scholarly journals Comparison of Screws to Plate-and-Screw Constructs for Midfoot Arthrodesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Jamal Ahmad
Keyword(s):  
Delayed Union ◽  
High Rate ◽  
Wound Complications ◽  
Postoperative Function ◽  
Pain Scores ◽  
Orthopaedic Literature ◽  
To Receive ◽  
With Screws

Category: Midfoot/Forefoot Introduction/Purpose: Arthritis of the midfoot’s 1st, 2nd, and/or 3rd tarsometatarsal joints (TMTJ) are routinely treated with arthrodesis when nonsurgical treatments fail. This surgery is traditionally performed with trans-articular screws, but newer plate- and screw constructs placed across the TMTJs may confer greater rigidity to the midfoot fusion. While in vitro biomechanical studies show advantages to using plate-and-screws over screws to achieve a solid midfoot arthrodesis, there have yet to be clinical comparative investigations about this subject. The purpose of this study is to prospectively evaluate and compare clinical and radiographic outcomes of trans-articular screws versus plate-and screw constructs for arthrodesis of the midfoot’s 1st, 2nd, and/or 3rd TMTJs in a single surgeon’s practice. Methods: Between April 2010 and December 2015, 68 patients presented with arthritis of the 1st, 2nd, and/or 3rd TMTJs that failed nonsurgical management. Of these persons, 50 enrolled in this study to receive a midfoot arthrodesis with either trans- articular screws or plate-and screw constructs. On the day of surgery, 25 patients were randomized to receive 4.0 mm partially- threaded cannulated cancellous screws (Synthes, Paoli, PA) while the remaining 25 were randomized to receive plate-and-screws (ALPS, Biomet, Warsaw, IN) at their involved TMTJs. Preoperative and postoperative function and pain was graded using the Foot and Ankle Ability Measures (FAAM) Scoring System and a Visual Analog Scale (VAS) of pain respectively. Radiographs were assessed for bony healing and hardware stability at the arthrodesis. Postoperative data regarding complications and revision surgeries were also recorded. Patients were routinely followed for 12 months from arthrodesis and then invited for updated longer-term follow-up to collect further data. Results: Of 25 patients with screws for arthrodesis, 21 (84%) achieved fusion within 6 months. Mean FAAM and pain scores changed from 46.4/100 and 8.3/10 preoperatively to 82.7/100 and 2.1/10 respectively at final follow-up. Three (12%) patients developed wound complications. Four patients (16%) experienced delayed union or nonunion of their arthrodesis. Of 25 patients with plate-and-screws for arthrodesis, 23 (92%) achieved fusion within 6 months. Mean FAAM and pain scores changed from 48.2/100 and 8.0/10 preoperatively to 86.3/100 and 1.8/10 respectively at final follow-up, which were not significantly different from patients with screws. Six (24%) patients developed wound complications, which is significantly higher than patients with screws. Two (8%) patients experienced delayed union or nonunion of their arthrodesis, which is less than patients with screws. Conclusion: A comparison of outcomes from performing midfoot arthrodesis with screws or plate-and-screw constructs has not been previously reported in the orthopaedic literature. This study demonstrates that using either screws or plate-and-screw to achieve TMTJ fusion results in a high rate of improving midfoot function and pain. While using just screws generate significantly less wound complications (P<0.05), employing plate-and-screws produce less problems with delayed union or nonunion of the fusion (P=0.30). Studies with a larger patient population may be needed to further confirm these results when using different types of implants for midfoot arthrodesis.

scholarly journals The modified anterior ellipsoidal cap titanium cable tension band for comminuted patellar fractures

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987401
Author(s):  
Fasheng Wang ◽  
Tianyi David Luo ◽  
Chunyong Chen ◽  
Yun Xie ◽  
Zhangxiong Lin ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Tension Band ◽  
High Rate ◽  
Wound Complications ◽  
Functional Rehabilitation ◽  
Postoperative Function ◽  
Patella Fractures ◽  
The Mean ◽  
Patellar Fractures

