The reported results of compression fractures are poor. These results are not influenced by the severity of compression, the fracture site or the residual deformity. Otherwise, the factors that determine a patient's recovery are unknown. This study wants to identify the factors determining a patient's recovery after surgical treatment of compression fractures of the thoracolumbar spine. Therefore, in 31 surgically treated patients the pre-injury versus the 12-month follow-up differences in back pain, in global outcome and in participation were prospectively recorded. For this, the visual analogue scale for pain (VAS scale) and the Greenough and Fraser low back outcome scale were used. Of the latter scale, the 3 questions pertaining to participation were combined to create a participation subscale. For these differences and for time lost from work multiple linear regressions with combinations of 16 possible predictors were performed.

At one year patients who smoke report a 25% less favorable global outcome and return 2.8 points (out of 10) less closely to their pre-injury pain level than patients who do not smoke. Patients with a fracture at the thoraco-lumbar junction return 3.3 points less closely to their pre-injury level on the VAS scale than those with a lumbar fracture. For each decrease in 1 of the 3 education levels, the patients stay away from work 15 weeks longer. Per degree of sagittal index at follow-up, patients stay 9 days longer at home. For each increase in level of occupation the return to the pre-injury participation level is 10% less favorable. The variability of time lost from work and of recovery of global outcome, pain and participation level explained by our models is 73%, 37%, 25% and 13% respectively.

Smoking, localization of the fracture at the thoraco-lumbar junction and a high pre-existent level of occupation are strong negative predictors for recovery. A lower education level and sagittal fracture deformity at follow-up are negative predictors for sick leave but might also reflect the concerns of the physician when deciding about return to work.

Introduction: Now that evidence base medicine gains importance scientifically good evaluation of the results of treatment is fundamental. There exist however a large number of evaluation tools for dorsolumbar disorders. These tools measure different aspects of outcome, like pain, impairment, handicap, disability, satisfaction and health perception. These tools are not always well validated either. These problems make it difficult to select the appropriate test for different purposes.

Aim of the study: To compose and evaluate a system of outcome measuring tools that covers most aspects of outcome and that is relevant to spine surgeons.

Materials and Methods: The tests were selected from literature, based on their scientific validity, their relevance, the frequency of their use by others and the ease of their use. The visual analogue scale for pain (VAS-pain), the low back outcome score (LBOS), the handicap subsection of the LBOS, the finger-tip to floor test (FTFT), The Oswestry disability index (ODI) and patient satisfaction were tested in a group of “pure-dorsolumbar-disorder-patients” (selected from a trauma group) and in a group of patients with degenerative disorders, as encountered in a spine surgery practice. The prospectively gathered pre- vs. postop. differences obtained with the different tests were compared with those obtained with the Oswestry disability index, which was chosen as “golden standard”. The obtained correlations (Kendall’s rank correlation coefficients and point-biserial coefficient) are a measure for the construct-validity and responsiveness of the different tests.

Results: The correlation with the ODI was: weak and not significant for VAS-pain in the degenerative group, for FTFT-distance in both groups, for FTFT-pain in the trauma group and for satisfaction in both groups. The same correlation was weak but significant for the VAS-pain in the trauma group and for the LBOS-handicap part in the trauma group. It was moderate for LBOS and the LBOS-disability part in both groups, for the LBOS-handicap part in the degenerative group and for FTFT-pain in the degenerative group. There was no correlation of satisfaction with the other tests. Correlation of FTF- pain with VAS-pain was not significant in the degenerative group and moderate and in the trauma group.

Aims: To explore potential predictors of functional outcome after conservative treatment of acute fractures of the base of the fifth metatarsal. These fractures are the most frequent fracture of the foot. The factors that influence final clinical outcome are rarely investigated. Regression analysis regarding this problem was never performed.

Methods: The study design was observational and retrospective. Adults, conservatively treated for an acute fracture of the base of the fifth metatarsal included. All patients were given a plaster cast at the emergency department and were instructed not to bare weight (NWB) on the affected limb for at least one week. The further modalities of treatment were decided by individual surgeons according to their current clinical practice. A validated scoring system was used. Additional questions were asked about residual cosmetic and shoe problems and also about intensity of pain and the general feeling of comfort. The respective influences of factors on clinical outcome were examined using multiple linear and logistic regression modeling.

Results: 38 patients (11 men, 27 women) were analysed. The mean age was 48 years. 6 had a Jones fracture, while 32 had a tuberosity avulsion fracture. The mean non-weight bearing period was 2 weeks and 4 days (range 1 to 5 weeks) while the cast was worn for a mean of 5 weeks and 3 days (range 1 to 10 weeks). Three Jones fractures and all the avulsion fractures were healed at the end of treatment. The mean follow-up time was 298 days, ranging from 51 to 603 days. The mean result of the ankle score at follow-up was 77.5 (range 20 to 100). Thirteen of the 38 patients reported problems in wearing shoes. Only 8 patients experienced cosmetic problems. The mean linear analogue score for pain was 2.34, that for general comfort was 8.11. Overall, the most significant predictors of poor functional outcome at final follow-up evaluation were increasing duration of NWB and longer follow-up time. Longer NWB was importantly associated with worse global score, pain, comfort and reported stiffness. Neither gender nor fracture type had any significant influence on the overall clinical outcome.

Conclusions: The most important variable linked to final clinical outcome is the duration of the non-weight bearing period. Neither gender, age, length of casting nor even fracture type, had any significant influence on the overall clinical outcome. Therefore NWB should be kept to a minimum for acute avulsions.

