Introduction: The efficacy and complications of the
Over 2 years, 14 patients with C1/2 instability underwent posterior
To assess the outcome and safety of
To assess the outcome and safety of
Objective: To review the clinical outcome of 37 consecutive patients undergoing C1– C2 transarticular fixation for patients with Rheumatoid Arthritis. Design: Prospective Observational Study. Methods: There were 37 patients at 2 centres. Age range was 37– 82 years. The time since diagnosis to treatment was 2– 23 years. Clinical presentation included suboccipital pain in 26/ 37 patients and neck pain in 29/37 patients. 22 patients had presented with myelopathy ( Ranawat grade II or III A). The preoperative imaging included Plain X Rays, CT scans and MRI scans. All patients underwent C1/ C2
Purpose: The current gold-standard for atlanto-axial fixation is C1-C2
The aim of this retrospective study was to compare the functional
and radiological outcomes of bridge plating, screw fixation, and
a combination of both methods for the treatment of Lisfranc fracture
dislocations. A total of 108 patients were treated for a Lisfranc fracture
dislocation over a period of nine years. Of these, 38 underwent
transarticular screw fixation, 45 dorsal bridge plating, and 25
a combination technique. Injuries were assessed preoperatively according
to the Myerson classification system. The outcome measures included
the American Orthopaedic Foot and Ankle Society (AOFAS) score, the
validated Manchester Oxford Foot Questionnaire (MOXFQ) functional
tool, and the radiological Wilppula classification of anatomical
reduction.Aims
Patients and Methods
The Lisfranc fracture dislocation of the tarsometatarsal joint (TMTJ) is a complex injury with a reported incidence of 9.2 to 14/100,000 person-years. Lisfranc fixation involves dorsal bridge plating,
Purpose of study.
Introduction: Occipito-cervical fusion has evolved from the used of simple onlay bone grafts to the use of sophisticated modular implants. Initial stiffness prevents micromotion and allows a higher fusion rate. Methods: A composite occipito-cervical model (OCM) was developed and validated using data obtained from cadaveric specimens. A jig was designed to pot the OCM, which allowed the application of independent moment forces to simulate flexion, extension, lateral flexion and rotation. The following implants were used 1 ) Grob plate with C1/C2
The purpose of this study is the biomechanical comparison of five C1 – C2 posterior arthrodesis techniques. Ten adult human cadaveric upper cervical spine specimens were sectioned at the C3 level. The occiput and C3 vertebra were potted in PMMA. The specimens were tested intact; after destabilizing with odontoid transection and sectioning of the transverse and capsular ligaments; and after stabilization with Brooks-Jenkins cable fixation, Brooks-Jenkins with unilateral
To define how pre-operative evaluation guides surgical planning in patients with atlanto-axial subluxation secondary to rheumatoid arthritis and to measure clinical outcome for the same group. Prospective evaluation of a consecutive cohort of 26 patients undergoing C1/2 fusion over 5 years (2004-2009). Pre-operative evaluation of posterior atlanto-dens interval (PADI), C1 lateral mass and C2 pedicle dimensions. Pre- and post-op Ranawat scores and visual analogue scores for neck and C2 pain. C1/2 instability resulted from rheumatoid arthritis (21), trauma (4) and infection (1). C1 lateral mass mean height 4.4mm, C2 pedicle mean height 5.1mm and mean width 3.4mm (30% width <3mm). Ranawat scale improved Grade II to Grade I (p=0.07). Neck pain (pre-op mean 5.5, s.d. 2.8; post-op mean 1.6, s.d. 2.1, t<0.05) and C2 pain (pre-op mean 2.1, s.d. 3.3; post-op mean 0.5, s.d. 1.2, t<0.05) improved. No instrumentation failure. In the rheumatoid group, 17/21 patients had C1 lateral mass and C1/2
Goals: Advantage of the dorsal fixation of C1/2. Materials and Methods: From 01/2006 to 12/2006 22 patients with a traumatic fracture of C1/2 were operativly stabilized. The avarage age was 79 year (66–92). No neurological deficit. Diagnostic was always a CT-scan for classification of fracture typ. 7 patients were temporarily immobilized with HALO fixateur. Within th next 8 days final operation hab been carried out. 7 patients with Anderson fractures typ II were stabilized with open fixation from ventral (group 1). 4 Jefferson fractures and 2 combined C1/2 fractures were were stabilized with open fixation from dorsal (Magerl) (group 2). Percutanous fixation from dorsal was done in 5 patients with fractures of the atlas, 4 with Anderson fractures typ II (group3). Clinical and radiological follow up was done in 18 patients. Results: Duration for operation was in 64min in group1, 134min in group 2 and in 42min in group3. No neurological deficit or damage of A.vertebralis occurred. Blood loss was in group 1 and 3 under 50ml in group 2 750ml. In group3 one slightly dislocation of screw happened without need of revision. Movement of cervical spine was reduced in group 2 and 3. During follow up 3 of seven ventral stabilized Anderson fractures typ II (group1) were dislocated. Dorsal percutanous fixation for operatively revision was done. Discussion: Percutanous dorsal
Introduction: The management atlanto-axial fractures, particularly those of the odontoid peg, remains controversial. We managed patients with C1/C2 fractures non-operatively in rigid immobilization until CT-scanning confirmed bony union, rather than for the standard 3-month period. We examined whether this improved outcomes and reduced the need for surgery. Method: All patients admitted to our unit with atlanto-axial fractures between 2001–2007 were retrospectively analyzed. All fractures had the ‘intention-to-treat’ conservatively in either halothoracic vest (85%) or Aspen collar (15%). Rigid immobilization was maintained until CT-scanning demonstrated bony fusion. Functional stability was subsequently assessed with flexion-extension radiographs after removal of rigid immobilization. Results: Twenty-seven patients were studied. Nineteen had odontoid peg fractures (10 type II; 9 type III). The remainder consisted of 3 Hangman’s, 3 lateral mass and 2 atlas ring fractures. 83% of patients progressed to union at an average of 13.2 weeks (range 5–22). Six complications related to halo immobilization were observed (three skull perforations/pin-site infections). All of these patients progressed to union non-operatively. Failure of non-operative management was deemed as non-union or poor patient tolerance of halo, and occurred in 4 patients (17%). All four had type II odontoid peg fractures, and had