Purpose: The purpose of this study was to assess the outcomes in a series of patients, who underwent cerclage and figure-of-eight tension band wiring using a single titanium cable for comminuted patellar fractures. Methods: We describe a modified tension band technique using a single titanium cable to create an ellipsoidal cap structure that combines the circumferential and figure-of-eight wrapping in the fixation of closed Association for the Study of Internal Fixation/Orthopaedic Trauma Association 34C2 and 34C3 patellar fractures. We retrospectively reviewed 25 patients (16 males and 9 females, mean age 54 years) who underwent the described fixation technique between 2015 and 2017. Postoperative function was evaluated using the Böstman score. Results: At the mean follow-up of 25 months (range 17–39 months), the mean Böstman score was 27.3 ± 2.6 points (range 23–30). Eighteen patients (72%) had excellent results (score ≥28); seven patients (28%) had good results (score 20–27); and no patients had an unsatisfactory result (score < 20). All surgical incisions healed without major wound complications. Two patients reported minor complications (soft tissue irritation, cellulitis). No patients demonstrated loss of reduction or implant failure during the follow-up period. Conclusion: The modified anterior ellipsoidal cap tension band using a single titanium cable created an effective tension band structure in the treatment of comminuted patella fractures. It is a simple operative technique that produced a stable fixation construct, which allowed early functional rehabilitation and weight-bearing with a high rate of excellent outcomes at 2 years after surgery.

scholarly journals Functional results after operative treatment of talus fractures

2021 ◽  
Vol 13 (1) ◽  
pp. 1-6
Author(s):  
Andreja Gavrilovski ◽  
Aleksandra Gavrilovska-Dimovska ◽  
Goran Aleksovski
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Functional Results ◽  
High Rate ◽  
Posttraumatic Osteoarthritis ◽  
Anatomic Reduction ◽  
Aseptic Osteonecrosis ◽  
The University ◽  
With Screws

Fractures of the talus do not occur frequently, accounting for about 0.1% of all fractures. Failure to achieve anatomic reduction, exponentially increases the risk of postoperative aseptic osteonecrosis and posttraumatic osteoarthritis. The purpose of this study was to evaluate and compare the short-term and medium-term functional outcomes in patients who underwent open reduction and internal fixation of talus fractures. Materials and methods: At the University Clinic for Traumatology in the period between 2017 to 2020, 14 patients with talus fractures were surgically treated. The inclusion and exclusion factors were determined, all patients signed the consent and the study passed the ethics committee. Results: All patients underwent open reduction and internal fixation with screws or reconstructive plate. Follow-up was done on the 14th postoperative day, 1st month, 3rd month and 6th month. At the 6th month follow-up, the functional outcome was tested using the Kitaoka score unified by the American Orthopedic Foot and Ankle Society. This injury is too rare for conclusions to be brought out of and to be compared to larger studies. However, all major studies from reference trauma centers lead to the same conclusions, that the treatment of these fractures is complex Anatomical reduction is mandatory for a better outcome. Conclusion: A protocol for the treatment of posttraumatic osteoarthritis should be introduced, given the high rate of its occurrence despite the satisfactory surgical technique.

scholarly journals Intra-surgical Site Vancomycin Powder Application in Infected Diabetic Heel Ulcers with Calcaneal Osteomyelitis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0014
Author(s):  
James D. Brodell ◽  
Irvin Oh
Keyword(s):  
Ankle Brachial Index ◽  
Group Versus ◽  
High Rate ◽  
Resection Margins ◽  
Wound Complications ◽  
Resistant Bacteria ◽  
Diabetic Patients ◽  
Vancomycin Powder ◽  
Vancomycin Group

