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S Taller

Publications and source records attributed to S Taller.

11 recordsLinked to original sources
PubMed2006

[Surgical treatment of fracture of the ring of axis - "hangman's fracture"].

PURPOSE OF THE STUDY: To evaluate surgical management of the fracture of the ring of axis (FRA), known as "hangman's fracture", and to discuss adequacy of this treatment. MATERIAL AND METHODS: Between 1994 and 2004, 41 patients with FRA were surgically treated in our hospital. We present a retrospective study of 30 cases treated by anterior cervical fixation and fusion and 11 cases treated by a posterior, CT-guided approach (published recently). Our diagnostic algorithm for evaluation of FRA included plain radiographs for basic diagnosis, detailed CT scan, MRI and finally passive lateral flexion-extension fluoroscopy (performed by physician) to assess stability. We also consider discography in selected cases, allowing further evaluation of discoligamentous injury. Fractures were classified according to Levine. Posterior compressive osteosynthesis according to Judet was performed in 11 patients with Levine type I fractures with fracture fragment distraction > 3 mm. Anterior graft and plate fixation was chosen in 30 patients with type II (25 patients) and type I (5 patients) fractures where C2/3 disc injury was confirmed by MRI or discography. There was no case of facet dislocation in our series (type III). Pain, motion restriction and overall satisfaction with neck status were assessed on a scale 1-5 (1 = best) in patients treated with anterior approach. Self-evaluation questionnaires were administered during follow-up (average, 7.3 years; 24 months to 11 years). RESULTS: Anatomically reduced fracture fusion was achieved in all cases (100%) at one year follow-up. Both autologous tricortical (22) and fibular allografts (8) were used for anterior approach. No perioperative complications occurred and no case was aborted. Average hospital stay in patients with standalone FRA was 6.8 days (3-15). Patients wore Philadelphia collar for 4-6 weeks. One patient died during follow up due to unrelated causes. None of the 29 patients treated with the anterior approach reported severe or very severe pain (grades 4 or 5). The average pain score was 1.28. Three patients with isolated FRAs reported slight subjective restriction of movement (grade 2). The "satisfaction with overall neck status" scale showed an average score of 1.62, never worse than grade 2. DISCUSSION: Despite increasing popularity of anterior surgical approach in the treatment of type II FRA, most authors still recommend conservative treatment. Surgical treatment is consensually recommended in type III fractures only. Type I is treated exclusively conservatively. There is currently no evidence-based data supporting any method of treatment of so called "hangman's fracture". The majority of treating surgeons do not consider the status of the intervertebral disc. Dynamic films, simulating the peak point of injury, are usually not performed. Hence, potentially unstable fractures are overlooked. This also explains the lack of long term follow-up data regarding the radiological status of C2/3 intervertebral disc as well as patients' subjective complaints. CONCLUSIONS: Surgery provides plausible results. Compared to conservative treatment, it can offer significant benefits: 1) immediate, better and stable reposition; 2) high fusion rate; 3) shortening of the treatment period with better quality of life. Contrary to conservative treatment modalities, surgery possesses a potential for further development.

Adolescent↗
PubMed2005

[Urgent management of the complex pelvic fractures].

AIM OF STUDY: The term "complex pelvic fractures" is reserved for pelvic ring fractures associated with soft tissue injuries in the pelvic region and with haemodynamic instability of the patient. These fractures represent only 10% of all pelvic fractures; however, the morality rate exceeds 33%. This study describes the algorithm of the urgent treatment of serious pelvic ring injuries. METHODS: Urgent application of pelvic clip or external pelvic fixator is considered as a part of the reanimation period. If the external pelvic ring fixation is not followed by stabilization of patient's circulation, the pelvis packing using the lower middle incision without opening of the abdominal cavity must be executed within a short time. The absence of the intraabdominal bleeding is essential. If the pelvis packing does not improve patient's haemodynamic conditions, the bleeding should be controlled by angiography and embolization or by direct ligature of the internal iliac artery. In the most severe cases, hemipelvectomy would be carried out as the life-saving procedure. DISCUSSION: Extreme blood loss associated with complex pelvic ring fractures is possible due to enlarged volume of the injured pelvis. This is caused by a gap within the symphysis or in the region of the pubic rami and by a shift in the posterior pelvic segment. In such situation, waiting for the self-packing of pelvis by haematoma can be dangerous. In case of parapelvic compartments disruption, the effect of the self-packing would not come at all. The management of the pelvic ring fractures should be completed by a surgical procedure, because non-surgical treatment is mostly disappointing. The best results can be achieved only by the early operation of the anterior and posterior pelvic segment aimed at the realignment of pelvic ring and proper anatomical relations. CONCLUSIONS: Complex pelvic ring fractures require the aggressive approach. The basic reanimation procedures include application of the pelvic clip. This is the only way how to control extensive haemorrhage associated with the pelvic ring fractures and how to improve patient's haemodynamic conditions. The final surgical treatment of the pelvis fractures should be completed early after the injury. This is within the competence of specialized centres.

