Aims. COVID-19-related patient care delays have resulted in an unprecedented patient care backlog in the field of orthopaedics. The objective of this study is to examine orthopaedic provider preferences regarding the patient care backlog and financial recovery initiatives in response to the COVID-19 pandemic. Methods. An orthopaedic research consortium at a multi-hospital tertiary care academic medical system developed a three-part survey examining provider perspectives on strategies to expand orthopaedic patient care and financial recovery. Section 1 asked for preferences regarding extending clinic hours, section 2 assessed surgeon opinions on expanding surgical opportunities, and section 3 questioned preferred strategies for departmental financial recovery. The survey was sent to the institution’s surgical and nonoperative orthopaedic providers. Results. In all, 73 of 75 operative (n = 55) and nonoperative (n = 18) providers responded to the survey. A total of 92% of orthopaedic providers (n = 67) were willing to extend clinic hours. Most providers preferred extending clinic schedule until 6pm on weekdays. When asked about extending surgical block hours, 96% of the surgeons (n = 53) were willing to extend operating room (OR) block times. Most surgeons preferred block times to be extended until 7pm (63.6%, n = 35). A majority of surgeons (53%, n = 29) believe that over 50% of their surgical cases could be performed at an ambulatory surgery centre (ASC). Of the strategies to address departmental financial deficits, 85% of providers (n = 72) were willing to work extra hours without a pay cut. Conclusion. Most orthopaedic providers are willing to help with patient care backlogs and revenue recovery by working extended hours instead of having their pay reduced. These findings provide insights that can be incorporated into COVID-19 recovery strategies. Level of Evidence: III. Cite this article: Bone Jt Open 2021;2(7):562–568

Nerve damage is a complication of THA and TKA procedures. The incidence of subclinical nerve injury following arthroplasty is unknown. The aim was to determine the prevalence of asymptomatic nerve deficits in an arthroplasty population group, and the incidence of post-operative changes in nerve function. A Secondary aim was to identify the nature of any deficits. And the association between nerve deficits and history of backache. A non-randomised prospective series of patients undergoing lower limb arthroplasty for osteoarthritis were studied at a single hospital. The peroneal nerve was investigated using nerve conduction in forty patients. Twenty patients had upper limb testing to differentiate between a polyneuropathy or isolated lower limb neuropathy. Nerve function deficits were detected in the peroneal nerve in fifteen patients pre-operatively and fifteen post-operatively, of those twelve had A waves detected suggestive of a generalised neuropathy. Ten patients who had upper limb testing had a conduction defect (five had asymptomatic Carpal tunnel). There was a positive correlation between presence of post-operative deficit and age(r=0.389, p=0.013). A negative correlation was found for presence of post-operative A waves and BMI(r=−0.370, p=0.019). The prevalence of pre-operative subclinical peroneal neuropathy is much higher than expected in this group (37.5%) of arthroplasty patients. There is a strong correlation between presence of post-operative conduction abnormalities and age. There is no relationship between peripheral neuropathy and history of backache or residual post-operative deficit

Objectives. To employ a simple and fast method to evaluate those patients with neurological deficits and misplaced screws in relatively safe lumbosacral spine, and to determine if it is necessary to undertake revision surgery. Methods. A total of 316 patients were treated by fixation of lumbar and lumbosacral transpedicle screws at our institution from January 2011 to December 2012. We designed the criteria for post-operative revision scores of pedicle screw malpositioning (PRSPSM) in the lumbosacral canal. We recommend the revision of the misplaced pedicle screw in patients with PRSPSM = 5′ as early as possible. However, patients with PRSPSM < 5′ need to follow the next consecutive assessment procedures. A total of 15 patients were included according to at least three-stage follow-up. Results. Five patients with neurological complications (PRSPSM = 5′) underwent revision surgery at an early stage. The other ten patients with PRSPSM < 5′ were treated by conservative methods for seven days. At three-month follow-up, only one patient showed delayed onset of neurological complications (PRSPSM 7′) while refusing revision. Seven months later, PRSPSM decreased to 3′ with complete rehabilitation. Conclusions. This study highlights the significance of consecutively dynamic assessments of PRSPSMs, which are unlike previous implementations based on purely anatomical assessment or early onset of neurological deficits.and also confirms our hypothesis that patients with early neurological complications may not need revision procedures in the relatively broad margin of the lumbosacral canal. Cite this article: X-J. Lin. Treatment strategies for early neurological deficits related to malpositioned pedicle screws in the lumbosacral canal: A pilot study. Bone Joint Res 2016;5:46–51

