SEARCH · PubMed Health

Results for “PSEUDARTHROSIS”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,549 records · Page 86Linked to original sources

PubMed2002

A prospective randomized comparison between the cloward procedure and a carbon fiber cage in the cervical spine: a clinical and radiologic study.

STUDY DESIGN: A prospective randomized study was conducted. OBJECTIVE: To determine whether the use of a cervical carbon fiber intervertebral fusion cage improves the outcome of anterior cervical decompression and fusion, as compared with the Cloward procedure using autograft. SUMMARY OF BACKGROUND DATA: Despite the theoretical advantages of using intervertebral cages, including reduced donor site morbidity and prevention of graft collapse, an improved clinical outcome has not yet been documented. METHODS: For this study, 103 patients were randomized to anterior cervical decompression and fusion with a carbon fiber intervertebral fusion cage (n = 52) or the Cloward procedure (n = 51). An independent observer quantified pain and functional disability. Fusion rate, segmental kyphosis, and disc height were assessed by radiographs. RESULTS: During a mean follow-up period of 36 months (range, 24-72 months) for 89 patients (86%), the pain and disability were similar for both treatments. Postoperative donor site pain was significantly less in the carbon fiber intervertebral fusion cage group. The fusion rate was 86% in the Cloward procedure group and 62% in the carbon fiber intervertebral fusion cage group (P < 0.05). In the latter group, patients with pseudarthrosis reported more severe pain than fused patients (51 and 33 visual analog scores, respectively), but the difference was not significant. The segmental kyphosis was less and the disc height increased in the carbon fiber intervertebral fusion cage group, as compared with the Cloward procedure group. Disc height was not correlated with outcome. Segmental kyphosis showed a weak (r = -0.3) but significant (P < 0.05) correlation with improvement of the Cervical Spine Functional Score, but not with other outcome variables. CONCLUSIONS: Except for reduced donor site pain, the clinical outcome for the carbon fiber intervertebral fusion cage is the same as for the Cloward procedure. Use of the cage results in a more lordotic alignment and an increased disc height, but in a higher pseudarthrosis rate than use of the Cloward procedure.

Adult↗

PubMed2004

Geometric results of anterior cervical plate stabilization in degenerative disease.

STUDY DESIGN: Consecutive case retrospective computerized analysis of lateral radiographs. OBJECTIVES: To investigate the time evolution of the geometry of anterior cervical discectomy and fusion using a new computer-aided measurement technique. SUMMARY OF BACKGROUND DATA: Prior clinical studies have reported benefits and complications of anterior cervical plate stabilization, but have not comprehensively described changes in sagittal geometry following arthrodesis and plating. High fusion success rates have been reported for single-level discectomy and fusion, whereas multilevel procedures have demonstrated lower clinical success rates with increased hardware failure and pseudarthrosis rates. METHODS: Sagittal alignment data were collected from lateral radiographs of 51 patients with 52 operations for single- or multiple-level anterior cervical discectomy and fusion, both with and without anterior cervical plate stabilization. Intervertebral angulation and separation at the operated segments before surgery, immediately after surgery, and at long-term follow-up were compared using a computer-aided technique. RESULTS: Single-level anterior cervical discectomy and fusion with plate stabilization lost 0.9 degrees of the operatively obtained lordosis after surgery compared to 7.5 degrees for single-level fusions with bone alone (P = 0.0001). In multilevel anterior cervical discectomy and fusion, the bottommost level of the anterior cervical discectomy and fusion construct was much more prone to collapse than the remaining levels (mean bottom-level loss of 4.0 degrees vs. mean 0.2 degrees increase at the remaining levels, P < 0.0001). CONCLUSIONS: Anterior cervical plate stabilization helps maintain operatively obtained segmental distraction and lordosis following anterior cervical discectomy and fusion. In multilevel procedures, this study found that postoperative collapse is largely localized to the bottommost level, where hardware failure and pseudarthrosis have been observed most often by others.

