INTRODUCTION: Intervertebral degeneration is characterised by instability due to permanent decrease in the stiffness of the intervertebral segment and concentration of stress upon the posterior portion of the disc, and by morphologic changes in the posterior elements due to posterior displacement of loading, notably enlargement of the lamina and zygapophyseal joints. These changes lead to reduction in the cross-sectional area of the vertebral canal. In order to counterbalance these changes, an implant has been developed with an interspinous blocker and an artificial ligament made of Dacron. This obviates the need for a permanent fixation in the vertebral bone, avoiding the risk of loosening. Inhibition of hyperextension limits narrowing of the posterior canal, resulting in an increase in its cross-sectional area of up to 40%. A first-generation implant for nonrigid stabilisation of lumbar segments was developed in 1986 with a titanium interspinous blocker. Following an initial observational study in 1988 and a prospective controlled study from 1988 to 1993, more than 300 patients have been treated for degenerative lesions with significant resolution of residual low back pain with no serious adverse effects. After careful analysis of the points that could be improved,a second-generation,improved implant called the ‘Wallis implant’ was developed with a redesigned blocker made of PEEK (polyetheretherketone), a more resilient material. METHODS: Biomechanical studies were used to verify the effectiveness of this implant in increasing intervertebral stiffness, reducing mobility, and unloading the facet joints and the posterior portion of the disc. A prospective multicenter international observational study was begun a year ago. RESULTS: Preliminary results confirm the clinical efficacy of this treatment on low back pain and nerve root symptoms, especially in recurrent disc herniation and canal stenosis. DISCUSSION: Nonrigid intervertebral fixation with the Wallis implant clearly appears to be a useful technique in the management of initial forms of degenerative intervertebral lumbar disc disease. The method should rapidly assume a specific role along with total disc prostheses in the new step-wise surgical strategy to obviate definitive fusion of degenerative intervertebral segments. Moreover, dynamic stabilisation with the Wallis system is totally reversible and leaves all other options open. Wallis is recommended for patients with lumbar disc disease who have: (i) discectomy for massive herniated disc leading to substantial loss of disc material, (ii) a second discectomy for recurrence of herniated disc, (iii) discectomy for herniation of a transitional disc with sacralization of L5, (iv) degenerative disc disease at a level adjacent to a previous fusion or prosthesis, (v) isolated disc resorption, notably with concomitant type-1 Modic changes, associated with low back pain, or (vi) symptomatic narrow canal treated by resection of the superior aspect of the laminae.
Plating displaced proximal humeral fractures is associated with a high rate of screw perforation. Dynamization of the proximal screws might prevent these complications. The aim of this study was to develop and evaluate a new gliding screw concept for plating proximal humeral fractures biomechanically. Eight pairs of three-part humeral fractures were randomly assigned for pairwise instrumentation using either a prototype gliding plate or a standard PHILOS plate, and four pairs were fixed using the gliding plate with bone cement augmentation of its proximal screws. The specimens were cyclically tested under progressively increasing loading until perforation of a screw. Telescoping of a screw, varus tilting and screw migration were recorded using optical motion tracking.Aims
Methods
Purpose: Instability of the injured elbow early after repair can lead to recurrent dislocation or failed fixation. Complementary immobilisation increases the risk of stiffness. The purpose of this study was to assess the contribution of
Femoral neck fractures account for half of all hip fractures and are recognized as a major public health problem associated with a high socioeconomic burden. Whilst internal fixation is preferred over arthroplasty for physiologically younger patients, no consensus exists about the optimal fixation device yet. The recently introduced implant Femoral Neck System (FNS) (DePuy Synthes, Zuchwil, Switzerland) was developed for
Nearly one quarter of ankle fractures have a recognized syndesmosis injury. An intact syndesmosis ligament complex stabilizes the distal tibio-fibular joint while allowing small, physiologic amounts of relative motion. When injured, malreduction of the syndesmosis has been found to be the most important independent factor that contributes to inferior functional outcomes. Despite this, significant variability in surgical treatment remains. This may be due to a poor understanding of normal dynamic syndesmosis motion and the resultant impact of static and
Three Cannulated Screws (3CS), Dynamic Hip Screw (DHS) with antirotation screw (DHS–Screw) or with a Blade (DHS–Blade) are the gold standards for fixation of unstable femoral neck fractures. Compared to 3CS, both DHS systems require larger skin incision with more extensive soft tissue dissection while providing the benefit of superior stability. The newly designed Femoral Neck System (FNS) for
INTRODUCTION. The elimination of motion and disc stress produced by spinal fusion may have potential consequences beyond the index level overloading the spinal motion segments and leading to the appearance of degenerative changes. So the “topping-off” technique is a new concept instructing
