.1007/s00259-015-3154-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/23/2015] [Indexed: 11/26/2022]
Abstract
Purpose Painful pseudarthrosis is one of the most important indications for (revision) surgery after spinal fusion procedures. If pseudarthrosis is the source of recurrent pain it may require revision surgery. It is therefore of great clinical importance to ascertain if it is the source of such pain. The correlation between findings on conventional imaging (plain radiography and CT) and clinical well-being has been shown to be moderate. The goal of this study was to determine the possible role of 18F-fluoride PET in patients after lumbar spinal interbody fusion by investigating the relationship between PET/CT findings and clinical function and pain. Methods A cohort of 36 patients was retrospectively included in the study after 18F-fluoride PET/CT for either persistent or recurrent low back pain (18 patients) or during routine postoperative investigation (18 patients) between 9 and 76 months and 11 and 14 months after posterior lumbar interbody fusion, respectively. Sixty minutes after intravenous injection of 156 – 263 MBq (mean 199 MBq, median 196 MBq) 18F-fluoride, PET and CT images were acquired using an integrated PET/CT scanner, followed by a diagnostic CT scan. Two observers independently scored the images. The number of bony bridges between vertebrae was scored on the CT images to quantify interbody fusion (0, 1 or 2). Vertebral endplate and intervertebral disc space uptake were evaluated visually as well as semiquantitatively following 18F-fluoride PET. Findings on PET and CT were correlated with clinical wellbeing as measured by validated questionnaires concerning general daily functioning (Oswestry Disability Index), pain (visual analogue scale) and general health status (EuroQol). Patients were divided into three categories based on these questionnaire scores. Results No correlation was found between symptom severity and fusion status. However, 18F-fluoride activity in the vertebral endplates was significantly higher in patients in the lowest Oswestry Disability Index category (i.e. with the worst clinical performance) than in patients in higher categories (p = 0.01 between categories 1 and 2 and 1 and 3). The visual analogue scale and EuroQol results were similar although less pronounced, with only SUVmax between category 1 and 2 being significantly different (p = 0.04). Conclusion We hypothesize that 18F-fluoride PET/CT may be able to provide support for the diagnosis of painful pseudarthrosis and could serve as a tool to discriminate between symptomatic and asymptomatic pseudarthrosis for revision surgery, as CT defines the consolidation status and PET pinpoints the ‘stress reaction’ at the vertebral endplates which significantly correlates with Oswestry Disability Index score.
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Affiliation(s)
- Marloes Peters
- Department of Orthopedic Surgery, Maastricht University Medical Center, Postbox 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Paul Willems
- Department of Orthopedic Surgery, Maastricht University Medical Center, Postbox 5800, 6202 AZ, Maastricht, The Netherlands
| | - Rene Weijers
- Radiology /Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Roel Wierts
- Radiology /Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Liesbeth Jutten
- Department of Orthopedic Surgery, Maastricht University Medical Center, Postbox 5800, 6202 AZ, Maastricht, The Netherlands
| | - Christian Urbach
- Radiology /Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Chris Arts
- Department of Orthopedic Surgery, Maastricht University Medical Center, Postbox 5800, 6202 AZ, Maastricht, The Netherlands
| | - Lodewijk van Rhijn
- Department of Orthopedic Surgery, Maastricht University Medical Center, Postbox 5800, 6202 AZ, Maastricht, The Netherlands
| | - Boudewijn Brans
- Radiology /Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Gulabi D, Erdem M, Cecen GS, Avci CC, Saglam N, Saglam F. Ilizarov fixator combined with an intramedullary nail for tibial nonunions with bone loss: is it effective? Clin Orthop Relat Res 2014; 472:3892-901. [PMID: 24777722 PMCID: PMC4397756 DOI: 10.1007/s11999-014-3640-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of tibial nonunion with bone loss is extremely difficult. A variety of techniques have been described, but each has shortcomings, in particular prolonged external fixation time as well as serious complications such as nonunion and infection. Accordingly, we developed a technique that seeks to reduce these complications by using a circular external fixator in addition to an intramedullary nail to achieve union, limb lengthening, and stability of the regenerated segment. DESCRIPTION OF TECHNIQUE First, the pseudoarthrosis area is resected, and acute compression is continued until bone contact at the docking site was achieved. Then primary grafting is applied to the docking site using a graft harvested from the patient's iliac bone, and the predrilled nail holes localized on the middle segment of the tibia are locked with a free-hand technique. Finally, lengthening is performed to overcome the leg-length discrepancy with an external fixator. METHODS Between 2008 and 2011, this technique was used to treat five patients with tibial nonunion with bone loss. All patients were available for a minimum of a 14-month followup (mean, 30 months; range, 14-58 months). General indications for the procedure were age older than 16 years, tibial nonunion with bone loss, and the absence of any psychiatric disorder. We evaluated external fixation time, external fixation index (defined as the duration of external fixation in months divided by the total amount of bone transported and/or the amount of lengthening in centimeters), and time to union on plain radiographs, clinical results using the Paley bone and functional assessment scores, and postoperative complications from chart review. RESULTS The external fixation time was 4 months (range, 3-5 months), and the average external fixation index was 0.4 months/cm. The mean time to bone union was 4.6 months (range, 3.5-5.5 months). All angles were determined to be in the normal range. No patients developed refracture or malalignment either on the docking site or the osteotomy site. Paley bone evaluation results were excellent in all five patients, and Paley functional results were excellent in four and good in one. We observed 10 pin-site infections as minor complications, and one patient was left with a residual equinus deformity of 5° as a major complication according to the Paley classification. CONCLUSIONS Our technique combining acute shortening and distraction osteogenesis had promising results for the treatment of tibial nonunion with bone loss in a small group of patients. However, future studies directly comparing available approaches to this difficult problem are required. Because this problem is uncommon, these studies will almost certainly require the cooperation of multiple large participating centers. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Deniz Gulabi
- Dr Lutfi Kırdar Kartal Training and Research Hospital, Semsi Denizer Cad. E5, Yanyol Cevizli Kavsagı Kartal, 34890, Istanbul, Turkey,
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Thein E, Chevalley F, Borens O. [Pseudarthrosis of the long bones]. Rev Med Suisse 2013; 9:2390-2396. [PMID: 24693590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
5 to 10% of all fractures present with a delayed union, whereas 1 to 5% progress to a nonunion, which can be defined as a fracture older than 6 months and lacks any potential to heal without any further intervention. Different fracture and patient related risk factors exist, and the management of a nonunion needs a thorough clinical, radiological and biological workup to classify them in one of the two main categories, the viable nonunions that need essentially more stability, usually by a more rigid fixation, and the non-viable nonunions that need essentially a biological stimulation by decortication and bone grafting. This treatment still remains the first choice with bony healing obtained in 85 to 95% of cases, but it also comes along with certain risks, and some valuable alternatives exist if chosen on the basis of rigid criteria.