Adult↗

PubMed2006

A preliminary study of the efficacy of Beta Tricalcium Phosphate as a bone expander for instrumented posterolateral lumbar fusions.

The associated morbidity of allograft(s) as bone graft expanders in spinal surgery has prompted the search for alternatives. The efficacy of Vitoss/Beta Tricalcium Phosphate (B-TCP: OrthoVita, Malvern PA, USA), an artificial bone substitute, combined with lamina autograft (50:50 mix) in 40 prospective posterolateral fusions utilizing pedicle/screw instrumentation was analyzed. Multilevel lumbar laminectomies (average 3.7 levels) were accompanied by 1 (27 patients) and 2 level (13 patients) fusions. Two neuroradiologists independently assessed fusion progression on dynamic x-rays and 2D-CT studies performed at 3, 6, and up to 12 months postoperatively. Outcomes were quantified utilizing Odom Criteria and Short-Form 36 (SF-36) questionnaires (preoperatively; and 3, 6, and 12 months postoperatively). By the sixth postoperative month, fusion was neuroradiologically confirmed on both dynamic x-rays and CT studies for 26 of 27 single level fusions (1 pseudarthrosis), and 11 of 13 two level fusions (L4-S1). Odom Criteria 3, 6, and 12 months postoperatively revealed continued improvement for all patients. SF-36 outcomes, however, revealed deterioration on 2 Health Scales (Role Physical, Role Emotional) 3 and 6 months post-operatively, and minimal to marked improvement on 6 Health Scales (PF, V, PF, V, SF, BP). Twelve months postoperatively improvement occurred on all 8 Health Scales, exceeding pre-operative baselines; minimal (RP, GH), mild (MH), moderate (PF, BP, V, SF), and marked improvement (RE). Although Vitoss/B-TCP and laminar autograft resulted in pseudarthrosis for 1 of 27 single level and 2 of 13 two level posterolateral instrumented lumbar fusions, only 1 of the latter patients required a secondary fusion.

Adult↗

PubMed2005

Serum levels of nickel and chromium after instrumented posterior spinal arthrodesis.

STUDY DESIGN: Cross-sectional study of 37 patients to measure serum levels of nickel and chromium after posterior spinal arthrodesis using stainless steel implants. OBJECTIVES: To investigate the relationship between factors such as age, gender, pain, time from surgery, length of arthrodesis, and level of arthrodesis to serum metal ion levels after instrumented spinal arthrodesis. SUMMARY OF BACKGROUND DATA: Measurable levels of metal ions in the serum can be detected after the use of stainless steel implants. There is some evidence to suggest that long-term exposure can potentially be toxic. Posterior spinal arthrodesis with stainless steel implants is a common procedure to treat spinal deformity in the adolescent population; however, the extent of metal ion exposure after posterior spinal arthrodesis is unknown. METHODS: Patients that underwent posterior instrumented spinal arthrodesis with more than 6 months follow-up were recruited for this study. Patients with altered neurologic function were excluded. Serum levels of nickel and chromium were measured using inductively coupled plasma mass spectrometry. Pain was assessed using the Oswestry questionnaire. Spine radiographs were used to look for evidence of pseudarthrosis. Forty-five patients were approached, and 37 agreed to the questionnaire and blood test. Ten patients were men and 27 were women. Mean age at surgery was 14 years with mean follow-up of 6 years. Statistical correlations between serum metal ion levels and age at surgery, time from surgery, gender, number of segments fused, spinal instrument interfaces, pain, and instrumentation type were assessed. RESULTS: Abnormally high levels of nickel and chromium above normal levels (0.3 ng/mL for nickel, 0.15 ng/mL for chromium) could be detected in serum after posterior spinal arthrodesis using stainless steel implants. There was a significant inverse correlation between serum nickel (r = -0.61, P < 0.001) and chromium (r = -0.64, P < 0.001) levels and time from surgery. When patients were grouped based on lengths of time from surgery, 0 to 2 years (n = 7), 2 to 4 years (n = 11), and >4 years (n = 8), the mean +/- SD for nickel (ng/mL) was 3.8 +/- 2.6, 1.3 +/- 1.1, and 0.9 +/- 0.8, respectively. Analysis ofvariance revealed significant group differences (P =0.004). Similarly, the chromium levels were 2.7 +/- 2.7, 0.6 +/- 0.4, and 0.3 +/- 0.3, respectively (P = 0.018). Only time from surgery was a significant multivariate predictor of nickel and chromium serum levels. Pseudarthrosis was not seen in this cohort. CONCLUSIONS: Elevated levels of nickel and chromium can be measured after posterior instrumented spinal arthrodesis. The levels diminish rapidly with time from surgery but still remained above normal levels 4 years after surgery. Long-term implication of this metal ion exposure is unknown and should be studied further.

