1
|
Phillips FM, Cheng I, Rampersaud YR, Akbarnia BA, Pimenta L, Rodgers WB, Uribe JS, Khanna N, Smith WD, Youssef JA, Sulaiman WAR, Tohmeh A, Cannestra A, Wohns RNW, Okonkwo DO, Acosta F, Rodgers EJ, Andersson G. Breaking Through the "Glass Ceiling" of Minimally Invasive Spine Surgery. Spine (Phila Pa 1976) 2016; 41 Suppl 8:S39-43. [PMID: 26839987 DOI: 10.1097/brs.0000000000001482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Frank M Phillips
- *Rush University Medical Center, Chicago, Illinois †Stanford University, Stanford, California ‡University of Toronto, Toronto Western Hospital, Toronto, Ontario Canada §Department of Orthopaedic Surgery, Stanford University Stanford, California ¶Instituto de Patalogia da Coluna, São Paulo, Brazil
- Spine Midwest, St. Mary's Hospital, Jefferson City, Missouri **University of South Florida, Tampa, Florida ††Orthopaedic Specialists of Northwest Indiana, Munster, Indiana ‡‡University Medical Center, Las Vegas, Nevada §§Spine Colorado, Durango, Colorado ¶¶Ochsner Clinic Foundation, New Orleans, Louisiana
- Northwest Orthopaedic Specialists, Spokane, Washington ***Lyerly Neurosurgery, Jacksonville, Florida †††Neo Spine, Puyallup, Washington ‡‡‡University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania §§§Keck Medicine, University of Southern California, Los Angeles, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Rodgers WB, Lehmen JA, Gerber EJ, Rodgers JA. Grade 2 spondylolisthesis at L4-5 treated by XLIF: safety and midterm results in the "worst case scenario". ScientificWorldJournal 2012; 2012:356712. [PMID: 23125555 PMCID: PMC3483667 DOI: 10.1100/2012/356712] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 07/29/2012] [Indexed: 11/25/2022] Open
Abstract
Spondylolisthesis is one of the most common indications for spinal surgery. However, no one approach has been proven to be more effective in treating spondylolisthesis. Recent advances in minimally invasive spine technology have allowed for different approaches to be applied to this indication, notably extreme lateral interbody fusion (XLIF). The risk, however, of using XLIF in treating grade II spondylolisthesis is the ventral position of the lumbar plexus, particularly at L4-5. Objective. This study reports the safety and midterm clinical and radiographic outcomes of patients with grade II lumbar spondylolisthesis treated with XLIF. Methods. 63 patients with grade II spondylolisthesis and spinal stenosis were treated with XLIF and were available for 12-month followup. Of those, 61 (97%) were treated at L4-5. Clinical (VAS, complications, and reoperation rate) and radiographic (anterolisthesis, disk height, and fusion) parameters were assessed. Study Design. Data were collected via a prospective registry and analyzed retrospectively. Results. Sixty-three patients were available for evaluations at least one year postoperatively. Average pain (visual analog scale) decreased from a score of 8.7 at baseline to 2.2 at 12 months postoperatively. Average anterior slippage was reduced by 73% and was well maintained. Average disk height (4.6 mm pre-op and 9.0 mm post-op) nearly doubled after surgery. Slight settling (average 1.3 mm) occurred over the twelve-month follow-up period. There were no neural injuries and no nonunions noted. Conclusions. XLIF is a safe and effective minimally invasive treatment alternative for grade II spondylolisthesis. Real-time neurological monitoring and attention to technique are mandatory.
