Factors associated with nonunion in conservatively-treated type-II fractures of the odontoid process.
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Fractures, Ununited↗
Biomedical subjects
D S Korres
Publications and source records attributed to D S Korres.
Intraoperative Bier's block as supplement to insufficient axillary block anesthesia in upper extremity surgery.
The authors reviewed 52 patients who underwent Bier's block, as supplementary anesthesia for insufficient axillary block in upper extremity surgical procedures. Prior to proceeding to the Bier's block, the mean value of pain using the visual optical analogue scale (VAS) was 7.0. In 48 of the patients supplementation with the Bier's block was sufficient (mean VAS score of 1.0) and all patients were comfortable throughout the procedure. In the remaining four patients supplementation with narcotics and sedatives via the other i.v. line was required. Intraoperative Bier's block provides a safe and effective alternative way of successfully compensating for an insufficient axillary block in upper extremity surgical procedures.
Adult↗
The symmetry of the medial collateral and anterior cruciate ligament properties: a biochemical study in the rat hind limb.
The medial collateral (MCL) and the anterior cruciate ligament (ACL) of the rat's knee are frequently used in biomedical research and occasionally in ligament healing studies. The contralateral normal ligament serves as a control. In this study the presence of symmetry in the biomechanical properties of the MCL and the ACL was investigated. Bilateral femur-MCL-tibia and femur-ACL-tibia preparations were obtained from the hind limbs of sixty rats and were subjected to tensile testing to failure under the same loading conditions. Tensile load to failure, stiffness and energy absorption capacity were measured and the mode of failure was recorded. All biomechanical parameters were not significantly different between the two knees of the same animal, although significant individual variation was evident. The most common mechanism of failure was mid-substance tear. Symmetry seems to exist in the biomechanical properties of the MCL and the ACL in the rat knee. When ligament healing is evaluated, increased group size is necessary and the use of a normal control group may be advisable. The contralateral normal knee ligament may serve as a control when the properties of an injured ligament are evaluated and when the parameters of tensile testing failure under similar load conditions are applied.
Animals↗
Treatment of lumbosacral radicular pain with epidural steroid injections.
Fifty patients with an average age of 47 years received epidural steroid injections for lumbosacral radicular pain due to disk herniation or spinal stenosis. All patients had failed previous conservative treatment. Mean follow-up was 24 months (range: 12-36 months). Immediately after injection, all 50 patients reported various degrees of relief from leg and back pain. At the last follow-up examination, 68% of patients were asymptomatic, 20% had no change in preinjection radicular symptoms, and 12% had various degrees of relief. No significant correlation was found between pain relief, age, or number of injections. Early pain relief may be anticipated after epidural steroid injections in 80% of patients with radicular symptoms due to disk herniation or spinal stenosis.
Adult↗
Degenerative spondyloarthropathy of the cervical and lumbar spine in jockeys.
This prospective study analyzed the long-term effects of horse riding on the cervical and lumbar spine of jockeys. Thirty-two jockeys were observed for 13 years. All jockeys had clinical and radiographic evaluation of the spine; three consecutive age groups were studied. Results were compared to age-matched, normal population control groups. The incidence of degenerative changes of the spine was higher in the jockeys compared with the control groups and was more prominent in the older age group for both the lumbar and cervical spine. These findings suggest that equestrian sports, particularly professional horse riding, apart from the increased risk of direct spinal injury caused by a fall from the horse, can lead to progressive spine degeneration as a result of repetitive trauma and increased physical stress on the spine.
Adolescent↗
Pain pattern in multiple vertebral hemangiomas involving non-adjacent levels: report of two cases.
Hemangioma of the bone is a benign tumor usually involving the spine and the bones of the skull and pelvis. It may be either a single lesion or part of a generalized multifocal disease. Multiple lesions involving non-adjacent vertebrae are rare. Two cases of multiple vertebral hemangiomas at non-adjacent levels with different pain patterns are presented at various stages of follow-up in order to emphasize the fact that multiple vertebral hemangiomas may present with different clinical characteristics over a long period of time. The change in the location and pattern of the initially presented pain in both patients suggested the possibility of multiple level involvement. Investigation revealed multiple hemangiomas involving three non-adjacent vertebrae in the first patient and four in the second. We stress the fact that the existence of multiple non-adjacent lesions may remain undiagnosed for a considerable period of time and may be responsible for even longer-term recurrent episodes of pain. Multifocal location of back pain in patients with a known vertebral hemangioma may be considered a relative indication for the presence of multiple non-adjacent level lesions.
Aged↗
Spontaneous interbody fusion after controlled injuries to the spine: an experimental study in rabbits.
