Nonunion of the scaphoid treated by anterior vascularized bone graft: a review of 26 cases / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the clinical and radiological outcome of anterior vascularized bone graft in the treatment of primitive nonunion of the scaphoid.</p><p><b>METHODS</b>This is a retrospective study of 26 scaphoid nonunion cases treated by this technique between 2004 and 2009. The mean age was 38 years. Nonunion was of types IIA and IIB according to the Alnot's classification and only one case showed a proximal pole necrosis (type IV). The fixation was ensured by K-wire. The mean immobilization period was 9 weeks.</p><p><b>RESULTS</b>At mean 19 months follow-up, the bone union rate was 88.5%. Failure was noted in three cases. No significant complications secondary to this technique were observed. The mobility in extension and flexion had an average recovery of 18 degree Nineteen patients (73%) were free of pain, and the others had occasional pain.</p><p><b>CONCLUSIONS</b>It is a meticulous surgical technique that provides better union rates than those of conventional scaphoid graft. This technique is first adopted in cases of failure of conventional grafts in the treatment of scaphoid nonunion but the encouraging results suggest expanding indications to primitive nonunion.</p>

[Pott's disease of the upper cervical spine [three cases and literature review]]

Sub-occipital Pott's disease is rare, but dangerous. To recall diagnostic aspects and spatially the neuroradiological ones of sub-occipital Pott's disease. We describe three patients with sub-occipital Pott's disease followed in our department from 2002 to 2007. there were two women and one man [mean age at onset: 48 years]. The early clinical picture was non specific. Exploration, in addition to standard radiographies included a computerized Tomography [CT] [n=2] and MRI [n=1 and n=3]. The diagnosis was confirmed histologically on a biopsy of the abscess [n=1], a bacteriological evidence [n=2] and retained thanks to argument presumption [n=3]. The treatment was based on quadruple antituberculous chemotherapy with external traction [n=2 and n=3] associated with urgent surgery [n=1] because of the worsening of the neurological complications. The evolution was fatal [n=1] and positive [n=2 and n=3]. Tuberculosis should be suspected in patients with chronic torticollis and residing in an area when tuberculosis is endemic. Medical treatment is based on a quadruple antituberculosis chemotherapy with fraction in the presence of atlanto-axial instability. Surgery is reserved in case of neurological worsening or persistent instability