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Kocak T, Däxle M, Reichel H, Lattig F. Alternative technique of cement augmentation of loosened pedicle screws -- technical note and presentation of two cases. Acta Chir Orthop Traumatol Cech 2013; 80:89-91. [PMID: 23452428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
An alternative cement augmentation technique for pedicle screws is described, which was applied in two patients with mono- and bisegmental non-union after preceding multisegmental lumbar fusion. The correctly placed pedicle screws in S1 with diameters of 6 and 8.5 mm had severely enlarged the screw cavities due to segmental instability. Revision screws with 10 mm diameter demonstrated sufficient purchase only on the left side. Therefore, cement augmentation was performed for the right sided screws. After verification of intact pedicle borders, the cavity was filled up with PMMA bone cement. Afterwards, a Kirschner wire was positioned centrally, the hardening of the cement was awaited, the cement was gradually drilled and the screw was placed. In both patients, sufficient purchase of the cemented pedicle screws was documented. Screw insertion after awaiting the hardening of the bone cement in pedicles and vertebral bodies with huge defect situations seems to be an alternative to previous cement augmentation techniques of pedicle screws with the advantage, that the screws could be more easily unscrewed, if necessary.
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Affiliation(s)
- T Kocak
- Department of Orthopaedic Surgery, University of Ulm, Germany
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Siddiqui YS, Abbas M, Zahid M, Asif N. Congenital pseudoarthrosis. Saudi Med J 2012; 33:794-795. [PMID: 22821317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- Yasir S Siddiqui
- Department of Orthopedic Surgery, PO Box 71, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh 202002, India.
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Sepahdari AR, Abemayor E. Radiology quiz case 1. First rib pseudarthrosis. Arch Otolaryngol Head Neck Surg 2012; 138:683-684. [PMID: 22801894 DOI: 10.1001/archoto.2012.919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Ali R Sepahdari
- David Geffen School of Medicine at UCLA, University of California, Los Angeles, USA
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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. Rom J Intern Med 2012; 50:43-59. [PMID: 22788093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Gh Burnei
- "Maria Sklodowska Curie" Emergency Hospital for Children, Bucharest, Romania.
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Jia LS. [Treatment and influencing factor of non-fusion after cervical surgery]. Zhonghua Wai Ke Za Zhi 2010; 48:801-802. [PMID: 21163044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- M A Haque
- Ortho-surgery, Upazilla Health Complex, Gafargaon, Mymensingh, Bangladesh
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Tarazona Velutini P, Romo Rodríiguez R. [Pseudoarthrosis of the first rib in a patient who practices yoga. A case report]. Acta Ortop Mex 2009; 23:383-385. [PMID: 20377005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Pseudoarthrosis of the first rib is a rare condition that may occur in athletes as a result of repetitive activities, mainly overhead. The usual clinical presentation is pain in the neck or the ipsilateral shoulder. CASE REPORT This is the case of a 19-year-old female patient who had sudden pain of the base of the neck while doing yoga. Pseudoarthrosis of the first rib was diagnosed with X-rays and CAT scan. Treatment consisted of a rehabilitation and physical therapy program that was successful despite the persistence of the pseudoarthrosis. DISCUSSION Cases of first rib fractures have been reported in athletes practicing multiple activities; however, pseudoarthrosis cases are rare since most of them progress to bone healing. This is the first reported case of a fracture or pseudoarthrosis in a patient practicing yoga. As in most reported cases, conservative treatment was successful. CONCLUSION Fractures and pseudoarthrosis of the first rib are rare in athletes and should be included in the differential diagnosis of athletes presenting with shoulder and neck pain. Conservative treatment is successful in most cases.
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Strassmair M, Mont MA, Seyler TM, Bosebeck H, Marker DR, LaPorte DM. The use of a Type-I lyophilisate collagen as an osteoinductive factor in pseudarthroses of the forearm. Surg Technol Int 2009; 18:213-218. [PMID: 19579208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The purpose of this study was to assess the use of a novel bone void filler consisting of Type I collagen and various growth factors (VEGF, TGFβ-1, TGFβ-2, IGF-1, BMP-2, BMP-3, and BMP-7) and surgical fixation to treat diaphyseal forearm pseudarthroses. Eleven patients underwent an osteosynthesis procedure for isolated pseudarthrosis fractures of the forearm (six radial and five ulnar diaphysis). The mean duration between the initial failed surgical fixation and re-operation was 38 weeks. Radiographic signs of fracture healing after the application of the bone void filler were noted at a mean of 5 weeks, and complete fracture consolidation was achieved at a mean of 6 weeks. All patients demonstrated improved range of motion and grip strength. Additionally, all patients were pain-free by 6 weeks. The combination of a novel bovine bone-derived bone void filler and stable internal fixation led to union and rapid healing of forearm pseudarthroses.