Category: Diabetes; Hindfoot Introduction/Purpose: The treatment of diabetic heel ulcers (DHU) with osteomyelitis is challenging, and dismal clinical results have been reported after calcanectomy, with reported revision rates of 0-63.5%. The topical application of vancomycin powder has reported to be beneficial in foot and ankle surgery amongst diabetic patients. However, no studies have examined the efficacy of intra-surgical site vancomycin powder application in DHU surgery. There are potential risks of intra-surgical site vancomycin powder application, such as the selection of gram-negative and multi-drug resistant bacteria, and increased wound complications. Thus, we aimed to 1) assess the clinical outcomes of calcanectomy for DHU and 2) investigate the clinical efficacy of intra-surgical site vancomycin powder application in patients who underwent partial- or total calcanectomies performed to treat infected DHU with osteomyelitis. Methods: This study was approved by our institution’s Research Subjects Review Board. Subjects were identified utilizing current procedural terminology code 28120 (Partial excision bone; talus or calcaneus) for partial or total calcanectomies performed at our academic institution. Thirty-eight calcanectomies performed secondary to DHU with osteomyelitis were identified. Patient demographics (age, sex, gender, body mass index), preoperative labs (hemoglobin A1c, blood glucose, white blood cell, erythrocyte sedimentation rate, C-reactive protein, serum creatinine, hemoglobin), ASA Class, peripheral arterial disease assessed by ankle-brachial index, Charleston Comorbidity Index, and intra-surgical site application of vancomycin powder were recorded. Duration of follow-up, type and quantity of systemic antibiotics administered during surgery, surgical complications, and return to the operating room (RTOR) were also recorded. There were two cohorts: those whose surgical wound was closed without vancomycin powder (initial 25 patients; ‘novancomycin’ group) versus those whose surgical site was closed with vancomycin powder (later 13 patients; ‘vancomycin’ group). Results: The average follow-up was 26.1 +- 15.0 months. Surgical pathology confirmed negative bone resection margins for all patients. Nineteen patients required an unplanned RTOR (50.0%). A revision amputation was performed in fifteen extremities (39.5%). Thirteen patients received intrawound vancomycin at closure, and 25 did not. Nine of thirteen (69.2%) patients who received vancomycin powder required RTOR. This includedTwo below-knee amputations (BKA), two irrigation and debridements (I&D), and six revision or total calcanectomies. There was a significantly higher rate of RTOR in the vancomycin cohort relative to the no-vancomycin cohort (76.9% vs 36.0%, p=0.038). Of the 25 no-vancomycin group, 17 did not return to the OR, 4 underwent BKA, 1 had I&D, and 2 required revision or total calcanectomy. Conclusion: In our cohort, calcanectomy performed for the surgical management of DHU with osteomyelitis yielded a high rate (50%) of unplanned follow-up procedures. Intra-surgical site vancomycin powder application during wound closure after calcanectomy did not result in clinical benefit and is likely unnecessary. The risk and benefit profile of intra-surgical site vancomycin powder application for diabetic foot infection surgery needs to be further investigated.

Functional Results of All-Inside Arthroscopic Broström-Gould Surgery With 2 Anchors Versus Single Anchor

2020 ◽  
Vol 41 (6) ◽  
pp. 721-727 ◽  
Author(s):  
Shi-Ming Feng ◽  
Ai-Guo Wang ◽  
Qing-Qing Sun ◽  
Zai-Yi Zhang
Keyword(s):  
Ankle Instability ◽  
Functional Results ◽  
High Rate ◽  
Wound Complications ◽  
Functional Score ◽  
Activity Levels ◽  
Level Of Evidence ◽  
Anchor Group ◽  
Significant Difference

