Open reduction and internal fixation of comminuted fractures of the radial head using low-profile mini-plates.
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Between 1996 and 2000, we treated ten patients with severely comminuted fractures of the radial head using low-profile mini-plates. Their mean age was 42 years (24 to 71). Three fractures were Mason type III and seven were Mason-Johnston type IV. At a mean follow-up of 28.5 months (15 to 44), all fractures had united. The plates were removed in nine patients. No patient had difficulty with daily activities or symptoms of instability of the elbow. The mean range of flexion of the elbow was from 7 degrees to 135 degrees, with 74 degrees of supination and 85 degrees of pronation. According to the Broberg and Morrey functional elbow index, the mean score was 90.7 points (73 to 100), and the outcome was excellent in three patients, good in six and fair in one. These results compare favourably with those reported previously. The technique is applicable to severely comminuted fractures of the radial head which otherwise would require excision. (+info)
Combined laminoplasty with posterior lateral mass plate for unstable spondylotic cervical canal stenosis--technical note.
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A technique of combined expanding laminoplasty using longitudinal interspinous iliac bone graft with posterior lateral mass plate is described for the treatment of cervical canal stenosis associated with spinal instability. A 52-year-old male and a 76-year-old female presented with cervical myelopathy. Imaging studies demonstrated spondylotic cervical canal stenosis associated with spinal instability. Posterior stabilization with lateral mass plate by the Axis Fixation System was performed after expanding laminoplasty using interspinous iliac bone graft. The symptoms improved and instability and malalignment (in the female patient) also improved after surgery. This combined surgical technique allows decompression of the spinal cord, immediate internal fixation by plate fixation, and subsequent long-term stabilization by interspinous bony fusion. This technique is indicated in selected patients with multiple segment spondylotic cervical canal stenosis associated with instability and/or malalignment of the spinal column for which simultaneous decompression and stabilization are required. (+info)
Thoracolumbar fracture stabilization: comparative biomechanical evaluation of a new video-assisted implantable system.
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Minimally invasive techniques for spinal surgery are becoming more widespread as improved technologies are developed. Stabilization plays an important role in fracture treatment, but appropriate instrumentation systems for endoscopic circumstances are lacking. Therefore a new thoracoscopically implantable stabilization system for thoracolumbar fracture treatment was developed and its biomechanical in vitro properties were compared. In a biomechanical in vitro study, burst fracture stabilization was simulated and anterior short fixation devices were tested under load with pure moments to evaluate the biomechanical stabilizing characteristics of the new system in comparison with a currently available system. With interbody graft and fixation the new system demonstrated higher stabilizing effects in flexion/extension and lateral bending and restored axial stability beyond the intact spine, as well as having comparable or improved effects compared with the current system. Because of this biomechanical characterization a clinical trial is warranted; the usefulness of the new system has already been demonstrated in 45 patients in our department and more than 300 cases in a multicenter study which is currently under way. (+info)
Biomechanical analysis of anterior cervical spine plate fixation systems with unicortical and bicortical screw purchase.
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Anterior plate fixation with unicortical screw purchase does not involve the risk of posterior cortex penetration and possible injuries of the spinal cord. However, there are very few biomechanical data about the immediate stability of non-locking plate fixation with unicortical or bicortical screw placement. The aim of the present study was to evaluate the immediate biomechanical properties in terms of flexibility of a non-locking anterior plate system with 4.5-mm screw fixation and unicortical or bicortical screw purchase applied to a single destabilized cervical spine motion segment. Using fresh cadaveric cervical spine specimens C3-C7, multidirectional flexibility was measured at the level C4-C5 before and after destabilization and fixation with an anterior plate with either unicortical or bicortical screw purchase. The results showed that fixed cervical spine segments with anterior plate and bicortical screw purchase were more rigid than intact specimens in all modes of testing. The difference was statistically significant for flexion and extension ( P<0.001). Plate fixation with unicortical screw purchase had statistically significant decreased ranges of motion compared to the intact specimen only in extension. Neither unicortical nor bicortical screw purchase decreased the range of motion significantly in axial rotation compared to the intact specimens. This in vitro study documented that neither unicortical nor bicortical screw purchase with non-locking plate fixation can increase stability in all modes of testing, in axial rotation in particular. Direct comparison between the group with uni- and that with bicortical screw fixation did not reveal significant differences, and therefore no advantage was shown for either type of screw fixation. Therefore, we demonstrated that both uni- and bicortical screw purchase with non-locking plate fixation can decrease immediate flexibility of the tested motion segment, with better results for bicortical purchase. No significant differences were found comparing the two groups of screw fixation. These data suggest that unicortical screw fixation can be used for anterior plate fixation with a comparable immediate stability to bicortical screw fixation. (+info)
Two asymmetric contoured plate-rods for occipito-cervical fusion.
