Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails. (73/716)

Between January 1991 and December 2002, we treated 92 acute, displaced, closed humeral shaft fractures (AO classification type A). We used three fixation methods: dynamic compression plates (DCP) in 36 patients, Ender nails (EN) in 32 patients and interlocking nails (ILN) in 24 patients. The patients were followed for a minimum of 24 months. At one year, all fractures except two (one DCP/one ILN) had united. Patients treated with EN had shorter mean operation time, 51 (35-110) min; less mean blood loss, 70 (30-170) ml and shorter mean hospital stay, 5.8 (3-12) days. There were three iatrogenic radial nerve palsies: two in the DCP group and one in the ILN group. There was one wound infection. There were three cases with impingement of the shoulder but range of motion was restored after nail removal. For patients with multiple trauma or high operative risk, EN fixation served as a safer and faster procedure. ILN fixation offered a stable fixation via a smaller incision but more fracture comminution might happen.  (+info)

Methyl methacrylate cranioplasty. (74/716)

We conducted a prospective study in order to audit our experience of repairing cranial defects using Methyl methacrylate. This included a total of 49 patients undergoing cranioplasty using methyl methacrylate, of which 45 were males and 4 females. The age of patients at the time of surgery ranged from 16 to 40 years old, with an average of 24 years. Malays were the majority (67%), followed by Chinese (23%) and Indian (10%). Cranial defects were mainly caused by motor vehicle accident (94%), while gunshot wounds, industrial accidents and tumours, each contribute 2%. Bone flaps were commonly removed during previous surgery related to traumatic subdural haemorrhage (33%), contusion (21%) and intracerebral haemorrhage (14%). The size of cranial defects ranged from 28 cm2 to 440 cm2, with an average of 201 cm2. Most had right sided (55%) and lateral defects [temporoparietal (52%) followed by temporal (16%), frontal (16%), frontotemporal (14%) and occipital (2%)]. Duration of surgery ranged from 70 to 275 minutes, with an average of 135 minutes. Nine of 12 patients (75%) with neurological disability had some improvement while 85% of symptomatic patients had symptoms improvement after cranioplasty. The infection rate in this series was 4%.  (+info)

Intraoperative evaluation of bone decompression in anterior cervical spine surgery by three-dimensional fluoroscopy. (75/716)

Sufficient bone decompression of osteophytes is essential for functional long-term outcome in surgery for spondylotic cervical myelopathy. Postoperative CT scans clearly show that decompression is sometimes insufficient. Intraoperative CT scanning has been used to monitor sufficient decompression. Instead of standard intraoperative fluoroscopy, we used an isocentered three-dimensional (3D) fluoroscopy with 3D image reconstruction to evaluate the extent of bone decompression. From October 2003 to April 2004, we have used intraoperative 3D fluoroscopy on seven patients with anterior cervical spine surgery due to cervical spondylotic myelopathy. Five patients were operated on in one level, two patients had surgery in two segments. If surgery was performed in two levels or preoperative cinetic MRT showed cervical instability, internal plate fixation was done additionally. All patients were positioned on a radiolucent operating table, made of carbon fibers. Three-dimensional fluoroscopy was always performed before wound closure to evaluate sufficient bone removal. The scanning time was 120 s and the whole procedure from scanning to evaluation is approximately 5 min. In all patients we were able to evaluate the extent of bone decompression. Additionally, placement of cage, plates and screws can be evaluated intraoperatively. In one patient, 3D fluoroscopy showed insufficient decompression, especially on the right side. Further bone removal was performed before the end of the procedure. Intraoperative 3D fluoroscopy is a valuable tool for imaging bone decompression and implant location in anterior cervical spine surgery. The technique is safe, reliable and should help us to avoid incomplete decompression or misplacement of implants and therefore improve long-term functional outcome in cervical spine surgery in the future.  (+info)

A comparison of plate versus staple-and-cast fixation in maintaining femoral tibial alignment after valgus tibial osteotomy. (76/716)

PURPOSE: To compare 2 methods of fixation for maintenance of alignment during healing of valgus tibial osteotomies. METHODS: We performed a retrospective chart and radiographic review of valgus tibial osteotomy cases of staple fixation supplemented by a postoperative cast and of blade plate fixation for maintenance of femoral-tibial alignment during healing of the osteotomy. RESULTS: Both groups (staple-and-cast, n = 16; plate, n = 28) were similar in terms of age, preoperative alignment, extent of osteoarthritis and degree of intra-operative correction. Between-group differences in the maintenance of femoral-tibial alignment during healing were not significant. In both groups there was a strong correlation between degree of bone contact at the osteotomy site and maintenance of alignment (p < 0.005). In cases done with the plate, 90% of osteotomies with good or excellent bone contact maintained alignment during healing; with poor or fair bone contact, 75% had loss of alignment > 5 degrees during healing. There was a trend toward a greater incidence of delayed or non-union with plate fixation compared with staple fixation that did not reach statistical significance. All of these cases of delayed/non-union had loss of femoral-tibial alignment > 5 degrees during healing. CONCLUSION: As a result of this study, we have modified our surgical technique. We now use intra-operative fluoroscopy for optimization of bone contact, and we have reverted to the less invasive staple method for fixation of tibial osteotomies.  (+info)