Adolescent↗
PubMed2003

[Surgical treatment of dislocated transverse fractures of the sacrum].

PURPOSE OF THE STUDY: Transverse fractures of sacrum are quite rare. Only about 70 cases have been reported in the relevant literature. Low frequency and rather difficult fracture imaging lead to therapeutical uncertainty and are a cause of a delay of urgent surgery. MATERIAL AND METHODS: A group of three male patients aged 17.43 and 31 years was studied. Two patients sustained the injury at a paragliding accident, one by fall from height. One patient underwent only a simple spinal canal decompression 24 days after the injury. The second patient underwent surgery on the fourth day and in the third patient the procedure was carried out sixteen hours after the injury. Procedure on the second and third patient included decompression of neural structures, fracture stabilization as well as spinal-pelvic fixation using an internal fixation. RESULTS: The delayed simple spinal canal decompression didn't improve patient's condition. On the other hand, surgeries performed urgently in the other two patients provided a considerable improvement of the neural deficit. DISCUSSION: Transverse fractures of the upper part of sacrum without any concomitant pelvic fracture are rare and rather difficult to diagnose. Clinical symptoms are inconclusive. However, low back pain, numbness in lower extremities and in the genital, anal region anesthesia should induce the suspicion of this type of trauma even in cases of normal AP and lateral lumbar spine X-rays. In addition to neurological investigation, a lateral x-ray of sacrum and CT and NMR imaging are essential. Conservative treatment, even if complemented with halo-femoral traction does not provide satisfactory results. Also the simple spinal canal decompression gives no contribution to the patient's recovery. Authors suggest a staged surgical procedure providing decompression of neural structures, reduction and stable fixation of the fracture (using screws and plates) and spinal-pelvic stabilization (using the internal spine fixator). Urgent and comprehensive treatment of this type of injury facilitates patient's early mobilization, enables his early discharge and improves neurological recovery. CONCLUSION: Severely displaced fractures of sacrum associated with a neural deficit require the same urgent and comprehensive treatment as vertebral fractures succeeded by a spinal cord injury. Due to low incidence of such injuries patients should be treated at highly specialized centers experienced with this type of surgery.

Adolescent↗
PubMed2003

[100 CT-guided pelvic operations].

PURPOSE OF THE STUDY: The authors present their 10-year experience with the computed tomography (CT) assisted insertion of implants in the sacroiliac (SI) region and acetabular region. Indications for these interventions and their detailed descriptions are reported. MATERIAL: A total of 98 patients, with the average age of 40.7 years and prevalence of men (70%), were treated. The most frequent cause of injury was a car accident, second in rank was fall from a height. Of these patients, 86 were followed up from 2 months to 3 years. METHODS: The surgical procedure was carried out in the CT department, in which conditions were provided to meet the criteria of an operating theatre. Computed tomography was used to plan the exact position of the implant and, during the procedure, to guide its precise insertion. These procedures required close cooperation of the surgeon and radiologist. A total of 73 CT-guided operations were performed on the SI region, using iliosacral screws or sacral rods. The operation was always preceded by surgery on the anterior pelvic segment. Iliosacral screws were also used in six patients operated on for pseudoarthrosis of the sacrum or chronic instability of the SI joint. The screws were also used in 19 patients who underwent surgical intervention in the acetabular region; in 14 cases it was for a fracture of the acetabular rim. All procedures were carried out by this minimal invasive technique. RESULTS: In all cases, correct insertion of the implant was achieved. There was only one serious preoperative complication due to the fact that the guidewire deviated from its planned direction without this being shown by CT scan. A late infectious complication following iliosacral screw application was recorded in one patient and, in another patient, a nut loosened on one side of the sacral rod. These implants, temporally immobilizing the SI joint, were removed at periods of 6 to 9 months after the operation. There was no case of secondary dislocation of the SI joint after the implant was removed. Complete bony healing of the fractures treated, including pseudoarthrosis, was achieved in all our patients. A comprehensive evaluation of the clinical results of CT-guided operations was difficult because of large inter-individual differences in the extent of pelvic injuries. DISCUSSION: CT-guided interventions are currently indicated predominantly for fractures of the sacrum or displacement of the SI joint up to a 15 mm distance. It is necessary to re-evaluate the extent of displacement after an exact reconstruction of the anterior pelvic segment and restoration of the anatomical conditions. The displacement in the posterior segment usually becomes markedly reduced. The simultaneous surgical treatment of both the anterior and posterior pelvic segments results in restoration of pelvic girdle continuity and maintenance of good stability of the pelvis. This permits early rehabilitation and mobilization of the patient. Other conditions indicated for CT-guided surgery include simple fractures of the acetabular rim with a distance between the fracture lines up to 7 to 10 mm, usually following hip dislocation, and simple oblique fractures of the acetabular columns. CONCLUSIONS: The CT-guided surgical procedure allows us to assess both the shape and course of fracture lines or distance between the injured structures. It also enables us to choose the optimal direction, in relation to these structures, for an implant to be inserted and to respect important anatomical structures in the surroundings. It helps us to determine the exact length of implants to be used. During the procedure, repeated CT scans facilitate checking the direction and position of both instruments and implants. In the closing phase of the operation, it is possible to assess closeness of the bones screwed together, the definitive placement of the implants and their reliable fixation. This method also permits to check whether a screw did not penetrate through the opposite cortical bone.

