Aims

Patients with diabetes are at increased risk of wound complications after open reduction and internal fixation of unstable ankle fractures. A fibular nail avoids large surgical incisions and allows anatomical reduction of the mortise.

The use of allografts for the treatment of bone tumours in children is limited by nonunion and the difficulty of finding a suitable graft. Furthermore, appositional growth can’t be expected of an allograft.

We used an overlapping allograft in 11 children, with a mean age of ten years (4 to 15), with a mean follow-up of 24.1 months (20 to 33). There were five intercalary and six intra-articular resections, and the tumours were in the femur in six cases and the humerus in five. Rates of union, times to union, remodelling patterns and allograft-associated complications were evaluated.

No allograft was removed due to a complication. Of the 16 junctional sites, 15 (94%) showed union at a mean of 3.1 months (2 to 5). Remodelling between host and allograft was seen at 14 junctions at a mean of five months (4 to 7). The mean Musculoskeletal Tumor Society score was 26.5 of 30 (88.3%). One case of nonunion and another with screw protrusion required re-operation.

Overlapping allografts have the potential to shorten time to union, decrease rates of nonunion and have positive appositional growth effect.

Cervical arthroplasty is usually performed for the treatment of soft disc herniation, but not for spondylotic radiculopathy. To our knowledge, there has no study to investigate the clinical and radiological results of cervical arthroplasty for spondylotic radiculopathy. We therefore performed the current study to evaluate clinical and radiological results of cervical arthroplasty for spondylotic radiculopathy with severe narrowing of the intervertebral disc space.

Eight patients, who underwent anterior decompression, overdistraction, and implantation of artificial cervical disc for primary, single-level spondylotic radiculopathy with severe narrowing of the disc space (decrease more than 50% of adjacent disc spaces) were included in this study. Four were male and 4 were female with mean age of 49.5 years. The operation level was 7 C5–6 and 1 C6–7. Five Prodisc-C and 3 Prestige LP prostheses were implanted. The clinical and radiological evaluations were performed with minimum one year follow-up (range, 12 – 19 months) after surgery.

VAS of the neck and arm pain improved (79.6 vs. 19.4 points, p < 0.01; 82.5 vs. 22.7 points, p < 0.01) at last follow-up, respectively. According to Odom’s criteria, satisfactory clinical outcome was achieved in 63% (5 out of 8, 3 excellent and 2 good) while fair result was achieved in 37% of the patients (3 out of 8). The disc space (3.0mm vs. 6.4mm, p < 0.01) and range of motion (1.4 vs. 6.3 degrees, p = 0.009) at the operated level increased, respectively. Overall sagittal alignment of the cervical spine was increased after surgery (5.2 vs. 11.3 degrees, p < 0.05). In 5 patients, segmental angle of the operated level was increased (0.2 vs. 5.3 degrees, p = 0.003) after surgery with maintained facet joint articulation overlap. However, in 3 patients, segmental angle of operated level became kyphotic from neutral (0 vs. −10.0 degrees, p = 0.295) with decreased facet joint articulation overlap.

In conclusions, cervical arthroplasty provided favorable clinical and radiological outcomes in most of the patients with spondylotic radiculopathy and severe narrowing of the disc space at minimum one year follow-up after surgery. However, in some of the patients, postoperative segmental kyphosis developed and clinical outcomes were not satisfactory.

In tibial plateau fracture, anatomical reduction of articular surface with stable fixation can restore the mechanical axis and allow early mobilization. Concomitant management of ligamentous and meniscal injury is essential for preservation of knee function. Open reduction and internal fixation has a significant complication rate.Percutaneous,fluoroscopically and arthroscopically assisted osteosynthesis with special fracture reduction and fixation technique can achieve the purpose of management of tibial plateau fracture, while limiting the soft tissue damage.

18 cases, including all J. Schatzker’s type of tibial plateau fracture, were operated with minimal access surgical technique. Male patients were predominant. The age ranged from 22 to 61 (mean 33.5). Detail pre-operatives planning with CT scan were performed in 16 patients. Fluoroscopy, arthroscopy and special fracture reduction and fixation technique were applied to all cases. All 18 cases could be reviewed. Follow up period ranged from 1 to 4 years (mean 2.3 yr.). Outcome was assessed by HSS Knee Score, standing radiograph and arthroscopy (2 cases).

According to HSS score, 14 patients were rated as excellent (100 to 85), 3 good (84 to 70), 1 fair (69 to 60) and none poor (< 60). Subjectively, 14 patients were satisfied with the treatment. 13 patients were working and participating in sport before injury. 15 took no analgesic, 2 took it once a week and 1 more often. In standing radiograph, only 2 patients showed minimal narrowing of joint space. There was no significant complication directly associated with the procedure.

Percutaneous, fluoroscopically and arthroscopically assisted osteosynthesis is a safe and effective minimal access surgical procedure. Precise pre-operative planning and special fracture reduction and fixation technique are all crucial for success. Short-term clinical outcome is encouraging.