Due to co-morbidities in elderly like atherosclerosis and approach-related risks, anterior lumbar surgery is mainly recommended for younger patients. We reviewed approach-related complications in anterior lumbar surgery in senior patients for complex reconstructions. Retrospective review of 12 patients (8 female and 4 male), mean age 65.5±4.9 years, treated with anterior fusion mainly for degenerative scoliosis and lumbar kyphosis in between 2007-10. 9(75%) patients had multilevel procedures. Most common co-morbidities were atherosclerosis (CT-proven in 7 patients), coronary heart disease and COPD. Renal impairment was present preoperatively in 3 patients.Introduction
Materials and Methods
To assess the risk of hip dislocations in children with cerebral palsy (CP) attending special schools, and the effects of preventative soft tissue surgery (psoas and adductor tenotomy). 110 children were reviewed from 1985-2000. Severity of CP was graded according to the Gross Motor Function Classification System (GMFCS). Hemiplegics - grade 1, Diplegics grades 2 & 3, Quadriplegics grades 4 & 5. Patients were grouped into age groups 5, 10 and 15 years and the number of hip dislocations in each group were noted. Numbers of patients who had preventative soft tissue surgery was also noted. Indication for surgery, >35% femoral head uncovering.Aim
Method
We reviewed 81 consecutive ABG primary total hip replacements in 72 patients operated between January 1993 to December 1998. The mean follow-up was 8.2 years (7 to 12 years). The mean age of the patients was 52 years (range: 28 to 65 years). The mean pre-operative Harris hip score of 42 (range: 24 to 48) improved to a post-operative 80 (range: 58 to 86). At the latest follow-up 2 patients had died through causes not related to surgery. 3 cups had been revised for aseptic loosening. However, 69 of the remaining 75 acetabular cups showed excessive superolateral wear of polyethylene liner. The wear was most pronounced in cups size 46 with a 28 mm head. 16 of the acetabular cups showed significant osteolysis in zone I and II of the acetabulum (Gruen) and are awaiting a revision. None of the stems has been revised to date. The cumulative survival of prosthesis is as follows: Stem survival with revision being the end point: 100% Acetabular cups with revision & aseptic loosening: 72% (95% CI: 61 to 78%) Acetabular liner with significant wear: 32% (95% CI: 28 to 52%) The failure of cups is related to the poor locking mechanism of the polyethylene liner. In spite of significant radiological failures of the cups most patients continued to have good Harris hip scores and remained fairly asymptomatic. The results of ABG stem in this series are good but in view of the cup failures we now no longer use the ABG I cups but advocate a long term regular follow-up of these hips
The treatment of Neer type 2 lateral end clavicle fractures presents a difficult problem due to the high incidence of non-union, delayed union, shoulder girdle instability and the need for implant removal. We report our experience in 10 patients with acute fractures treated with a simple modified tension band suturing technique. Following accurate reduction of the fracture, antero-posterior holes are drilled through both fracture fragments. Ethibond suture (number 5) is passed through the drill holes and tied in a ‘figure of 8’ on the superior side. This is reinforced with an identical second tension band suture. As the coracoclavicular ligaments remain attached to the lateral fragment, the principle of the surgery is to maintain the approximation of the fracture fragments with the tension band until fracture union, thereby resuming shoulder girdle stability.Introduction
Surgical technique