Aim: The purpose of this study was to evaluate the extent of neurological deficit following excision of spinal neurofibromas. Methods: Retrospective case series, combined with contemporary neurological examination and outcome questionnaires. Results: 46 patients (26 males, 20 females) with a mean age of 46 between the years of 1985 – 2005. The incidence of neurological deficit subsequent to nerve sectioning to remove the tumour was 28/46 (60.9%) in the acute period. In the long term this reduced to 28%. Conclusions: Despite the sectioning of nerves during surgery motor or sensory deficit was surprisingly rare. It was mainly sensory and recovered with time. This is presumably due to neural plasticity and dermatomal overlap. These results provide useful information for surgeons to counsel their patients preoperatively

Recurrent anterior shoulder instability (RASI) is related to progressive bone loss on the glenoid and on the humeral head. Bone deficit magnitude is a well-recognized predictor of recurrence of instability after an arthroscopic Bankart surgery, but the best way to measure it is unknown. In this study, we want to determine which measurement method is the best predictor of recurrence of instability and function. For 10 years now, all patients undergoing surgery for RASI in 4 centers are included in a prospective study: the LUXE cohort. Patients with a pre-operative CT-scan and a minimum of 1-year follow-up were included. ISIS score was used to stratify patients. WOSI and Quick-Dash questionnaires were used to characterise function. Bone defects were assessed using the Clock method, the Glenoid Ratio, the Humeral Ratio, the Glenoid Track method and the angle of engagement in the axial plane. A total of 262 patients are now included in the LUXE study. One hundred and three patients met the inclusion criteria for analysis with a majority of male (79%) and a mean age is 28 years old. The median number of dislocations prior to surgery was 6. Seventy patients had an arthroscopic Bankart repair and 33 patients underwent an open Latarjet procedure. The ISIS score for these groups were of 2.7 and 4.8 respectively (p<0.001). The mean bone defect on the glenoid was of 1h51 with the Clock method (range: 0h-4h48; SD=1h46) and of 9% for the glenoid ratio (0–37%, 10%). On the humeral side, the bone defect was of 1h59 (0h-4h08; 0h49) for the Humeral clock method, 15% (0–36%; 6%) with the ratio method and 71 degrees of external rotation (SD=30 degrees) with the angle of engagement measurement. On the combined evaluations, 53 patients presented an off-track lesion, with mean combined hours of 3h53 (SD= 2h13). The greatest correlation obtained was between the glenoid ratio and the glenoid clock method (r=0.919, p<0.001). Eighteen patients had a recurrence of shoulder dislocation after the initial surgery, leading to a recurrence rate of 23% in arthroscopic surgery versus six percent after a Latarjet (OR= 4.6, p=0.034). No bone defect was correlated to Latarjet failure. For the arthroscopic group, the risk of recurrence was related to a smaller angle of engagement of the Hill-Sachs (p=0.05), a smaller Humeral clock measurement (p=0.034) and a longer follow-up (p=0.006). No glenoid or combined measurements were correlated with arthroscopic procedure failure. Recurrence of dislocation was associated to worst function according to the WOSI (1036 vs 573, p=0.002) and DASH (32 vs 15, p=0.03). Even with lower ISIS score, arthroscopic procedures are still leading to high risk of recurrence in this “all comer” consecutive cohort study AND it is related to humeral side parameters. Recurrence is also affecting daily function and creating higher anxiety related to the shoulder