Collapse
Affiliation(s)
- W B Rodgers
- Spine Midwest, Inc., Suite 301, 200 St. Mary's Medical Plaza, Jefferson City, MO 65101, USA
| | | | | | | |
Collapse
|
3
|
Lucio JC, VanConia RB, DeLuzio KJ, Lehmen JA, Rodgers JA, Rodgers WB. Economics of less invasive spinal surgery: an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period. Risk Manag Healthc Policy 2012; 5:65-74. [PMID: 22952415 PMCID: PMC3430081 DOI: 10.2147/rmhp.s30974] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is great debate about the costs and benefits of technology-driven medical interventions such as instrumented lumbar fusion. With most analyses using charge data, the actual costs incurred by medical institutions performing these procedures are not well understood. The object of the current study was to examine the differences in hospital operating costs between open and minimally invasive spine surgery (MIS) during the perioperative period. METHODS Data were collected in the form of a prospective registry from a community hospital after specific Institutional Review Board approval was obtained. The analysis included consecutive adult patients being surgically treated for degenerative conditions of the lumbar spine, with either an MIS or open approach for two-level instrumented lumbar fusion. Patient outcomes and costs were collected for the perioperative period. Hospital operating costs were grouped by hospitalization/operative procedure, transfusions, reoperations, and residual events (health care interactions). RESULTS One hundred and one open posterior lumbar interbody fusion (Open group) and 109 MIS patients were treated primarily for stenosis coupled with instability (39.6% and 59.6%, respectively). Mean total hospital costs were $27,055.53 for the Open group and $24,320.16 for the MIS group. This represents a statistically significant cost savings of $2,825.37 (10.4% [95% confidence interval: $522.51-$5,128.23]) when utilizing MIS over traditional Open techniques. Additionally, residual events, complications, and blood transfusions were significantly more frequent in the Open group, compared to the MIS group. CONCLUSIONS/LEVEL OF EVIDENCE Utilizing minimally invasive techniques for instrumented spinal fusion results in decreased hospital operating costs compared to similar open procedures in the early perioperative period. Additionally, patient benefits of minimally invasive techniques include significantly less blood loss, shorter hospital stays, lower complication rate, and a lower number of residual events. Long-term outcome comparisons are needed to evaluate the efficacy of the two treatments. LEVEL OF EVIDENCE III CLINICAL RELEVANCE: This work represents a true cost-of-operating comparison between open and MIS approaches for lumbar spine fusion, which has relevance to surgeons, hospitals and payers in medical decision-making.
Collapse
Affiliation(s)
- John C Lucio
- St Mary’s Health Center, Jefferson City, MO, USA
| | | | | | | | | | - WB Rodgers
- Spine Midwest, Inc, Jefferson City, MO, USA
| |
Collapse
|
4
|
Affiliation(s)
- Kevin J Deluzio
- Queen's University, Kingston, Ontario, Canada. E-mail address:
| | - John C Lucio
- St. Mary's Health Center, Jefferson City, MO. E-mail address:
| | - W B Rodgers
- Spine Midwest, Jefferson City, MO. E-mail address:
| |
Collapse
|
5
|
Rodgers WB, Gerber EJ, Patterson JR. Fusion after minimally disruptive anterior lumbar interbody fusion: Analysis of extreme lateral interbody fusion by computed tomography. SAS J 2010; 4:63-6. [PMID: 25802651 PMCID: PMC4365611 DOI: 10.1016/j.esas.2010.03.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Less invasive fusion approaches, such as extreme lateral interbody fusion (XLIF), have proliferated, but few reports have critically assessed fusion rates. To date, no studies have reported computed tomography (CT) documented fusion rates following XLIF. METHODS An institutional review board-approved prospective radiographic and CT assessment of minimally disruptive anterior lumbar interbody fusion (mini-ALIF) fusions performed through the XLIF approach. Sixty-six patients (88 operative levels) were examined 12 months after XLIF to determine the rate and quality of anterior lumbar fusion. RESULTS Eighty five of the 88 levels (96.6%) were judged fused by CT. Sixty-four of the 66 patients (97.0%) were judged fused by CT. Patient satisfaction at 12 months after surgery was high, with 89.4% reportedly "satisfied or very satisfied" with their results. No revisions were necessary for pseudarthrosis. CONCLUSION Mini-ALIF using an XLIF approach reliably results in anterior lumbar fusion.
