Ventral cervical fusion at multiple levels using free vascularized double-islanded fibula - a technical report and review of the relevant literature.
(33/716)
Reconstruction of the cervical spine using free vascularized bone flaps has been described in the literature. The reports involve either one level or, when multiple levels, they describe en bloc resection and reconstruction. Stabilization of different levels with a preserved intermediate segment with a single vascularized flap has not been described. We report on the case of a 55-year-old man, who had been operated several times using conventional techniques for cervical myelopathy and instability, who presented to us with severe neck pain. Diagnostic procedures showed pseudarthrosis of C3/4 and stress-overload of the C3/4 and C5/6 segments. The C4/5 fusion was adequately rigid, but avascular. We performed anterior cervical fusion at the C3/4 and C5/6 levels with a vascularized fibula flap modified as a double island. The rigidly fused C4/5 block was preserved and vascularized with the periosteum bridging the two fibular islands. The method and technique are described in detail. Fusion was adequate. Donor site morbidity was minimal and temporary. The patient is symptom free to date (25 months). The suggested method provides the possibility of vertebral fusion at different levels using a single vascularized flap. The indications for this procedure are (1) repeated failure of conventional methods, (2) established poor bone healing and bone non-union with avascular grafts and (3) a well-fused or preserved intermediate segment. The relevant literature is reviewed. (+info)
Complication rate and factors affecting outcome of olecranon osteotomies repaired with pin and tension-band fixation in dogs.
(34/716)
The objective of this study was to determine the complication rate and evaluate factors affecting the outcome of olecranon osteotomy in dogs. Medical records were searched to identify dogs that had undergone olecranon osteotomy (stabilized with 2 Kirschner wires and a figure-of-8 wire) during internal fixation of a supracondylar or condylar humeral fracture. Signalment, description of the fracture, parameters regarding the osteotomy and its repair, and radiographic outcome were recorded. A logistic regression model compared patient and technical parameters with the osteotomy outcome. Of the 19 dogs, 7 (37%) had complications of the osteotomy, including osteomyelitis, loss of reduction, and improper placement and migration of the Kirschner wires. Olecranon osteotomy is associated with a high complication rate in dogs; however, there was no correlation between patient-related or technical parameters and the development of complications. Further clinical and biomechanical investigations are warranted to improve the results of olecranon osteotomy and its repair. (+info)
Non-union of the humeral shaft treated by internal fixation.
(35/716)
We reviewed 40 cases with non-union of the humeral shaft. There were 31 men and nine women patients with an average age of 38.5 (35-65) years. Thirty-four non-unions were of the atrophic type. Non-union was most often found at the transition of the middle third to the lower third of the humeral shaft. Six fractures were classified as open at the time of the initial injury. All patients were treated by open reduction and internal fixation with a dynamic compression plate (DCP). Cancellous bone graft was used in all atrophic non-unions. In one patient an additional fibular graft was used. The average follow-up was 13 (6-18) months. Final results were available for 34 patients. Thirty-one fractures (91%) healed in an average of 4.5 (3-9) months. Main complications were temporary radial nerve palsy in two patients and deep infection in one. (+info)
Spinal reconstruction for symptomatic thoracic haemangioma using a titanium cage.
(36/716)
Most vertebral haemangiomas are asymptomatic. A case of spinal reconstruction for symptomatic extraosseous thoracic haemangioma using a titanium cage is reported. Radiographs of the T11 vertebra demonstrated characteristic vertical striations. Magnetic resonance imaging and computed tomography showed spinal cord compression by extraosseous tumour extension. Several tumour feeding vessels were shown by angiography. Through a transpedicular biopsy, a histological diagnosis of cavernous haemangioma was made. Embolisation of feeding vessels was performed using coils before surgery. Laminectomy and subtotal vertebrectomy were performed by a single posterior approach. Rigid stabilisation of the spine was achieved with pedicle screw systems and a cage filled with an autogenous bone graft. Five months postoperatively, stabilisation of the spine was established without loosening of the cage or pedicle screws. Clinical symptoms were improved. (+info)
Treatment of old dislocations of the lower cervical spine.
(37/716)
We treated surgically 12 patients with an old dislocation of the lower cervical spine. The time from injury to presentation averaged 3.5 (range 1.5-12) months, and the majority of the dislocations were between C4-5. Treatment started with 1 week of skull traction. If this resulted in reduction the area was stabilised by anterior fusion with plate fixation. If reduction by traction did not succeed a posterior partial facetectomy was performed. If this allowed reduction it was followed by a posterior fusion with plate fixation. If reduction was not achieved the traction was continued for a further week and then followed by anterior discectomy and fusion with plate fixation. The average follow-up was 34 (range 12-54) months, and all patients developed bone fusion and showed neurological improvement. (+info)
Thoracoplasty with acrylic plate-marlex mesh combination following near total resection of sternum: a case of chondrosarcoma of sternum.
(38/716)
Removal of the whole sternum for malignant tumours results in a large defect, causing severe deformity and possible paradoxical movements of the chest wall. The reconstruction of the resultant large defect of the chest wall is often complex and difficult. Commonly used materials include rib autograft, steel strus acrylic plate and various synthetic meshes such as Goretex or Marlex mesh, with a myocutaneous flap for coverage. A case of a 48-year-old man with sternal chondrosarcoma successfully treated with thoracoplasty using acrylic plate-marlex mesh combination following near total resection of sternum is reported. (+info)
Lateral and anterior plating of intra-articular distal femoral fractures treated via an anterior approach.
(39/716)
Thirty-five patients with 36 displaced distal femoral fractures (16 AO-type C2 and 19 AO-type C3) were treated with an anterior approach and double plating and followed for an average of 7 (3-44) months. Bone grafting with allograft and demineralized bone matrix was used. Postoperative therapy included immediate ROM and non-weight bearing for 12 weeks. Two patients died during hospitalization and one was lost to follow-up. Reductions were near anatomic in all but three patients. Uneventful healing by 16 weeks occurred in 24/36 fractures. Double plating via the anterolateral approach minimized stripping of the medial side and improved controlled access to the distal femur. (+info)
Osteosynthesis of distal radial fractures with a volar locking screw plate system.
(40/716)
We developed a locking screw plate system for the stabilisation of distal radial fractures, which can be inserted through a standard volar approach and in which the locking mechanism allows early post-operative mobilisation. Forty-nine patients with 50 fractures underwent surgical treatment; 66% were type C fractures. The mean follow-up was 26 months. According to the scores of Gartland and Werley and Green and O'Brien, 92% and 68% respectively had an excellent or good outcome; 46% were radiologically identical to the uninjured side and in 42% the reduction remained unchanged after 2 years. The most frequent complication was rupture of the flexor pollicis longus tendon, which occurred in six cases (12%) at a mean of 10 months after operation. (+info)