Adolescent↗

PubMed2006

Anterior thoracic spine reconstruction using a titanium mesh cage and pedicled rib flap.

STUDY DESIGN: A retrospective clinical study. OBJECTIVES: To evaluate the safety and efficacy of using an integrated titanium mesh cage and pedicled rib flap for thoracic spine reconstruction in patients at high risk of pseudarthrosis. SUMMARY OF BACKGROUND DATA: A variety of materials are available for interbody thoracic reconstruction; however, the optimal treatment of patients at high risk of pseudarthrosis remains a challenging problem. Free or pedicled bone flaps have been shown to be highly effective in terms of promoting fusion and titanium mesh cages provide excellent structural support. METHODS: Eleven patients who underwent anterior thoracic corpectomy and spinal reconstruction using an integrated titanium mesh cage and pedicled rib flap were analyzed with a mean follow-up of 37 months (range, 25-55 months). The etiology of spinal disease was infection in 7 (64%) patients and tumor in the remaining 4 (36%) patients. Seven (64%) patients were treated with only an anterior approach while the remaining 4 (36%) patients underwent circumferential spinal reconstruction. RESULTS: All patients demonstrated clinical and radiographic evidence of spinal fusion at the time of follow-up. All patients had stable or improved Frankel grades after surgery. There was a mean kyphosis correction of 7 degrees for both the focal and regional thoracic kyphosis. There were three significant postoperative complications: bilateral pleural effusion, gram-negative bacteremia, and transient right lower extremity weakness requiring reoperation and pedicle screw revision. Two patients died after surgery: one from aneurysmal subarachnoid hemorrhage and the other from complications of breast cancer. CONCLUSIONS: The use of an integrated rib flap and titanium mesh cage construct appears to be a safe and effective means of providing immediate and substantial anterior column support as well as achieving arthrodesis in challenging fusion candidates.

Adult↗

PubMed2006

Prospective radiographic and clinical outcomes of dual-rod instrumented anterior spinal fusion in adolescent idiopathic scoliosis: comparison with single-rod constructs.

STUDY DESIGN: Anterior single or dual-rod instrumentation may be performed for the treatment of main thoracic, thoracolumbar, or lumbar adolescent idiopathic scoliosis (AIS) curves. OBJECTIVE: To compare the results of anterior dual-rod instrumentation in single-major AIS curves with our previous experience using single-rod constructs. SUMMARY OF BACKGROUND DATA: Several reports have described the use of anterior single-rod instrumentation for the treatment of AIS curves with acceptable correction rates but with pseudarthroses/implant failures of up to 31%. METHODS: A total of 60 consecutive patients with AIS (12 males and 48 females; average age 15.3 years) with major thoracic (n = 18) or thoracolumbar/lumbar (n = 42) curves were treated with dual-rod instrumented anterior spinal fusion. Follow-up was 2-5 years. Patients were evaluated prospectively with Scoliosis Research Society (SRS) questionnaires. RESULTS: Major thoracic curves were corrected from a mean of 55 degrees to 27 degrees (51% correction), while major thoracolumbar/lumbar curves were corrected from an average of 51 degrees to 17 degrees at latest follow-up (67% correction). No pseudarthroses were identified. With the use of single-rod constructs, a similar amount of coronal correction was obtained for both thoracic (47%) and thoracolumbar/lumbar curves (70%). However, the pseudarthrosis rate for single-rod constructs was 5.5%. The obvious trend toward a lower pseudarthrosis rate in dual-rod (0/60) versus single-rod (5/90) constructs was not statistically significant (P = 0.07). Follow-up SRS questionnaire data for patients with dual-rod instrumentation showed 95% satisfaction, and 93% would choose the same treatment with similar results in the single-rod instrumentation study, 88% patient satisfaction, and 89% choosing the same treatment. Overall SRS scores improved after treatment (P < 0.01). SRS domain scores improved at a significant level for pain (P = 0.05), self-image (P < 0.01), and function (P = 0.01). CONCLUSION: In this largest, to our knowledge, single-center report of dual-rod constructs for patients with AIS, a similar amount of radiographic deformity correction was obtained when compared to single-rod implants. However, the absence of any pseudarthroses in the 60 patients with dual-rod is a distinct advantage.

