Outcome of thoracolumbar burst fractures: decompression, pedicle screw fixation and posterolateral fusion

A total of 29 patients with unstable [according to Denis classification] thoracolumbar burst injury underwent transpedicular spinal instrumentation using the SAS screw-rod system. We were able to follow-up 23 patients for more than 6 months. The 23 patients [13 males and 10 females] with mean age 33.30 +/- 10.18 years [range 19-56 years] presented with severe back pain. Four patients with complete neural injury 14 patients with partial neural injury, and 5 without neurological deficit Surgery consisted of either indirect or direct neural decompression, internal fixation, and autogenous iliac bone grafting. Annulotaxis was performed in patients with complete injury [n=4] and those with canal compromise more than <40% [n=10]. Transpedicular decompression was performed for other patients. A total of 92 pedicle screws were placed in 20 patients with one unstable motion segment and 3 patients with two unstable motion segments. All patients were submitted for routine clinical and radiographic follow-up including CT-scan. Mechanical stability was maintained through the follow-up in all patients with fusion rate of 87%. All screw purchases were satisfactory but 5 [94.57%]. Mean kyphus deformity reduced from 20.09 +/- 9.77 to 11.26 +/- . 6.25 degrees postoperative. Mean canal compromise corrected from 36.30 +/- 23.44% to 11.74 +/- 5.56% postoperative. No operative mortality, wound infection, or necessity for reoperation were reported. All patients with partial neural injury improved at least one Frankel grade. Those with complete neural injury as well as those without neurological deficit remain unchanged. Morbidity included two isolated nerve root deficits one transient and one permanent. Pedicle screw-rod fixation allows early mobilisation, short segment fixation. and preservation of adjacent motion segments. It offers high biomechanical stability with high fusion rate. The technique is dem and ing and meticulous nevertheless it is associated with minimum morbidity in trained h and s

Volar inlay bone graft and K-wire fixation in stable scaphoid non-union

Stable undisplaced non-united fracture of scaphoid showed an increasedincidence of displacement and angulation with subsequent radioscaphoidarthritis over longer duration of non-union. 16 patients with stable scaphoidnon-union were treated by volar inlay graft and k-wire fixation. For clinicalassessment, the wrist score of Coony et al was applied pre and postoperatively. Bone healing was obtained in 15 out of the 16 patients. Thepostoperative wrist score was significantly improved even in the 2 patientswith satisfactory preoperative assessment. The stable ununited scaphoidfractures, even with mild or no symptoms, should be treated precisely to improvethe functional status of wrist and to decrease the incidence of radioscaphoidarthritis

Unreamed interlocking nail versus external fixator in the management of open tibial fractures, a randomized trial

Thirty-four patients with open tibial fractures [OTF] were treated by either unreamed interlocking tibial nail [UITN] or external fixator. Cases were randomized to both treatment protocols on alternate basis. The mean age was 36 years, with 28 males and 6 females. Exclusion criteria included children, associated injuries of the knees, ankles, and tarsus and type I soft tissue injuries. The average interval from injury to operation was 8 hours. There were 17 cases in external fixation group and 17 cases in UITN group. The patients were followed for an average of fifteen months. The results of UITN in the treatment of open tibial fractures were superior to external fixation with shorter time of union, better alignment, lower infection rate and shorter wound healing time