Large femoral neck defects pose a great challenge for orthopedic surgeons and are frequently associated with neglected femoral neck fractures, post infective sequale and failed implants around femoral neck. We present our technique (AIIMS Box Technique) of neck reconstruction aiming to preserve the natural femoral head and restoring the function of hip in cases of large femoral neck defects.

A total number of 52 patients (age range 20 to 56 years with an average of 38 years) with large femoral neck defects were treated from January 1990 to May 1997 and were followed for a minimum of 10 years (range 10 to 17 years). Neck defect was converted into a box using osteal flaps (Base from greater trochanter, Anterior wall from head, Quadratus Femoris muscle pedicle graft posteriorly). This box was filled with cancellous bone autograft along with three cancellous screw fixation.

Union occurred in all patients in a mean time of 16 weeks (range 12–20 weeks). One patient in our series had avascular necrosis (AVN) of femoral head. Eighteen out of 52 results were classified as excellent, 28 good and 6 fair. No patient had poor result. Good functional mobility including squatting was seen in all but two patients. Complications included coxa vara in two patients, hardware problems in four patients.

Our study shows that large femoral neck defects can be managed successfully with preservation of vascularity of femoral head. This procedure can be considered an alternative to excisional or replacement arthroplasty, particularly in young adults.

Introduction: Spine fractures are common manifestation of osteoporosis. After an acute osteoporotic vertebral compression fracture pain persisting even after 3 months and clinical tenderness should raise the suspicion of pseudarthrosis. Pseudarthrosis is not a rare complication of a benign osteoporotic vertebral collapse occurs in about 10% of cases after an acute collapse. Treatment plan needs to be individualized. Cement augmentation procedures such as kyphoplasty and vertebroplasty can be performed in the absence of neurological deficit, whereas decompression and stabilization is necessary in presence of neurological deficit.

Study Design: Prospective cohort study

Methods: 31 patients who were diagnosed to have an acute osteoporotic vertebral compression fracture were managed conservatively. Pain persisting after 3 months and clinical tenderness in 5 patients prompted further investigation, revealing pseudarthrosis. None of them had neurological deficit. Imaging of two patients revealed vacuum sign with intravertebral cleft on plain radiographs and on MRI. All of them were at the Dor-solumbar junction and of crush typeof VCF.

Results: The incidence of pseudoarthrosis after an oste-porotic VCF was found to be 16.12%. One patient was treated with kyphoplasty, one with vertebroplasty with good pain relief and restoration of functional ability, and rest three are awaiting kyphoplasty.

Conclusion: High suspicion of pseudarthrosis is to be kept in mind as it is not an uncommon complication of benign osteoporotic collapse. Vertebral augmentation procedures such as kyphoplasty and vertebroplasty are promising procedures for treatment in absence of neurological deficit.

Background: The usefulness of open (fenestration/ laminotomy) discectomy for the treatment of a herniated lumbar disc has been studied extensively. In the current prospective, randomized study, the results of this procedure were compared with those of Microendoscopic discectomy.

Methods: One hundred and twelve patients who had objective evidence of a single level, central or para-central herniation of a lumbar disc caudal to the first lumbar vertebra were randomized into two groups; Group 1 (55 patients) was managed with Microendoscopic discectomy, and Group 2 (57 patients) was managed with open (fenestration/ laminotomy) discectomy. None of the patients had had a previous operation on the low back, and all had failed to respond to nonoperative measures. Analysis of the outcomes of both procedures was based on the patient’s self-evaluation before and after the operation through Oswestry scoring, the preoperative and postoperative clinical findings, and the patient’s ability to return to a functional status. The patients were followed at one week, 6 weeks, 6 months and for a minimum of one year postoperatively.

Results: On the basis of the patient’s preoperative and postoperative self-evaluation, the findings on physical examination, and the patient’s ability to return to work or to normal activity, 53 patients (96 percent) in Group 1 and 54 patients (95 percent) in Group 2 were considered to have had a satisfactory outcome. The mean surgical time, mean anaesthesia time, postoperative stay, was significantly less in Group 1. The overall satisfaction score was higher after the endoscopic microdiscectomies than after the laminotomies and discectomies especially in immediate postoperative period (one and six weeks) as assessed through Oswestry scoring.

Conclusions: The data from this randomized, prospective study suggest that Microendoscopic discectomy may be useful for the operative treatment of specific symptoms, including radiculopathy, that are caused by lumbar disc herniation, provided that patients are properly selected—that is, they must have a herniated disc at a single level as confirmed on imaging studies, have failed to respond to nonoperative management and have no evidence of spinal stenosis. All the major advantages of an endoscopic procedure like less hospital stay, lesser morbidity, and early return to work can be passed on to the patients without in anyway compromising the surgical goals viz. decompression of the canal and the compressed nerve root. However, endoscopic microdiscectomy is a demanding technique and should not be attempted without specific instruction and training.