Adolescent↗

PubMed2003

Resorbable plate osteosynthesis of dislocated or pathological mandibular fractures: a prospective clinical trial of two amorphous L-/DL-lactide copolymer 2-mm miniplate systems.

The purpose of this study was to evaluate the indication for resorbable miniplates in traumatic and pathological mandibular fractures. Two resorbable miniplate systems, the 2.0-mm MacroSorb (Macropore, San Diego, Calif.) and the PolyMax (Synthes, Oberdorf, Switzerland), were prospectively used in 24 mandibular osteosyntheses. Made from amorphous 70:30 poly-L/DL-lactide, amorphous copolymer plates have not yet been evaluated for mandibular osteosyntheses. The main advantage of the amorphous copolymer-structure is continuous hydrolysis through water penetration into the implant body during the first 6 months. Hydrolysis breaks the copolymer chains into smaller particles that later become degraded through phagocytotic cells. Twelve patients, aged 13 to 83 years, were treated after providing informed consent. Fourteen dentate patients with moderately dislocated traumatic fractures and two edentulous atrophic and dislocated traumatic mandibular fractures were treated. Two patients with pathological fractures due to osteomyelitis received osteosynthesis after sequestrectomy. Histological specimens of the plates, screws, and surrounding soft tissues were taken after 3, 6, 9, and 12 months in secondary dental implant operations. A total of 22 osteosyntheses healed well without clinical or radiological signs of dislocation, insufficient or excess formation of callus, pseudarthrosis, or plate fracture. The follow-up time ranged from 4 to 22 months. One patient with osteomyelitis worsened because of widespread osseous infection, and one with atrophic fracture developed a bland fibrous pseudarthrosis. The histological specimens showed a moderate inflammatory foreign body reaction. No sinuous drainage or clinically apparent inflammation occurred. The presented osteosynthesis systems showed reliable stability for mandibular osteosynthesis in cooperative patients; however, two treatment failures occurred (8 percent). Disadvantages of the resorbable osteosyntheses were costs, greater diameter, screw breakage, and the need to place the screws vertically to the plate. The use of resorbable osteosyntheses in dislocated fractures should be further evaluated in controlled studies.

Absorbable Implants↗

PubMedDate not supplied

Dennyson-Fulford subtalar arthrodesis.

Forty-six patients who had undergone Dennyson-Fulford subtalar arthrodesis for hindfoot valgus deformities secondary to various pathologies were reviewed both radiographically and clinically. Mean age at surgery was 7.67 years; mean follow-up was 5.67 years. Evaluation showed 70% good, 20% fair, and 10% poor results. Pseudarthrosis rate was 6.4%, and was not necessarily related to undercorrection or progressive deformity. Screw sclerosis, which is common, is associated with pseudarthrosis, but not with hardware failure. Hardware problems can be anticipated with intraoperative radiographs, and penetration of the lateral calcaneal cortex up to 1.0 cm is well tolerated.