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Affiliation(s)
- M Strassmair
- Department of Orthopaedic Surgery, Klinikum Starnberg, Starnberg, Germany
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17
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Kołodziej L, Bohatyrewicz A, Kotrych D. Congenital pseudoarthrosis of the clavicle: is operative treatment necessary? A report of four cases and literature review. Chir Narzadow Ruchu Ortop Pol 2008; 73:277-256. [PMID: 18847020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Congenital pseudoarthrosis of the clavicle (CPC) is not a common condition. The exact number of cases reported in literature is fewer than two hundred. We present four well-documented cases of true congenital pseudoarthrosis of the clavicle, including two cases of familial occurrence. None of the patients in this study were treated surgically. Evaluation of upper extremity function was done with use of the Constant-Murley method. In spite of clavicle pseudoarthrosis the score results were similar to the unaffected shoulder. Although vertical elevation of the upper ribs or cervical ribs has been suggested as a cause of congenital clavicle lesions, radiological examination failed to reveal such pathology in any of the patients described here. Clavicle pseudoarthrosis is generally regarded as a benign condition. The majority of patients who underwent surgery because of cosmetic or functional heal well and proceed with a normal, unrestricted life. However, for those patients who are not bothered by the cosmetic appearance of their CPC and are asymptomatic in that they are not functionally limited, non-surgical treatment is a viable option.
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Affiliation(s)
- Lukasz Kołodziej
- Clinic of Orthopedy and Traumatology, Pomeranian Medical Academy in Szczecin.
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18
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Kokott P. [Emergency checklist: fracture of the skaphoid bone]. MMW Fortschr Med 2008; 150:43. [PMID: 18447291 DOI: 10.1007/bf03365364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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19
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Bumbasirević MZ, Tomić SM, Lesić AR, Atkinson D. [Nonunion--pseudoarthrosis of the scaphoid bone treated with percutaneous fixation, with compression and distraction]. Acta Chir Iugosl 2008; 55:75-80. [PMID: 19245145 DOI: 10.2298/aci0804075b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Fractures, and especially pseudoarthroses of the scaphoid bone, are a great problem in orthopedic surgery, because the failure percentage is remarkably high (20-30%) even with the top modem treatment methods. Use of grafts, especially well-vascularized ones, along with good fixation, has improved treatment outcomes, but the failure and complication percentages remain high. In the pilot study, we present the first five patients with the pseudoarthrosis of the scaphoid bone, male, of 26.8 years of average age (from 22 to 34-years-old), in whom the method of extrafocal fixation, with distraction and compression, was applied. The fracture healing was achieved in all patients after an average period of 87 days (from 60 to 100 days), with the healing time also including a minimum of a month of physical therapy, after the fixator was removed. The result was evaluated using the Mayo wrist score, and from the preoperative 26 points, 82 points were achieved.
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21
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Abstract
Fractures of the scaphoid are the most common carpal fractures. A review of the literature indicates that the prevalence of the fracture in the case of clinical suspicion is less than 50%. A quality X-ray examination remains essential as an initial diagnostic tool in the evaluation of scaphoid fractures. Its sensitivity varies from 59 to 79%. Patients with negative X-rays present with about 18.7% of scaphoid fractures; 5% of bruised scaphoid; 13% of radius fractures and 7% of miscellaneous bone lesions. If not treated promptly, a scaphoid fracture may be compounded by non-union with associated risk factors such as avascular necrosis and osteoarthritis. Considering these risks, patients with suspected scaphoid fracture with normal X-rays, routinely undergo wrist immobilization until imaging confirms or denies the presence of fracture. Consequently, more than half of the patients undergo wrist immobilization needlessly. This may have a negative impact on their professional life and personal activities while representing a high medical cost. MRI is the imaging technique of choice for suspicious or negatice X-rays. MDCT is less costly than MRI or bone scan, readily available and highly effective for trauma patients but is lacks accuracy and should be used with caution in this indication.
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Affiliation(s)
- A Blum
- Service d'Imagerie Guilloz, CHU, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France.
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Al-Hadidy A, Haroun A, Al-Ryalat N, Hamamy H, Al-Hadidi S. Congenital pseudoarthrosis associated with venous malformation. Skeletal Radiol 2007; 36 Suppl 1:S15-8. [PMID: 16967289 DOI: 10.1007/s00256-006-0175-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 05/18/2006] [Accepted: 06/08/2006] [Indexed: 02/02/2023]
Abstract
Congenital pseudoarthrosis is a pathologic entity that may be isolated, or may be associated with neurofibromatosis. We report the case of a 3-year-old female with congenital pseudoarthrosis involving the right tibia and fibula. Magnetic resonance imaging (MRI) and complementary magnetic resonance angiogram (MRA) revealed a lobulated mass with vivid enhancement, which led to the diagnosis of venous malformation. This is the first report of congenital pseudoarthrosis caused by the presence of a vascular malformation.
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Affiliation(s)
- A Al-Hadidy
- Radiology Department, Jordan University Hospital, Marka, Amman, Jordan.
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Teo HEL, Peh WCG, Akhilesh M, Tan SB, Ishida T. Congenital osteofibrous dysplasia associated with pseudoarthrosis of the tibia and fibula. Skeletal Radiol 2007; 36 Suppl 1:S7-14. [PMID: 16944141 DOI: 10.1007/s00256-006-0177-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 06/08/2006] [Indexed: 02/02/2023]
Abstract
The association between congenital pseudoarthrosis and osteofibrous dysplasia of the tibia and fibula is a rare entity that has been recently recognized. We report a male newborn who was found to have swelling and deformity of the left lower leg. Radiographs and magnetic resonance imaging showed an extensive destructive lesion of the tibial shaft, with dysplastic congenital pseudoarthrosis of the lower fibula. Histopathological examination confirmed the diagnosis of congenital pseudoarthrosis of the tibia and fibula with underlying osteofibrous dysplasia involving both bones. Immunohistochemical stains showed cytokeratin positivity.
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Affiliation(s)
- Harvey E L Teo
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899 Singapore
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24
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De Smet L, Degreef I. Symptomatic pseudo-arthrosis of a trapezial ridge fracture. Acta Chir Belg 2007; 107:86-7. [PMID: 17405610 DOI: 10.1080/00015458.2007.11680022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present a fracture of the ridge of the trapezium with evolution towards a pseudo-arthrosis.
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Affiliation(s)
- L De Smet
- Department of Orthopaedic Surgery, U.Z. Pellenberg, Lubbeek, Belgium.