Introduction: TMTJ fusion is performed for arthritis or painful deformity. First TMTJ fusion may be performed for Hallux valgus deformity. K-wire and trans-articular screws are usually used to stabilize the joints. We present our audit of experience with LP for TMTJ fusion. Patients and Methods: 33 TMTJ in 19 patients were fused and stabilised using LP between January and September 2008. The procedure was performed for Lisfranc arthritis in 13 and Lapidus procedure in 6. Two out of 6 were revisions after failed fusion using
Introduction: Tarsometatarsal joint (TMTJ) fusion is performed for arthritis or painful deformity. First TMTJ fusion may be performed as a part of corrective surgery for hallux valgus deformity. K-wires and trans-articular screws are often used to stabilize the joints. We present our experience with the use of locking plates (LP) for TMTJ fusion. Patients and Methods: Thirty-three TMTJ’s in 19 patients were fused and stabilised with LP’s between January and September 2008. The procedure was performed for Lisfranc arthritis in 13 patients and Lapidus procedures in six. Two out of 6 were revisions after failed fusion using
Pedicle screws give the best bone purchase of all posterior fixation techniques of the cervical spine, which would suggest a frequent utilisation. However, the cervical pedicles are small and the potential danger of misplacing a screw limits their use. In in vitrostudies the misplacement frequency has been shown to be unacceptably high, whereas this is not seen clinically, maybe due to different insertion techniques. Fortunately a misplaced screw rarely leads to a clinical complication. To minimise the risks, however, we now only use pedicle screws in the cervical spine where stability is critical, i.e. at the extremes of a fixation. For example: A C1–C2 fixation in rheumatoid arthritis or in fracture of the dens would utilise C2–C1
Introduction: The management of cervical spine fracture, subluxation or dislocation in the elderly may present difficulties in decision-making. Frequently, the elderly suffer from medical comorbidity and a limited physiological reserve, which need to be considered in deciding on surgical versus conservative management of fractures and dislocations. Debate exists regarding the merits of surgical versus nonsurgical management of these injuries. 1,. 2,. 4. Methods: Retrospective analysis of 16 patients with traumatic cervical spine fractures with or without dislocation or subluxation in patients greater than 65 years of age, spanning 1994 to the present were carried out. Success of spine stabilisation, time in hospital, ability to return to pre-injury function and medical or surgical complications were measured. Results: The average age of the patients was 76 years with a range of 67–86 years of age. A variety of cervical injuries and fixation methods were identified, the most common injury being odontoid fracture requiring
Purpose: Cage fusion of the L5–S1 segment is a controversial issue due to the weak stabilisation of the spine during extension and axial rotation. Complementary fixation appears to be needed to improve stability, but the presence of the bifurcation of the great vessels is an anatomic limitation. We studied the anatomy of this area to examine the feasibility of anterior plate fixation. Material and methods: According to the recognised anatomic references (Rouvière, Bouchet and Cuilleret, Louis), a 33-mm safety zone was described at the aortoiliac and iliocaval bifurcation. This space free from contact with the greater vessels lies in front of the L5–S1 disc. Pre-operative angio-MRI was used to assess the size of this safety zone. A triangular anterior plate was designed for arthrodesis (Pyramid Sofamor Danek, USA). An L5–S1 arthrodesis was performed in 15 consecutive patients using this plate. Follow-up was one year. A video-assisted anterior retroperitoneal approach was used in all cases. The Prolo and Oswestry scores were used for the preoperative and last follow-up evaluations. Results: According to the anatomic study and the MRI views, 89% of the patients had a sufficient safety zone for plate fixation. The method was contraindicated in two patients who had a low bifurcation. Angio-MRI was found to be simple and reproducible. The MRI analysis was confirmed at surgery (no false negatives). The plate was successfully implanted in 15 patients with no contact with the great vessels. There were no serious complications (vascular, neurological, urological, digestive). The economic Prolo score was improved from 2.7 to 4.2 and the functional score from 2.6 to 4.3. The Oswestry score improved 33%. The rate of clinical success was 93% (14/15 patients). Discussion and conclusion: Implantation of an anterior plate for L5-S1 fusion is feasible. The key points are: 1) rigorous preoperative evaluation of the greater vessel bifurcation; 2) anatomic plate design; 3) appropriate surgical technique. The risk of retrograde ejaculation is related to retraction of the hypogastric plexus and should be investigated with a prospective study. This osteosynthesis technique can avoid secondary operations for fixation with pedicular or
Introduction: Fixation of the atlantoaxial complex has traditionally involved