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.

Objectives: Nowadays estimating paediatric bone age is done using methods based on standards from the 50’s and 70’s. These methods are often difficult to perform, they require experience in the analysis of multiple bones and are based on subjective measures. Many times, the age calculated stands within a wide range of age interval. We investigate a new method based on AP foot X-rays.

Material and Methods: 971 radiographs taken from 220 paediatric patients (0–18 years old) were analyzed. 34 different ratios were designed by measuring ossification centres of the bones of the first and second foot rays. These ratios were statistically studied searching for the relation with variables as gender, laterality, foot pathology and forefoot formulae. Finally, regression lines and curves from each ratio were calculated as well as their correlation with chronological age.

Results: The best suited correlations are obtained with the ratios calculated from the epiphysis of the proximal phalange of the first and second toes. With them, multiple regression analysis is able to establish an equation that estimates bone age, with a chronological age correlation of 0,86 for general population, 0,85 for boys and 0,90 for girls (p< 0,01). It is applicable for either feet, and valid for every forefoot formula or pathologic feet.

Conclusions: This new method is designed to estimate bone age in children using either plain radiographs or digital images. The method is objective, precise, universal and easy to calculate. It proves a good correlation in children between 1 and 13 years old. It is based on a modern population and adjusted with lineal regression equations to both genders.

Introduction and Objectives: Our aim is to describe the versatility of the Becker flap in different pathological conditions of the hand as treated in a orthopaedic trauma centre.

Materials and Methods: The Becker flap surgical technique is described as it is used in our centre as a means for coverage of injuries of the soft tissues in the palmar region of the hand. The procedure is described in three patients. One of these was a salvage procedure for recurrent carpal tunnel syndrome. The second was performed after an acute infection of the hypothenal eminence. The third involved coverage of a hand following trauma with a loss of tissue.

Results: In spite of the varied aetiologies of these cases, coverage was complete in all three cases, and there was no vascular compromise of the flap, nor dehiscence of sutures or acute infections. The use of the cubital flap was sufficient to resolve these conditions. On follow up, overall functional results for the hands were good, and the aesthetic results were acceptable for both the hand and the donor site.

Discussion and Conclusions: The Becker flap represents a good option for coverage of palmar cutaneous defects of the hand. Its versatility in the field of orthopaedic trauma makes it a practical and efficacious flap for use in acute and delayed cases.