Background: The all-inside arthroscopic Broström-Gould technique gained particular attention among clinicians and researchers due to its high rate of satisfactory results. Thus far, there is a lack of evidence regarding the differences in clinical outcomes between the use of 1 anchor and 2 anchors. The purpose of this study was to compare the differences in clinical function and activity levels in patients treated with 1 or 2 anchors in all-inside arthroscopic Broström-Gould surgery for chronic lateral ankle instability (CLAI). Methods: The data of 75 patients with CLAI (unilateral) admitted from May 2013 to July 2016 were retrospectively analyzed. All patients were treated with all-inside arthroscopic Broström-Gould surgery. The patients were divided into a single-anchor group ( n = 36) and double-anchor group ( n = 39) according to the number of anchors used. There was no statistical difference in general characteristics between the 2 groups before surgery. After 36 to 72 months of follow-up, the pain visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), and Foot and Ankle Outcome Score (FAOS) were used to evaluate and compare the clinical function results between the 2 groups. Results: The incidence of wound complications; reaction to the suture; injury to the nerve, blood vessel, or tendon; and length of postoperative hospitalization were similar between the 2 groups. At the last follow-up, there was no significant difference in the VAS and AOFAS scores between single- and double-anchor groups, but the KAFS and FAOS in the double-anchor group were significantly higher than in the single-anchor group. Additionally, more patients in the double-anchor group returned to preinjury sports activities. Conclusion: All-inside arthroscopic Broström-Gould surgery for the treatment of CLAI yielded a better functional effect and better recovery to preinjury mobility when 2 anchors were used instead of a single anchor. Level of Evidence: Level III, comparative study.

Immediate Gore-Tex Sling Suspension for Management of Facial Paralysis in Head and Neck Extirpative Surgery

2007 ◽  
Vol 137 (2) ◽  
pp. 228-232 ◽  
Author(s):  
Mia E. Skourtis ◽  
Stephen M. Weber ◽  
J. David Kriet ◽  
Douglas A. Girod ◽  
Terance T. Tsue ◽  
...  
Keyword(s):  
Head And Neck ◽  
Late Complications ◽  
Facial Reconstruction ◽  
High Rate ◽  
Wound Complications ◽  
Early Results ◽  
Aesthetic Results ◽  
Long Term Follow Up

OBJECTIVE: We sought to evaluate the functional and aesthetic outcomes of immediate facial reconstruction with a Gore-Tex (expanded polytetrofluoroethylene) sling in irradiated patients undergoing large head and neck tumor extirpation with facial nerve resection. STUDY DESIGN AND SETTING: We conducted a retrospective study of 17 patients at two academic institutions who underwent extirpative surgery with immediate Gore-Tex sling reconstruction and completed radiotherapy. Functional and aesthetic results were evaluated at three intervals. RESULTS: All patients had excellent immediate results and good or excellent intermediate-term results. At long-term follow-up, results were good to excellent in 47% and unacceptable in 35% of patients. CONCLUSION: In irradiated patients undergoing total parotidectomy with immediate facial reconstruction using Gore-Tex slings, early results are excellent, but there is a high incidence of major wound complications and unacceptable results in long-term follow-up. SIGNIFICANCE: There is a high rate of late complications associated with immediate facial reconstruction with Gore-Tex slings in irradiated patients.

scholarly journals Rotationplasty for Severe Congenital Femoral Deficiency

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 462
Author(s):  
Corey B. Fuller ◽  
Craig H. Lichtblau ◽  
Dror Paley
Keyword(s):  
Delayed Union ◽  
Senior Author ◽  
Wound Complications ◽  
Tibial Osteotomy ◽  
Radiographic Outcomes ◽  
Tibial Condyle ◽  
Age At Surgery ◽  
Reconstructive Option ◽  
Severe Degree

Rotationplasty is a reconstructive option for severe congenital femoral deficiency (CFD). The senior author (D.P.) developed five new rotationplasty techniques for use in CFD based on the Paley classification, including the Paley–Brown (fusion femur to pelvis), Paley (fusion femur to femoral head), Paley–Winkelman (insertion tibial condyle to acetabulum), PaleySUPERhip–Van Nes (hip osteotomy with knee fusion) and PaleySling–Van Nes (hip reconstruction with knee fusion revision) rotationplasty techniques. The purpose of this study is to retrospectively evaluate the complications, radiographic outcomes and need for secondary surgery in 19 rotationplasty cases performed by the senior author (D.P.) for severe CFD from 2009 to 2019. Rotationplasty comprised only 2% of the authors treated CFD cases during this period. Average age at surgery was 8.6 years old. Average follow-up was 3.3 years. Sixteen concomitant procedures were performed including temporary arthrodesis, tibial osteotomy and SUPERhip procedure. The most common complication was wound necrosis/dehiscence, which occurred in 52% of the cases related to the circumferential incision and required a total of 31 additional debridements. Additional complications were successfully treated and included sciatic nerve palsy decompressed by abducting the femur, a tibial delayed union that underwent bone grafting, two distal femur failed epiphysiodesis treated by revision with one osteotomy and a thigh compartment syndrome requiring debridement. Indication specific rotationplasty successfully addresses the severe degree of femoral deficiency, deformity, and discrepancy in patients with CFD, despite high rates of wound complications.