Introduction. Cauda Equina is a condition requiring urgent operative intervention to avoid debilitating long term neurological compromise. The recommended maximium time delay before lack of surgical decompression results in persisting neurological deficit has been suggested to be 24 hrs and more recent studies have even indicated 48 hours as acceptable. We wanted to assess if any persisting neurological deficit occurred in our practice when treated at 12 hours or less. Aim. To assess if patients treated within half of the maximum recommended time for surgical decompression following cauda equina i.e 12 hours, are still pre-disposed to persisting neurological compromise. Methods. We reviewed all patients who underwent a spinal decompression for cauda equina, based on clinical presentation, examination and magnetic resonance imaging at our institution. Over a seven year period, seven patients were found to have operative findings consistent with cauda equina syndrome. The clinical presentation, time from presentation to operative decompression and type of procedure done, as well as the clinical review at follow up, were noted. Results. The time from presentation to operation was 8 hours 30 mins to 11 hours 48 in 6 patients and 25 hrs in one patient. All seven patients had resolution of symptoms except for dermatomal sensory deficit. Two patients had some recurrence of sciatica, two of these patients having similar operations done at the same level within 18 months. Discussion. Our study shows that urinary compromise resolves with early decompression but that persisting neurological symptoms in the form of sensory deficit can persist even when decompression is performed within 12 hours. We conclude that early decompression is necessary but it does not alleviate all neurological symptoms

Aim: To evaluate the outcome of late anterior decompression in patients with dorsal and lumbar spinal injuries with neurological deficit. Background: Anterior decompression and bone graft stabilisation of the spinal injuries allows direct decompression of the spinal canal and provides favourable environment for neurological and functional recovery. Proponents of both early and delayed decompression have shown favourable results. However, what is unclear is the timing of the surgery. Methods: A prospective study of 12 patients with spinal injuries, who had anterior decompression a minimum of 4 weeks after the injury (mean 7.5 weeks). 5 had incomplete and 7 had complete neurological deficit at presentation. The indication for the operation was persistent neurological deficit with retropulsed fragment of bone causing canal compromise. Anterior stablisation after decompression was by means of a tri-cortical iliac crest graft or a rib graft. Results: 8 males, 4 females with average age 26.8 years. 7 lumbar and 5 dorsal spine injuries. Average follow-up of 5.5 years with minimum of 5 years. Post-operative improvement was seen only in patients who sustained injury at the lumbar level, with 6 of the 7 patients regaining normal bladder and bowel function after decompression. Immediate post-operative improvements obtained in the Kyphotic angle were not maintained probably due to the settling of the graft, so posterior or anterior stabilisation may be needed in addition to anterior bone grafting to prevent worsening of the kyphotic angle. Conclusion: Delayed anterior decompression of the lumbar spine in patients who had spinal fractures, is an effective procedure, which may help neurological recovery, especially of the bowel and bladder function

Introduction: Spontaneous spinal epidural haematoma is an uncommon clinical problem which may lead to severe and permanent neurological deficit. The treatment options for spinal cord compression by extradural haematoma in the anticoagulated patient are limited. The majority of cases reported have been treated surgically. 1. Operative intervention carries a potential risk of extending the haematoma with further deterioration of the neurological deficit. Methods: A case of paraplegia following spontaneous epidural haemorrhage is reported with a review of the prognostic factors that determine likely improvement in neurological function post-surgery. Case report: A 59-year old man was referred to the regional Spinal Trauma Centre with a 34-hour history of severe lower back pain of sudden onset and 14 hour history of neurological deficit in both legs and urinary overflow incontinence. He had undergone aortic valve replacement two years previously, with subsequent anticoagulation with Warfarin. Examination showed complete paraplegia below L3 with grade 1 power on hip flexion only. On catheterisation, the residual volume of urine was 1200mls. The INR was 3.5. An MRI of the spine showed epidural haematoma that extended from the level of T11 to L5. The patient was treated non-operatively. On discharge at 10 weeks he had normal sensation to L3 and grade 5-power on left knee extension and grade 4-power on the right. There was no motor recovery distal to this. He had a hypotonic neurological bladder with sufficient resting tone in the sphincter to prevent incontinence. Discussion: Although associated with a definite mortality, surgical decompression of the spinal cord and evacuation of the haematoma improves neurological outcome and is the treatment of choice. 1. The decision to treat non-operatively should be based on the duration and severity of the neurological deficit. A literature review identifies neurological deficit greater than 12 hours and severe neurological deficit on presentation are poor prognostic indicators. 2. The prognosis for neurological recovery in this case was poor. In a patient with severe coexisting medical problems these factors can assist when making the decision to operate on an individual patient with spinal epidural haematoma

