Background: The Wallis Interspinous implant was developed as a minimally invasive and anatomically conserving procedure without recourse to rigid fusion procedures. The initial finite element analysis and cadaver biomechanical studies showed that the Wallis ligament improves stability in the degenerate lumbar motion segment. Unloading the disc and facet joints reduces intradiscal pressures at same and adjacent levels allowing for the potential of the disc to repair itself.

Aims & Methods: The purpose of this prospective study is to demonstrate the survivorship and clinical effectiveness of Wallis implant against low back pain and functional disability in patients with degenerative lumbar spine disease. Patients were assessed pre operatively and post operatively every 6 months by VAS pain score, Oswestry Disability Index, SF-36. All the patients had pre operative radiographs, MRI scans and followed up with interval radiographs. The results were assessed in three sub groups. Group-1 is decompression and stabilisation, group-2 is stabilisation alone, and group- 3 is “Topping off” a fusion.

Results: A total of 211 Wallis Ligaments were inserted in 203 patients between July 2003 and November 2006. In total 179 patients were reviewed with mean age of 54(24–85) were followed for an average 30 months (6–40). The most common level is L4/5 (59%) followed by L3/4. In all the subgroups pain scores and oswestry disability index improved by 50%. And similarly SF-36 scores improved. There is 75–80% good clinical outcome with a survivorship of 98–99%.

Low infection rate of 1.1%. Two cases of prolapsed discs at the same level requiring further discectomy and one case of iatrogenic L4 paraesthesia.

Conclusions: The Wallis ligament represents a successful non fusion alternative in treatment of degenerative lumbar spine disease with least soft tissue damage, quick rehabilitation, less morbidity and associated low complication rate.

The Wallis implant treats pain, preserves mobility, anatomy and stability while being fully reversible, therefore leaving all subsequent options open.

Purpose of Study: To prospectively study the clinical and radiological outcomes following lumbar interbody fusion with an intersegmental device(SpineLink™, Biomet) in smokers versus non smokers.

Materials and Methods: 64 patients who underwent spine fusion with intrasegmental fixation were prospectively studied at Mayday University Hospital. 54 patients with suffient follow up were included. Patients were assessed pre and postoperatively clinically using validated scoring systems (VAS pain score, SF-36 v1, Oswestry Disability Index). Radiologically classified into fused, indeterminate or pseudoarthrosis.

Results: There were 54 patients in the analysis (34 patients in the smoker group and 20 patients in the non smoking group) with an average age of 52 years and an average follow-up of 28 months. 32 patients had multilevel procedures (25 two level, 5 three level, 2 four level). The treatment groups were comparable with respect to demographic, diagnostic (53% spondylolisthesis, 35% degenerative disc disease, 12% other) and surgical variables. No other significant medical problems affected patients in either group. Radiographically there were no pseudarthroses observed in either group. The SF-36 physical health score increased from 22.4 to 40.1 (+18.0) following surgery in smokers compared to an increase from 25.0 to 36.0 (+11.0) in non-smokers. The SF-36 mental health score increased from 36.4 to 45.0 (+8.6) in smokers compared to an increase of 30.8 to 42.7 (+2.9) in non-smokers. Complications included 2 nerve root injuries requiring hardware removal, and 3 deep infections which resolved with appropriate treatment.

Conclusions: There were no differences between smokers and non-smokers in radiographic fusion success or postoperative complications. As expected, smokers had lower SF-36 physical health and mental health scores pre-op, but unexpectedly, smokers had a greater degree of improvement in these scores postoperatively than non-smokers. Thus, from our experience, there is an incremental benefit to the use of intrasegmental fixation in smokers and warrants further investigation.

Introduction: Paediatric Pelvic fractures are rare and constitute only 1% to 3% of all fractures in children; they are different from other fractures in children due to concomitant injuries that occur immediately.

Method: A retrospective analysis was performed in order to review the pattern of paediatric pelvic fractures, indications for surgical treatment and outcome of pelvic fractures in children. In our study we included paediatric patients with significant pelvic fractures, who were treated surgically between 1992 and 2004. We excluded tendon-bone avulsion injuries and acetabular fractures from study.

Results: We treated 29 paediatric pelvic fractures in this duration. Mean age was 14.17 (5 to 17) years. All of these patients had procedure under general anaesthetic under care of single consultant. 10 had ORIF of pelvis, 13 had external fixator application, 5 had sacral screw fixation and 6 had examination under anaesthesia. We shall discuss the results in detail in presentation

Discussion: We concluded that although pelvic fractures in children are uncommon but require early diagnosis and management and this should not differ greatly from those in adults.

Displaced supracondylar fractures of the paediatric elbow are a serious, but well described injury. Although complications are common, avascular necrosis (AVN) of the capitellum has not been described or reported before. We describe a case with this complication. A review of the relevant literature is also presented

A three-year-old boy presented to our emergency department with a painful swollen left elbow after a fall. X-ray done in Accident and Emergency, reveal, a displaced, extension type, supracondylar fracture (Gartland Grade III¹). An open reduction (medial approach) was done and the fracture reduced and stabilised with two crossed K wires.

The fracture healed in an excellent position. However, at the three-month follow up, the elbow remained stiff with flexion from only 20 to 90 degrees and with very little supination. Eight months after the injury an arthrogram was undertaken which confirmed diagnosis of avascular necrosis of capitellum. No specific treatment for AVN given. Check radiographs showed healing of capitellum with no functional limitations.