Modified Bankart procedure for recurrent anterior dislocation and subluxation of the shoulder in athletes.
Thirty-four athletes (34 shoulders) with recurrent anterior glenohumeral instability were treated with a modified Bankart procedure, using a T-shaped capsular incision in the anterior capsule. The inferior flap was advanced medially and/or superiorly and rigidly fixed at the point of the Bankart lesion by a small cancellous screw and a spike-washer. The superior flap was advanced inferiority and sutured over the inferior flap. Twenty-five athletes (median age: 22) were evaluated over a mean period of follow-up of 65 months. The clinical results were graded, according to Rowe, as 22 (88%) excellent, 3 (12%) good, and none as fair or poor. The mean postoperative range of movement was 92 degrees of external rotation in 90 degrees of abduction. Elevation and internal rotation was symmetrical with the opposite side. Twenty-four patients returned to active sport, 22 at their previous level. This modified Bankart procedure is an effective treatment for athletes with recurrent anterior glenohumeral instability. (+info)
Results of the Bosworth method for unstable fractures of the distal clavicle.
Eleven consecutive Neer's type II unstable fractures of the distal third of the clavicle were treated by open reduction and internal fixation, using a temporary Bosworth-type screw. In all cases, fracture healing occurred within 10 weeks. Shoulder function was restored to the pre-injury level. A Bosworth-type screw fixation is a relatively easy and safe technique of open reduction and internal fixation of type II fractures of the distal third of the clavicle. (+info)
In vivo and in vitro CT analysis of the occiput.
Arguments concerning the best procedure for occipito-cervical fusion have rarely been based upon occipital bone thickness or only based on in vitro studies. To close this gap and to offer an outlook on preoperative evaluation of the patient, 28 patients were analysed in vivo by means of spiral CT. Ten macerated human skulls were measured by means of CT and directly. Measurements were taken according to a matrix of 66 points following a grid with 1 cm spacing based upon McRae's line. Maximum thickness in the patient group was met 4 cm above the reference plane in the median slice (11.87 mm; SD 3.41 mm) and 5 cm above it in the skull group (15.85 mm; SD 1.81 mm). Correlation between CT and direct measurements was good (91.79%). Intra-individual discrepancies from one side to the respective point on the other side are common (difference > 1 mm in 60%). Judging areas suitable for operative fixation using the 10% percentile value (6.68 mm for the maximum value of 11.87 mm) led to the conclusion that screws should only be inserted along the occipital crest in an area extending from 1.5 cm above the posterior margin of the foramen magnum to the external occipital protuberance (EOP). At the level of the EOP screws may also be inserted up to 1 cm lateral of the midline. A reduction of screw length to 7 mm (9 mm for the EOP) is proposed. Preoperative evaluation of the patient should be carried out by spiral CT with 1 mm slicing and sagittal reconstructions. (+info)
Lumbar intradiscal pressure after posterolateral fusion and pedicle screw fixation.
In vitro biomechanical testing was performed in single-functional spinal units of fresh calf lumbar spines, using pressure needle transducers to investigate the effect of posterolateral fusion (PLF) and pedicle screw constructs (PS) on intradiscal pressure (IDP), in order to elucidate the mechanical factors concerned with residual low back pain after PLF. IDP of 6 calf lumbar spines consisting of L4 and L5 vertebrae and an intervening disc was measured under axial compression, flexion-extension and lateral bending in the intact spine, PS, PLF and the destabilized spine. Relative to the intact spines, the destabilized spines showed increased IDP in all of lordings and moments. IDP under PS and PLF were significantly decreased in axial compression, extension and lateral bending loads (p<0.05). In flexion, IDP under PS and PLF increased linearly proportional to the magnitude of flexion moment and reached as high as IDP of the intact spines. These results demonstrated that despite an increase in the stiffness of motion segments after PLF and PS, significant high disc pressure is still generated in flexion. Flexibility of PS and PLF may cause increased axial load sharing of the disc in flexion and increased IDP. This high IDP may explain patients' persisting pain following PS and PLF. (+info)
MR imaging for early complications of transpedicular screw fixation.
This series comprises ten patients treated with transpedicular screw fixation, who suffered early postoperative problems such as radicular pain or motor weakness. Besides plain radiographs, all patients were also evaluated with MR imaging. Three patients were reoperated for either repositioning or removal of the screws. MR images, especially T1-weighted ones, were very helpful for visualizing the problem and verifying the positions of the screws. In cases of wide areas of signal void around the screws, the neighboring axial MR images at either side, which have fewer artifacts, gave more information about the screws and the vertebrae. (+info)
Unusual presentation of spinal cord compression related to misplaced pedicle screws in thoracic scoliosis.
Utilization of thoracic pedicle screws is controversial, especially in the treatment of scoliosis. We present a case of a 15-year-old girl seen 6 months after her initial surgery for scoliosis done elsewhere. She complained of persistent epigastric pain, tremor of the right foot at rest, and abnormal feelings in her legs. Clinical examination revealed mild weakness in the right lower extremity, a loss of thermoalgic discrimination, and a forward imbalance. A CT scan revealed at T8 and T10 that the right pedicle screws were misplaced by 4 mm in the spinal canal. At the time of the revision surgery the somatosensory evoked potentials (SSEP) returned to normal after screw removal. The clinical symptoms resolved 1 month after the revision. The authors conclude that after pedicle instrumentation at the thoracic level a spinal cord compression should be looked for in case of subtle neurologic findings such as persistent abdominal pain, mild lower extremity weakness, tremor at rest, thermoalgic discrimination loss, or unexplained imbalance. (+info)
Spinal instrumentation for unstable C1-2 injury.
Seventeen patients with unstable C1-2 injuries were treated between 1990 and 1997. Various methods of instrumentation surgery were performed in 16 patients, excluding a case of atlantoaxial rotatory fixation. Posterior stabilization was carried out in 14 cases using Halifax interlaminar clamp, Sof'wire or Danek cable, or more recently, transarticular screws. Transodontoid anterior screw fixation was performed in four cases of odontoid process fractures, with posterior instrumentation in two cases because of malunion. Rigid internal fixation by instrumentation surgery for the unstable C1-2 injury avoids long-term application of a Halo brace and facilitates early rehabilitation. However, the procedure is technically demanding with the risk of neural and vascular injuries, particularly with posterior screw fixation. Sagittal reconstruction of thin-sliced computed tomography scans at the C1-2 region, neuronavigator, and intraoperative fluoroscopy are essential to allow preoperative surgical planning and intraoperative guidance. (+info)
The 'MW' sacropelvic construct: an enhanced fixation of the lumbosacral junction in neuromuscular pelvic obliquity.
Fixation to the lumbosacral spine to correct pelvic obliquity in neuromuscular scoliosis has always remained a surgical challenge. The strongest fixation of the lumbosacral junction has been achieved with either a Galveston technique with rods or screws or with iliosacral screws. We have devised a new fixation system, in which iliosacral screws are combined with iliac screws. This is made possible by using the AO Universal Spine System with side opening hooks above and below the iliosacral screws and iliac screws below it. The whole sacropelvis is thus encompassed by a maximum width (MW) fixation, which gives an 'M' appearance on the pelvic radiographs and a 'W' appearance in the axial plane. We report on our surgical technique and the early results where such a technique was used. We feel that this new means of fixation (by combining the strongest fixation systems) is extremely solid and should be included in the wide armamentarium of sacropelvic fixation. (+info)