Controversies in Managing of Thoracic-Lumbar Upper Burst Fractures

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Sahat Edison Sitorus
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Posterior Instrumentation ◽  
Burst Fracture ◽  
Surgical Decompression ◽  
Neurologic Deficit ◽  
Retroperitoneal Approach ◽  
Burst Fractures ◽  
Lateral Fixation

Upper burst fracture of Th12-L1 has unique anatomy because it contains lower spinal cord, medullary cone, and diaphragm which separates between the thoracic and lumbar spine.The presence or absence of neurologic deficit is the single most important factor in the decision making. The presence of profound but incomplete neural deficit in association with canal compromise represents an urgent indication of surgical decompression. Antero-lateral direct decompression with trans-thoracic trans-pleural–retroperitoneal approach given the proximity the cord and conus is the most effective method, with inter-vertebral instrumentation with or without lateral fixation or posterior instrumentation.

scholarly journals Variables affecting complication rates in type III paediatric supracondylar humerus fractures

2021 ◽  
pp. 1-8
Author(s):  
Andrew T. Livermore ◽  
Jason M. Sansone ◽  
Maxwell Machurick ◽  
Paul Whiting ◽  
Scott B. Hetzel ◽  
...  
Keyword(s):  
Fellowship Training ◽  
Rotational Instability ◽  
Complication Rates ◽  
Posterior Displacement ◽  
Type Iii ◽  
Radiographic Outcomes ◽  
Supracondylar Humerus Fractures ◽  
The Impact ◽  
Pin Configuration ◽  
Lateral Fixation

Purpose Unstable supracondylar humerus (SCH) fractures may have different outcomes as a result of direction of displacement and pin configuration. This study evaluates the impact of fracture displacement, pin configuration and fellowship training on clinical and radiographic outcomes in unstable fractures. Methods A total of 99 patients with completely displaced type III fractures were identified at an academic centre and a local community hospital. Patient characteristics and the fellowship training of the treating surgeon were recorded, and injury films documented the direction of displacement. Pin configuration, coronal and sagittal alignment were recorded from postoperative radiographs and at healing. Radiographic outcomes including coronal, sagittal and rotational malunion as well as clinical complications were analyzed. Results Fractures with direct posterior displacement had a lower composite malunion rate compared with those with posterolateral (PL) or posteromedial (PM) displacement (6.9%, 36.4%, 29.2% respectively; p = 0.019). PM displacement had a higher rate of coronal malunion compared with PL (18.2% versus 0%; post hoc p = 0.024). All-lateral constructs resulted in more rotational malunions (20.9% versus 1.8%; p = 0.002) compared with crossed pinning. PL fractures treated with all-lateral fixation showed a trend toward increased rotational instability or malunion (23.8% versus 1.3%; p = 0.073). Higher composite complication rates were noted in patients treated by surgeons with non-paediatric, non-trauma fellowship training. Conclusion For displaced SCH fractures, all-lateral fixation is associated with higher rates of rotational instability and malunion. Posteromedially and posterolaterally displaced fractures have higher rates of malunion compared with fractures with straight posterior displacement. Fellowship training other than paediatric or trauma was associated with increased complications. Level of Evidence Level III

Controversies in Managing of Thoracic-Lumbar Upper Burst Fractures

2018 ◽  
Vol 1 (2) ◽  
pp. 23
Author(s):  
Sahat Edison Sitorus
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Posterior Instrumentation ◽  
Burst Fracture ◽  
Surgical Decompression ◽  
Neurologic Deficit ◽  
Retroperitoneal Approach ◽  
Burst Fractures ◽  
Lateral Fixation

Upper burst fracture of Th12-L1 has unique anatomy because it contains lower spinal cord, medullary cone, and diaphragm which separates between the thoracic and lumbar spine.The presence or absence of neurologic deficit is the single most important factor in the decision making. The presence of profound but incomplete neural deficit in association with canal compromise represents an urgent indication of surgical decompression. Antero-lateral direct decompression with trans-thoracic trans-pleural–retroperitoneal approach given the proximity the cord and conus is the most effective method, with inter-vertebral instrumentation with or without lateral fixation or posterior instrumentation. 

Endoscopic lateral fixation using a T-shaped mesh implant is an effective way of correcting apical genital prolapse

2018 ◽  
Vol 2_2018 ◽  
pp. 120-125
Author(s):  
Aryutin D.G. Aryutin ◽  
Vaganov E.F. Vaganov ◽  
Belousova A.A. Belousova ◽  
Toktar L.R. Toktar ◽  
Toniyan K.A. Toniyan ◽  
...  
Keyword(s):  
Genital Prolapse ◽  
Mesh Implant ◽  
Lateral Fixation

scholarly journals Lateral fixation of AO type-B2 ankle fractures in the elderly: the Knowles pin versus the plate

2006 ◽  
Vol 31 (6) ◽  
pp. 817-821 ◽  
Author(s):  
Yih-Shiunn Lee ◽  
Hui-Ling Huang ◽  
Ting-Ying Lo ◽  
Chien-Rae Huang
Keyword(s):  
The Elderly ◽  
Ankle Fractures ◽  
Lateral Fixation

scholarly journals Vertical muscle transposition augmented with lateral fixation (Foster) suture for Duane syndrome and sixth nerve palsy

Eye ◽  
2013 ◽  
Vol 27 (10) ◽  
pp. 1188-1195 ◽  
Author(s):  
S Akar ◽  
B Gokyigit ◽  
G Pekel ◽  
A Demircan ◽  
A Demirok
Keyword(s):  
Nerve Palsy ◽  
Muscle Transposition ◽  
Sixth Nerve Palsy ◽  
Duane Syndrome ◽  
Lateral Fixation ◽  
Sixth Nerve

Biomechanical comparison: stability of lateral-approach anterior lumbar interbody fusion and lateral fixation compared with anterior-approach anterior lumbar interbody fusion and posterior fixation in the lower lumbar spine

2005 ◽  
Vol 2 (1) ◽  
pp. 62-68 ◽  
Author(s):  
Sung-Min Kim ◽  
T. Jesse Lim ◽  
Josemaria Paterno ◽  
Jon Park ◽  
Daniel H. Kim
Keyword(s):  
Interbody Fusion ◽  
Screw Fixation ◽  
Anterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Content Type ◽  
Transpedicular Fixation ◽  
Lower Lumbar Spine ◽  
Lateral Fixation ◽  
Fine Print

Object. The stability of lateral lumbar interbody graft—augmented fusion and supplementary lateral plate fixation in human cadavers has not been determined. The purpose of this study was to investigate the immediate biomechanical stabilities of the following: 1) femoral ring allograft (FRA)—augmented anterior lumbar interbody fusion (ALIF) after left lateral discectomy combined with additional lateral MACS HMA plate and screw fixation; and 2) ALIF combined with posterior transpedicular fixation after anterior discectomy. Methods. Sixteen human lumbosacral spines were loaded with six modes of motion. The intervertebral motion was measured using a video-based motion-capturing system. The range of motion (ROM) and the neutral zone (NZ) in each loading mode were compared with a maximum of 7.5 Nm. The ROM values for both stand-alone ALIF approaches were similar to those of the intact spine, whereas NZ measurements were higher in most loading modes. No significant intergroup differences were found. The ROM and NZ values for lateral fixation in all modes were significantly lower than those of intact spine, except when NZ was measured in lateral bending. All ROM and NZ values for transpedicular fixation were significantly lower than those for stand-alone anterior ALIF. Transpedicular fixation conferred better stabilization than lateral fixation in flexion, extension, and lateral bending modes. Conclusions. Neither approach to stand-alone FRA-augmented ALIF provided sufficient stabilization, but supplementary instrumentation conferred significant stabilization. The MACS HMA plate and screw fixation system, although inferior to posterior transpedicular fixation, provided adequate stability compared with the intact spine and can serve as a sound alternative to supplementary spinal stabilization.

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