Study design: Retrospective clinical study.

Objective: To assess the results of spondylodiscitis treated by surgery. To compare debridement and instrumentation with debridement without instrumentation.

Methods: Between February 1989 and February 2008, 29 patients with a diagnosis of spondylodiscitis underwent surgery. The mean age at the time of surgery was 57 years (range, 12–84). The average follow-up period was 8.4 years (range, 1–20). Pyogenic spondylodiscitis was diagnosed in 17 cases and tuberculous spondilodyscitis in 12 cases.

The results of 14 patients treated by debridement and instrumentation (Group I) were compared with 15 patients who received debridement without instrumentation (GroupII). The saggital angle, loss of correction and clinical results were compared.

Results: The clinical presentation was: intractable pain 20.7%, severe pain irradiating lower limbs 20.7%, pain and neurologic deficit 44.8%, pain and kyphotic deformity 3.4%, pain and psoas abscess 10.3%.

Preoperative punction CT-guided was performed in 51.7% of patients. It was positive in 26.7% of those patients.

Blood cultures were positive in 29.4% and intra-operative culture was positive in 53% of the pyogenic spondylodiscitis. Staphylococcus aureus was the most common organism.

The averaged onset of symptoms-surgery period was 6.75 months in tuberculous spondylodiscitis and 3.2 months in pyogenic spondylodiscitis.

Double-level spondylodiscitis was observed in 41.4%. The spinal region most frequently affected by spondylodiscitis was the thoracolumbar and lumbar spine in 66% of cases.

All of the patients with incomplete neurologic impairment showed improvement after surgery.

There were no recurrences of infection.

There was a statistically significant difference (p=0.011) in the loss of correction of saggital angle: more loss of correction in Group II 7.07° (range, 0°–17°) than in Group I 1.8° (range, 0°–5°).

The saggital angle preoperative/postoperative/3 months postop/6 months postop/12 months postop/ Final was: 14.42° /1.96° /2.75° /2.83° /2.92° /3.75° (means) in Group I.

−7.57°/–8.43°/ −3.21°/ −1.71°/ −1.93°/ −1.36° in Group II (in this group, there was a significant loss of correction between inmediate postoperative-3 months postop and 3 months postop-6 months postop).

There were statistically significant differences in operative time and in blood loss (more in Group I).

The preoperative Visual Analogic Scale score averaged 9 in Group I and 9 in Group II and improved to 2.4 and 2.33 after surgery, respectively.

Conclusion: Instrumentation in spondylodiscitis does not increase the recurrence of infection, and additionally it stabilized the affected segment maintaining the saggital angle. Instrumentation is recommended in tho-racolumbar spine, kyphotic deformity and in multiple-level spondylodiscitis.

Introduction and purpose: One of the sequelae that patients with recurrent shoulder dislocation must face is a significant limitation of their capacities for daily living and sports activities. The purpose of treatment is the recovery of stability in order that patients can return to their activities with the as little loss of mobility and strength as possible. The aim of our study was to analyze the evolution of physical activity and correlate final stability with postoperative sports activity.

Materials and methods: We carried out a retrospective study on a sample of 30 patients diagnosed with recurrent shoulder dislocation who underwent surgery between January 2001 and May 2005. After a minimum 2 years’ follow-up, mobility and strength in the operated shoulder was assessed, comparing it to the contralateral limb; the stability and possible recurrence in the affected limb were also evaluated. Furthermore, at that time, data was collected on the sports activities of the patients.

Results: After more than 2 years’ follow-up a statistically significant decrease in the number of patients who performed high-risk sports was observed. Furthermore, in those patients who continued to practice high-risk sports after surgery, greater stability was seen in comparison with those patients who did not (p> 0.05).

Conclusions: Patients that undergo surgery for recurrent shoulder dislocation decrease their sports activities in comparison with their preoperative activities and the results of surgery are independent of postoperative sports activity.

Introduction and Objectives: Though not a common disease, proximal femoral epiphysiolysis (PFE) is one cause of premature degeneration of the joint. The aetio-pathogenesis is unknown. The challenge with this disorder is making an early diagnosis. This study presents the experience of our center in surgical treatment of this condition.

Materials and Methods: This is a retrospective study of 27 cases of PFE in 25 patients treated between 1990 and 1998, analyzing therapeutic management at the time of presentation and clinical, radiographic, and subjective findings in the short and medium terms. Based on duration of symptoms, the disorder is classified as acute, chronic, or subacute. Degree of displacement is classified as mild (less than 30%), moderate (30–60%), and severe (great than 60%). Dunn and Angel’s criteria were used for clinical evaluation, as modified for this study. Radiographic follow-up was based on the capitodiaphyseal Southwick angle, measuring the amount of correction postoperatively and in the medium-term examination.

Results: There were 17 males (63%) and 10 females (37%). Average age was 12.5 years. The right side was affected in 10 cases (40%), the left in 13 (52%), and both sides in 2 (8%). The majority of patients presented with chronic epiphysiolysis (44%) with mild displacement (74%). In most cases, surgical intervention consisted of in situ fixation with or without a previous attempt at reduction, based on the degree of displacement on an orthopaedic table with scope guidance. Fixations were performed primarily with Kirschner wire or cannulated screws. Preoperative complications included incomplete reduction of the fracture, breakage of the Kirschner wire, and superficial infection of the surgical wound.

Discussion and Conclusions: The worst results were seen in patients with epiphysiolysis with severe initial displacement and in patients who developed aseptic necrosis of the femoral head or chondrolysis. Intra-articular penetration with this material and valgus positioning should be avoided. At present, we are doing the fixation of the epiphysis using a single cannulated screw. We believe early detection of the process is very important in cases featuring gradual displacement.