The purpose of this study was to review the early results of a consecutive series of patients undergoing periac-etabular osteotomy (PAO) at Cappagh National Orthopaedic Hospital. The procedure was first carried out in 1998, and a total of 85 PAOs have been performed in 79 patients. The mean follow-up was 42 months (range 6-84 months). There were 72 females and 7 males with a mean age at the time of the operation of 22.9 years (range, 14-41 years). The preoperative diagnosis was developmental hip dysplasia in 80 hips, Legg-Calve-Perthes disease in one hip, congenital coxa vara in three hips, and slipped capital femoral epiphysis in one hip. The average Merle d’Aubigne score increased from 12.4 points preoperatively to 16 points at latest followup. The lateral center edge angle of Wiberg was between – 20 and +28 before surgery and was improved from 12 to 48 (average 30 degrees) following PAO. While, the anterior center edge angle of Lequesne and de Seze was between – 22 and +35 preoperatively and was improved by an average of 28 degrees (range, 17 – 40) postoperatively. The acetabular index angle decreased from an average of 24.8 preoperatively to 8.4 postoperatively. Clinical follow-up revealed that 77% of patients had no or mild pain, 33% of patients had a limp and 64% of patients were unlimited in physical activity, representing a markedly improved clinical outcome. Four patients underwent subsequent total hip arthroplasty. The short term results in this group of patients treated with PAO show reliable radiographic correction of deformity and improved clinical scores. The study reflects the learning curve associated with performing this procedure and the results that can be expected with a smaller clinical case-load than described in previous studies. We suggest that PAO may safely be carried out at a non-super-specialized institution provided the surgeons have sufficient experience and patients are selected appropriately.

Study Design: A retrospective review of the functional outcome of neurologically intact patients with burst fractures of the first lumbar vertebra.

Objective: To assess the functional outcome of patients treated either surgically or conservatively following burst fractures of L1.

Methods: A retrospective review of 38 neurologically intact patients with burst fractures of L1 was performed. Follow-up clinical evaluation was obtained from 26 patients, eleven of whom were treated surgically and fifteen of whom were managed conservatively. Patients were assessed with regard to pain, employment status, ability to partake in recreational activities and their overall satisfaction with treatment. Radiographic evaluation of anterior body compression and vertebral kyphosis was performed at the time of injury. Computed tomography scanning of spinal canal compromise was also recorded at the time of injury. Subsequent recordings of vertebral kyphosis were assessed at the time of remobilisation and at 3-month follow-up evaluation.

Results: Mean follow-up time for the 26 patients was 43.02 months. At final clinical follow-up of the fifteen patients managed conservatively, 6 patients (40%) had little or no pain; 12 patients (80%) had returned to work with 6 (40%) stating that they had little or no restrictions in their ability to work; 8 patients (53%) had returned to the same level of recreational activity as prior to their injury with 7 (47%) stating they had little or no restrictions in their ability to participate in recreational activities. One patient (9%) reported being very dissatisfied with the operative treatment of their spine fracture.

No correlation was found between kyphotic deformity, extent of canal compromise and clinical outcome.

Conclusions: Non-operative management of burst fractures of the first lumbar vertebra is a very safe and effective method of treatment. It reduces hospitalisation time and avoids the costs and risk of surgery. Patients return to the functional activities of daily living quickly and have a better clinical outcome when compared with operative management.