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The author presents a retrospective clinical study addressing the outcome after posterior stabilisation of the occipital-cervical spine using a new cranio-spinal implant. The range of surgical methods for operative treatment of occipito-cervical instability remains wide, and it is still a demanding technique that frequently requires improvisation by the surgeon. No previous studies have been published of occipito-cervical reconstructions using two contoured asymmetrical occipital plates interdigitating in the midline at the occiput and allowing various methods of cervical fixation, by means of different hooks, a claw device or screws. Nine patients with severe occipito-cervical instability and/or subaxial malalignment underwent reconstructive surgery with the new implants between 1998 and 2001. Seven patients suffered from rheumatoid arthritis (RA) including cranial settling. Two patients had widespread cervical metastases. All patients suffering RA were treated by preoperative cervical traction for up to 28 days, and intraoperative traction, to try to restore the malalignment. Traction was also used, to diminish pain and to improve neurological symptoms. The lowest vertebra fused was T3. All patients were immobilised with an external orthosis or brace for 6 weeks or 3 months. A solid fusion was achieved in all patients. None of the patients deteriorated postoperatively. No serious complications occurred. One occipital screw broke and one hook loosened, needing a re-fixation. The simplicity of applying these cranio-cervical implants makes them practical for every orthopaedic or neurosurgeon with a special interest in cervical spine surgery. (+info)
Osteosynthesis-associated bone infection caused by a nonproteolytic, nontoxigenic Clostridium botulinum-like strain.
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A nonproteolytic, nontoxigenic Clostridium botulinum strain identified by conventional and molecular techniques as type B-, E-, or F-like (BEF-like) was isolated from a human postsurgical wound. All previous reports of such strains have been from environmental sources. Since toxin production is the main taxonomic denominator for C. botulinum, a new name is needed for nonproteolytic, nontoxigenic BEF-like clinical isolates. (+info)
Percutaneous plating of distal tibial fractures.
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We studied 20 patients (mean age 47.9+/-3.9, range 25-85 years) undergoing percutaneous plating of the distal tibia for 43A or 43C fractures in the period 1999-2002. Bony and functional results were classified into four categories ranging from excellent to poor. Union was achieved in all but one patient. Seven patients had angular deformities between 7 and 10 degrees, but none of these patients required further operations. No patient had a leg-length discrepancy greater than 1 cm. Thirteen patients had excellent and good bone results, and none used walking aids. Seven patients reported stiffness of the operated ankle. This reported use of percutaneous techniques in the management of fractures of the distal tibial metaphysis is preliminary. However, the functional results and the lack of soft tissue complications are encouraging. (+info)
Surgical management of high cervical disc prolapse associated with basilar invagination--two case reports.
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C3-4 cervical disc prolapse was associated with basilar invagination and short neck in a 21-year-old man and additionally with an extensive Klippel-Feil abnormality and fusion of multiple cervical vertebrae in a 32-year-old man. The transoral surgical route was adopted for cervical discectomy in the latter case and an additional odontoidectomy in the former case. Interbody plate and screw fixation was carried out in the patient with Klippel-Feil abnormality. Both the patients were relieved of symptoms and remained asymptomatic at follow up. Simultaneous fixation procedure is not mandatory after transoral surgery in patients with basilar invagination. (+info)