Adolescent↗

PubMedDate not supplied

The modified Blair fusion.

The Blair fusion is the accepted method to achieve an ankle arthrodesis in the presence of avascular necrosis or absence of the body of the talus. This procedure has not however, been reliable. A pseudarthrosis rate of 28% and fibrous ankylosis of the foot secondary to prolonged immobilization compromise the end result. A tibiotalar compression arthrodesis has been developed using an intermediate hip compression screw and a modified Stone staple. Five patients with avascular necrosis of the talus underwent a modified Blair fusion. Protected weightbearing was started at 6 weeks and healing occurred within 3 months. Although the number of cases is small, this study indicates that the addition of compression fixation to the Blair arthrodesis will significantly decrease the pseudarthrosis rate and perhaps the healing time.

Adult↗

PubMed2006

Early complications of posterior rod-screw fixation of the cervical and upper thoracic spine.

OBJECTIVE: The technique of rod-screw fixation of the cervical spine is well described. However, there is very little data on the complications incurred by the application of these devices. The purpose of this study was to quantify the risks associated with rod fixation of the cervical spine. METHODS: A prospective study was performed on 100 consecutive patients treated with this technique. Clinical and radiographic assessment was performed immediately after surgery 3, 6, and 12 months postoperatively, and annually thereafter. The mean follow-up interval was 16.7 months. RESULTS: A total of 888 screws were implanted in 100 patients. Perioperative complications included radiculopathy (n = 4, 0.45% per screw placed), infection and other wound-healing problems (n = 4), screw malposition (n = 2), loss of alignment (n = 1), and cerebrospinal fluid leak (n = 1). There were no examples of spinal cord or vertebral artery injury. Early complications (within 6 mo of surgery) included pseudarthrosis (n = 2) and screw breakage (n = 2, 0.22% per screw placed). There were no late complications. Reoperation was required in eight cases, all within 6 months of the index procedure. Indications for reoperation included wound-healing problems (n = 4), malpositioned screw (n = 2), and pseudarthrosis (n = 2). No patient required another operation for any indication beyond the 6-month postoperative interval. CONCLUSION: Rod-screw fixation was an effective method of posterior cervical stabilization that could be safely applied in a wide range of spinal disorders. In a complex group of patients, the complication rates were modest, and compared favorably with other methods of fixation.

Adult↗

PubMed1984

Excision arthroplasty for infected total hip replacements.

A study of excision arthroplasty (Girdlestone's pseudarthrosis) for infected total hip replacements is presented. Twenty-two patients were reviewed with a minimum follow-up of one year. Reduction in pain was significant but the functional results were poor. Factors contributing to poor function were old age, poor medical condition and arthritis of the contralateral hip; these were in addition to the gross instability resulting from the pseudarthrosis. The patients were easily fatigued and dependent on external supports; calipers were found to be unacceptable. The symptoms after excision arthroplasty are compared with those before the original hip replacement.

Aged↗

PubMed2005

Pathomorphology and treatment of congenital anterolateral bowing of the tibia associated with duplication of the hallux.

Congenital unilateral anterolateral tibial bowing in combination with a bifid ipsilateral great toe is a very rare deformity which resembles the anterolateral tibial bowing that occurs in association with congenital pseudarthrosis of the tibia. However, spontaneous resolution of the deformity without operative treatment and with a continuously straight fibula has been described in all previously reported cases. We report three additional cases and discuss the options for treatment. We suggest that this is a specific entity within the field of anterolateral bowing of the tibia and conclude that it has a much better prognosis than congenital pseudarthrosis of the tibia, although conservative treatment alone may not be sufficient.

Abnormalities, Multiple↗

PubMed1995

Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis.