Introduction: The optimal treatment for acute thoracolumbar burst fractures remains controversial, particularly in the patient with minimal or no neurologic deficit. While this group could be treated conservatively, at Burwood we prefer to utilise short segment instrumented stabilisation. We wished to review the indications for surgical intervention and the outcomes in this group with emphasis on safety, rate of rehabilitation, function, and pain levels. Methods: The clinical notes and X-rays were reviewed for 34 consecutive patients with thoracolumbar burst fractures with minimal or no neurologic deficit, and treated by Dick fixator between August 1995 and September 2001. A questionnaire was mailed to all patients. Results: At presentation this group had a mean age of 30.7 yrs (range 16–59), mean kyphotic deformity (Cobb method) of 16.1°, decrease in vertebral body anterior height of 40.9%, and decrease in canal area of 41.2%. Operative fixation was successful in greatly improving both height and kyphosis. No major complication such as metal-ware breakage, thromboembolism, deep infection, or neurologic deterioration was encountered. Average operating time was 71 min, time to discharge was 8.4 days, except where an associated injury limited mobility (17.1 days). Questionnaires were returned by 29 of 34 patients at a mean of 3 years post-injury. All of these had returned to work or usual level of activity at 14.3 weeks (4–36 wks). Pain was experienced never or occasionally by 18 (62%), in relation to activity by 9 (31%), and on most days by 2 (7%). The average visual analog pain score was 2.1/10. No patient required regular or opioid analgesia. Discussion: This form of operative fixation appeared to benefit this group of patients by allowing rapid rehabilitation with early mobilisation, discharge, and return to work. Pain frequency and severity were both low at medium term follow up and no major complication was encountered

INTRODUCTION: The optimal treatment for acute thoracolumbar burst fractures remains controversial, particularly in the patient with minimal or no neurologic deficit. While this group could be treated conservatively, at Burwood we prefer to utilise short segment instrumented stabilisation. We wished to review the indications for surgical intervention and the outcomes in this group with emphasis on safety, rate of rehabilitation, function, and pain levels. METHODS: The clinical notes and X-rays were reviewed for 34 consecutive patients with thoracolumbar burst fractures with minimal or no neurologic deficit, and treated by Dick fixator between August 1995 and September 2001. A questionnaire was mailed to all patients. RESULTS: At presentation this group had a mean age of 30.7 years (range 16–59), mean kyphotic deformity (Cobb method) of 16.1°, decrease in vertebral body anterior height of 40.9%, and decrease in canal area of 41.2%. Operative fixation was successful in greatly improving both height and kyphosis. No major complication such as metalware breakage, thromboembolism, deep infection, or neurologic deterioration was encountered. Average operating time was 71 minutes, time to discharge was 8.4 days, except where an associated injury limited mobility (17.1 days). Questionnaires were returned by 29 of 34 patients at a mean of three years post-injury. All of these had returned to work or usual level of activity at 14.3 weeks (4–36 weeks). Pain was experienced never or occasionally by 18 (62%), in relation to activity by 9 (31%), and on most days by 2 (7%). The average visual analog pain score was 2.1/10. No patient required regular or opioid analgesia. DISCUSSION: This form of operative fixation appeared to benefit this group of patients by allowing rapid rehabilitation with early mobilisation, discharge, and return to work. Pain frequency and severity were both low at medium term follow-up and no major complication was encountered

Introduction: Pseudoarthrosis in Ankylosing spondylitis is often misdiagnosed as infection. It is a slow progressing lesion resulting in a kyphosis and slow onset weakness of the lower limbs. We are presenting our strategy and experience in treating 9 patients with such a lesion. Method: 9 patients age range from 40–55 years who presented with pseudoarthrosis of the ankylosed spine underwent back-front surgery during 2001–204. 6 patients had dorsal spine lesion, 2 had dorso-lumbar junctional lesion and 1 had cervico-dorsal junctional lesion. 8/9 patients had insidious onset with progressive weakness of both lower limb. 1 patient had an acute onset with deformity. 7/9 patients had neurodeficit (Frankel C) 1/9 had complete paraplegia. All patients underwent posterior kyphosis correction and decompression of the spinal cord. During posterior decompression 8/9 patients had an incidental dural tear due to adherence fractured lamina. The dura was repaired primarily or patch graft. 5/9 patients had single stage back and front surgery. The rest of the patients had staged surgery. The front surgery was excision of the tough fibrotic psuedoarthosis and reconstruction using strut graft/cage. Results: Average duration of surgery was 4 ½ hours (3 ½ to 6 hours). Blood loss was 800 ml (600–1300 ml). All patients required blood transfusion. Primary dural repair was done in 7/8 cases, patch graft in 3/8 cases, ceiling with fusion glue and fat graft in 1 patient. 5 patients who had less that 1000 ml blood loss during posterior surgery had same stage anterior reconstruction. Rest of the patient had 2 staged surgery. 4/9 patients had previous THR B/L. All patients showed rapid improvement in the neurological status and at 3 months follow up all were Frankel E. Conclusion: The surgical outcome of the ankylosing spondylitis patients with Andersson lesion with neurological deficit is encouraging. Excision of the pseudoarthroses anteriorly and posterior spinal stabilization resulted in full recovery of the deficit. However there were difficulties encountered during the posterior decompression due to adhesions of the posterior elements to the dura