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25
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Roetman B, Schildhauer TA, Muhr G. [Pelvic stabilization in cases of septic instability. Triangular osteosynthesis in case of infection related vertical pelvic ring instability]. Unfallchirurg 2006; 109:422-4. [PMID: 16705430 DOI: 10.1007/s00113-006-1112-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The combination of transiliac screws and lumbopelvic distraction osteosynthesis is usually an appropriate procedure to treat vertical pelvic ring instabilities under the condition of full weight bearing. In this case, due to the extent of septic destruction of the dorsal portion of the iliac bone, the common triangular fixation method using conventional pedicle screws was not possible. Using the transiliac dorsoventral screw position with special long screws, we achieved high mechanical triangular stability sufficient for pelvic ring fusion despite the large bony defect.
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Affiliation(s)
- B Roetman
- Chirurgische Klinik und Poliklinik der BG-Kliniken Bergmannsheil, Universitätsklinik, Bürkle-de-la-Camp Platz 1, 44789 Bochum.
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26
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Abstract
Tumor necrosis factor (TNF) blocking agents, such as adalimumab, are well tolerated and provide improvement in the symptoms and signs of rheumatoid arthritis (RA). Due to its immunosuppressive effect, an increased risk of infection has been suggested, but so far no differences between adalimumab and placebo groups have been found in pivotal trials. Patients with RA succumb to postoperative complications because they have a systemic disease and use medication with immunosuppressive effects. We report on a patient with longstanding, active RA who had received adalimumab 40 mg every other week with prolonged infection, wound dehiscence and pseudoarthrosis following reconstructive forefoot surgery due to deformities secondary to RA. The postoperative infection occurred although adalimumab therapy had been stopped 8 days before surgery. The half-life of adalimumab is 10.0-13.6 days following a single intravenous dose. Whether patients under therapy with adalimumab are at an increased risk of developing postoperative complications is unclear, a retrospective analysis of the pivotal studies would be helpful in estimating the risk of perioperative (wound) infections in patients receiving anti-TNF. Moreover, it is not clear when therapy should be stopped prior to surgical intervention. Obviously prospective clinical trials would be more convincing.
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MESH Headings
- Adalimumab
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antirheumatic Agents/adverse effects
- Antirheumatic Agents/therapeutic use
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/surgery
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Foot Deformities, Acquired/surgery
- Forefoot, Human/surgery
- Humans
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/therapeutic use
- Injections, Subcutaneous
- Male
- Middle Aged
- Pseudarthrosis/chemically induced
- Pseudarthrosis/diagnosis
- Pseudarthrosis/surgery
- Reoperation
- Surgical Wound Dehiscence/chemically induced
- Surgical Wound Dehiscence/diagnosis
- Surgical Wound Dehiscence/surgery
- Surgical Wound Infection/chemically induced
- Surgical Wound Infection/diagnosis
- Surgical Wound Infection/surgery
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Affiliation(s)
- M Pfeiffer
- Universitätsklinik für Orthopädie, Medizinische Universität, Währinger Gürtel 18-20, 1090, Wien, Osterreich.
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Abstract
Injuries to the upper cervical spine (C0-C2) play a major role in surgical treatment of traumatic sequelae in the entire cervical spine. Even though the number of such operations has increased in recent years, there are no clear treatment recommendations for most types of cervical spine injuries. In view of the wide range of injury types and the correspondingly large number of treatment options, this review focuses mainly on the following types of injuries: C0 fractures, occipital condyle fractures (OCF), atlanto-occipital dislocation (AOD), atlas fractures, atlantoaxial dislocation (AAD), and axis fractures. Important aspects of the mechanisms of injury, clinical signs and symptoms, diagnostic procedures, and treatment options are discussed. Special emphasis is placed on comparatively reviewing the different treatment options discussed in the literature. A summary in table form is presented at the end of each chapter for quick reference.
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Affiliation(s)
- R Kayser
- Zentrum für spezielle Chirurgie des Bewegungsapparates, Klinik und Hochschulambulanz für Unfall- und Wiederherstellungschirurgie, Charité, Campus Benjamin Franklin, Universitätsmedizin Berlin.
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Chen LH, Kao FC, Niu CC, Lai PL, Fu TS, Chen WJ. Surgical treatment of spinal pseudoarthrosis in ankylosing spondylitis. Chang Gung Med J 2005; 28:621-8. [PMID: 16323553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND In ankylosing spondylitis (AS), the spine with osteoporotic changes is fragile and vulnerable to trauma. Patients may develop spinal pseudoarthrosis (SP), whose clinical features are usually misdiagnosed as a tuberculous infection. This study reports our experience with surgical treatment for SP in AS. METHODS Eight patients with AS and SP at the thoracolumbar area were treated surgically and followed-up for at least 3 years. All had persistent back pain and progressive kyphosis. One patient had neurologic deficits preoperatively. Anterior debridement and interbody fusion followed by posterior stabilization were performed in all patients. A posterior corrective osteotomy was additionally done in 3 patients whose kyphotic angle exceeded 45 degrees. RESULTS All patients with persistent back pain obtained significant pain relief postoperatively. On a visual analogue scale, there was an average improvement of 43 points on the clinical scores. The patient with neurologic deficits showed improvement after the operation. Solid bony fusion was achieved in an average of 7.5 months, and correction of the kyphotic angle averaged 18.6 degrees. CONCLUSIONS Spinal pseudoarthrosis should be considered in patients with AS, and must be differentiated from tuberculous and other infections. The results of this study show that pain relief and correction of the kyphotic deformity can be achieved by surgical treatment for ankylosing spondylitis complicated with pseudoarthrosis.