scholarly journals MON-LB110 A Phase 2 Evaluation of a Ready-To-Use Liquid Stable Continuous Subcutaneous Glucagon Infusion for the Treatment of Hypoglycemia Associated Autonomic Failure

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jeremy H Pettus ◽  
Samer Nakhle ◽  
Fernando Ovalle ◽  
Michael Roehrhoff Rickels ◽  
Guillermo Enrique Umpierrez ◽  
...  
Keyword(s):  
Autonomic Failure ◽  
High Rate ◽  
Phase 2 ◽  
Hormone Response ◽  
Percent Change ◽  
Long Term Follow Up ◽  
To Receive ◽  
Low Rate

Abstract OBJECTIVE:A novel, ready-to-use, liquid stable, continuous subcutaneous glucagon infusion (CSGI; Xeris Pharmaceuticals) was evaluated for the treatment of adults with type 1 diabetes (T1D) with documented Hypoglycemia Associated Autonomic Failure (HAAF). METHOD:This was a Phase 2 prospective, multi-center, randomized, placebo-controlled, double-blind, parallel trial in T1D adults with documented HAAF, defined as Gold Scale Score ≥4. Subjects were randomized in a 1:1:1 ratio to receive 4 weeks of continuous treatment (via Omnipod pump) with high rate CSGI (80mcg/hour), low rate CSGI, (20mcg/hour) or placebo (matched infusion rates for low and high rate CSGI). The primary endpoint evaluated at 4 weeks was the percent change of the epinephrine hormone response after 30 minutes of induced hypoglycemia. Epinephrine levels and hypoglycemia symptoms were recorded following a stepwise hypoglycemia clamp, and results compared between study treatment arms. Following the first four weeks, subjects continued for an additional 24 weeks to assess their epinephrine hormone response to hypoglycemia measured at 3 months post-treatment (16 weeks), and 6 months post-treatment (28 weeks). RESULTS:Forty-nine subjects were randomized to receive treatment with high rate CSGI (n=15), low rate CSGI (n=18), or matching placebo (n=16). At the end of study treatment, there were no statistically significant differences between the treatment arms for percent change of epinephrine hormone response during a stepwise hypoglycemia clamp (CSGI vs. placebo; p=0.160). As a result, long-term follow-up of the subjects was stopped early. The long-term follow-up data collected to date will be reported separately. The administration of low and high rate CSGI was associated with mild to moderate nausea (5.9%, 20%, respectively) and vomiting (11.8%, 13.3%, respectively) that was self-limited and required no additional intervention. In this 4-week assessment, CSGI was not associated with pain nor significant injection site reactions, and no SAEs related to CSGI were reported. CONCLUSION:In this proof-of-concept study, CSGI did not demonstrate statistically significant improvements in plasma epinephrine concentration when compared to placebo at 4 weeks. While there were positive epinephrine and improved hypoglycemia awareness responses observed in some subjects, the equivocal efficacy results observed may be explained by the unanticipated and incomplete elimination of hypoglycemia on CSGI therapy, and those on placebo therapy experienced hypoglycemia improvement. CSGI can be safely used with concomitant diabetes medications, and there were no SAEs related to CSGI. The 4-week administration of both low and high rate CSGI was safe and well tolerated.