Introduction. Ankle fusion presents a difficult problem in the presence of infection, inadequate soft tissue, poor bone stock and deformity. Nonunion and infection remains a problem even with internal fixation. Ilizarov frame provides an elegant solution to the problem with stable remote fixation while allowing lengthening, deformity correction and weight bearing. Patients and methods. Twenty-one consecutive patients were studied. The mean age at onset of disease was 52 years (range 4-70). Mean duration of the problem was 59.9 months (6-372). Aetiology included traumatic arthritis in 5, traumatic arthritis with osteomyelitis in 1, failed ankle fusion in 8, septic arthritis in 1, infected ankle fracture nonunion in 1, avascular necrosis of talus in 1, congenital deformity in 3 and failed ankle arthroplasty in 1. 15 patients had deformity of the ankle at the time of presentation. 15 of the 21 patients had either clinical or radiological evidence of infection. Treatment principles involved local excision, deformity correction with good alignment and soft tissue management. Static Compression was achieved with an Ilizarov frame while
Introduction and Aims: Eight thousand Duraloc 300 cups were implanted worldwide in 2002. To our knowledge, no 10-year results have been published to date. We undertook this study to ascertain whether this optimism was justified. Method: One hundred consecutive total hip replacements using a Duraloc 300 cup were reviewed at a minimum of 10 years. Post-operative x-rays were analysed for cup placement and interface gaps. Follow-up films were analysed for lucent lines, osteolysis, wear and migration. Kaplan-Meier survivorship analysis was performed. Results: All components were found to be stable with no evidence of loosening or migration. The mean rate of wear was 0.12mm per year. Three hips developed pelvic osteolysis in zone 2 at the level of the apex hole, of which two have successfully undergone a bone grafting procedure and one patient is awaiting surgery. Conclusion: The Duraloc 300 cup has excellent 10-year results with no cases of loosening. There was a low incidence of pelvic osteolysis. Cementless
Introduction: We prospectively followed all hip fracture patients admitted between 2004–2006, identified cases where the intention was to treat conservatively and compared their functional outcome and mortality with a similar cohort treated surgically over the same period. Methods: We recorded length of hospital stay, place of discharge, pre and post-fracture mobility and residence, 30 day and 1 yr mortality, re-admission and delayed surgery. The group treated surgically was recruited and matched for age, gender, pre and post fracture mobility, mental confusion and independence with the conservatively treated group. Results: 25 patients were treated conservatively. 22 patients treated surgically over the same period were recruited. The mean hospital stay was 13 days in both groups. There were 4 extracapsular (3 displaced) and 21 intracapsular fractures (5 displaced) in the conservative arm and 11 extracapsular and 9 intracapsular fractures in the surgically treated arm. 4 patients from the conservative treatment group underwent late surgery 20 days – 2 months after the index event. Surgically treated group had 11
A particular pattern of complex instability of the elbow is “the terrible triad”, in which elbow dislocation is associated with fractures of the coronoid and radial head. Other frequent patterns are the variant of Monteggia lesions (Bado II) described by Jupiter which is characterized by ulnar fracture associated with fracture-dislocation of proximal radius, and the articular fracture of the distal humerus associated with elbow dislocation. The goal of treatment is to restore the primary stabilizers of the elbow such as the coronoid process, olecranon and both collateral ligaments by internal fixation and reconstruction of the ligaments. If elbow stability obtained at operation is unsatisfactory or internal fixation not enough stable, there an indication for applying a dynamic external fixator (DEF). The latter allows:. the articular congruence to be maintained and the ligaments to heal in adequate tension and position,. internal fixation and ligaments reconstruction to be protected, and. immediate joint motion to be carried out. From 2005 to 2008, we treated surgically 31 patients with complex instability of the elbow. DEF was applied in 38% of cases, namely 3 terrible triads, 5 fracture-dislocations of Monteggia and 4 articular fractures of the humerus associated with elbow dislocation. The mean age of patients was 44 years (range 30–74). All patients underwent ORIF, reconstruction of ligaments and
Aims: The aim of this prospective study is to compare the results regarding non-union and AVN of two different methods of treatment after displaced femoral neck fractures in young and middle age population. Methods: Between 1980–1998 we treated 91 patients with displaced femoral neck fractures. In 56 patients (Group A) we performed open reduction,
Fractures of the proximal femur are one of the
greatest challenges facing the medical community, constituting a
heavy socioeconomic burden worldwide. Controversy exists regarding
the optimal treatment for patients with unstable trochanteric proximal
femoral fractures. The recognised treatment alternatives are extramedullary
fixation usually with a sliding hip screw and intramedullary fixation
with a cephalomedullary nail. Current evidence suggests that best
results and lowest complication rates occur using a sliding hip screw.
Complications in these difficult fractures are relatively common
regardless of type of treatment. We believe that a novel device,
the X-Bolt dynamic plating system, may offer superior fixation over
a sliding hip screw with lower reoperation risk and better function.
We therefore propose to investigate the clinical effectiveness of
the X-bolt dynamic plating system compared with standard sliding
hip screw fixation within the framework of a the larger WHiTE (Warwick
Hip Trauma Evaluation) Comprehensive Cohort Study. Cite this article: