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PubMedDate not supplied

[Results of treatment of hip joint prosthesis-related infections].

The article present results of the operative treatment of deep infections in the hip joint prostheses. Ninetieth patients treated from 1980 through 1998 were analysed. Gram-positive organisms were found in 65% of the cases and gram-negative in 35%. Staphylococcus aureus were isolated in 50% of the cases. The two-stage reimplantation procedure is performed in four patients. Excellent results were reported in three patients, and poor results in one patient. The Girdlestone pseudarthrosis as a definitive procedure is performed in fifteen patients. Good results were reported in two patients, fair results in twelve, and poor results in one patient. The mean shortening of the limb was 4.5 cm. The infection were controlled in 93% of the cases. Better functional results are obtained by the two-stage reimplantation than the Girdlestone pseudarthrosis, though is an acceptable method of controlling infection.

Adult↗

PubMed2000

[Vascularized bone grafts in children. Specifics and indications].

The authors report on the vascularized bone grafts used in children. Some of them are the same as those used in adults, like the fibula free flap. Others are growth plate transfers as the proximal fibular epiphysis, the iliac crest or the lateral scapular crest. Finally, other transfers are periosteal vascularized grafts. The indications and results are discussed concerning the congenital pseudarthrosis of the tibia (43 cases treated by the first author), the congenital pseudarthrosis of the forearm, the tumors of the limb and the post-traumatic defects. The specific indications in children are the microsurgical growth plate transfers, especially the epiphyseal growth fibula for the upper limb and the iliac crest for the lower limb.

Bone Transplantation↗

PubMed2000

Instrumented posterior arthrodesis of the lumbar spine in patients with diabetes mellitus.

The existence of diabetes mellitus has been postulated to have a deleterious effect on the outcome following lumbar spine surgery. We retrospectively examined the records and radiographs of 32 diabetic patients (mean age, 60 years) who underwent posterior lumbar fusions using transpedicular instrumentation and iliac crest autograft. Ten patients were insulin-dependent and 22 required oral hypoglycemic agents for at least 1 year prior to surgery. The minimum follow-up time was 2 years after surgery (mean, 2.5 years). Surgical indications included herniated lumbar disk, lumbar spinal stenosis, thoracolumbar trauma, and lumbar pseudarthrosis. Clinical results were evaluated by chart review and/or interview by using Odom's criteria. At follow-up, 75% of patients were graded as excellent or good, and 25% as fair or poor. Twenty-five of 32 patients (78%) had improvement of back pain. Twenty of 27 (74%) patients had improvement of leg pain. Eight of 15 (53%) patients had improvement in motor strength, and 6 of 11 (54%) had improvement in light-touch sensation. Insulin dependence and the presence of polyneuropathy were associated with a poorer outcome. The average time to radiographic fusion was 5 months. Twenty-nine of 32 patients (91%) developed solid fusion by strict radiographic criteria. The three patients with a pseudarthrosis had persistent back pain and a poor result. Ten of 32 (31%) of the patients experienced perioperative complications, including prolonged wound drainage (n = 5), deep wound infection (n = 1), superficial wound infection (n = 1), atrial fibrillation (n = 1), ruptured cerebral aneurysm (n = 1), and ulnar nerve neuropathy (n = 1). We conclude that posterolateral lumbar spinal fusion with internal fixation in diabetic patients yields clinical results comparable to those of nondiabetic patients, with similar risks of perioperative complications.

Bone Screws↗

PubMed2002

Extracoelomic mini approach for anterior reconstructive surgery of the thoracolumbar area.

OBJECTIVE: An extracoelomic mini approach is introduced as a less invasive technique for surgery of the thoracolumbar area performed via the anterior approach. METHODS: Twenty-one patients with spinal pathological findings at the thoracolumbar junction were assessed. The reasons for surgery were as follows: burst fracture of the first lumbar vertebra (n = 5), degenerative disc at L1-L2 (n = 4), spondylodiscitis at L1-L2 (n = 8) and at T11-L1 (n = 1), pathological fracture of the first lumbar vertebra (n = 2), and pseudarthrosis at T11-L1 after failed reconstruction (n = 1). The anterior surgical procedure was performed via an extracoelomic mini approach. Intersomatic fusion was performed in 13 patients, corpectomy and bone grafting in 4, corpectomy and vertebral replacement with titanium cage packed with bone cement in 3, and removal of a cage in a failed fusion and bridging the defect with a strut bone graft in 1. Posterior instrumentation of the affected segment was performed in the same sitting. RESULTS: The mean +/- standard deviation of operative time of the anterior procedure was 101.2+/-36.5 minutes. The mean blood loss during the anterior procedure was 724 +/- 483.5 ml. The procedure was safe. No pseudarthrosis was encountered, and the reconstructed bone was stable in the three patients in whom bone cement was used. CONCLUSION: The extracoelomic mini approach is less invasive; it results in less incisional morbidity, and it avoids opening the pleural and peritoneal cavities.

Bone Cements↗

PubMedDate not supplied

[Recent fractures of the humeral diaphysis. Apropos of a continuous series of 200 cases, of which 107 were treated with a hanging cast alone. (Arterial intra-osseous vascularization of the humerus)].

Were reviewed 200 fractures of humeral diaphysis, two cases have been excluded because they were incomplete; 175 patients out of 200 have been reexamined a long time after; 23 have not been reexamined but held a sufficient follow up. Most of the transversal fracture were met among young adults (56 per 100 traffic accidents). The intraosseous vascularisation was studied elucidating partly the greatest frequency of pseudarthrosis in the part 1/3 middle-1/3 inferior especially after exaggerated periostal elevation. Among 107 cases treated by hanging cast were noted 4 pseudarthrosis, 12 shoulder's stiffnesses. Traction or external fixation were rarely useful (comminuted fractures, burns). Surgical procedures were rarely necessary because this type of fracture usually united with good result after conservative treatment. The outcomes of 40 osteosynthesis were examined and non-unions were noted. Vascular (4 out of 200) and nervous (29 out of 200) complications were also noted.

Adolescent↗

PubMed1992

[Compression neuropathy of the cubital nerve at the elbow].

Compression neuropathy of the ulnar nerve at the elbow has numerous known etiologies, and the anatomy of the ulnar nerve around the elbow leaves it vulnerable to compression at numerous sites. The compression may be extrinsic such as in occupational neuropathy or in cases of postanesthesia neuropathy. The so-called idiopathic compression may be favored by some anatomic variations. The cubital tunnel retinaculum may be loose, leading to ulnar nerve dislocation or subluxation or tight compression of the nerve during flexion of the elbow. Bulging of the synovium in the floor of the tunnel may be the cause of compression in rheumatoid arthritis, whereas osteophytes may be the cause in degenerative osteoarthritis. Cubitus valgus or instability due to a pseudarthrosis of the lateral epicondyle or to ligamentous injury may stretch the nerve. The choice of a surgical technique must be based on (i) the pathophysiology of chronic nerve compression at the elbow, (ii) an understanding of the etiology of the nerve compression in the particular patient's case, and (iii) the knowledge of the potential technical drawbacks of the various operative procedures. Simple decompression is the first choice in case of minimal compression without instability of the nerve. Decompression of the nerve with a medial epicondylectomy is indicated in case of instability of the nerve and is the first choice in case of pseudarthrosis or malunion of the medial epicondyle. Ulnar nerve transposition is technically the most demanding procedure. Inadequate surgical technique creates new sites of compression.(ABSTRACT TRUNCATED AT 250 WORDS)

Elbow↗

PubMed1992

The use of gentamicin-PMMA chains in the treatment of infected tibial nonunion.

Local antibiotic therapy with gentamicin-PMMA chains and external fixation permit effective simultaneous therapy of both components of infected tibial pseudarthroses: sequestering osteomyelitis and pseudarthrosis. The local concentrations of gentamicin which can be achieved by implantation of gentamicin-PMMA chains are far above the MIC of most common pathogens. This form of local antibiotic therapy is superior to any form of systemic antibiotic therapy. The gentamicin-PMMA chains serve as well as space holders for the bone graft to promote bone consolidation in the absence of infection. The results can be improved by successful management of the soft tissue damage often associated with tibial pseudarthrosis. Pedicled or free muscle graft with microvascular anastomosis is the method of choice.

Drug Therapy, Combination↗

PubMed2005

Autogenous tibial strut grafts used in severe kyphoscoliosis: surgical policies and preliminary results.

BACKGROUND: Surgery for severe kyphoscoliosis is frequently unsatisfying because of loss of correction, high rate of pseudarthrosis and neurological complications. Several authors reported that the anterior fusion with strut grafts might improve the surgical outcome. This article describes and assesses the surgical strategies and the application of autogenous tibial strut in the treatment of severe kyphoscoliosis. METHODS: Severe kyphoscoliosis patients (n = 39) admitted from April 1998 to September 2003 formed the study group. Different surgical strategies had been used according to the flexibility, neurological function and curve level. All patients received staged anterior and posterior surgery with a tibial strut used in the anterior fusion. The patients were followed up for 9 months to 6 years (mean 37 months). RESULTS: The mean preoperative and postoperative kyphosis was 82 degrees and 52 degrees respectively, and the mean scoliosis was 84 degrees and 44 degrees respectively. Complications included pseudarthrosis (2 cases, one with graft fracture and the other with hook displacement), posterior elements fractures (4), pleura penetrations (3, in the plastic surgery of the thoracic cage), dura tear (2), exudative pleuritis (2, in the anterior surgery), and tibia fracture of the harvesting site (1). The mean loss of correction in coronal and sagittal plane was 6 degrees and 7 degrees respectively. Except for 1 case, the patients with incomplete paraplegia showed improvements to varying extents. CONCLUSION: Autogenous tibial strut can provide excellent support to the kyphoscoliotic spine: it reduces pseudarthrodic rate, loss of correction and complications of graft harvest, it also prevents the occurrence of neurological impairment.

Adolescent↗

PubMedDate not supplied

The Lefevre ulnar nail.

The Lefevre nail applies the principles of locked intramedullary nailing in the treatment of fractures of the ulna. It is made up of two segments which slide telescopically, so that assembly may be in compression, distraction or neutral. Fixation at the two ends of the ulna is guaranteed by two transverse screws. It may be used in pseudarthrosis and osteotomies for lengthening and shortening, as well as in simple or complex fractures. The cases presented provide an overview of the use of the nail at the Brest Center, where the nail was invented and developed, and at the Rizzoli Institute. The study includes 22 fractures, 1 pseudarthrosis and 1 osteotomy. Consolidation was obtained in all of the cases after an average of 2.5 months. Immobilization in plaster was required only in cases with associated lesion of radius. The functional results obtained were satisfactory.

Adolescent↗

PubMed1991

Microscopically assisted posterior lumbar interbody fusion.

Microscopically assisted posterior lumbar interbody fusion was performed on 27 patients who had either spondylolisthesis or chronic lower back pain after previous lower back surgery. Overall improved satisfactory results occurred in 22 of 27 patients. Roentgenographic, stable, interbody fusion occurred in 22 of 27 patients. The poorest results and highest rate of pseudarthrosis occurred in patients with double-level fusions. Pseudarthrosis occurred in four of six patients with double-level fusions and unsatisfactory clinical results occurred in five of six patients with double-level fusions. Advantages of the microscopic technique are better examination of the surgical site, less blood loss, and less surgical dissection than other surgical salvage techniques. This procedure should be reserved for single-level pathology in the lumbosacral spine.

Back Pain↗

PubMedDate not supplied

[Osteosynthesis of the dens axis fracture].

Fractures of the dens axis are very rare and their treatment has always been conservative. But in many fractures, principally in those of the fracture type II, a pseudarthrosis develops. The instability, which results from this pseudarthrosis is a dangerous situation, that can be responsible for late neurological complications such as quadriplegia or sudden death, even years after the primary accident. A series of 5 patients with a fracture of the dens axis, which are stabilized by a direct screw osteosynthesis, is presented. The operation technique is discussed in detail. The results of the technique are compared with other series in the recent literature.

Adolescent↗

PubMed1991

Luque interpeduncular segmental fixation of the lumbosacral spine.

Interpeduncular segmental fixation of the lumbar and lumbosacral spine with Luque screws and plates is becoming increasingly popular. In this retrospective study, 52 consecutive patients treated with this technique were followed for 16 to 44 months (average, 21). Indications for surgical arthrodesis included lumbar instability from degenerative disease (16 cases), spondylolisthesis (25 cases), pseudarthrosis (eight cases), fracture (two cases), and tumor (one case). Fusion with instrumentation spanned one level in nine patients, two in 38 patients, three in four patients, and four in one patient. Patients wore a rigid lumbar orthosis for an average of six months (range, two to 16). Ten complications occurred in nine patients: two superficial wound infections, four neurologic complications, three loosened screws, and one broken screw. An overall fusion rate of 96% was achieved; pseudarthrosis is suspected in one case and failed arthrodesis secondary to trauma in a second patient. At four months postoperatively, solid unions had resulted in most of the cases, as seen roentgenographically. All patients reported decreased back pain; however, one patient is addicted to narcotics. Twenty-five of the 29 patients employed were able to return to work at an average of six months postoperatively.

Adolescent↗

PubMed1990

[The interlocking nail for long comminuted and compound fractures of the femur and tibia. Technique and results].

Interlocking nailing is presented as an optimal method for the treatment of fractures of femur and tibia, which are complicated because of the length of these bones. Cases from the literature and cases treated by the authors gave a total of 208 fractures of the femur and 158 fractures of the tibia (comminuted fractures and fractures "à deux étages"). There is a low complication rate as a closed procedure was applied whenever possible. In the femur the nail fractured in eight cases (3.9%), while in seven cases infection was observed (3.5%) and in three cases pseudarthrosis. Following interlocking nailing of the tibia we found deviation of the axis by greater than 5 degrees in eight cases (5%) of 158, including 44 open fractures. Fracture of the nail occurred in one case (0.6%), and we observed six cases of infection (3.8%) and one of pseudarthrosis (0.6%).

Adolescent↗

PubMedDate not supplied

Three-dimensional CT imaging in postsurgical "failed back" syndrome.

One hundred consecutive patients with postsurgical "failed back" syndrome (PSFBS) without fusion and 100 patients with PSFBS with fusion were evaluated with direct CT, two-dimensional (2D) multiplanar, and three-dimensional (3D) imaging. In the patients with and without fusion, 3D images were found to best display the following: the surgical procedure and its extent, lateral neural foraminal narrowing, and fractures of the posterior elements. The 3D images enabled optimal demonstration of fusion: solidity, pseudarthrosis, incorporation of transverse processes and facet joints, and transitional syndrome. In the patients without fusion, 3D images provided improved appraisal of surgical results in 31%; it showed additional fracture(s) in 9%, better displayed lateral neural foraminal narrowing in 42%, and showed additional posterior element fractures in 11% as compared to axial and 2D multiplanar reconstructed (MPR) scans. Three-dimensional imaging uncovered incomplete fusion in 17%, transitional syndrome in 13%, and pseudarthrosis in 6%. Thus, the 3D imaging provided additional information over the direct axial and MPR images (2D images) in 56 of 100 patients without fusion and 76 of 100 patients with fusion. At our institution, this imaging modality is now routinely performed in this patient population.

Female↗

PubMed1989

Pitfalls of spinal deformities associated with neurofibromatosis in children.

A study of 116 patients younger than 12 years of age conclusively diagnosed as having neurofibromatosis was undertaken to determine the incidence of significant orthopedic problems. Deformities of the spine comprised the most common skeletal problem. Seventy-four patients (64%) had spinal deformities. Forty-six patients were treated by posterior spinal fusion. Ten required exploration for pseudarthrosis; six were found to have pseudarthrotic defects in the fusion mass. Eight patients had more kyphosis than scoliosis. Only three patients with kyphoscoliosis obtained a solid posterior spinal fusion after multiple surgical procedures. Anteroposterior and lateral roentgenograms of the cervical spine are recommended at the time of initial evaluation of all spinal deformities. Four patients had severe cervical spine deformities, only one of whom was initially identified as having a cervical spine disorder while under treatment for scoliosis. Three of these patients were seen by other surgical services for neck masses. Following removal of posterior elements, the osseous structures were unstable. Only one patient developed spondylolisthesis. Because of the exceedingly high incidence of pseudarthrosis and spinal instability following attempts at spinal fusion, certain guidelines have evolved for the management of these deformities. High-volume computed tomographic myelography in the prone, lateral, and supine positions or magnetic resonance imaging should be performed on all patients prior to surgical treatment. Anterior disc excision and bone graft followed by posterior arthrodesis with instrumentation are indicated if the kyphotic angle is greater than 50 degrees or if scoliosis is greater than 80 degrees. Even combined anterior and posterior arthrodesis operations did not guarantee successful permanent spinal stability in young patients with neurofibromatosis.

Child↗

PubMed1989

Scoliosis surgery in neurofibromatosis.