Collapse
|
6
|
|
7
|
Rodgers WB, Kennedy JG, Hergreuter CA, Kasser JR. Massive subperiosteal hemorrhage and femoral shaft osteonecrosis: a complication of tissue plasminogen activator therapy for purpura fulminans. Am J Orthop (Belle Mead NJ) 2000; 29:315-9. [PMID: 10784021] [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: 02/16/2023]
Abstract
We present the case of a child who developed a massive subperiosteal hemorrhage and subsequent osteonecrosis of her right femur after treatment with tissue plasminogen activator for post-varicella streptococcal purpura fulminans. Radiographs showed posteromedial translation of the capital femoral epiphysis on the necrotic shaft, and the hip was immobilized. The femur slowly remodeled and has continued to grow. The child is independently ambulatory with a 2.1-cm leg length discrepancy, a varus deformity of the hip, and a valgus distal femur.
Collapse
Affiliation(s)
- W B Rodgers
- Capital Region Orthopaedic and Sports Medicine, Jefferson City, Missouri, USA
| | | | | | | |
Collapse
|
8
|
Rodgers WB, Coran DL, Emans JB, Hresko MT, Hall JE. Occipitocervical fusions in children. Retrospective analysis and technical considerations. Clin Orthop Relat Res 1999:125-33. [PMID: 10416401] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This report presents a retrospective analysis of the authors' experience with occipitocervical fusions in children and adolescents during the last 2 decades. A description of an operative technique devised by the senior author (JEH), and a comparison of the results using this and other methods of fusion are given. Twenty-three patients underwent occipitocervical fusion. Fifteen of the patients were operated on using the authors' technique. To achieve stable fixation of the distal cervical vertebra a threaded Kirschner wire was passed transversely through the spinous process; occipital fixation was achieved by the traditional method of wiring corticocancellous bone graft to the skull through burr holes. The occipital wires then were wrapped around the Kirschner wire and the graft was cradled in the resulting nest. Halo immobilization was used in 10 patients for an average of 12.5 weeks (range, 6-24 weeks). Twenty-two patients achieved successful fusion at an average followup of 5.8 years (range, 1-14.33 years). Several complications, including transient quadriplegia in one patient, pseudarthrosis in two (one of which persists), hardware fixation failure in one, unintended distal extension of the fusion, pneumonia, wound infection, halo pin infection, skin breakdown under the halo vest, hydrocephalus, cerebrospinal fluid leak, and traumatic fusion fracture were encountered. Results using the technique described herein are comparable with or better than the results reported in the previous literature, and the results of the patients in this series in whom the technique was not used.
Collapse
Affiliation(s)
- W B Rodgers
- Department of Orthopaedic Surgery, Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | |
Collapse
|
9
|
Abstract
The strong association between congenital heart disease and spinal deformity is well established, but data on the risks and outcome of spinal fusion surgery in patients with congenital heart disease are scarce. The purpose of this study was to identify predictors of perioperative risk and outcome in a large series of children and adolescents with congenital heart disease who underwent spinal fusion for scoliosis or kyphosis. In the authors' retrospective analysis of 74 consecutive patients with congenital heart disease undergoing spinal fusion, there were two deaths (2.7%) and 18 significant complications (24.3%) in the perioperative period. Preoperative cyanosis (arterial oxygen saturation < 90% at rest) with uncorrected or incompletely corrected congenital heart disease was associated with both deaths. Complications occurred in nine of 18 (50%) patients with cyanosis and in 11 of 56 (20%) patients without cyanosis. As judged by multivariate analysis the best predictors of perioperative outcome were the overall physical status of the patient as represented by the American Society of Anesthesiologists' preoperative score and a higher rate of intraoperative blood loss. Seventeen of 43 patients (40%) with an American Society of Anesthesiologists score of 3 or higher experienced complications including two perioperative deaths. Successful spinal fusion and correction were achieved in 97% of patients. Children and adolescents with congenital heart disease can undergo elective spinal fusion with risks that relate to overall cardiac status. Careful assessment of preoperative status by pediatric cardiologists and cardiac anesthesiologists familiar with surgical treatment of patients with congenital heart disease will assist the orthopaedic surgeon in providing the most realistic estimate of risk.