Adolescent↗
PubMed2002

[Primary osteosynthesis of the odontoid process: a multicenter study].

PURPOSE OF THE STUDY: Direct osteosynthesis is a method of choice for the treatment of odontoid process fractures. It is based on insertion, from the anterior approach, of one or two screws from the C2 body into the apex of the odontoid across the fracture line. The tensile action of screws results in compression of fragments and stabilization of the fracture. The aim of the study was to evaluate a group of patients treated by this method and to compare our results with those reported in the foreign literature. MATERIAL: A total of 99 patients were treated by direct osteosynthesis of the odontoid in the departments involved in the study between 1994 and 2001. METHODS: Patients indicated for this surgery were those with fractures of type II according to Anderson and D'Alonzo and those with type III fractures but only when the fracture line went across the articulation surfaces of C1-C2, when closed reduction was not possible or the patients were not indicated for halo fixation. Direct osteosynthesis was not applied to fractures with comminution at the base of the odontoid, irreducible fractures, odontoid fractures combined with dislocated fractures of the atlas or pathological fractures. Severe kyphosis of the cervical spine or a large thoracic cage was also regarded as a contraindication. RESULTS: All the 99 patients were followed up from 3 up to 102 months, with an average of 28.5 months; only in seven patients, the follow-up period was shorter than 6 months. The most frequent subjective complaint was a painful operation wound. This usually resolved within two weeks of surgery. Except for four patients, alle were satisfied with the outcome. Type II fractures were diagnosed in 84 and type III fractures in 15 cases. A total of 174 screws were inserted into the odontoid processes of 99 patients. A single screw was used in 25 and two screws in 73 patients. In one case, three screws had to be inserted. Screw lenght ranged from 36 to 44 mm, diameter was 40.9 mm. Three months after surgery, X-ray examination, both in flexion and extension, did not reveal any instability in any of the patients. No morphological change in the C2-C3 intervertebral space was observed Of 92 (92.9%) paitents under longterm follow-up, 84 (91.3%) showed complete healing of the fracture, three died and five patients eventually developed pseudoarthrosis, which was due to a broken screw in three of them. This condition was treated by dorsal fixation of C1-C2 according to Magerl or by one of the dorsal cerclage techniques. The group was free of any perioperative complications related to the anterior approach or injury to nerve structures by screws. DISCUSSION: The most frequent subjective complaint was a painful operation wound. Treatment of odontoid fractures varies according to the type of injury, bone quality and also practice at each department. Type II injuries are highly unstable and, because of the small fracture surface, their healing ability is much lower than in type III fractures. Previously, most of the patients with odontoid injuries were treated conservatively by immobilization in a plaster cast or a brace or, later, by a halo device. In the long term, however, they showed a high proportion of pseudoarthroses (10 to 100%). Direct osteosynthesis of the odontoid by screws permits the maintenance of rotation of the C1-C2 mobile segment. We followed the scheme of indications used abroad but did not perform osteosynthesis to correct pseudoarthrosis. The number of osteosyntheses healed (91.3%) was also in agreement with the literature data. Earlier, we used two screws for all types of fractures. Recently, we have preferred insertion of a single screw in type II and III fractures in narrow odontoids. In the later, there is no danger of rotational dislocation during screw insertion; to insert one screw from the centre of the C2 base is easy and speeds up the procedure. However, in displaced type II and type II T fractures, two screws are a necessity. Similarly to other authors, we recorded a slight limitation of cervical spine rotation in patients at long-term follow-up, particularly in elderly subjects with advanced osteochondrosis. No complications leading to deterioration of the patient's state were recorded. CONCLUSIONS: Direct osteosynthesis is a method of choice for most of the type II and indicated cases of type III fractures of the odontoid process of the axis. This surgical procedure facilitates restoration of anatomical conditions of the spine and its immediate stability. Consequently, patients can be readily mobilized and rehabilitated.