To evaluate the rationale of spontaneous spine fusion after a spinal injury, the authors conducted an experimental study that consisted of three types of controlled injuries to a rabbit spine model. The first was injury to the intervertebral disk (type I injury). The second was injury of the intervertebral disk along with injury to one of the adjacent vertebral end plates (type II). In type III injury, both the opposing end plates were injured along with the intervertebral disk. In 38 rabbits, a total of 82 injuries of these three types were inflicted. Twenty-six injuries were of type I (n = 22 rabbits), 26 were type II (n = 24 rabbits), and 30 were type III (n = 26 rabbits). Spontaneous fusion occurred only in type III injuries. From the 30 type III injuries, fusion occurred in 20 (66.6%). For an autofusion to occur, both epiphyseal plates may be injured. In the clinical situation, this observation suggests that a radiographically obscure lesion of both neighboring vertebrae may proceed to autofusion of that spinal segment observed later.
Animals↗
Operative treatment for Maisonneuve fracture of the proximal fibula.
This study reviewed operative treatment of Maisonneuve fracture of the fibula in 26 patients. Operative treatment consisted of restoration of the fibular length, repair of the lateral and medial ankle ligamentous structures, and placement of one or two suprasyndesmotic screws. After average follow-up of 6.4 years, the clinical results were satisfactory in 23 (88.4%) patients. Operative treatment is the treatment of choice for Maisonneuve fractures, and a satisfactory outcome may be anticipated after appropriate management of any associated bony and syndesmotic injuries.
Adult↗
Long-term mechanical stability of the impacted morselized graft-cement interface in total joint replacement: an experimental study in dogs.
This experimental study compared the long-term (12 months) mechanical stability of the morselized graft-cement interface with the conventional bone-cement interface in both femoral bones of 10 adult dogs. For mechanical testing, three-point bending and push-out loading tests of composite bone-cement beams were used, while the incorporation of the graft was assessed by serial radiographs. Although the parameters fracture load and interface failure load showed inferior values in the specimens with a morselized graft-cement interface compared to those in specimens with a conventional bone-cement interface, no statistically significant differences were found between groups. Radiographic reconstitution of the lateral femoral cortex was observed in all animals at 3 months while signs of advanced remodeling were apparent at 6 months. These results indicate the long-term mechanical stability of the impacted morselized graft-cement interface is comparable to that of the conventional bone-cement interface created in primary total hip replacements provided the grafted area is protected from early heavy loading.
Animals↗
Seven- to 20-year outcome of lumbar discectomy.
STUDY DESIGN: A retrospective, follow-up study. OBJECTIVES: To assess the effects of conventional surgery for lumbar disc herniation over an extended period of time and to examine factors that might correlate with unsatisfactory results. SUMMARY OF BACKGROUND DATA: Although the short-term results of lumbar discectomy are excellent when there is a proper patient selection, the reported success rates in the long-term follow-up studies vary, and few factors have been implicated for an unsatisfactory outcome. METHODS: One hundred-nine patients with surgically documented herniated lumbar disc were analyzed, retrospectively, by an independent observer. Long-term follow-up (mean 12.2 years) was done by a mailed, self-report questionnaire that included items about pain relief in the back and leg, satisfaction with the results, need for analgesics, level of activity, working capacity, and reoperations. Subjective disability was measured by the Oswestry questionnaire. Radiographic review was carried out in 66% of patients. End results were assessed using the modified Stauffer-Coventry's evaluating criteria. Several variables were examined to assess their influence to the outcome. RESULTS: The late results were satisfactory in 64% of patients. The mean Oswestry disability score was 18.9. Of the 101 patients who had primary procedures, 28% still complained of significant back or leg pain. Sixty-five percent of patients were very satisfied with their results, 29% satisfied, and 6% dissatisfied. The reoperation rate was 7.3% (8 patients), about one-third of which was due to recurrent disc herniation. Sociodemographic factors predisposing to unsatisfactory outcome, including female gender, low vocational education, and jobs requiring significant physical strenuousness. Disc space narrowing was common at the level of discectomy, but was without prognostic significance. CONCLUSIONS: The long-term results of standard lumbar discectomy are not very satisfying. More than one-third of the patients had unsatisfactory results and more than one quarter complained of significant residual pain. Heavy manual work, particularly agricultural work, and low educational level were negative predictors of a good outcome. These indicators should be used preoperatively to identify patients who are at high risk for an unfavorable long-term result.
Adult↗
The significance of rotation in fracture-separation of the articular pillar of a lower cervical vertebra. A clinical and cadaveric study.
