Objectives: To assess the stabilizing effect of Ender nails on humeral shaft fracture and to assess proper nail length.

Materials and Method: Ender nailing was performed in 67 patients. Age ranged from 22 to 79 years. 9 were open fractures, and the 58 were closed ones; 13 comminuted, 28 spiral, 23 transverse, and 3 segmental fractures. 19 had associated injuries in other parts. One nail was used in 18 cases, two nails in 46 cases, and three nails in 3 cases. In 16 cases long nails were used. In the 12 elderly patients nail was inserted under local anesthesia, In all cases the sling and swathe was applied postoperatively to avoid rotatory shear.

Results: Radiologically visible bridging callus was observed at 6.8 weeks on average: the earlist one was at postop 5 weeks, and the latest was at postop 15 weeks. The average clinical union time was 9.3 weeks. In the 6 cases the long nail distracted the fracture gap, and resulted in delayed union. In the 10 remainders the distracted gap was spontaneously reduced when the nails migrated proximally through an entry hole. In cases of proximal nail migration, shoulder pain and partial stiffness were complicated, which disappeared after nail removal.

Conclusion: It is found that intramedullary Ender nailing is a simple and less invasive surgical procedure in humerus which brings the successful fracture union with least complications.

Objectives: To assess the early diagnostic procedures and results of treatment for pyogenic discitis and to propose the ideal method of treatment for it.

Materal and Methods: 35 patients underwent open discectomies : 24 males and 11 females. 34 had single level and one had two-level discectomies. Blood were analysed on pre- and postop 3rd, 7th, 14th days, and 6 weeks. MRI exam in 6 patients and bone scintigraphy in 3 were done. Clinical symptoms of infection was observed on the postop 7 day on average. The characteristic features were back pain with muscle spasm, muscle cramping in legs, malaise, mild fever. 32 had conservative treatment and two had anterior radical surgery. Tobramycin, cloxacillin, and clindamycin were used for 4–6 weeks.

Results: WBC, ESR, CRP and body temperatures (BT) at postop 3rd, 7th and 14 days, and 6 weeks were checked; WBC were 11,500, 13,000, 9,300, 6,300 respectively: ESRs at one hour were 39, 50, 46, and 26mm : CRPs were 16.8, 23.5, 8.1 and 2.5. BT on average at postop 3rd, 7th and 14th days were 37.6, 37.4 and 37.2. Muscle spasm subsided together with cramping in legs 7–12 days after chemotherapy, but back pain persisted even after control of infection in most of the cases. MRI disclosed the infection in 5 of 6 cases, while in all 3 bone scans were positive. Infection was controlled in all. In 2 cases bony destruction advanced during chemotherapy, and in 2 other cases after anterior surgery infection exacerbated and spreaded to the neighbouring bone and joints.

Conclusion: Antibiotic therapy is found sufficient in controlling discitis, and surgery should be reserved for the patients without response to antibiotics.

Objectives: To assess the effectiveness of the two different types of C-D instrumentation constructs on the unstable thoracolumbar and lumbar spine fractures.

Material and Method: 45 fractures in 42 patients(age range, 18 to 57 years) were treated with C-D instrumentation and posterolateral fusion, and were followed up over 2 years(26±72 months). The level of injuries were T12 in 6 cases, L1 in 15, L2 in 12, L3 in 3, L3-4 in 6, and L4-5 in 3. The fracture types were bursting in 21, flexion-distraction in 15, fracture-dislocation in 9. Three had both L1 flexion-distraction and L3 bursting fractures. 9 had incomplete paralysis. Vertebral height and kyphosis angle were measured. All fractures were reduced by normally contoured rod handling without distraction or compression, and the vertebrae one above and one below the fractured spine were fused posterolaterally. 9 had posterior decompression surgery including reduction of retropulsed fragment. In 21 cases long rodding(group-I : over three level stabilization) and in 18 cases short rodding(group-II : one above and below) were performed.

Results: Fracture consolidation was achieved at 6.5 months (5±10 months). Overall fusion rate was 78.6%: 75% in Group-I and 83.3% in Group-II. In group-I average kyphosis at preop, immediate and fi nal postop follow-up were 20.3°, 7° and 11.4°, respectively, while in group-II those were 14.7°, 2.4° and 8.4°, respectively. The losses of correction in group-I and group-II were 4.4° and 5.7°. In group-I and group-II anterior body height losses at preop, immediate postop and fi nal follow-up were 45.6%, 14.6%, 17.1% and 40.3%, 15.8%, 23.7%, respecitvely. Complications were : screw breakage in group-I and II were 3 and 6 cases : plug dislodgement in 3 cases of group-I, and hook dislodgement in 3 of group-II.

Conclusion: Long rodding and posterior fusion is preferably recommended to minimize the loss of reduction.