Tipifarnib in combination with idarubicin and cytarabine in patients with newly diagnosed acute myeloid leukemia (AML) or high risk myelodysplastic syndrome (MDS)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6557-6557
Author(s):  
F. Ravandi-Kashani ◽  
H. Kantarjian ◽  
G. Garcia-Manero ◽  
S. O’Brien ◽  
S. Verstovsek ◽  
...  
Keyword(s):  
High Risk ◽  
Chemotherapeutic Agents ◽  
High Rate ◽  
Clinical Activity ◽  
Farnesyl Transferase ◽  
Farnesyl Transferase Inhibitor ◽  
Common Grade ◽  
Grade 3

6557 Background: Tipifarnib (Zarnestra [Z]) is a non-peptidomimetic farnesyl transferase inhibitor (FTI) with clinical activity in AML and MDS. In vitro studies have demonstrated synergy when combining tipifarnib with chemotherapeutic agents. Methods: We have conducted a study where pts (aged 15 to 60 years) with previously untreated AML or high-risk MDS (blasts >10%) were treated with Idarubicin 12 mg/m2/d on days 1–3, cytarabine 1.5 g/m2 IV over 24 hours daily on days 1–4 and Z; the first cohort (7 pts) received Z 200mg orally twice daily (BID), and all others 300 mg BID for 21 days. Pts achieving CR received consolidation (5 courses) with Idarubicin 8 mg/m2/d on days 1–2, cytarabine 0.75 g/m2/d on days 1–3, and Z 300 mg BID for 14 days every 4–6 weeks. Maintenance was with Z 300 mg BID for 21 days every 4–6 wk for 6 months. Results: We have treated 33 pts; median age 51 yrs (17–59 yrs). Twenty two pts (67%) have achieved CR, 3 (9%) CRp, and 2 (6%) PR. There were no induction deaths. Response (CR/CRp) by cytogenetics was: 13/15 (86%) for diploid, 5/6 (83%) with −5/−7, 1/2 (50%) with t(8;21), and 6/10 (60%) with other abnormalities. Response by Flt3 was 19/22 (86%) for unmutated Flt3, 3/5 (60%) for mutated Flt3. CR by age (excluding t(8;21)) was 13/16 (81%) if ≤ 50yrs, 4/6 (67%) if >50yrs and diploid, and 5/8 (63%) if >50yrs and other cytogenetics. With a median follow-up of 45 weeks, 5 pts have relapsed after 13 to 39 weeks and 1 died (in CR) after 18 wks. The most common grade 3 adverse events include reversible diarrhea in 7 (21%) and hyperbilirubinemia in 6 (18%). Twenty (61%) and 8 (53%) pts have required dose reductions during induction and consolidation courses, respectively. Conclusions: Z combined with Idarubicin and cytarabine induces a high rate of CR in AML/high risk MDS, with increased incidence of diarrhea and hyperbilirubinemia. Role of Z in prolongation of CR duration requires further follow-up. [Table: see text]

scholarly journals Insertional Achilles Tendinopathy:  Operative Outcomes in the Military

2020 ◽  
Author(s):  
Greg E Lausé ◽  
Rachel A Egbert ◽  
Paul M Ryan
Keyword(s):  
Active Duty ◽  
Achilles Tendinopathy ◽  
High Rate ◽  
Operative Outcomes ◽  
Pain Scores ◽  
Superficial Wound ◽  
Return To Duty ◽  
The Military ◽  
Insertional Achilles Tendinopathy

