A comprehensive met-analysis of anterior knee pain post intramedullary nailing of the tibia was performed by Katsoulis et al in 2006. The principle findings were that 47.4% of patients had anterior knee pain at 2 years post tibial nailing. Worse results were found following a patella tendon splitting approach when compared with a medial para-patellar tendon approach. These conclusions were drawn from 20 studies including 1460 patients. Currently both approaches to the proximal tibia for nailing are used at JCMH Blanchardstown. A retrospective study was performed to compare the results of tendon splitting and tendon sparing approaches to tibial nails and to compare the results of JCMH with those stated in literature. Patients who underwent tibial nailing in 2007 and 2008 were identified using the hospital coding system. Those patients who were treated under the care of Mr Kenny had a medial para-tendinous approach and those treated the care of Mr O'Flanagan and Mr Keogh had a tendon splitting approach. Apart from the approach the nailing technique using the Trigen Knee Nail and the post operative physiotherapy protocol were identical. Follow up included questions regarding knee pain and return to previous function. Specifically: Knee pain that affects daily life, Knee pain on kneeling, Knee pain on ascending or descending stairs, Return to work and Return to sports or active hobbies.Introduction
Method
Prospective cohort study. To assess the safety and efficacy of an intra-operative gamma probe in the surgical treatment of osteoid osteomas and osteoblastomas arising from the spine.Study Design
Objective
All these patients had equal or greater than Meyerding grade III slips. Clinical presentation included severe back pain with disability and a severe cosmetic deformity (including flexed knees, proptotic abdomen and loin creases). The indications for surgery were pain relief and neurological symptoms/signs, and to improve the sagittal alignment. Surgery consisted of first stage Gill procedure, L5 root decompression, and insertion of Schanz pins into L4 pedicles and ilium, and application of the fixateur-externe. Second stage consisted of gradual correction of kyphosis and translation (average 1 week duration). Third stage entailed anterior interbody fusion, removal of fixator and instrumented fusion L5 to sacrum.
Nine (82%) patients reported improved pain scores on the VAS, improved quality of life and cosmetic appearance. There was significant reduction of the translation (in most cases to grade II) and correction of the lumbosacral kyphosis. All patients went on to a solid arthrodesis and there was no late loss of correction.