Ten patients who had been managed with posterior spinal arthrodesis and Texas Scottish Rite Hospital instrumentation because of idiopathic scoliosis had a delayed deep wound infection at an average of twenty-five months after the operation. The signs of infection included spontaneous drainage in eight patients and fluctuance in two patients. In addition, six patients--including five of the eight who had drainage--had mild pain in the back. The average erythrocyte sedimentation rate was thirty-nine millimeters per hour (range, nineteen to eighty-one millimeters per hour). The instrumentation was removed from all of the patients. In two patients, a pseudarthrosis that had not been noted on preoperative radiographs was noted intraoperatively; in both patients, the pseudarthrosis occurred at a level at which two hooks had been placed in one intervertebral space. Primary closure was performed in seven patients, and delayed primary closure was performed on the third postoperative day in three patients. All wounds healed uneventfully. Cultures of specimens taken from deep within the wound were positive for Propionibacterium acnes (five patients), Staphylococcus epidermidis (two patients), a rare coagulase-negative Staphylococcus species (one patient), or Micrococcus varians (one patient). No organisms grew on culture of the specimen obtained from the remaining patient. Propionibacterium acnes required an extended period of incubation before identification. Antibiotics were administered parenterally to all of the patients after the removal of the hardware, and this treatment was followed by oral administration of antibiotics for nine of the patients. We suspect--but can not prove--that several of the delayed infections resulted from intraoperative seeding and remained subclinical for an extended period of time.

Adolescent↗

PubMed1977

Subcapital fractures of the femur treated with two thin Smith-Petersen nails.

The results of treatment of 71 patients with subcapital fractures of the femur, fixed with two thin Smith-Petersen nails, are presented, after a follow-up time of between 2 and 4 years. Excellent results of treatment were achieved in 39 out of 60 cases and good results in 11 cases. Six cases of ischemic necrosis of the femoral head were recorded, and there were four cases with pseudarthrosis of the femoral neck, one developed because of postoperative infection and three were attributed to an imperfect operative technique. The method is recommended for subcaptial femoral neck fractures amenable to closed reduction and internal fixation. Pseudarthrosis may be prevented by good reduction of the fracture and a careful nailing technique.

Adolescent↗

PubMed1996

Radiographic and clinical follow-up review of Caspar plates in 49 patients.

Although they are excellent clinical tools, Caspar anterior cervical plates have not been studied closely with regard to their mechanisms of failure. As more extensive operations are contemplated on older, sicker patients, it is imperative to know when a plating system might be prone to failure and what the mechanism of that failure might be. Therefore, the authors reviewed 49 patients undergoing Caspar plate placement in whom sufficient radiographs were obtained to determine if the fate of the hardware was related to the patient's age, type of operation, and the length of construct. Eleven of 49 patients suffered hardware failure, defined as any amount of screw backout or breakage, plate pullout, or pseudarthrosis. Four patients underwent hardware removal; one underwent posterior fusion for pseudarthrosis. Only two required treatment in a halo brace. There was an eventual fusion rate of 100%, including one fibrous union, and one of the patients who underwent repeat surgery was lost to follow-up review. No graft extrusions or new neurological deficits were incurred as a result of hardware failure. Plate length predicted plate failure in a statistically significant manner. Increasing age and reoperation correlated with plate failure but were not statistically significant in this small number of patients. Telescoping of the bone graft and vertebral bodies, with concomitant migration of the plate and slippage of the screws, was common. However, telescoping was more profound in the group in which the plates failed. The authors conclude that Caspar plate failures are more likely to occur in the elderly and in patients who need longer constructs. Bone fusion can be expected even when the hardware loosens.

Adult↗

PubMed2002

Percutaneous transpedicular vertebroplasty with calcium phosphate cement in the treatment of osteoporotic vertebral compression and burst fractures.

