Modified Buck's method for the treatment of spondylolysis and spondylolisthesis

20 patients who had symptomatic spondylolysis and Grade I spondylolisthesis, were treated using the Buck's method for internal fixation with screws and bone grafting of the defect of the pars interarticularis. 12 of them were males and 8 were females. The average age at the operation was 22 years. After an average period of follow-up of 30 months, the results were satisfactory in 80% of the patients

Proximal tibial osteotomy for knee osteoarthritis with various deformity

Proximal tibial osteotomy was performed on 80 osteoarthritic varus knees in 60 patients. They were 25 men and 35 women, aged 43 -70, average 60.3 years. They were followed up for over 5 years. The Ahlback's hip-knee-ankle mechanical axis was determined preoperatively on standing full-length weight-bearing posteroanterior radiographs. This preoperative angle was 158 - 179, mean 172. The operative technique used was a medial-opening wedge osteotomy above the tibial tuberosity. The size of the wedge was predetermined on tracings from radiographs of the Ahlback's mechanical axis in the standing position The wedge needed was measured from the amount of opening of the osteotomy site necessary to obtain a normal mechanical axis of 180° according to Ahlback's. A bicortical iliac crest bone-graft of the appropriate size was impacted into the opened wedge to keep it open, and was maintained in position by internal fixation by plate and screws. Weight-bearing was usually possible after 3 months when incorporation of the bone-graft took place and bony union became solid. Active exercise was possible within 3 days after the operation. Late results after 5 years were: Postoperative Ahlback's mechanical axis angle: 173 - 190, mean 182.5°; Painless walking distance for at least 1 km: 55 knees [68.8%]; No appreciable diminution of knee movement; all pain-free knees were stable; all unstable knees were painful; 22 knees [27.5%] were unstable before operation, but only 7 knees [8.8%] were unstable postoperatively; radiographic changes: medial compartmental changes progressed in 30 knees, remained unchanged in 20, and improved in 30. Complications: Transient peroneal nerve palsy 1, superficial wound infection 2, inadequate correction 10

Transpedicular fixation for spinal fusion

The material studied comprised 28 patients, 14 males and 14 females. Their age was 38 - 62 years, mean 40.0 years. They suffered from dorsolumbar vertebral fracture [8 = 28.6%], spondylolisthesis [10 = 35.7%], spondylosis [10 = 35.7%]. They were all treated by spinal fusion of the affected level by 2 transpedicular corticral or cancellous screws, together with 2 bone plates and paravertebral cancellous bonegrafts. The followup lasted 2 years. Of the 8 fracture patients 5 [62.5%] obtained a stabilised spine and their paralysis recovered. They could go back to their original work. 3 [37.5%] could not because of vertebral instability and of persistent paralysis. However their nursing and rehabilitation were rendered much easier. Of the 10 spondylolisthesis patients 7 [70%] returned to their original heavy work, and 3 [30%] continued to complain of sciatica. Of the 10 spondylosis patients 8 [80%] returned to their previous heavy work and 2 [20%] had residual symptoms

Early or late open reduction and internal fixation of pelvic ring fractures

Open reduction and internal fixation [ORIF] was performed on 33 patients in Sunnybrook Health Science Centre, Toronto, Canada, in the period of January 1990 to January 1991. They were '7 females and 26 males. Their age was 13 - 79 years. [ORIF] was done early [EORIF], ie within 72 hours from the time of the accident in 15 patients [45.4 7%], or late [LORIF] in 18 patients [54.6%]. The cases were studied retrospectively. The findings were as follows. All 33 patients had multiple abdominal or skeletal injuries. The types of pelvic fractures were: In EORIF group: AP compression: 2; Lateral compression 1; Vertical shear: 7; Complex: 2; Acetabular ring disruption: 3. In LORIF group the respective numbers were: 0, 0, 9, 1, 8. Emergency preoperative evaluation: CT scan, abdominal and pelvic: 83 patients; Angiography in 8 EORIF and 6 LORLF patients with suspected significant retroperitoneal haemorrhage which was confirmed in 5 and 3 cases respectively. EORIF group delay in being operated: whole group's average 38 hours; in 7 it was possible within 24 hours. In the LORIF group the average was 7.8 days. Measures to recover the general condition: Days on respirator: EORIF: avenge 3 days, range 0 - 14 days; LORIF: average 1 day, range 0 - 2. Days confined to bed: EORIF: 5.8, 2 - 31; LORIF: 12.5, 2 - 60 respectively. Days of hospitalisation: EORIF: 32.0, 10 - 90; 37.0, 10 - 95 respectively. Complications: Pulmonary: EORIF 2, LORIF 4; Urinary tract infection 6 and 4; Deep vein thrombosis: 2 and 0; Wound infection: 2 and 5; Other complications: 5 and 4, respectively. Six patients were excluded from above averages, 2 in EORIF group and 4 in LORIF group, because they were confined to bed for prolonged periods due to complications. One case died in EORIF group on the 12th postoperative day from uncontrolable massive retroperitoneal haemorrhage. It is concluded that EORIF in centres well prepared for it has many advantages over LORIF that allow recommendation of its use

Anterior diskectomy and interbody fusion for cervical spondylosis with radiculopathy

The results are analysed of 30 anterior cervical discectomies combined with fusion of the spine in patients with cervical spondylosis. Good to excellent results were obtained in 85% of patients. The results were superior in the presence of single-level disc disease. They were better following multilevel rather than limited surgical eradication in the presence of more than one level disc disease. Myelography was found a useful adjunct to preoperative clinical assessment of the symptomatic disc levels. The low incidence of complications encountered in this series further confirms the ease and efficacy of the anterior approach in the surgical treatment of cervical spondylotic radiculopathy