Collapse
Affiliation(s)
- D L Coran
- Department of Orthopaedic Surgery, Children's Hospital, Boston, MA, USA
| | | | | | | | | |
Collapse
|
10
|
Rodgers WB, Coran DL, Kharrazi FD, Hall JE, Emans JB. Increasing lordosis of the occipitocervical junction after arthrodesis in young children: the occipitocervical crankshaft phenomenon. J Pediatr Orthop 1997; 17:762-5. [PMID: 9591978] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Five children were treated before age 6 years with occipitocervical fusion for occipitocervical instability. Long-term (average, 11.8 years; range, 8.4-14.5 years) follow-up revealed increasing lordosis across the fused segment in four of the patients, a finding we here refer to as the occipitocervical crankshaft phenomenon. On average, occipitocervical lordosis increased 1.06 degrees per level fused per year until skeletal maturity. Although such a progression might be expected, to our knowledge this is the first report of its occurrence. Compensatory subaxial motion was able to overcome this increase in all of the patients. We recommend occipitocervical fusion in a neutral or slightly flexed position in the very young child to account for this predictable increase in lordosis.
Collapse
Affiliation(s)
- W B Rodgers
- Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | |
Collapse
|
11
|
Abstract
STUDY DESIGN A retrospective review of transpedicular instrumentation used in a series of 24 patients with myelodysplastic spinal deformities and deficient posterior elements. OBJECTIVE To describe the usefulness and efficacy of these instruments in the treatment of complicated myelodysplastic spinal deformity. METHODS The mean preoperative scoliosis was 75.7 degrees (range, 39-130 degrees) in the 22 patients with scoliotic deformities; 4 patients with thoracic hyperkyphoses averaged 70.5 degrees (range, 46-90 degrees) and 10 patients with lumbar kyphoses averaged 80.5 degrees (range, 42-120 degrees). The instrumentation extended to the sacrum in 4 patients and the pelvis in 9; 10 patients also underwent anterior release and fusion and 7 underwent concomitant spinal cord detethering. At an average follow-up of 4.0 years (2.0-7.7 years; one patient died at 8 months), all patients have fused (with the exception of two lumbosacral pseudarthroses). RESULTS At last follow-up, deformity measured 32.1 degrees scoliosis (range, 6-85 degrees), 30.8 degrees thoracic kyphosis (range, 24-35 degrees), and 0.0 degree lumbar kyphosis (range, 35 degrees kyphosis to 29 degrees lordosis). Three patients lost some neurologic function after surgery; two recovered within 6 months and one has incomplete recovery. No ambulatory patient lost the ability to walk. Five patients required additional surgical procedures; in three cases, there was instrumentation breakage associated with pseudarthrosis or unfused spinal segments. CONCLUSIONS Pedicle screw instrumentation is uniquely suited to the deficient myelodysplastic spine. Compared with historical control subjects, these devices have proven capable of significant correction of both scoliotic and kyphotic deformities. This instrumentation appears particularly useful in preserving lumbar lordosis in all patients and may preserve more lumbar motion in ambulatory myelodysplasia patients.
Collapse
Affiliation(s)
- W B Rodgers
- Department of Orthopaedic Surgery, Children's Hospital, Boston, Massachusetts, USA
| | | | | | | |
Collapse
|
12
|
Kharrazi FD, Rodgers WB, Coran DL, Kasser JR, Hall JE. Protrusio acetabuli and bilateral basicervical femoral neck fractures in a patient with Marfan syndrome. Am J Orthop (Belle Mead NJ) 1997; 26:689-91. [PMID: 9349891] [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: 02/05/2023]
Abstract
A 22-year-old man with Marfan syndrome and bilateral protrusio acetabuli presented with bilateral femoral neck stress fractures after vigorous stretching exercises for hip "stiffness." Fifteen years later, his fractures, which were treated with internal fixation, have healed, his acetabular protrusion has not worsened, and his perceived hip "stiffness" persists. This case demonstrates a rare manifestation of Marfan syndrome, protrusio acetabuli, and a possible side effect of vigorous stretching in the face of abnormal joint mechanics.
