To assess the efficacy of percutaneous K wiring in the treatment of distal radius fractures.

A retrospective audit was performed of patients with distal radius fractures treated with the combination of manipulation under anaesthetic, K wiring and cast application at Auckland Hospital. Patients were identified by using the Orthopaedic Trauma Database. Charts were reviewed for patient demographics, preoperative delay and complications. X-rays were reviewed recording Frykman Grade and radial tilt, radial inclination and ulnar variance preoperatively, immediately postoperatively and at 6 weeks postoperatively.

Seventy five consecutive cases were identified over an 18 month period between May 2002 and October 2003 with 4 excluded because of inadequate notes or x-rays. The majority of patients were female with an average age of 55 years. Most operations were performed by Advanced Trainees using 3 wires with at least one trans styloid wire. 55% of fractures were intra articular. Radial tilt was restored to within 10 degrees of normal in all but 3 patients immediately postoperatively but at 6 weeks 12 patients had more than 10 degrees dorsal tilt. All patients had less than 2mm positive ulnar variance immediately postoperatively but at 6 weeks postoperatively 11 patients had more than 2mm positive ulnar variance. 9 patients (13%) experienced local complications related to the wires.

Manipulation under anaesthetic, K wiring and cast application offers a useful treatment option for distal radius fractures which are reducible but unstable. Care is required with patient selection and surgical technique to minimise complications.

The purpose of this study was to assess the regional variation in the incidence of hip fractures in patients over 65 years. in New Zealand. Data from the National Minimum Data Set (NMDS) for hip fractures from 1 July 1998 to 31 June 2000 was obtained. The data was divided into 21 District Health Board (DHB) regions by mapping from domicile code to DHB. Population of interest as at 30 June 1999 was estimated on the basis of previous census in 1996. The incidence of hip fracture per 100,000 for each region was calculated and divided into age and sex cohorts.

There is a significant difference between DHBs in the sex and age adjusted incidence of hip fractures. The rates ranged from 556 per 100,000 to 838 per 100,00. As expected there was a higher fracture rate in women and the fracture rate increased with age. There was a weak correlation with sunshine hours (p=0.029) with increasing fracture incidence as sunshine hours decrease.

This study demonstrates a large variation in the incidence of hip fractures per DHB region. The cause for this is unclear, but the cost implications are significant. DHB’s with a high incidence of hip fractures in their region may wish to investigate strategies for reducing the incidence.

Introduction: Large anterior column defects of the thoracolumbar spine, after fracture decompression, tumour or other pathological resection, or spinal osteotomy present significant difficulties in respect to autograft procurement, donor site morbidity, graft instability and residual spinal instability. Titanium Mesh Cages for reconstruction thoracolumbar vertebral body defects (after corpectomy) offer an alternative to structural iliac crest autograft or allograft. The use of TMCs for inter-body reconstruction has been addressed yet the use of larger cages for corpectomy reconstruction has not. This study examines implant stability and deformity correction of TMCs following corpectomy reconstruction in the thoracolumbar spine.

Methods: Independent radiological review before, after and at follow-up (one year) was performed for 27 patients having implantation of TMCs. Measurement of thoracolumbar kyphosis was performed before surgery, immediately post operatively, and at one year follow-up. Correction of kyphosis was expressed both as angular improvement and percentage improvement. Cage settling into adjacent vertebral bodies, translational deformities and any evidence of implant failure was sought.

Results: Indications for reconstruction with TMC included burst fracture (13), post traumatic kyphosis (8), primary tumour resection (3), debridement of infection (1), and stabilisation of severe kyphotic deformity in achodroplasia with associated spinal stenosis requiring decompression (2). Desired resection and decompression was achieved as indicated. Correction of kyphosis was a mean of 12 deg / 61% (range 0 – 38 deg, 0–85%). No cage moved. One patient had kyphosis recurrence of > 5 deg (12 deg). Five patients demonstrated some settling of the cage within adjacent vertebral bodies (1–8%, mean 3.4% of height loss over construct length – the vertebral body above to the body below). Translational malposition of three cages occurred. One of these cases demonstrated the maximum settling and another was associated with the only case of instrumentation failure. Clinically significant spinal canal intrusion did not occur. One cage demonstrated buckling of the wall without evidence of other problem and the clinical result was excellent.

Discussion: Use of TMCs is safe when managing vertebral body reconstruction. Significant kyphosis or translational deformity has not occurred, however minor cage settling within adjacent vertebra may occur. Fusion rate is unknown as the cage mesh obscures graft maturation. Construct failure has only occurred after pre operative translational malalignment could not be corrected. This demanding procedure offers a reconstructive option with superior structural stability and reduced bone grafting morbidity.

Introduction: Titanium mesh cages (TMC) for the reconstruction of thoracolumbar vertebral body defects offer an alternative to structural iliac crest autograft or allograft. The stability and safety of these cages has not been addressed.

Aim: To assess the stability and safety of titanium mesh cages in the reconstruction of thoracolumbar vertebral body defects.

Method: Independent radiological review before and after surgery, and at follow-up was performed for 27 patients having implantation of TMCs. Measurements of thoracolumbar kyphosis, cage settling, translational deformities and any evidence of implant failure were recorded.

Results: Indications for reconstruction with TMC included burst fracture (13), post-traumatic kyphosis (8), primary tumour resection (3), debridement of infection (1) and stabilisation of severe kyphotic deformity in achondroplasia with spinal stenosis (2). Kyphoses were corrected by a mean of 12 degrees (61%, range: zero degrees to 38 degrees, 0% to 85%). No cage moved. One patient had a recurrence of the kyphosis of more than five degrees (12 degrees). Five patients demonstrated some settling of the cage within adjacent vertebral bodies (1% to 8%, mean = 3.4% of height loss over length). Translational malposition of three cages occurred. One of these cases demonstrated the maximum settling and another was associated with the only case of instrumentation failure. Spinal canal intrusion did not occur.

Conclusions: We found that the use of TMCs was safe when managing vertebral body reconstruction. Significant kyphosis or translational deformity did not occur, however minor cage settling within adjacent vertebra did. The fusion rate is unknown as the mesh cage obscured graft maturation. Construct failure only occurred after pre-operative translational malalignment could not be corrected. This demanding procedure offers a reconstructive option with superior structural stability and reduced bone grafting morbidity.