Late sequelae of anterior decompression and fusion for cervical spondylotic radiculo - myelopathy

Twenty-seven patients with cervical spondylotic radiculomyelopathy were managed by anterior decompression and fusion and were followed up for five years to review late sequelae in the adjacent segment to the site of previous fusion. The main evident complication was recurrent radiculomyelopathy at a new level adjacent to the site of previous fusion [five cases], three cases of them developed on the third year, one case on the fourth year and the last case on the fifth year, these levels were symptoms free on the first fusion. The greatest incidence was at the inter-space between the fifth and the sixth and between the sixth and the seventh cervical vertebrae, these cases did not respond to non-operative management and were treated by another anterior cervical decompression and fusion. It was observed that symptomatic adjacent segment disease affected about one fifth of all patients within five years after anterior cervical decompression and fusion. A single level fusion involving the fifth or sixth cervical space and pre-existing radiologic evidence of degeneration at adjacent levels appear to be the greatest risk factor for a new disease, so it is recommended that all degenerated segments causing radiculopathy or myelopathy should be included in the anterior cervical fusion and the patients should be informed of the substantial possibility that a new disease will develop at an adjacent level over the long term

Double v-shaped cancellous osteotomy of the radius for kienbock's disease

Seventeen patients with kienbock's disease were treated by radial shortening, by double V-shaped osteotomy. After and average of 2 years, relief of pain was satisfactory in ten patients [58.9%]; two patients [11.8%] were dissatisfied because they had persistant pain; while 5 patients [29.4%] had a mild tolerated pain. The range of motion improved moderately, in all cases, nonunion at the site of radial shortening osteotomy did not occur. Radiograph at follow up showed consolidation and healing of the lunate in 10 patients [58.9%], non progression of the disease in 5 patients [29.4%] and increase of the carpal collapse and osteoarthritis of the wrist in only 2 cases [11.8%]. The procedure helps to prevent further collapse of the lunate especially in early affected cases, provides a rich media for increase vasularity of the lunate and decrease the compressive forces of lower end of the radius on the lunate bone

comparative study between plaster casting and uniaxial external fixation with plating for comminuted distal radial fractures

External fixation in comminuted fractures of the distal radius has been used for almost 80 years, closed reduction and casting usually failed in 30% of unstable fractures, A comparative study was done for 14 comminuted fractures of the distal raduis treated by closed reduction and casting with another 14 comminuted fractures of the distal radius treated by combined uniaxial external fixator with open reduction and plate fixation, the cast group had a higher age incidence than the other group and they were more or less satisfied by the final end results [although they gave 50% satisfactory results], the combined external internal fixation group gave better results on the backgroup of Lindstrom and Sacraments scales, uriaxial external fixation maintained the length of the radius and provided facilities in reduction of the fractures, plate fixation provided buttressing effect on distal comminuted radial fracture and prevented angulation and deformity, the plaster group gave satisfactory results in 7 fractures [50%] while external-internal fixation group gave satisfactory results in 13 fractures [92.8%]

Evaluation of the results of internal fixation of displaced acetabular fractures

Displaced acetabular fractures must be treated as soon as the patient is stable, ideally in the first two weeks postinjury. Now, surgical reconstruction of recent displaced acetabular fractures has become the accepted treatment of choice for achieving the best long term results following injury. Early radiological evaluation yielded a perfect reduction in [26] patients [28.38%], near perfect reduction in [31] patients [37.11%], good reduction in [26] patients [28.38%] and failure in [7] patients [7.10%]. The late radiological results after at least 12 months, were excellent in [36] [13.3%], poor in [8] patients [8.8%], 34 patients were good and 12 patients were fair. The functional results were excellent in [29] patients [32.2%], good in 44 patients [48.9%].Fair in 10 patients [11.1%] and poor in 7 patients [7.8%]. The common postoperative complications, were sciatic nerve injury in [8] patients [8.9%] and heterotopic ossification in 8 patients [8.9%]

Atlanto - axial rotatory instability

Atlanto-axial rotatory subluxation was diagnosed in 13 patients. Traumatic cases has been recorded in [11] patients [84.16%] in which the rotatory instability was postulated as a result of direct trauma. Seven cases [63.63%] out of 11 cases] were diagnosed early by the aid of radiography and computed axial tomography and they were reduced spontaneously. While the remaining 4 cases [36.37%] were treated by short period of halter traction to achieved reduction and were followed by collar support. Non traumatic subluxation of the altantoaxial joint following peripharyngeal inflammation [Grisel's syndrome], were seen in 2 patients [15.48%] which has been attributed to laxity of the transverse ligament caused by inflammatory hyperemia. These [2 cases, [15.84%]] were diagnosed 10 months later and were submitted to cervical fusion in situ for instability