Midline skin incision and medial arthrotomy for knee arthroplasty may be preformed in flexion or extension. Anatomical studies have revealed a risk to the infra patellar branch of the saphenous nerve. This study addresses. whether sensory loss is greater following skin incision in flexion or extension. The area of sensory loss six months following knee arthroplasty. Null hypothesis- there is no detectable difference in sensation before and after knee arthroplasty. Pilot study- light touch, sharp touch and two point discrimination were evaluated pre-operatively, at one week, six weeks and six months postoperatively in twelve patients recruited prospectively. Randomization was achieved using an envelope system. Six patients underwent approach and closure in flexion and six in extension. Prospective cohort study – 50 patients underwent sensory mapping for light touch and sharp touch pre-operatively. These control results were compared with the post-operative findings at six months. All measurements were standardised to anatomical landmarks with the knee in 90 degrees flexion. There is a constant area of sensory loss lateral to the midline scar, which shows some recovery with time. The sensory loss affects both light and sharp touch. Initially, this is in a similar distribution anteriorly and laterally extending from the superior pole of the patella to the tibial tubercle, approximately 2cm lateral to the midline. The loss is most marked immediately after surgery. There is a noticeable recovery in sharp touch by six weeks. The recovery in light touch is slower and less complete at the six month review. There is no demonstratable difference in sensory loss regardless of whether the incision is made in flexion or extension, (p=0.1). Lateral sensory loss is a constant feature in this series six months following knee arthroplasty. Patients may benefit from pre-operative counselling regarding the likelihood of lateral cutaneous sensory deficit following knee arthroplasty

A 14 year-old-female, underwent a T3-L3 instrumented posterior spinal fusion for a double major curve. Surgery under controlled hypotensive anesthesia was uneventful, with normal somatosensory and motor potentials. After instrumentation, patient underwent a normal wake-up test. The preoperative haemoglobin and haematocrit was 15.1g/dl with 41%, respectively. Estimated blood loss was 400cc and postoperative haemoglobin and haematocrit were 9.7g/dl and 31% respectively. Clinical examination was normal immediately postoperatively, on the first postoperative day and the beginning of the second postoperative day. At the end of POD 2, the patient started to feel both lower extremities “heavy” and sensitive to touch. She developed generalized proximal lower extremity weakness and was unable to stand. She was also unable to void after catheter removal. At this stage, her hemoglobin had dropped from 10 g/dl on POD 1 to 7.3 g/dl. Her haemoglobin fell to 6.2 g/dl the next day with a haematocrit of 18%. No significant bleeding was noticed, and other than lightheadedness, no haemodynamic changes were noted. Transfusion was performed correcting the haemoglobin to 9.3 g/dl and haematocrit to 27%. Compressive etiology was ruled out by post-operative myelogram-CT. Patient was discharged on POD 13 and was neurologically intact at three month follow-up. Discussion: Delayed neurological deficits have been reported, and are associated most frequently with epidural haematomas. Postoperative hypotension as the etiological factor has been reported only in an adult patient. As cord compression was ruled-out the only event we can correlate with the beginning of the neurological deficit is the unexplained acute drop in haemoglobin levels on the second day, possibly impairing normal cord oxygenation. If this is not the case, we would have to accept false negative results for the three standard methods currently available for spinal cord monitoring during surgery. In this case, the normal postoperative neurological exams, performed during the first 48 hours after surgery, and the subjective symptoms the patient experienced associated with the beginning of motor deficit, leads us to conclude that the injury happened on the second day in relation to the postoperative anaemia. Although we believe children tolerate low levels of haemoglobin, transfusion policies might have to be reconsidered as the cord may be transiently at risk for ischemic events after deformity correction