Collapse
Affiliation(s)
- F D Kharrazi
- Orthopaedic Trauma Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | | | | |
Collapse
|
13
|
Rodgers WB, Kennedy JG, Zimbler S. Chondromyxoid fibroma of the ala of the sacrum presenting as a cause of lumbar pain in an adolescent. Eur Spine J 1997; 6:351-3. [PMID: 9391809 PMCID: PMC3454609 DOI: 10.1007/bf01142685] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report a case of chondromyxoid fibroma of the ala of the sacrum: its presentation, diagnosis, treatment, and resolution. Although this tumor is admittedly rare, our case demonstrates the need for careful evaluation of pack pain in an adolescent.
Collapse
Affiliation(s)
- W B Rodgers
- Capital Region Orthopaedics and Sports Medicine, Jefferson City, MO 65109, USA
| | | | | |
Collapse
|
14
|
Rodgers WB, Schwend RM, Jaramillo D, Kasser JR, Emans JB. Chronic physeal fractures in myelodysplasia: magnetic resonance analysis, histologic description, treatment, and outcome. J Pediatr Orthop 1997; 17:615-21. [PMID: 9591999 DOI: 10.1097/00004694-199709000-00008] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Thirteen myelodysplastic children with 19 chronic physeal fractures were treated. All were treated with prolonged immobilization (average, 5.8 months; range, 3-18 months) in either braces or casts; four of the fractures required operative fixation to facilitate healing. All were healed at 4.8-years follow-up but, in four of the fractures, the growth plate closed prematurely. Three of the children underwent magnetic resonance imaging (MRI) of the injured physes, and one underwent physeal biopsy as part of her operative epiphysiodesis. Histologic analysis revealed three distinct zones of physeal pathoanatomy: a normal zone of proliferation; a thickened, disorganized zone of hypertrophy; and a vascularized zone of fibrous tissue adjacent to the metaphysis. On MRI, there was thickening of the physis and irregularity of the zone of provisional calcification. The physeal cartilage and the juxtametaphyseal fibrovascular tissue enhanced with gadolinium. These findings corroborate earlier mechanistic proposals for physeal injury in myelodysplasia: chronic stress or trauma to the poorly sensate limb produces micromotion at the zone of hypertrophy, yielding a widened, disorganized physis, and leading to fracture, displacement, and delayed union.
Collapse
Affiliation(s)
- W B Rodgers
- Department of Orthopaedic Surgery, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | |
Collapse
|
15
|
Kennedy JG, Rodgers WB, Zurakowski D, Sullivan R, Griffin D, Beardsley W, Sheehan L. Pyrexia after total knee replacement. A cause for concern? Am J Orthop (Belle Mead NJ) 1997; 26:549-52, 554. [PMID: 9267555] [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: 02/05/2023]
Abstract
Ninety patients who had undergone 92 total knee replacements were reviewed to determine predictors of postoperative pyrexia and to evaluate the relative value of septic screening in this group of patients. Postoperative pyrexia was defined as an axillary temperature greater than 37 degrees C (98.4 degrees F) on any or all of the 5 days after surgery. All of the patients in this series developed a postoperative pyrexia after knee arthroplasty. None of 16 patients (17% of arthroplasties) with a temperature of 39 degrees C (102 degrees F) or greater had evidence of infection. None of the 4 patients with urinary tract infections developed a pyrexia exceeding 38 degrees C (101 degrees F). At a minimum of 2 years' follow-up, none of the 90 patients had developed an infected arthroplasty. Logistic regression analysis showed that the risk of becoming significantly febrile (temperature > 39 degrees C) doubled for every unit drop in hematocrit and increased fourfold for each unit of blood transfused after surgery. Perioperative blood loss and pyrexia were correlated, but the correlation was not statistically significant. The duration of procedure, tourniquet time, and patient age or sex were not associated with risk of pyrexia. In this series, there was no association between a pyrexia greater than 37 degrees C, septic screening, and the presence of an infective focus. Early postoperative pyrexia after arthroplasty is a normal physiological response, and a significant pyrexia can be predicted by a drop in hematocrit and/or after postoperative transfusion. Pyrexia in the early postoperative period following total knee arthroplasty warrants detailed laboratory and radiographic investigation only in the presence of positive physical findings.