Adolescent↗
PubMed2000

CT-guided internal fixation of a hangman's fracture.

Most hangman's fractures are treated conservatively. If surgery is indicated, an anterior approach using a C2/C3 graft and plate fusion is usually preferred. Another surgical method according to Judet is direct transpedicular osteosynthesis by the dorsal approach. This surgery is frequently rejected because of the high risk of spinal cord damage or vertebral artery tear. Direct transpedicular osteosynthesis of hangman's fracture according to Judet is a "physiological operation" that does not cause fusion and creates anatomical conditions. This procedure enables appropriate reduction, compression of fragments and immediate stabilization of the C2 segment. A new aspect of Judet's method of internal fixation of a hangman's fracture is now proposed. Computed tomographic (CT) guidance is used to ensure safe and exact introduction of two screws from the posterior approach. This method of CT-guided internal fixation of hangman's fracture allows, preoperatively, for an accurate assessment of the pattern and course of fracture line, selection of the anatomically safest screw path and determination of an appropriate screw length. The procedure also allows for accurate intraoperative control of instrument and implant placement, screw tightening, fracture reduction and anchoring of the screw tip in the contralateral cortex, using repeated CT scans. The procedure is performed in a CT unit under sterile conditions. This method was used in the treatment of eight male and two female patients aged 21-71 years. All treated patients were without neurological deficit. Follow-up ranged from 12 to 57 months (mean 33.3 months). No intraoperative or early or late postoperative complications were apparent. This new aspect of the surgical procedure ensures highly accurate screw placement and minimal risks, and fully achieves the "physiological" internal fixation.

Adult↗
PubMed2000

[Surgical treatment of fractures of the odontoid process].

Forty-one cases of C2 odontoid process fractures, from a group of 273 surgically treated cervical spine trauma patients, were treated by anterior screw fixation during a 6-year period. There were 37 patients with Anderson and D'Alonzo type II. fractures and 4 with type III. The mean age of the patients was 52 years and the fracture was caused by falls in most cases. Medical complications were not observed during surgery, but in 3 patients, implant-related technical problems were recorded. In the 3-month follow-up, 2 patients died because of medical complications not related to the procedure. There were no other complications in the remaining patients. We included 21 patients in a 6-month follow-up. In 19 of them, the fracture healed (90.5%), while in 2 patients osteosynthesis failed, which required further stabilization. In the authors' opinion, direct osteosynthesis should be considered the method of choice in most C2 type II fractures as well as in some of type III fractures.

Adolescent↗
PubMed1995

[CT-guided pelvic osteosynthesis. Preliminary report on a new operative technic].

The authors proposed new method for surgical treatment of slightly dislocated fractures of the sacrum and acetabulum and also small traumatic dislocations in the sacroiliac joint. Cannulated screws were used for percutaneous osteosynthesis under guidance of computerised tomography. CT guided surgery enables to choose the correct direction and length of introduced screws with regard to the shape and localisation of the fracture. During the step by step procedure the reduction effect can be directly checked and the surgical strategy immediately modified. The advantages of this method are minimal invasiveness, high accuracy and possibility of rapid mobilisation of treated patient.

Adult↗
PubMed1990

[Halo fixation for injuries of the cervical spine].

The authors present the treatment of 16 serious cervical spine fractures by halo traction with the restoration of anatomic condition and significant improvement of the neurological state. The authors describe the technical equipment of their own construction, the method and advantages of the treatment. The results achieved have proved that the halo traction considerably improves the possibilities of the conservative treatment of cervical spine injuries. With reliable fixation in the anatomic position it promotes more rapid mobilization of the patient and substantially reduces the period of hospitalization.

Adolescent↗