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Affiliation(s)
- Lih-Huei Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taipei
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29
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Ait Essi F, Rafai M, Largab A, Trafeh M. [Neglected fracture-dislocation of the elbow: surgical reduction with enlarging osteoplasty of the trochlear notch. Case report]. ACTA ACUST UNITED AC 2005; 24:177-80. [PMID: 16121625 DOI: 10.1016/j.main.2005.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Elbow dislocations in the infant are not very frequent and are associated to the fractures. Their management must be urgent and rigorous if complications are to be avoided. We report the case of a child aged 12 who presented with a fracture-dislocation of the right elbow, after falling from a tree. The patient was treated in a standard manner for one month. Four months later, the patient presented again, this time complaining of stiffness of the elbow. Physical examination confirmed the reduced range of movement of the elbow (flexion 80 degrees, extension -30 degrees) without associated neurovascular complication. Radiography of the elbow showed a posterior dislocation with remodelling of the humeral contours. Surgical exploration revealed normal articular cartilage, a pseudoarthrosis of the epitrochlea, a dislocation of the radial head and the sigmoid fossa of small size in relation to the trochlea. A reduction was only possible after an "enlargement plasty" of the trochlear notch. The patient was seen after an interval of six months. The elbow was stable with no vasculo-nervous complication.and had flexion of 110 degrees with extension of -30 degrees.
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Affiliation(s)
- F Ait Essi
- Service de traumato-orthopédie (Pavillon 32), CHU de Ibn-Rochd, BP 15199 Casa principal, Casablanca, Maroc.
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine the effect on fusion of adding platelet gel to autologous iliac crest graft. SUMMARY OF BACKGROUND DATA Platelet gel is an osteoinductive material prepared by ultra-concentration of platelets and contains multiple growth factors. Proprietary commercial methods are available for harvesting autologous platelet gel concentrates for use as graft supplement in spine fusions. METHODS We reviewed 76 consecutive patients who underwent instrumented posterolateral lumbar fusion with autologous iliac crest bone graft mixed with autologous growth factor (AGF). A control group was randomly selected from patients who underwent instrumented posterolateral lumbar fusion with autologous bone graft alone. The groups were matched for age, sex, smoking history, and number of levels fused. Demographic, surgical, and clinical data were collected from medical records. Diagnosis of nonunion was based on exploration during revision surgery or evidence of nonunion on computerized tomography. The Fisher exact test was used to compare fusion rates. RESULTS In both groups, mean age was 50 years, and 24% were smokers. The nonunion rate was 25% in the AGF group and 17% in the control group. This difference was not statistically significant (P = 0.18). CONCLUSIONS Platelet gel preparation requires blood draws from the patient. This procedure adds to the risk and cost of surgery. The technique for AGF harvest evaluated in this study provides the highest concentration of platelets among the commercially available methods. Despite this, we showed that platelet gel failed to enhance fusion rate when added to autograft in patients undergoing instrumented posterolateral spinal fusion. The authors do not recommend the use of platelet gel to supplement autologous bone graft during instrumented posterolateral spinal fusion.
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Abstract
STUDY DESIGN Calculate the apparent pseudarthrosis rate for anteriorly plated cervical spine fusions using different threshold levels of intervertebral rotation. OBJECTIVES Determine whether the apparent pseudarthrosis rate depends on the amount of intervertebral rotation used to characterize a fusion as a pseudarthrosis. SUMMARY OF BACKGROUND DATA Intervertebral motion at a spine fusion site is an important outcome measure in most spine fusion research studies. Intervertebral motion measures are used to determine if a device can be sold for use in spine fusion surgery. There is no consensus on how much motion is too much motion at a spine fusion site, and the intervertebral motion threshold that is used to define a pseudarthrosis is arbitrary. There are only limited data on the dependence of the pseudarthrosis rate on the threshold used to define a pseudarthrosis. METHODS Intervertebral motion at the fusion site was measured from flexion extension radiographs taken 1 year after cervical spine fusion using anterior plates and allograft in 200 patients. The number of cases where intervertebral motion at the fusion site exceeded thresholds between 1 degrees and 4 degrees were calculated. RESULTS.: The apparent pseudarthrosis rate varied from 6% when the intervertebral motion threshold was 4 degrees to 44% when the intervertebral motion threshold was 1 degrees . CONCLUSIONS The apparent pseudarthrosis rate was highly dependent on the threshold of motion used to define a pseudarthrosis.
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Affiliation(s)
- John A Hipp
- Baylor College of Medicine, Department of Orthopedic Surgery, Houston, Texas, USA.
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Abstract
INTRODUCTION Vertebroplasty is a relatively new procedure for the treatment of vertebral body fractures of different origin. Due to early promising results the rate of performed procedures increases constantly. Indeed an increasing number of partially severe complications are reported. A summary of the existing findings seems therefore necessary. METHODS On the basis of a medline inquiry important aspects of vertebroplasty in the fields of basic science, diagnostics, indications, contraindications, technique, results and complications were compiled. RESULTS Especially for the field of indications, possible longterm effects and for the "ideal" technique open questions exist, mainly due to missing prospective, randomized long-term clinical trials. CONCLUSIONS A final assessment of the significance of vertebroplasty for osteoporotic fractures in comparison to conservative treatment is actually not possible. In contrast vertebroplasty is a therapeutical option for malignomas in selected cases.
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Affiliation(s)
- R Schmidt
- Orthopädische Klinik mit Querschnittgelähmtenzentrum der Universität Ulm.
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Güneş T, Erdem M, Sen C. [A case of congenital pseudarthrosis of the clavicle]. Acta Orthop Traumatol Turc 2005; 39:266-9. [PMID: 16141735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Congenital pseudarthrosis of the clavicle is a rare condition of unknown etiology. It usually presents as a painless mass in the clavicular region; however, it may sometimes be associated with pain and weakness in the shoulder. We presented a 21-year-old male patient who had pain and weakness in the right shoulder during sportive and daily vigorous activities due to congenital pseudarthrosis of the clavicle. The patient was successfully treated by excision of the ends of the medial and lateral fragments, reconstruction of the defect with a tricortical iliac crest autograft, and internal fixation of the clavicle with a plate and bone screws. After seven months postoperatively, his complaints disappeared, with a full range of motion and Constant score.