Decision-making regarding operative versus non-operative treatment of patients with thoracolumbar burst fractures in the absence of neurological deficits is controversial, and evidence from trials is sparse. We present a systematic review and meta-analysis of randomised trials comparing operative treatment to non-operative treatment in the management of thoracolumbar burst fractures. With the assistance of a medical librarian, an electronic search of Medline Embase and Cochrane Central Register of Controlled trials was performed. Trials were included if they: were randomided, had radiologically confirmed thoracolumbar (T10-L3) burst fractures, had no neurological deficit, compared operative and non-operative management (regardless of modality used), and had participants aged 18 and over. We examined the following outcomes: pain, using a visual analogue scale (VAS), where 0=no pain and 100=worst pain; function, using the validated Roland Morris Disability Questionnaire (RMDQ); and Kyphosis (measured in degrees). Two randomised trials including 79 patients (41 operative vs. 38 non-operative) were identified. Both trials had similar quality, patient characteristics, outcome measures, rates of follow up, and times of follow up (mean=47 months). Individual patient data meta-analysis (a powerful method of meta-analysis) was performed, since data was made available by the authors. There were no between-group differences in sex, level of fracture, mechanism of injury, follow up rates or baseline pain, kyphosis and RMDQ scores, but there was a borderline difference in age (mean 44 years in operative group vs. 39 in non-operative group, p=0.046). At final follow up, there were no between group differences in VAS pain (25 in operative group vs. 22 non-operative, p=0.63), RMDQ scores (6.1 in operative group vs. 5.8 non-operative, p=0.85), or change in RMDQ scores from baseline (4.8 in operative group vs. 5.3 non-operative, p=0.70). But both kyphosis at final follow up (11 degrees vs. 16 degrees, p=0.009) and reduction in kyphosis from baseline (1.8 degrees vs. -3.3 degrees, p=0.003) were better in the operative group. Operative management of thoracolumbar burst fractures appears to improve kyphosis, but does not improve pain or function

Purpose. Compartment syndrome is a limb threatening condition. Prior research has been limited by an inability to assess functional and histologic changes in muscle over time. This study was designed to assess and quantify functional deficits and histologic changes following acute compartment syndrome of the lower limb in a novel rat model. Method. Twenty-three male Wistar rats were trained to perform an incentive-based standard task on an optical gait tracking system. Animals were then randomized to three groups: Control (n=4), Sham (n=4) and Compartment Syndrome (CS, n=15). Control and sham animals had no elevation of intracompartmental pressure, while CS animals had elevated intracompartmental pressure to 30mmHg for 180 minutes in the anterior compartment of the left hind limb using a saline infusion technique. Following intervention, gait analysis was performed at 2hrs, 24hrs, 48hrs, 72hrs and 7days following injury. Several parameters for the injured hind limb were analyzed including: print area, print intensity, maximum contact timing, duty cycle and stance phase time. A 2-way ANOVA with Bonferroni post-hoc analysis was performed. The EDL muscle was harvested (n=17), fixed in formalin and prepared with an H&E stain. Mid-muscle sections were analyzed by a blinded senior pathologist for cell infiltration, necrosis and regeneration. Results. Function Changes: Mean print intensity was 96.5518.7 at 48hrs for CS animals, compared to 145.538.2 in control animals and 144.9612.71 in sham animals (p<0.001). At the 2hrs, 24hrs, and 48hrs time intervals post injury the CS animals showed significant decreases in print width (p<0.001), maximum contact (p<0.001), mean print intensity (p<0.001) and stance phase (p<0.01). There were no significant differences between baseline and 72hr results for any gait parameter (p>0.05). Histologic Changes: Cellular infiltration was noted at 24hrs, peaked at 48hrs and was still present at 7 days to a lesser degree. Necrosis began as early as 24hrs post injury and also peaked by 48hrs and returned to baseline levels by 7days. Minor regenerative changes were identified as early as 24hrs however the majority of changes were identified at 7 days post-injury. Conclusion. Developing and evaluating animal models for the study of compartment syndrome is essential for better understanding the condition and testing new treatment modalities. Gait analysis was a reproducible means of assessing function after compartment syndrome. Animals demonstrated an antalgic gait pattern demonstrated by decreased stance phase, decreased print intensity, and increased print width, with recovery demonstrated by 72hrs post-injury. Defining the histologic changes such as necrosis, cellular infiltration and regeneration associated with compartment syndrome has allowed us to further understand the evolving pathology of compartment syndrome over time. This study facilitates the evaluation of functional and histologic testing for the evaluation of new therapeutic interventions