Abstract Introduction: Insertional Achilles tendinopathy (IAT) operative outcomes within the active duty United States military have not been previously reviewed. Materials and Methods: A single center retrospective review of consecutive patients diagnosed with IAT was performed. Surgical patients were followed until they returned to full duty or were released from the military. Outcomes included Visual analog scale (VAS) pain scores, the ability to return to running and time to do so, and the ability to return to military specific duty. All complications were recorded and followed until resolution. Statistical analysis was performed with an independent samples t Test. Results: Our data analysis included 113 active duty military patients. Fifty-eight (55%) patients underwent operative treatment for insertional IAT. Eight patients had bilateral procedures for a total of 66 Achilles procedures evaluated. Mean duration of follow up was 42 months (range, 12-143). Mean age at time of surgery was 37.2 years (range, 21-54). Length of pre-operative physical therapy had a mean of 6.5 months (range, 2-36). Visual analog scores significantly improved at all time points from 5.4 pre-op to 2.7, 2.9, 2.7, 2.9 at 3, 6, 12, and 24 months respectively. There was no significant improvement in VAS scores after the 3-month post-operative visit. Mean return to run time was 9 months (range 4.5-16). At 1 year, 80% (46/58) of patients returned to military duty although 43% of patients that returned to duty had restrictions in regards to running. Complications were recorded in 18 of 66 procedures (27%). The most common complication was superficial wound infection or superficial wound dehiscence. Complications requiring return to the OR were observed in 6 patients (9%).Conclusions: This is the first study to evaluate the outcomes of IAT in an active military population. Active duty patients diagnosed with IAT failed non-operative management and required surgical intervention in 55% of the population studied. For those patients who were treated surgically we documented an 80% return to duty rate and a significant reduction of subjective pain scores from a mean of 5.4 to a mean of 2.6 at final follow-up. There was no significant change in the VAS score after the 3-month post-operative evaluation. Service members were able to return to duty at a mean of 7 months and return to running at a mean of 9 months. The high rate of return to duty and significant improvement in pain scores demonstrate that the surgical management of IAT is a viable treatment option for patients who could not otherwise remain on active duty. With that said, the complication rate of 27% is high. Patients and providers should consider the risks, benefits, and the duration of therapy during their shared decision-making process.

183 Short Segment Posterior Fixation with Index Level Screws Versus Long Segment Posterior Fixation for Thoracolumbar Spine Fracture: Angle of Correction and Pain

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 248-248
Author(s):  
Ahmed Mamdouh Sallam
Keyword(s):  
Thoracolumbar Spine ◽  
Spine Fracture ◽  
High Rate ◽  
Posterior Fixation ◽  
Short Segment ◽  
Cobb’S Angle ◽  
Index Level ◽  
Short Segment Fixation ◽  
With Screws

Abstract INTRODUCTION As a simple and commonly used technique, short-segment pedicle instrumentation of thoracolumbar instability seems to have a high rate of implant failure and recurrence of instability.Data obtained from those studies suggest that the use of transpedicular screws at the fractured level provides the advantages of a stiffer construct, an increased biomechanical stability and the effect of 3-point fixation of the unstable segment leads to gardening against pulled-out. METHODS Methods: A prospective study of 61 patients, have single level thoracolumbar spine fracture with Cobb's angle = 25°, underwent posterior fixation. Of them, Thirty three patients underwent short segment fixation one level above and one level below with screws into the index level, and twenty eight patients underwent long segment fixation with two levels above and two levels below with skipped index level. All patients were followed up for about 1 year until the fusion achieved. The angle of correction and pain were regularly assessed by Cobb's angle measurement and visual analogue scale (VAS) respectively. RESULTS >The sixty one patients who underwent posterior fixation was grouped into 33 short segment cases and 28 long segment cases. the post operative mean angle of correction were 6.8° ± 2.6° and 5.8° ± 1.6° respectively (P = 0.098). After 1 year follow up, the angle of correction have become 7.8° ± 1.6° and 7.9° ± 1.8° respectively (P = 0.860). The pain was assessed by VAS on regular base follow up. In short segment group the pre-operative VAS was 5.6 ± 2.1 whereas the long segment group VAS was 5.1 ± 2.1 (P = 0.284).On one year follow up the VAS were 1.4 ± 0.5 and 1.8 ± 0.4 (P = 0.590) respectively. CONCLUSION The short segment fixation with screws into index level can maintain the angle of correction till the fusion achieved as long segment fixation

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