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Affiliation(s)
- Taner Güneş
- Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Anabilim Dali), Medicine Faculty of Gaziosmanpaşa University, Tokat, Turkey
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Cucurella Vidal L, Guerrero Laleona C, Belenguer Carreras L, Visiedo Fenollar A. Deformidad en la clavícula derecha. An Pediatr (Barc) 2005; 62:85-6. [PMID: 15642252 DOI: 10.1157/13070192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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35
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Hayashi S, Kobayashi D, Satsuma S, Yoshiya S, Kurosaka M. Acquired pseudarthrosis of the radius and ulna in a neurofibromatosis patient with radiographic normal bone: a case report. J Hand Surg Am 2005; 30:168-71. [PMID: 15680576 DOI: 10.1016/j.jhsa.2004.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Accepted: 07/07/2004] [Indexed: 02/02/2023]
Abstract
Pseudarthrosis, often associated with neurofibromatosis, usually is present at birth or is the result of pathologic fracture. We present a rare case of a 29-month-old patient with acquired pseudarthrosis in radiographically normal bone.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe Children's Hospital, and Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City, Hyogo Prefecture 650-0017, Japan
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Rudzki JR, Lenke LG, Blanke K, Riew KD. Pseudarthrosis of a thirty-nine-year-old dens fracture causing myelopathy. A case report. J Bone Joint Surg Am 2004; 86:2509-13. [PMID: 15523026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jonas R Rudzki
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 11300, West Pavilion, St. Louis, MO 63110, USA
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Abstract
BACKGROUND Isolated spinous process fractures of the thoracic or lumbar spine are not well described in the literature. Initial conservative treatment of these fractures can result in resolution of symptoms without lasting effect. However, in cases where localized pain persists despite appropriate treatment, pseudoarthrosis should be suspected. METHODS The diagnosis, surgical treatment, and outcome of one patient with isolated pseudoarthrosis of the lumbar spine that failed conservative treatment and was surgically excised are reviewed. RESULTS Following excision of the spinous process pseudoarthrosis, the patient's pain resolved, allowing return to competitive sports without limitation. CONCLUSIONS In certain cases, excision of an isolated spinous process pseudoarthrosis can improve patients' back pain. However, prior to surgery, conservative treatment must be exhausted and other causes of back pain must be ruled out.
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Affiliation(s)
- Amir H Fayyazi
- Department of Orthopedic Surgery, Institute for Spine Care, State University of New York Upstate Medical University, Syracuse, New York 13202-3072, USA.
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Ciprian S, Iochum S, Kohlmann R, Dautel G, Dap F, Blum A. Valeur de l’IRM dans l’évaluation du potentiel de guérison des pseudarthroses du scaphoïde traitées par greffe osseuse. ACTA ACUST UNITED AC 2004; 85:1699-706. [PMID: 15669563 DOI: 10.1016/s0221-0363(04)97734-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the accuracy of MR imaging in predicting bone graft healing in patients with scaphoid non-union. MATERIAL AND METHODS 21 patients with scaphoid non-union were examined with MR imaging prior to bone grafting (conventional bone graft in 14 cases and vascularized bone graft in 7 cases). The protocol included unenhanced and Gadolinium-enhanced sequences. Signal intensity and homogeneity of the proximal fragment was analysed by two independent radiologists. MRI findings were then correlated to the postoperative rate of union. RESULTS Healing occurred in 17 cases and failed in 4 cases with a mean follow up of 14 months. Intraobserver agreement in MR reading was respectively 0.92 et 0.86. Interobserver agreement was 0.88. On Tl-wi, the proximal fragment was hyperintense in 1 case (with positive surgical result), heterogeneous low signal intensity in 7 cases (healing in n = 7) and homogeneous low signal intensity in 13 cases (healing in n = 9). On T2-wi, the proximal fragment was hypointense in 4 cases (healing in n = 3), homogeneous high signal in 5 cases (healing in n = 4) and heterogeneous high signal intensity in 12 cases (healing in n = 10). After Gadolinium injection, enhancement was homogeneous in 4 cases (healing in n = 4), heterogeneous in 8 cases (healing in n = 7) and absent in 9 cases (healing in n = 6). In the group with no enhancement, 5 patients were treated with vascularized bone graft (healing in n = 4) and 4 with conventional bone graft (healing in n = 2). CONCLUSION The absence of enhancement of the proximal scaphoid fragment leads to poor surgical results except for vascularized bone graft.
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Affiliation(s)
- S Ciprian
- Service d'Imagerie Guilloz, CHU Nancy, 54000 Nancy
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39
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Dacho A, Germann G, Sauerbier M. [The reconstruction of scaphoid pseudoarthroses with the operation of Matti-Russe. A retrospective follow-up analysis of 84 patients]. Unfallchirurg 2004; 107:388-96. [PMID: 15114476 DOI: 10.1007/s00113-004-0748-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND In a retrospective study 84 patients were examined who were treated with a Matti-Russe procedure between 1985 and 1997 due to scaphoid non-union. The purpose of this study was to evaluate the long term results after scaphoid reconstruction and to get impressions about subjective feeling of the patients. PATIENTS AND METHODS 79 patients were male, 5 were female. The average follow-up period was 88 months. Measured parameters were: grip strength and range of motion, pain was evaluated with a visual analog scale (VAS) from 0 to 100. The functional and subjective outcome was evaluated with the DASH-questionnaire. RESULTS A bony consolidation could be verified in 82% of the patients. The mean postoperative pain score was 3 (non-stress) and 33 (stress) in patients with scaphoid union. The DASH-score reached 15. Active range of motion and grip strength were 82% and 92% compared to the contralateral side. 81% of the patients have been working in strenuous jobs. CONCLUSION The results show the reliability of the Matti-Russe procedure in non-union of fractures of the scaphoid. Alternative treatment options have no advantages in bony union.
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Affiliation(s)
- A Dacho
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie-Schwerbrandverletztenzentrum-, Berufsgenossenschaftliche Unfallklinik Ludwigshafen.
