Treatment of trochanteric fractures by external fixator in patients with high unacceptable operative risk

External fixation has been used for the management of fractures since a long period of time. Good fixation, mild blood loss and early ambulation are always the main advantages for this technique. Other advantages include: it is simple, quick, inexpensive and causes minimal surgical trauma. The goal of this study was to report and evaluate the place of external fixation in the treatment of trochanteric fractures in patients with high unacceptable operative risk to withstand conventional osteosynthesis and to obviate the many disadvantages of traction and prolonged rest in bed. From January 1998 to December 2000, 22 patients, 6 males and 16 female, mean age 65.03 years, suffering from trochanteric fracture and considered preoperatively as "poor medical status"; were treated by external fixation and early mobilization. Technique was prescribed. All fractures except one were united at approximately 12.2 weeks [range 11.4-12.85 weeks]. Soft tissue interposition led to non-union in one patient. Deep screws-track infection was found in one case. Two cases had DVT. The use of the external fixator in these patients reduced their time in the hospital and facilitated their postoperative rehabilitation by allowing uncomplicated healing of a complicated fracture

Spinal cord decompression and stabilization for secondries of the thoracic and lumbar spine

A retrospective assessment of the decompression-stabilization procedures for malignant spinal lesions was done. Twenty-six patients underwent decompression-stabilization procedures for metastatic spinal lesions. The patients were classified according to their malignant lesion involvement of the three columns of the spine. One column was involved in only one case, two columns were involved in eleven cases and three columns were involved in fourteen cases. A posterior approach alone was done in eight patients, while combined anterior- posterior approach was done in eighteen cases. A variety of posterior stabilization procedures was used. The results obtained from direct anterior approaches using vertebrectomy and anterior reconstruction of the anterior and middle columns produced the best results in terms of neurological improvement. Almost all of the patients had two or three columns involvement, but the results did not support the three columns theory, where the significant results regarding the pre- or postoperative radiographic measurements [mechanical instability] and pre- or postoperative neurologic findings [neurologic instability] could not be correlated with the number of the involved columns

Lumbar pedicle screw fixation to improve correction of idiopathic scoliosis

Twenty-three consecutive patients with King-Moe type-I [thoracolumbar and lumbar] adolescent idiopathic scoliosis were treated with posterior spinal instrumentation using lumbar pedicle screw constructs. From the plain radiographs, the Cobb angles of the major curves and their correction were noted. Apical vertebral rotational angle and its correction were estimated from a single CT scan through the apical vertebra of the curve. A balance was also assessed on the posteroanterior [PA] radiographs by measuring a deviation from the median sacral line off C7. The average time of follow up examination was 28.8 months after surgery [range, 19-34 months]. The study concluded that using lumbar pedicle screw constructs for King-Moe type-I curve, idiopathic scoliosis was effectively derotating the scoliotic curve with no evidence of decompensation or imbalance within the coronal plane. Segmental pedicle screw fixation is a safe and effective method for correcting the triplanar deformity of the idiopathic thoracolumbar and lumbar scoliosis