Frey's syndrome after condylar fracture: case report. (77/716)

Frey's syndrome is the occurrence of hyperesthesia, flushing and warmth or sweating over the distribution of the auriculotemporal nerve and/or greater auricular nerve while eating foods that produce a strong salivary stimulus. Frey's syndrome is also known as auriculotemporal syndrome and gustatory sweating. We present a case of Frey's syndrome after a condylar fracture and its treatment by internal rigid fixation. A review of the literature is provided along with mention of a simple test (Minor's test) that can help in the diagnosis of this syndrome.  (+info)

Triplate fixation: a new technique in limb-salvage surgery. (78/716)

Massive endoprostheses using a cemented intramedullary stem are widely used to allow early resumption of activity after surgery for tumours. The survival of the prosthesis varies with the anatomical site, the type of prosthesis and the mode of fixation. Revision surgery is required in many cases because of aseptic loosening. Insertion of a second cemented endoprosthesis may be difficult because of the poor quality of the remaining bone, and loosening recurs quickly. We describe a series of 14 patients with triplate fixation in difficult revision or joint-sparing tumour surgery with a minimum follow-up of four years. The triplate design incorporated well within a remodelled cortex to achieve osseomechanical integration with all patients regaining their original level of function within five months. Our preliminary results suggest that this technique may provide an easy, biomechanically friendly alternative to insertion of a further device with an intramedullary stem, which has a shorter lifespan in revision or joint-sparing tumour surgery. A short segment of bone remaining after resection of a tumour will not accept an intramedullary stem, but may be soundly fixed using this method.  (+info)

Functional recovery following pertrochanteric hip fractures fixated with the Dynamic Hip Screw vs. the percutaneous compression plate. (79/716)

The Dynamic Hip Screw (DHS) is currently the most frequently used implant for the treatment of pertrochanteric hip fractures. The Percutaneous Compression Plate (PCCP) is a recently developed, alternative device that involves minimal invasive surgery. The objective of the present study was to compare functional recovery following these two surgical procedures. A total of 76 consecutive elderly subjects (mean age and standard deviation, 80.6 +/- 5.5) following pertrochanteric hip fracture fixation were evaluated prospectively. Functional recovery was assessed 3 and 12 weeks and 2 years following surgery. Differences between groups 3 weeks postsurgery were found only in pain level during ambulation and in the weight-bearing capability of the operated extremity, which were both in favor of the PCCP. By 3 months, both groups had improved in all measures, but did not reach their preinjury level of independence. However, the PCCP group ambulated with fewer assistive devices and demonstrated better recovery of basic activities of daily living (BADL). While the majority of the subjects from both groups ambulated independently 2 years postsurgery, the PCCP group exhibited less pain during ambulation, was more independent in ADL, and required fewer assistive devices for ambulation. To summarize, the PCCP presents enhanced short- and long-term recovery of functional abilities in comparison to DHS. However, given the limited number of patients, further studies are necessary to substantiate these results.  (+info)

Anterior instrumentation for cervical spine tuberculosis: an analysis of surgical experience with 61 cases. (80/716)

OBJECTIVE: To evaluate the efficacy of anterior instrumentation in patients with subaxial and cervicodorsal spinal tuberculosis in reconstruction of the spine, providing pain relief, neurological recovery and prevention of deformity. MATERIALS AND METHODS: The records of 61 consecutive patients, of surgically treated spinal tuberculosis affecting C3 to D2 region, in our neuro and spinal surgery unit over a five-year period were retrospectively reviewed. Patients with involvement of the C3-C6 vertebrae underwent excision of the involved vertebrae and intervertebral discs followed by reconstruction with titanium implants by anterior approach. A transclavicular approach was used for patients with involvement of the C7-D2 vertebrae. A five-drug antituberculous regimen was administered for a period of one year. The follow-up ranged from 24 to 84 months (mean 38 months). Clinical and radiological assessment using flexion and extension radiographs was performed at 24 months for all cases. RESULTS: The neck pain score based on a visual analog scale (1-10) changed from a pre-operative average of 7 to 2 at follow-up after 4 months. Fifty-two patients (85%) had complete relief of pain while 16 patients who had Grade III to IV muscle strength regained complete power. The asymmetric wasting in patients with involvement of the cervicodorsal region did not recover completely. Flexion-extension radiographs at 24 months did not show any evidence of instability or nonunion. CONCLUSIONS: Anterior reconstruction using titanium plates and locking screws for stabilization of the subaxial and cervicodorsal region tuberculosis is a useful adjunct in preventing kyphotic deformity. A satisfactory segmental stability and fusion is achieved by this technique.  (+info)