Introduction Osteoarthritis of the knee is a very common disease.In 80 to 90% of the cases it starts in the medial compartment and tends to remain there.Therefore, the Oxford Unicondylar Knee Prosthesis (OUKP) is a attractive device as it only replaces the diseased parts of the knee.For the past 15 years, the results of the OUKP, especially those achieved by the designer’s group, have mostly been very good. However, reports about long-term follow-up are scarce. For the designer group, Murray reported a 98% ten year survival. The only independent research bij Svard an Price and by Lewold of the Swedish Arthroplasty Study showed a good survival of 95% at 10 years and a poor survival of 87% at 8 years respectively.Our independent study reviews a ten year follow up of 149 OUKP’s.

Methods and Results One hundred forty-nine medial prostheses were implanted in 140 patients between 1988 and 1996. After a mean of 67 months 28 patients had died, without the need for revision. Seventeen prostheses were lost to follow-up. Revision surgery using a total knee prosthesis was performed in 16 cases. In 4 others, a lateral prosthesis was implanted subsequently to a medial one. One of these 4 was revised to a total knee prosthesis 6 years later. In another 4 cases, late complications of the meniscal bearing were treated with replacement of this bearing. In the group af patients older than 75 years, no revisions were recorded. The surviving prostheses were seen back after a mean of 126 months. The cumulative survival rate at 10 years was 82% for the whole population and 84% when knees with a previous high tibial osteotomy were excluded.

This difference is significant (p=0,0000).

Conclusion These results are in line with those of the Swedish arthroplasty register and compare poorly to the survival of total knee arthroplasty, therefore this prosthesis is not the first choice for most cases. Because it preserves a maximum of bone stock and is revised to a total prosthesis almost without difficulty, it is the first-choice implant for medial unicompartmental osteoarthritis in the relatively young patient.The survival rate in the group of patients older than 75 years is as good as or better than that for total knee arthroplasty.Since the OUKP can now be placed minimally invasive, it might have its place in this subgroup. It should not be used in osteotomized knees.

Aims: To assess the long-term results of the Oxford Uni-compartmental knee prosthesis for unicompartmental osteoarthritis and to discuss these results in comparison to other, scarce, long term follow-up. Methods: Sixty-þve medial and 6 lateral prostheses were placed in 67 patients. After an average of 10 years, they were evaluated with the Hospital for Special Surgery (HSS) knee score. Results: Fifteen patients died after a mean of 7 years, without need for revision. Eight prostheses were lost to follow-up. Ten (16%) revisions were noted: in 4 cases (6%) this was associated with an initially poor operative indication or a postoperative malalignment. The mean HSS score in 35 medial and 3 lateral prostheses was 164. (79% excellent or good, 10.5% moderate and 10.5% poor results) compared to 168 at 4.5-years of follow-up. There is no signiþcant difference between the score of patients older and patients younger than 65 years of age. Conclusions: Because this type of prosthesis preserves a maximum of bone stock and is revised to a total prosthesis without much difþculty it is the þrst choice prosthesis for medial unicompartmental osteoarthritis in the relatively young patient. In the light of other, very scarce long-term follow-up series, and compared to follow-up of total knee prostheses, the revision rate is high. Therefore, in spite of the very good and lasting HSS score in this group, this prosthesis is not the þrst choice in the elderly.

Aims: To assess the results of the Oxford unicompartmental knee prosthesis, and compare these with other prostheses. Methods: Ninety-seven prostheses (87 medial; 10 lateral) in 86 patients were evaluated with the HSS (Hospital for Special Surgery) score after 2–14 years (mean follow-up: 6 yrs-9 mos). Results: Five prostheses were lost to follow-up. Eight patients died after a mean of 7 years, none of them had undergone a revision. Fourteen revisions (of which 1 bilateral unicompartmental knee prosthesis), 11 medial and 3 lateral, were performed. The mean HSS-score of the 69 UKPñs is 178.8 (80% excellent, 10% good, 4% fair, 6% poor). Conclusions: With proper patient selection (i.e. degenerative medial unicompartmental arthritis, good range of motion, sedentary occupation and with a light body weight) and a consistent operating technique, the results are good. It is the þrst-choice prosthesis for the relatively young patient (with regard to later revisions). Since we also obtain good results in the elderly, it seems a good choice of treatment in this group.

Aims: To throw a new light on the fragmentary information from litera-ture, to add information to the mechanism of this injury, to clarify the cloudy treatment indications in the group between 4 and 10 years and to report the outcome of conservative treatment after a mean of 80 months. Materials: After reviewing the þles and X-rays, 11 children were included in this series, according to strict criteria. The decision for closed reduction depended on the severity of the deformity, on the associated lesions and on the age of the patient. At follow-up, they were subjected to a thorough anamnesis and clinical evaluation with speciþc concern about pain, function and cosmesis. Comparative X-rays to evaluate the remodeling were made in a standardized way. Results: The mean age at the trauma was 7 years. (4 to 12) In 3 patients, the fracture was caused by a transverse force. The diagnosis was missed 3 times. Five patients were simply put in a plaster cast, in 6 others closed reduction was performed þrst. In 8 patients a residual curve was accepted. After the age of 6, spontaneous remodeling was poor, with a bad cosmetic result in 1 case (residual curve of 11û) and a functional problem in at least 1 other case. Conclusions: 1. Contrary to literature, these injuries can be caused by a transverse force as well. 2. Spontaneous remodeling is far less than generally accepted. 3. Curves > 10û need reduction with an adapted technique from as early as 7 years of age on.