Twenty-three patients who were treated by posterior spinal fusion with neurofibromatous scoliosis were reviewed to study the adequacy of spinal fusion, rate of pseudarthrosis, and incidence of complications. Twenty patients achieved a solid fusion with posterior surgery alone. Thirteen patients required one or more posterior augmentation procedures because of progressive deformity. Three patients with dystrophic kyphoscoliosis required an anterior spinal fusion in addition to the posterior fusion to achieve a solid fusion mass. The type of graft material, Harrington instrumentation, and degree of kyphosis or scoliosis had no effect on the rate of pseudarthrosis. Preoperative neuroradiographic evaluation was found to be warranted for all patients with neurofibromatous scoliosis.

Adolescent↗

PubMed1989

[Traumatic dislocations/dislocation fractures of the cervical spine. Neurosurgical experiences in 42 surgical patients].

Neurosurgical results in 42 patients operated on for cervical spine dislocations or fracture-dislocations are described. The study shows that repositioning with the Crutchfield extension is almost always successful. Imbricated fractures must occasionally be repositioned surgically (2 cases). A strikingly large proportion of patients (50%) in whom decompression was carried out ventrally were found to be suffering from traumatic disc hernia in the lower cervical spine. This was often accompanied by laceration of the posterior longitudinal ligament. Operative stabilization of unstable fractures, especially pseudarthrosis, of the odontoid process was performed in the main by dorsal immobilization (blocking) at C1/C2 (pelvic bone chips/wiring), whereby the residual rotational limitation was only of moderate degree and well tolerated subjectively. Two patients in whom stabilization was achieved in this way developed secondary ossification of the old pseudarthrosis of the odontoid process. In 2 cases the operation was carried out by the transbuccal route, again with the use of pelvic bone chips. Operative stabilization below C2 was performed 15 times using the ventral approach only, namely 13 times by Cloward's method and twice by Caspar's method. A combined ventrodorsal approach was used a total of 13 times in patients with severely damaged dorsal ligaments; here we made use ventrally of autologous pelvic bone chips, dorsally of wire osteosynthesis. The results were in the main good in respect of repositioning, uniformly good in respect of stability. In the great majority of cases with medullary or radiculomedullary deficits, the operation resulted in complete healing or at least an improvement, namely in 75% of patients with lesions of the odontoid process and in 81% of those with lesions below C2. In the second part of the study, the advantages and disadvantages of the various methods are set out and discussed in the light of recent advances and in particular of operative experience with tumours in the region of the cervical spine.

Adult↗

PubMed1986

Neurofibromatosis in children.

The clinical diagnosis of neurofibromatosis in childhood will usually be based on the presence of numerous café-au-lait spots. Early diagnosis allows for continuing follow-up and appropriate counselling. Symptomatic therapy can be provided if necessary. The disorder has a tendency via its mesodermal route to affect almost every system in the body; however, few laymen have even heard of the disorder and, except for the "Elephant Man" notoriety, are totally unaware of it, whereas muscular dystrophy, cystic fibrosis, and Down syndrome although occurring less frequently are well known to the general public. The management of neurofibromatosis in children covers an extremely wide spectrum: at times the management appears to be simple, involving little more than clinical evaluation and simple investigations. However, in view of the protean manifestations of the condition, a complete history including family history is obligatory, and investigation must include radiographic studies of the abdomen, chest, spine, and skull, the latter to include special views of the orbits and optic foramina. My investigation of this disorder has been extremely frustrating because of the progressive character of the disease. Nothing seems to alter the natural course of the disease. I cannot say that my investigative efforts have revealed any breakthroughs in treatment. An aggressive surgical approach to the myriad of lesions associated with this disease, especially neuromata or segmental problems, is probably advisable. The early treatment of tibial pseudarthrosis by polyprophylene orthotic and pulsating electromagnetic fields shows encouraging results over the short course, although I am not so sure as to whether or not the patients would do as well with the custom fit orthotic with or without the electronics. Early stabilization of spinal deformity has proven to be more than moderately successful and is strongly recommended following appropriate intraspinal evaluation. The management of tumors of the brain and spinal cord, as well as those associated with limb hypertrophy and congenital tibial pseudarthrosis, is undergoing innovations at this time which may result in a better cure rate. Procedures include the use of CT to evaluate tumors [Coleman et al. have attempted to differentiate neurofibromas from neurofibrosarcoma by contrast enhancement methods], the use of CO2 lasers to remove previously inoperable CNS tumors, microvascular bone transplantation and pulsating electromagnetic field to treat pseudarthrotic bones.4+he National

Bone Diseases↗