Centre Hospitalo-Universitaire de Bordeaux, Service de Pathologie du la Colonne Vertébrale, Bordeaux, France. Assessment of cervical lordosis using a standardised digital acquisition procedure in the normal population Three independent reviewers measured static lordosis. The EOS¯ system, which utilises low dose radiation and provides reliable standardized digital 2D acquisition with 3D reconstruction was employed. Measurements were carried out twice by every examiner on two different occasions. Cohort of the general public of 180 subjects divided into 4 groups (both sexes individually, age less than 40 and greater than 50 individually). None had any previous history of spinal disorders or sagittal imbalance. General cervical lordosis (C2 to C7) as well as upper and lower cervical lordosis were assessed. Cervical lordosis in the general population has a very wide range in both sexes. Overall cervical lordosis was 37 degrees. Lower cervical lordosis (superior endplate of C4 to inferior endplate of C7) demonstrated an average of 16 degrees, and upper cervical lordosis was found to be 21 degrees. No particular age group or sex was more prone to having lesser/greater lordosis. Current literature is sparse and provides large ranges, different standards and variable methods for assessing standard cervical lordosis. Overall cervical lordosis is very variable amongst the sexes and age groups. We provide a standard set of values which help to provide the spinal surgeon with values to aim for when seeking to restore cervical lordosis.
Centre Hospitalo-Universitaire de Lille, Service de Neurochirurgie et Chirurgie du Rachis, Lille, France. Assessment of current thoughts regarding spinal fellowships amongst spinal fellows in the United Kingdom and abroad Qualitative analysis provides rich and contextual detail that cannot be borne out by quantitative research. We undertook detailed interviews amongst fellows who have varying fellowship experience both in the United Kingdom and abroad. Ten fellows, all of whom were approaching their Certificate of Completion of Training (or equivalent) in Trauma and Orthopaedic surgery, or just awarded the certificate. All undertaking/undertaken at least one 12-month fellowship. Qualitative experiences A large unit provides a breadth of pathology that may is usually not encountered in smaller units. Fellows who worked in such units felt confident that they would recognise a variety of pathologies, but did not necessarily feel confident in their surgical management. Operative exposure to deformity surgery, whilst not necessarily a future part of practice, was felt useful for the added technical skills it provides. Fellows attending a smaller unit, where they may have been the sole ‘spinal fellow’, reported greater satisfaction in operative experience. Interestingly, there was felt to be a ‘saturation point’, where a fellow perceived no further educational benefit from remaining in one particular unit. A fellowship in spinal surgery is useful in preparing for independent practice as a spinal surgeon. Large units provide skills that are applicable to several aspects of spinal surgery. There appears to be a difference in breadth and complexity of pathology versus operative experience.
Although described by Gattelier and Chastang in 1924, the transfibular approach to the ankle has been slow to emerge as a conventional orthopaedic technique. To date, applications have been confined to the treatment of tibiotalar arthrodesis, ankle joint incongruity and exposure of the fractured talus, where the distal fibula is also fractured. While seemingly undocumented, it is also proving effective in mosaic-plasty of the talus. This paper outlines an innovative technique of segmental distal fibula osteotomy and its role in the treatment of osteochondritis dissecans of the postero-lateral talar dome.