Collapse
Affiliation(s)
- J G Kennedy
- Department of Surgery, Mater Misericordiae Hospital, Dublin, Ireland
| | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
Significant spinal deformity is particularly common in nonambulatory patients with myelodysplasia. Progressive deformity may be caused by congenital anomalies, paralytic collapse, hip contractures, or spinal cord tethering. Existing or projected functional impairment should be the principle indication for treatment. Surgical treatment is complicated by poor soft tissue coverage, associated contractures, lack of sensation, weak bone, and absence of posterior elements. Successful fusion can be achieved by circumferential (anterior and posterior) fusion and current rigid segmental instrumentation. The unique deformities and bony anatomy require individualized techniques to achieve fixation.
Collapse
Affiliation(s)
- W B Rodgers
- Department of Orthopaedic Surgery, Children's Hospital, Boston, MA 02115, USA
| | | | | |
Collapse
|
17
|
Abstract
OBJECTIVE To describe our experience with four cases of severe pelvic dislocation associated with difficult parturition. DESIGN Retrospective case series. PATIENTS Four patients, each with rupture of the symphysis pubis and sacroiliac joints during labor. All injuries were associated with significant initial pain and disability. All developed persistent symptoms related to the sacroiliac disruption. INTERVENTIONS The three patients who had presented acutely were freated with closed reduction and application of a pelvic binder. Two underwent closed reduction of their pelvic dislocation while anesthetized with a general anesthetic. One patient (N.A.), who presented late, had not been treated with a binder. RESULTS All four patients had persistent posterior pelvic (sacroiliac) pain. In two patients a postpartum neuropathy persisted. CONCLUSIONS Severe pelvic dislocations are rare during labor, with conservative treatment reported to be successful in most cases. The persistence of symptoms in our patients emphasizes the need for careful examination and follow-up of these rare injuries. Because the outcome in our patients was poor and results in the literature are equivocal, we suggest the consideration of an operative approach to treatment in patients with symphyseal diastasis of > 4.0 cm.
Collapse
Affiliation(s)
- F D Kharrazi
- Orthopaedic Trauma Service, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | | | | | | |
Collapse
|
18
|
Rodgers WB, Mankin HJ. Metastatic malignant chondroblastoma. Am J Orthop (Belle Mead NJ) 1996; 25:846-9. [PMID: 9001683] [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: 02/03/2023]
Abstract
A case of malignant chondroblastoma with metastases is reported. The patient initially presented with a lytic lesion in his left pubic ramus. He was treated with curettage, but the lesion recurred 3 years later. After repeated curettage, radiation therapy, and the late development of multiple bone and soft-tissue metastases, he succumbed to his disease 13 years after diagnosis. The surgical pathology from each of his several procedures was reviewed. Although no definite malignant transformation was apparent, a metastatic deposit curetted 3 months prior to death showed some increase in mitotic activity. Flow cytometry of specimens from the patient's first local recurrence and a late distant metastasis was performed and revealed the interval development of a minor aneuploid peak between the two samples. This fatal chondroblastoma is the only one in our series of 80 patients treated over the past 25 years.
Collapse
Affiliation(s)
- W B Rodgers
- Capital Region Orthopaedics and Sports Medicine, Jefferson City, Missouri, USA
| | | |
Collapse
|
19
|
Rodgers WB, Kharrazi FD, Waters PM, Kennedy JG, McKee MD, Lhowe DW. The use of osseous suture anchors in the treatment of severe, complicated elbow dislocations. Am J Orthop (Belle Mead NJ) 1996; 25:794-8. [PMID: 8959261] [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: 02/03/2023]
Abstract
Seventeen patients who sustained severe trauma resulting in dislocation or fracture-dislocation of the elbow were treated using osseous suture anchors to repair the soft-tissue constraints of the elbow. In 15 of these patients, the medial collateral ligament and flexor-pronator origin were repaired. Ten patients underwent repair of the lateral collateral ligament using anchors. Five patients were also treated with a hinged external fixator. All of the elbows were rendered grossly unstable by the injury; all of the patients had stable elbows at follow-up. Elbow flexion averaged 127 degrees; an average 19 degrees extension loss was noted. The arc of forearm rotation averaged 156 degrees. The aggressive approach detailed in this report is applicable only to severe injuries to the elbow, not routine dislocations. These cases demonstrate the reliability of the osseous suture anchor in the operative treatment of massive trauma to the elbow.