OBJECT: Osteoporotic vertebral fractures occasionally lead to late-onset collapse, kyphosis, persistent back pain, and disability. The authors describe a series of patients in whom they performed percutaneous vertebroplasty by using calcium phosphate cement (CPC) to obtain early pain relief and improve the integrity of the osteoporotic vertebral body (VB). METHODS: Between August 2000 and February 2001, they performed 17 percutaneous transpedicular CPC-assisted vertebroplasty procedures in 16 patients who harbored thoracic or lumbar osteoporotic vertebral fractures. Following repositioning and curettage of the pathological soft tissues, CPC-assisted vertebroplasty was percutaneously performed in four patients with osteoporotic burst fracture and pseudarthrosis (Procedure A). In situ CPC-assisted vertebroplasty was performed in 12 patients with fresh vertebral compression fractures due to osteoporosis (Procedure B). Back pain and low-back pain were evaluated using a visual analog scale (VAS). The deformity index of the VB was measured on a lateral radiograph as the ratio of the VB's height (sum of measurements at anterior, middle, and posterior regions) to its longitudinal diameter. Based on VAS scores, pain was decreased in all patients immediately after surgery, and pain relief was maintained at the last follow up. The mean preoperative deformity index score of the VB was 1.43 in Procedure A and 1.67 in Procedure B; postoperatively scores improved to 1.59 and 1.93, respectively. At the 6-month follow-up examination, the mean deformity index score rebounded to 1.52 in Procedure A and 1.79 in Procedure B. Bone union was documented in all patients. Complications, such as a temporary respiratory insufficiency and a small amount of CPC leakage into the spinal canal, were observed in patients who underwent Procedure B. CONCLUSIONS: Percutaneous transpedicular CPC-assisted vertebroplasty is a minimally invasive procedure that provides early relief of pain and prevents vertebral collapse and pseudarthrosis in patients with osteoporotic vertebral fracture.

Aged↗

PubMed1995

Anterior stabilization of thoracolumbar burst fractures using the Kaneda device: a preliminary report.

Anterior decompression and fusion is a valuable technique in the treatment of thoracolumbar burst fractures. Anterior instrumentation has evolved to correct deformity and stabilize the spinal segments during decompression and bone grafting as a single-stage procedure. One anterior device developed by Kaneda has been used in our institution since 1989. This study is an initial review of our experience with this instrumentation. Anterior decompression and fusion augmented with the Kaneda device was performed in 20 patients with thoracolumbar burst fractures. Timing of surgery was early (< 15 days) in 13 patients, intermediate (16 to 120 days) in 2, and delayed (> 121 days) in 5. Sixteen patients were neurologically intact (Eismont grade D), 3 with distal weakness (Eismont grade B or C) and 1 with complete paraplegia (Eismont grade A). All patients with deficits recovered one Eismont grade after anterior decompression and fusion. Complications included pulmonary problems in 2 patients, a thoracic duct laceration requiring ligation, and a sympathectomy effect of the lower extremity. One patient had a pulmonary embolus and developed a hematoma at the graft harvest site while on anticoagulants with resultant meralgia paresthetica. There have been three screw failures and one definite pseudarthrosis. Anterior decompression and fusion supplemented by the Kaneda device was performed on 20 patients with thoracolumbar burst fractures. The average correction of kyphosis was approximately 50% acutely, with loss of approximately 50% of correction at follow up. In some patients, coronal plane deformity was created by the device. No effect on neurologic recovery could be shown with this small series. Perioperative complication rate was 30%, and 1 patient developed pseudarthrosis.

Accidental Falls↗

PubMed2006

External fixation and infection of soft tissues close to fracture localization.

We evaluated the method of external fixation for stabilization of unstable closed and open first-degree diaphyseal fractures of long bones of lower extremities in 19 patients with infections of soft tissues close to the fracture location. The results are compared with those of another group (n = 392) of patients, with similar fractures without infections close to the fracture site, treated with inner stabilization methods. In the first group of patients, we noticed postoperative osteitis of the tibia in two cases (10%), but no pseudarthrosis or lesions of important blood vessels. In the second group of patients, the incidence of postoperative osteitis was 8.6% (n = 34) and the incidence of pseudarthrosis was 2% (n = 8). Among these patients, three lesions of important blood vessels were diagnosed. Our conclusion is that when the method of external fixation is used in combination with skillful operative techniques, the infection of soft tissues near the fracture location has no principal influence on the frequency of osteitis.

Croatia↗