We report 13 fracture-separations of an articular pillar at the lower cervical spine in 12 patients. There were 9 men and 3 women with a mean age at injury of 32 years, with involvement of C4, C5 and C6 vertebrae. Neurological symptoms were present in 9 patients, 2 were classified as ASIA A and 7 as ASIA D. The average magnitude of rotation of the articular pillar was 24 degrees (10 degrees-36 degrees). 4 patients with neurologic deficit and a rotated articular pillar of more than 25 degrees were operated on, while 8 patients, 3 of which had a rotation of more than 25 degrees, had closed treatment. Patients were followed from 8 months to 15 years (mean 9 years). Patients who had closed treatment and/or with a rotated fractured articular pillar of more than 25 degrees had less satisfactory results. This observation was affirmed by cadaveric studies which showed that rotation of more than 25 degrees is an additional factor of instability in a fractured articular pillar.
Adult↗
Surgical treatment of 35 volar Barton fractures. No need for routine decompression of the median nerve.
35 patients with volar Barton fractures were treated operatively from 1985-1994. The injury was due to a high velocity motor vehicle accident in 20 patients. All fractures were closed without major carpal injuries. 11 fractures were type B3.1, 21 type B3.2 and 3 type B3.3. according to the AO classification. All fractures were openly reduced and internally fixated by small buttress plates and screws. In 31 cases, the median nerve was unaffected by the injury and was not explored or decompressed during surgery. The patients were assessed clinically and radiographically after mean 6 (2-10) years. According to the criteria of Pattee and Thompson (1988), 23 patients had excellent results, 10 good and 2 fair. Posttraumatic arthrosis was found in 12 patients and was related to the congruency of the articular surface achieved at surgery. We conclude that the median nerve, when not damaged or compressed, should not be explored or decompressed during surgery.
Adolescent↗
Spinal extradural angiolipoma.
We present a case of an extradural thoracic spinal angiolipoma in a 27-year-old woman. The epidural tumor was evaluated with computerized tomographic scans and magnetic resonance imaging scans. The tumor was removed, and the clinical symptoms improved remarkably.
Adult↗
Old injuries of the lower cervical spine treated surgically.
The present study involves 16 surgically treated patients who had sustained an old injury of their lower cervical spine. This group represents the 29% of the 55 patients that were admitted in our Department with an old injury of the cervical spine. The aim of the present study is to see the effect of surgery on these old injuries in relation to clinical and radiological parameters. Operative treatment was indicated in the presence of instability and the resulting deformity or pain or, more important, in case of further deterioration (or development) of the neurological status. The patients were followed up for 1-14.4 years (mean 5.5 years). At follow-up, fusion was sound in all but 1 patient and the deformity was improved in 12 cases. As for the clinical evaluation, pain was still present in two patients and the neurological status was improved in all but one patient with complete tetraplegia. Surgical treatment is of value irrespective of time delay to avoid fixed deformities and/or permanent neurological lesions.
Adult↗
The "tear drop" (or avulsed) fracture of the anterior inferior angle of the axis.
Fourteen cases of an anterior inferior angle fracture of the axis treated in the Orthopaedic Department of the University of Athens from January 1970 to December 1992 were analysed. The mean follow-up time was 8.5 years. The so-called "tear drop" fracture of the axis composes a special entity characterised by an avulsed fragment, of varying size, from the anterior inferior angle of the body of the axis as a result of hyperextension. This type of injury is not a frequent one, representing 3% of the cervical spine trauma in our Department. There were eight men and six women with a mean age of 47 years. Road traffic accident is by far the most common mode of aetiology. The stability of this lesion is questioned by certain authors, resulting in disagreement concerning the choice of treatment to be followed. All the patients in our series were treated conservatively, consisting at the beginning with Glisson traction and then the use of a simple cervical collar. The rotation of the detached fragment, its anterior displacement, the posterior displacement of the vertebral body as well as the presence of instability at the C1-3 levels were analysed. The high incidence of co-existing lesions at the same or at a more distal level is discussed. This study revealed that there was no significant displacement of the vertebral body, and thus disturbance of the posterior ligaments, rendering the fracture stable.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
The anterior inferior angle fracture of a lower cervical vertebra.
Thirty-eight cases of a "tear drop" fracture of the lower cervical spine treated in our department during the last 20 years are reported. They represent 8.3% of all cervical injuries. We classified our cases into four types with regard to the extent of the bony lesion and the resulting posterior displacement of the vertebral body. Posterior displacement is of paramount importance. Neurological lesions were present in 52.6% of the patients, and they were related to the type of injury. Five patients died, and 33 were followed up for a mean period of 10 years. Five patients were operated on. All patients with a complete neurological lesion remained unchanged irrespective of the type of treatment. Incomplete neurological lesions showed a better tendency to recover after surgical treatment. Types III and IV are the more serious lesions, and they represent an absolute indication for surgical treatment. Type I is more benign and, if treated properly, has a good prognosis similar to type II.
Adult↗