Summary Statement. The mechanism of spinal cord injury varies across the human population and this may be important for the development of effective therapies. Therefore, detailed understanding of how variables such as impact velocity and depth affect cord tissue damage is important. Introduction. Studies have shown an independent effect of impact velocity and depth on injury severity, thereby suggesting importance of the interaction between the two for spinal cord injury. This work examines both the individual and interactive effects of impact velocity and impact depth on demyelination, tissue sparing, and behavioural outcomes in the rat cervical spinal cord. It also aims to understand the contribution of the energy applied during impact, not only the impact factors. Decoupling the effects of these two impact parameters will help to describe the injury mechanism. Maximum principal strain has also been shown to be useful as a predictor for neural tissue damage in vivo and in finite element (FE) models. A better understanding of this relationship with experimental results may help to elucidate the mechanics of spinal cord injury. Methods. In this study, 54 male Sprague-Dawley rats were given a contusion spinal cord injury at impact speeds of 8 mm/s, 80 mm/s, or 800 mm/s with depths of 0.9 mm or 1.5 mm. Animals recovered for 7 days followed by behavioural assessment and examination of the spinal cord tissue for demyelination and tissue sparing at 1 mm intervals, ±3 mm rostrocaudally to the epicentre. In parallel, a previously developed finite element model of the rat spinal cord was used to examine the resulting maximum principal strains in the spinal cord for correlations with histological and mechanical impact data. Results and discussion. Impact depth was a consistent factor in predicting axonal damage, tissue sparing, and the resulting behavioural deficit. Increased impact velocity resulted in significantly higher impact energies and measureable tissue damage at the 1.5 mm impact depth, but not at the 0.9 mm impact depth and is best displayed by the percentage of axon damage at the injury epicentre. Linear correlation analysis with FEA strain showed significant (p≪0.001) correlations with axonal damage in the ventral (R2=0.86) and lateral (R2=0.74) regions of the spinal cord and with white matter (R2=0.90) and grey matter (R2=0.76) sparing. Discussion and Conclusion. The difference in injury severity to velocity at different impact depths identifies the existence of threshold interactions between the two impact factors. Beyond this point incremental increases in either velocity or depth are more likely to result in significantly increased impact energy and thus tissue damage and functional impairment. The relationship between the impact depth and velocity of injury demonstrated a more rate sensitive response to spinal cord tissue damage at the deep (1.5 mm) impact depth than at the shallow (0.9 mm) impact depth. Impact velocity also became quickly less significant than impact depth in determining tissue damage further from the epicentre. Furthermore, the results shown by this work extend the research identifying significant correlations between maximum principal strain and neurological tissue damage

Aim of study: To establish whether there was a correlation between the degree of bony spinal canal encroachment and initial neurological deficit and subsequent neurological recovery. Methodology and Results: Twenty-six Patients with Thoraco-lumbar Burst fractures presenting with Frankel Grades C, D and E were studied retrospectively. All the Patients were admitted to the spinal injury centre within seven days of injury and were managed conservatively with bed rest for six weeks (mean) followed by brace or a POP jacket for a further period of approximately six weeks. Neurological progress was assessed by Frankel Grade and American Spinal Injury Association (ASIA) motor score. The degree of spinal canal encroachment was determined from coronal sections of the CT scan by measuring the antero- posterior diameter (APD) and the surface area (Area). (APD 18.84% – 80.62%, Area 9.5% – 81.29%). Average period of follow up was 24.8 months. All Frankel Group C improved to Frankel D and six out of the 13 Frankel D patients improved to Frankel E. The other seven Frankel D patients out of the 13 patients also had improvement in motor scores but did not change Frankel grade. Conclusion: There appeared to be no statistically significant correlation between the degree of canal encroachment, the degree of initialneurological impairment or the degree of neurological recovery in patients who had motor sparing within one week of injury

