PubMed · 4412211
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E Rontal, W Meyerhoff, K Wilson. 1974. Biphase external fixation: technique and application.. https://doi.org/10.1288/00005537-197408000-00016
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A case of an unusual lumbosacral fracture-subluxation associated with bilateral fractures of the first sacral pedicles is described. The authors are aware of only one reported case in the literature. A 58-year-old man was involved in an accident during which his trunk was severely twisted toward the left and flexed. He also demonstrated L5 and S1 radiculopathies. He was successfully treated with surgical decompression of the L5 and S1 nerve roots with bilateral foraminotomies, followed by posterolateral arthrodesis at the lumbosacral junction using a transpedicular screw system that extended fixation into the ilia.
Thirty-seven children with fresh, displaced (more than 2 mm in any direction) fractures of the lateral condyle of the humerus were treated by open reduction and internal fixation with a partially threaded 4.0-mm diameter AO lag screw. They were reviewed at a mean follow-up of 4.8 years. Painless, full-elbow movements were obtained in 36 cases. Delayed union, with loss of 10 degrees of elbow motion, was observed in one case (2.72%). Radiologically, less than 4 degrees of varus deviation, compared with the contralateral side, was found in four cases (10.8%). Mild fishtailing was observed in three cases (8.18%). Nonunion, avascular necrosis or clinically significant premature epiphysial fusion was not observed. Elbow function was excellent, irrespective of minor radiologic abnormalities.
We studied the morphology of the thoracic vertebrae in the spines of seventeen human cadavera in order to define parameters that could be used as guidelines for the placement of hooks and screws in the pedicles to obtain internal fixation. We also reviewed computerized tomographic scans of nineteen thoracic spines in living patients who had no evidence of any vertebral deformity. The transverse diameter of the pedicle, which helps to determine the size of the screw, ranged from a mean (and standard deviation) of 4.5 +/- 1.2 millimeters in the fourth thoracic vertebra to a mean of 7.8 +/- 2.0 millimeters in the twelfth thoracic vertebra. The pedicles were inclined anteromedially throughout the thoracic spine, and the angle ranged from 0.3 degree toward the midline in the twelfth thoracic vertebra to 13.9 degrees in the fourth thoracic vertebra. The morphometric data revealed wide variations in the dimensions of the pedicles, demonstrating the importance of accurate preoperative imaging with transaxial computerized tomographic scans to visualize the precise osseous margins and angles of insertion of the thoracic pedicles.