To review the medium-term results of the Dynesys stabilisation system used in 113 consecutive patients with discogenic back pain. 113 consecutive patients with discogenic back pain were treated with Dynesys as the sole intervention. Inclusion criteria included mri proven disc degeneration and an improvement in symptoms following an injection into the disc with local anaesthetic and steroid (spinal disc probing). Patients were followed up for a minimum of 5 years, with outcome measures including SF-36, Oswestry disability index (ODI) and visual pain analogue scores (VPAS). Additional factors reviewed included previous spinal operations, complications, loosening and revision rates with subsequent outcomes. Mean pre-operative ODI was 49.5, SF-36 was 37.6 and VPAS back pain was 60.9. At one year post operatively, these scores were 36.9, 49.4 and 39.8, at five years follow up, the scores were 33.3, 51.8 and 40.1 respectively. We note wide variations in our results. Several significant factors appear to contribute to the outcome of surgery. These include undergoing surgery before the age of 43, no more than 2-level disc degeneration, leg pain less than VPAS 4, and no previous spinal surgery. 19 patients had screw loosening evident on plain film x-rays (4 requiring removal), and 2 patients had screw breakages. 19 patients had implant removal for failure and 2 patients went on to have a fusion procedure.Purpose of Study
Methods and Results
Fractures of the distal radius are common skeletal injuries. In most practices patients are discharged within few weeks to few months. The aim of this study is to investigate whether there is a difference in outcome between 6 months and 1 year with different treatment methods with special focus on conservative management. A one-year prospective cohort study of patients with fractures of the distal radius was set in York Hospital. From 204 patients included, 200 (98%), 182 (89%) and 164 (82%) patients were evaluated at 6 weeks, 6 months and 1 year, respectively. Two patients had bilateral fractures. In total 162 fractures were treated conservatively, and 8 fractures were treated operatively following failure of conservative immobilization. Outcome assessment included Gartland and Werley, DASH and SF-36 scoring systems. Between 6 months and 1 year there was statistically significant improvement in the over-all Gartland and Werley score (p<
0.001) and most of its components such as the subjective evaluation, grip strength, arthritis change, finger function, and the range of motion. There was no significant improvement in pain and deformity. In the conservatively treated patients a good or excellent result was found after 6 months in 77%, after 1 year in 92%. In the failed conservative group it was 61% (5/7) and 83 % (5/6).
In 16 cadaver humeroulnar joints, the distribution of subchondral mineralisation was assessed by CT osteoabsorptiometry and the position and size of the contact areas by polyether casting under loads of 10 N to 1280 N. Ulnas with separate olecranon and coronoid cartilaginous surfaces showed matching bicentric patterns of mineralisation. Under small loads there were separate contact areas on the olecranon and coronoid surfaces; these areas merged centrally as the load increased. They occupied as little as 9% of the total articular surface at 10 N and up to 73% at 1280 N. Ulnas with continuous cartilaginous surfaces also had density patterns with two maxima but those were less prominent, and in these specimens the separate contact areas merged at lower loads. The findings indicate a physiological incongruity of the articular surfaces which may serve to optimise the distribution of stress.
Revision hip arthroplasty in patients with massive acetabular bone deficiency has generally given poor long-term results. We report the use of an 'anti-protrusio cage', secured to the ischium and ilium, which bridges areas of acetabular bone loss, provides support for the acetabular socket, and allows pelvic bone grafting in an environment protected from excessive stress. Forty-two failed hip arthroplasties with massive acetabular bone loss were revised with the Burch-Schneider anti-protrusio cage and evaluated after two to 11 years (mean five years). There was failure due to sepsis in five hips (12%) and aseptic loosening in five (12%); the remaining 32 hips (76%) showed no evidence of acetabular component failure or loosening.