Abstract

Aims: Aim of the work is evaluation of outcome after reconstruction of acetabular bone stock deþcit in revision hip alloplastics. Methods: Material consists 113 patients with septic and aseptic acetabulum loosening after THA, 31 (27,4%) with cementless and 82 (72,6%) with cemented THA. For evaluation of the functional outcome has been used AAOS scale. Loosening was evaluated on X-rays on behalf of symptoms described by De Lee and Charnley. Surgical tactic was based on Paprosky anatomical bone stock deþcit evaluation Results: Functional Harris hip scores after realloplastic showed improving in passive motion and lowering of pain complaints. There has been concluded full graft in osteointegration in cases with stabile placement of thick cancellous bone graft, with good contact between graft-bone interface and cup. Conclusions: Solid liophylized and milled cancellous bone grafts, used in reconstruction of acetabulum, can remodel and osteointegrate even in cemented technique if there is a sufþcient contact between acetabulum wall and graft. It is possible to obtain good long-term functional and radiological results with usage of operative technique based on remodeling of bone grafts.

Purpose: To document the incidence of neurological lesions and functional outcome following displaced acetabular fractures.

Patients and Methods: Prospective review of patients who underwent stabilisation of acetabular fractures in a University Hospital trauma centre. From December 1994 to November 2000 136 patients were identified with acetabular fractures. The open reduction and internal fixation of the acetabular fixation was performed by standard operative techniques. The time from the initial injury to the operation ranged from 24 hours to I4days. Patients with sciatic nerve injuries were prospectively followed up and long-term outcome recorded. Weakness or absence of dorsiflexion or plantar flexion was graded according to the standard Medical Research Council. Abnormalities of sensation, including absent or diminished sensation to light touch and pinprick as well as dysesthesia or hyperesthesia of the dorsal and plantar aspects of the foot were recorded. None of the patients had an injury of the spinal cord. Intra-operative monitoring was performed in most cases, and routine electromyography and nerve -conduction studies were done post-operatively and at least on one more occasion to record the level and severity of the lesion and to monitor progress of recovery. All the patients were followed up clinically in the trauma clinics and functional improvement was routinely assessed. The mean follow up of the patients was 3.4 years (range 1.5–6 years).

Results: Out of 136 patients who underwent stabilisation of acetabular fractures there were 27 (19.8 %) cases of neurological lesions. In 12 cases the femoral head was dislocated posteriorly. Twenty were men and eight were woman. The mean age was 33.8 (range 16–66). 15 patients had associated injuries. The mean ISS was 12.6 (range 9–34). At initial presentation there were 13 patients with a complete dropped foot lesion, 10 patients with foot weakness and 4 patients with burning pain and altered sensation over the dorsum of the foot. Intra-operative monitoring was performed in 16 cases. All the patients had EMG studies for neurophysiological assessment of the lesion. EMG studies revealed sciatic nerve lesions in all the cases but in nine patients with a dropped foot there was evidence of a proximal (sciatic) and distal (neck of fibula) lesion, “double crush syndrome”. Only in 3 of these cases there was documentation of an ipsilateral knee injury. In two patients there was deterioration of foot function after surgery due to iatrogenic damage. At final follow-up, clinical examination and associated EMG studies revealed full recovery in 5 cases with initial muscle weakness (mean time 4.2 years (2–5)) and complete resolution of sensory symptoms (burning pain and hyposthesia) in 4 cases (mean time 3 years (2–4)). There was improvement of functional capacity (motor and sensory) in two cases with initially complete drop foot and in 4 cases with muscle foot weakness (mean time 3.6 years (range 2–6). In 11 of the cases with dropped foot (all nine with “double crush”) at presentation, there was no improvement in function, (mean time 3.9 years (range 2–6).

Conclusion: Acetabulum fractures associated with sciatic nerve injuries continue to be a significant cause of long-term morbidity in trauma patients. In cases where there is evidence of “double crush lesions” the prospect of functional recovery is low as seen in this group of patients. Single lesions appear to be associated with a more favourable prognosis.