We evaluated the following parameters:
Neck-shaft angle The thickening of the Calcar The Bone loss-sedimentation of the head of the femur The cortex thickness at the level of the lesser trochanter The distance-on the axis of the femur’s neck-between the rotation center of the hip and the point where the above axis crosses the transtrochanteric line. These parameters were measured from two idependent observers. Every single measurement was done twice from both observersjn order to estimate the interobserver and the intraobserver error. The measurements were done in both hips of the patients-the affected and the healthy one-on an A-P pelvis radiogramm.
We evaluate the patients with lumbar spinal stenosis in multiple levels that were treated with posterior decompression and posterolateral fusion, using transpedicular screw fixation system. Twenty-six patients, mean age 65.7 years (range 49 to 77years), with lumbar spinal stenosis, in more than three levels, were treated surgically between 1994 and 2002. Indications for surgical treatment included low back pain and neurogenic claudication for more than 6 months. The diagnostic approach consisted of x-rays, MRI, myelography and myelo-CT. Oswestry disability score and VAS (visual analog scale), were used for the clinical evaluation of the patients. Surgical procedure consisted of wide posterior decompression, regarding laminectomy, complete or incomplete facetectomy and foraminotomy, combined with posterolateral fusion, using transpedicular screw systems and bone graft. Fusion in three levels was performed at seven patients, in four levels at ten, in five levels at seven, in six and seven levels at one patient respectively. Mean follow-up was 26.8 months (range 12 to 38 months). Oswestry score and VAS revealed improvement 40.75% and 5.4 levels respectively. The better results were concerned to pain (2.88 levels improvement) and the less good to lifting (1.58 levels improvement). Two cases with superficial infections were observed and treated with surgical debridement. Screw breakage was observed in 1 patient and treated conservatively. Loosening of two sacral screws, which were removed, was observed in one patient. We conclude that myelography and myelo-CT revealed with satisfactory accuracy intra and outer foraminal lumbar spinal stenosis. Posterior decompression and instrumented fusion, offer satisfactory clinical results in patients with lumbar spinal stenosis in multiple levels when performed by experienced surgical team.
We evaluate the effectiveness of external fixation exchange by intramedullary nailing during consolidation phase following callus distraction phase. In 12 skeletally mature female sheep, equally divided in two groups (group A and group B), we performed tibial shaft osteotomy and 2cm gradually callus distraction using Ilizarov external fixator in a 0.5mm/12h rate. In group A, immediately after lengthening completion, Ilizarov fixator was removed, and static unreamed intramedullary nail was inserted under fluoroscopic guidance. In group B (control group), Ilizarov frame remained (according to the usual technique) during consolidation phase. Callus maturity was studied in both groups, in specific time intervals, with plain x-rays, ultrasonograms, triplex and digital subscription angiograms. All animals were sacrificed 70 days after osteotomy and bone specimens including callus, were evaluated with MRI, DEXA and histopathologic examination. In group A, all animals successfully tolerated intramedullary nailing, keeping limp alignment. All but one formatted a mature callus and kept callus length before being sacrificed. One sheep had a delayed formation of the callus and 0.5cm loss of callus length, because of failed insertion of distal locking screw in the nail. In group B, four of six formatted mature callus, two had axis disorder, three superficial pin-track infections and one deep infection in the same time. We conclude that replacement of Ilizarov device by static unreamed intramedullary nail during callus consolidation phase decreases the total duration of external fixation, limits articular stiffness, pin-track infections and axial deformities, and provides protection against refracture. Our results suggest that there is no considerable difference between callus formations in the two groups.
End results analysis of operative treatment in transcaphoid perilunate dislocations.
From 1/1/91 to 1/1/01 twenty transcaphoid perilunate dislocations were operative treated. Ligamentous lesions were repaired through a dorsal approach, either by directly suturing the ligaments (10cases), or by using mini Mitek anchors (8 cases). Simple approximation and stabilization with K-wires was performed in 2cases. Scaphoid fractures were treated by open reduction and internal osteosynthesis with Herbert screw (12 cases), cortical AO 2.0 screw (2cases) or K-wires (6 cases). The wrist remained immobilized in a slight flexed position with short arm plaster for 8 weeks. Physiotherapy was necessary for all patients to regain full range of motion. Clinical and radiological evaluation was possible for all patients. The end results were estimated according to Cooney’s evaluation system. Kinematics of the injured wrists was also tested by cineradiography in order to estimate the dynamic behaviour of the wrist. The Average follow-up time was 52 months (range 11–76).
Twelve patients had excellent result, 4 good, 1 fair, and 3 poor. Fourteen out of 16 cases returned to their previous work. Additional operations were required in two patients: 1) four corner arthrodesis because of aseptic necrosis of the proximal pole of the scaphoid with arthritic changes, 2) Scaphoid reoperation because of non-union by Matti-Russe procedure. The later was found in cineradiography to present a painless rotational instability.
Transcaphoid perilunate dislocation has a very good response to early operative treatment. Dorsal ligament repair with mite mini anchors seems to be a reliable easy made method. Scaphoid fracture stabilization requires a stable compressive fixation. Herbert screw is ideal and can be safely placed from proximal to distal via the dorsal incision. Cineradiography is the best way to evaluate normal wrist kinematics.