Collapse
Affiliation(s)
- W B Rodgers
- Capital Region Medical Center, Jefferson City, Missouri, USA
| | | | | | | | | | | |
Collapse
|
20
|
Abstract
We retrospectively reviewed the results of operative treatment of chronic Monteggia lesions (Bado type I or the equivalent) with anterior radiocapitellar dislocation in seven patients. The mean age at the time of the reconstruction was six years and nine months (range, eleven months to twelve years), and the mean time from the injury to the operation was twelve months (range, five weeks to thirty-nine months). The mean duration of follow-up was four years and six months (range, two years to eleven years and three months). There were fourteen complications, including malunion of the ulnar shaft in one patient; residual radiocapitellar subluxation in two patients (one anterior and one posterolateral); radiocapitellar dislocation (dynamic anterior subluxation of the radial head in supination) in one patient; transient ulnar-nerve palsy in three patients (with residual weakness in two); partial laceration of the radial nerve in one patient; loss of the fixation in two patients; and non-union of the ulnar osteotomy site, compartment syndrome, conversion reaction, and possible fibrous synostosis of the forearm in one patient each. The patients lost a mean of 36 degrees of pronation and a mean of 27 degrees of supination of the forearm compared with the contralateral, uninjured extremity. Two patients demonstrated a loss of flexion of the elbow of 8 and 13 degrees and three had a loss of extension (mean, 15 degrees) compared with the contralateral side. There were three good, two fair, and two poor results.
Collapse
Affiliation(s)
- W B Rodgers
- Department of Orthopaedic Surgery, Harvard Medical School, Boston Children's Hospital, Massachusetts 02115, USA
| | | | | |
Collapse
|
21
|
Kharrazi FD, Rodgers WB, Waters PM, Koris MJ. Dislocation of the elbow complicated by arterial injury. Reconstructive strategy and functional outcome. Am J Orthop (Belle Mead NJ) 1995; Suppl:11-5. [PMID: 7663955] [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: 01/26/2023]
Abstract
Four cases of arterial injury complicating posterior dislocation of the elbow are described. All of these patients were treated by emergent revascularization; reconstruction of the soft-tissue constraints of the elbow joint was performed by using osseous suture anchors. Despite prompt treatment of the vascular injury and successful restoration of elbow articulation and stability, all of the patients had residual functional disability. The previous literature has not discussed the functional results of these reconstructions. This report underscores the severity of these injuries, details our reconstructive strategy, and analyzes the functional outcome of these badly traumatized extremities.
Collapse
Affiliation(s)
- F D Kharrazi
- Harvard Combined Orthopaedic Surgery Residency Program, Boston, Massachusetts, USA
| | | | | | | |
Collapse
|
22
|
Abstract
A case history of a trauma patient who developed a palsy of the marginal mandibular nerve from compression by a cervical spine hard collar is presented. After clinical and radiographic screening found no evidence of occult cervical spine pathology, the collar was removed; the palsy resolved uneventfully during the next 2 days.