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40
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Ihme N, Mahnken AH, Schmidt-Rohlfing B, Röhrig H, Weber M. [Posteromedial bowing of the lower leg and neuroblastoma with possible neurofibromatosis type I: a case report and literature review]. ACTA ACUST UNITED AC 2004; 142:97-102. [PMID: 14968392 DOI: 10.1055/s-2004-818034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The posteromedial bowing of the tibia is a rare condition that is not yet known to be related to neurofibromatosis. The case of a three month-old boy with the tentative diagnosis of neurofibromatosis is described. He developed paraplegia due to an abdominal neuroblastoma at the age of 9 months. This led us to a review of the literature. METHOD 122 cases of posteromedial bowing of the tibia in 20 publications of the years 1949 - 2000 were analysed under special respect to gender, side of affection, shortening of the lower leg, treatment and possible cause. RESULTS The posteromedial bowing of the lower leg seems to affect more boys as well as the left side. As far as described in all but one case it was the first delivery. Regularly, a limb shortening and pes calcaneovalgus is to be found. 99 children were treated conservatively, 21 got an operation of the affected side. In 19 performed osteotomies no pseudarthrosis occurred. One case of a fracture due to an adequate trauma without healing problems is described.
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Affiliation(s)
- N Ihme
- Orthopädische Klinik Universitätsklinik der RWTH Aachen.
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41
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Wenaden AET, McHugh K, Hill RA, Hall CM. Pseudarthrosis presenting as a late complication of meningococcal septicaemia and disseminated intravascular coagulation. Skeletal Radiol 2004; 33:287-90. [PMID: 14997350 DOI: 10.1007/s00256-004-0747-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2003] [Revised: 12/09/2003] [Accepted: 12/24/2003] [Indexed: 02/02/2023]
Abstract
Late skeletal complications of meningococcal septicaemia and disseminated intravascular coagulation are well recognised in children and are largely centred on the growing epimetaphyseal region of long bones. In this article we describe a case of pseudarthrosis of the mid-ulna presenting 18 months following a devastating episode of meningococcal septicaemia in a 3-year-old boy. Radiographs and MRI demonstrated the ulna abnormality. We briefly review the late skeletal complications of the disease and other causes of pseudarthrosis.
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Affiliation(s)
- A E T Wenaden
- Department of Radiology, The Hammersmith Hospital, Du Cane Road, W12 OHS, London, UK.
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42
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Abstract
Fractures of the first rib are uncommon in athletes and present a different clinical entity from traumatic first rib fracture associated with high energy thoracic trauma. These fractures are stress induced and precipitated by chronic muscular forces acting on the first rib. Typically they heal with conservative treatment. This report describes a fracture of the first rib in a tennis player that developed into a symptomatic pseudarthrosis as a result of persistent overhead activities. Symptoms mimicked ipsilateral shoulder injury. Pseudarthrosis of the first rib should be included in the differential diagnosis of chronic persistent shoulder pain in the overhead athlete.
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Affiliation(s)
- K Mithöfer
- Shoulder and Sports Medicine Service, Hospital for Special Surgery, New York, USA.
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43
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Abstract
All along the operative treatment of distal tibial fractures is a difficult procedure. In most cases the clinical situation is characterized by small distal fragments in combination with crucial soft-tissue conditions. That's why complications as primary or secondary displacements, mal unions, delayed or non unions and as well as a high rate of deep wound infection are often seen. Thus internal fixations with traditional implants (standard screws and plates) could consider inevitable this crucial biology and biomechanics only insufficiently. The nowadays available internal fixators with optional angular-stable screws expand the possibilities of internal fixation in these severe situations. Their minimal invasive application (MIPO, Minimally Invasive Plate Osteosynthesis) takes care of the soft tissue and reduces the surgical trauma furthermore. With the variety of their possible applications (combination of angular stability with standard application) also the demands increase, however, both onto the surgeons, but also onto the general practitioners in the aftercare. The combination of most different tactics in one implant results in the consequence, that at the same bone simultaneously direct and indirect bone healing will be expected. The radiological differentiation between desired and unwanted healing processes becomes thus difficult. Pre- and perioperative procedures require from the trauma surgeon a huge infrastructure and a high measure of biomechanical and biological experience. In the postoperative management of these injuries an unlimited cooperation between traumatologists and general practitioners is indispensable for a further successful course.
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Affiliation(s)
- C Ryf
- Spital Davos, Klinik für Chirurgie-Orthopädie, Davos Platz.
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Duggal N, Mendiondo I, Pares HR, Jhawar BS, Das K, Kenny KJ, Dickman CA. Anterior Lumbar Interbody Fusion for Treatment of Failed Back Surgery Syndrome: An Outcome Analysis. Neurosurgery 2004; 54:636-43; discussion 643-4. [PMID: 15028138 DOI: 10.1227/01.neu.0000108423.87889.9e] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2003] [Accepted: 11/06/2003] [Indexed: 11/19/2022] Open
Abstract
AbstractOBJECTIVEAnterior lumbar interbody fusion (ALIF) has gained popularity for the treatment of degenerative disease of the lumbar spine. In this report, we present our experience with the ALIF procedure for treatment of failed back surgery syndrome (FBSS) in a noncontrolled prospective cohort.METHODSIn a 2-year period, we treated patients diagnosed with FBSS with ALIF. Clinical and radiological outcomes were recorded in a prospective, nonrandomized, longitudinal manner. Neurological, pain, and functional outcomes were measured preoperatively and 12 months after surgery. Operative data, perioperative complications, and radiological and clinical outcomes were recorded.RESULTSThirty-three patients with a preoperative diagnosis of FBSS, with degenerative disc disease (n = 17), postsurgical spondylolisthesis (n = 13), or pseudarthrosis (n = 3), underwent ALIF. Back pain, leg pain, and functional status improved significantly, by 76% (P < 0.01), 80% (P < 0.01), and 67% (P < 0.01), respectively.CONCLUSIONOn the basis of our results, we found ALIF to be a safe and effective procedure for the treatment of FBSS for selected patients.