Collapse
Affiliation(s)
- J A Rodgers
- Division of Plastic Surgery, New England Deaconess Hospital, Boston, Massachusetts, USA
| | | |
Collapse
|
23
|
Kramer DL, Rodgers WB, Mansfield FL. Transpedicular instrumentation and short-segment fusion of thoracolumbar fractures: a prospective study using a single instrumentation system. J Orthop Trauma 1995; 9:499-506. [PMID: 8592263 DOI: 10.1097/00005131-199509060-00007] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.7] [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: 02/02/2023]
Abstract
Eleven patients were prospectively treated with bilateral short-segment transpedicular instrumentation using the Posterior Segment Fixator (Ace Medical Co., Los Angeles, CA, U.S.A.) construct combined with posterolateral fusion using autogenous iliac crest bone graft for the treatment of thoracolumbar vertebral fractures. All patients were evaluated clinically, radiographically, and functionally for a minimum of 2 years (mean 33 months). Four of the 11 patients (36.3%) had breakage or disengagement of the caudad screws during this interval. During the follow-up period, the angle of kyphosis increased an average of 12.9 degrees. The loss of correction was greater in those patients in whom the instrumentation failed (22 degrees) than in those patients in whom it did not (7.7 degrees). Five of the patients (45.5%) had a progressive increase in the angle of kyphosis of 10 degrees or more. At follow-up, the average loss of anterior vertebral body height for all 11 patients was 14% when compared with the body height that had been attained at surgery. Six of these patients (54.5%) had 10% or more loss of anterior body height. Despite the high incidence of failure of the instrumentation, progressive increase in the angle of kyphosis, and progressive loss of anterior vertebral body height, there was no worsening in the patients' Frankel grade postoperatively. The high rate of hardware failure and major postoperative loss of fracture reduction associated with this construct suggest that posterior short-segment pedicle-screw instrumentation with the Posterior Segment Fixator was not adequate to ensure stabilization of thoracolumbar fractures in this small group of patients. Maintenance of postoperative fracture reduction was the most consistent predictor of satisfactory functional outcome.
Collapse
Affiliation(s)
- D L Kramer
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
| | | | | |
Collapse
|
24
|
Evans D, Rodgers WB. Long-arm Charnley splint. Contemp Orthop 1994; 28:505-6. [PMID: 10147222] [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: 04/12/2023]
Abstract
Fractures of the distal forearm--the eponymic Colles' or Smith's fractures--are among the most common injuries treated by the orthopaedist. Most of these fractures are amenable to closed reduction and immobilization. A new modification of the Charnley splint is presented for use in the acutely injured patient. The major advantages of this new splint are decreased weight and ease of application.
Collapse
Affiliation(s)
- D Evans
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston
| | | |
Collapse
|
25
|
Abstract
Trigger digits are uncommon in infants. We prospectively examined 1046 newborns to determine the congenital incidence of this condition. No trigger digits were identified among these children. This correlates by power calculation to an incidence of 0-3 trigger digits per 1000 live births. We then retrospectively reviewed the records of all children who had undergone surgical release of trigger digits at our hospital from July 1989 to July 1992. Seventy-three children underwent 89 trigger thumb releases and 5 children had 11 trigger finger releases. Only seven of these children presented at less than 6 months of age and none presented at less than 3 months of age. This study raises the possibility that trigger digits may represent lesions acquired after birth.
Collapse
Affiliation(s)
- W B Rodgers
- Department of Orthopaedic Surgery, Harvard Medical School, Boston Children's Hospital, MA 02115
| | | |
Collapse
|
26
|
Rodgers WB, Hall JE. One-bone forearm as a salvage procedure for recalcitrant forearm deformity in hereditary multiple exostoses. J Pediatr Orthop 1993; 13:587-91. [PMID: 8376557] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Hereditary multiple exostoses commonly affect the forearm and cause significant deformity. The response of this disease to operative intervention is usually gratifying, but in recalcitrant cases salvage procedures may be necessary. We report two patients treated with radial-ulnar fusion, review the technical aspects of the creation of the so-called "one-bone forearm," and discuss the classification and treatment alternatives available to surgeons treating patients with forearm exostoses. Treatment of both forearms resulted in functional, painless extremities at 3- and 14-year follow-up.
Collapse
Affiliation(s)
- W B Rodgers
- Department of Orthopaedic Surgery, Boston Children's Hospital, Massachusetts
| | | |
Collapse
|
27
|
Affiliation(s)
- W B Rodgers
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115
| | | | | |
Collapse
|
28
|
Affiliation(s)
- W B Rodgers
- Department of Orthopaedic Surgery, Children's Hospital, Boston, Massachusetts
| | | |
Collapse
|