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Affiliation(s)
- Neil Duggal
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
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45
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Kim DY, Lee SH, Jang JS, Chung SK, Lee HY. Intravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of intravertebral instability. J Neurosurg 2004; 100:24-31. [PMID: 14748570 DOI: 10.3171/spi.2004.100.1.0024] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECT The objectives of this study were to: 1) describe the incidence and clinical features of intravertebral vacuum phenomenon (IVVP) in a relatively large number of cases; 2) quantitatively evaluate intravertebral instability and determine the factors affecting instability; and 3) evaluate the efficacy of percutaneous vertebroplasty in the treatment of this phenomenon. METHODS A retrospective review was conducted of the records of 67 patients with IVVP among 652 consecutive cases of osteoporotic compression fracture. Comparisons between the IVVP group and a control group, a stable group, and an unstable group were conducted. Percutaneous vertebroplasty was performed in all patients. There were 67 patients (10.3%) in whom there were 70 vacuum phenomena of the intravertebral space. Intravertebral vacuum phenomena occurred predominantly in the thoracolumbar junction (81%) and in patients with a longer duration of symptoms (10.6 +/- 9.8 months) compared with the control group. Of 59 vertebrae for which flexion-extension radiographs were available, 26 vertebrae were categorized as stable and 33 as unstable. Twenty-one vertebrae (64%) had undergone compression fracture in the unstable group compared with nine (35%) compression fractures in the stable group. There were 28 (85%) fractures of the wedged vertebrae in the unstable group compared with 16 (61%) fractures in wedged vertebrae in the stable group. Percutaneous vertebroplasty was performed with successful clinical outcome. CONCLUSIONS Intravertebral vacuum phenomenon is more common than has been previously appreciated. The results of this study indicate that biomechanics, not ischemic or avascular theory, may play an important role in pathogenesis of this phenomenon. Percutaneous vertebroplasty was found to be a minimally invasive and effective procedure for the treatment of IVVP.
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Affiliation(s)
- Dong-Yun Kim
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
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46
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Karakurt L, Yilmaz E, Belhan O, Incesu M, Serin E. [Pseudarthrosis of a calcaneus fracture: a case report]. Acta Orthop Traumatol Turc 2004; 38:288-90. [PMID: 15618773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Nonunion after a calcaneus fracture is rare. A forty-two-year-old man presented with complaints of extreme left heel pain on weight-bearing, that required him to use crutches. Clinical and radiological studies yielded a diagnosis of calcaneal nonunion. He had a history of an open calcaneal fracture that occurred in a traffic accident eight months before, for which he received cast treatment. He underwent surgical treatment (curettage, bone graft, and internal fixation) for the nonunion of the calcaneus. Eight months after the operation, no problem was observed at the union site, and the patient returned to his normal activity levels. He had a slight heel pain appearing only after walking long distances, which was attributed to the subtalar joint.
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Affiliation(s)
- Lokman Karakurt
- Firat Universitesi Tip Fakültesi, Ortopedi ve Travmatoloji Anabilim Dali, Elaziğ.
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Abstract
Segmental neurofibromatosis refers to individuals who have manifestations of neurofibromatosis type 1 (NF-1) limited to one area of the body. It results from a post-conceptional mutation in the NF-1 gene leading to somatic mosaicism. Although it is generally considered a rare condition, this report of 39 children with segmental NF-1 demonstrates that it is commonly seen in a pediatric NF-1 referral center. The mean age at diagnosis was 7.8 years (range: 2-25 years). Twenty-nine patients had only pigmentary manifestations of segmental NF-1, including seven who had only café-au-lait macules and 22 who had café-au-lait macules and freckling. Two patients had isolated plexiform neurofibromas; a third patient had a plexiform neurofibroma of the eyelid in addition to ipsilateral dysplasia of the sphenoid wing and Lisch nodules. A 12-year-old girl had an isolated tibial pseudarthrosis. An 8-year-old boy had an isolated optic pathway tumor, which behaved both biologically and radiographically as an NF1-associated tumor. While most children with segmental NF-1 have only localized pigmentary changes, some children will have isolated plexiform neurofibromas, pseudarthroses, or optic pathway tumors. Accurate diagnosis of segmental NF-1 is crucial for both management and genetic counseling.
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Affiliation(s)
- Robert Listernick
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60614, USA.
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48
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Abstract
Pseudarthrosis of the capitate bone is extremely rare. In this case, the injury and pseudarthrosis was so old, the bone with a nutrient vessel was grafted, and bone union and excellent results are obtained.
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Affiliation(s)
- Yasushi Morisawa
- The Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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49
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Kesmezacar H, Oğüt T, Yücel I, Babacan M, Ağritmiş A. [Defective forearm pseudoarthrosis with a neglected elbow dislocation]. ULUS TRAVMA ACIL CER 2003; 9:218-21. [PMID: 12923701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Neglected elbow dislocations, rarely seen in the developed countries, are very attractive due to the difficulties of treatment and diversity of prognosis. A 32 year-old woman was admitted with chronic elbow dislocation and defective forearm pseudoarthrosis due to an accident four months prior to admission. Open reduction and distraction arthroplasty using hinged external fixator for the elbow, open reduction and internal fixation with plate-screws with fibula allograft for the forearm was performed. The elbow was stable and had 110 degrees and -15 degrees of active flexion and extension respectively on the ninth month of follow-up. Both radius and ulna were united.
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Okada K, Miyakoshi N, Takahashi S, Ishigaki S, Nishida J, Itoi E. Congenital pseudoarthrosis of the tibia treated with low-intensity pulsed ultrasound stimulation (LIPUS). Ultrasound Med Biol 2003; 29:1061-1064. [PMID: 12878253 DOI: 10.1016/s0301-5629(03)00906-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A 16-year-old Japanese boy was admitted to our institution in September 2000 because no apparent callus had appeared around a fracture after 6 weeks of cast fixation. Physical examination revealed a tenderness of the right lower leg, and multiple small subcutaneous tumors and café-au-lait spots in extremities and trunk. Radiographs showed the fracture of the right lower tibia with bony sclerosis and a localized fusiform osteolytic lesion at the fracture site. The affected tibia bowed anteriorly and the medullary space in the lower tibia was narrow. A diagnosis of Boyd type IV congenital pseudoarthrosis of the tibia was made. Treatment with low-intensity pulsed ultrasound (US) stimulation (LIPUS) was administered for 20 min/day, and a nonweight-bearing gait was continued with a cast or brace fixation. At 6 months after the treatment, a small amount of bridging callus was seen. We continued the treatment for 1 year until the solid fusion was observed on radiographs and the patient started full-weight-bearing.
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Affiliation(s)
- Kyoji Okada
- Department of Orthopedic Surgery, Akita University School of Medicine, Akita, Japan.
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