ABSTRACT
Long segmental fixation with TSRH posterior instrumentation for 19 patients who had unstable thoracolumbar fracture was performed between October 1992 and April 1995. The patients were followed for an average of 22 months. Measurements of the deformity angle, kyphosis, vertebral height, and the intervertebral angle were made. The patients were divided into 2 groups according to configurations of instruments for lower segmental fixation. For one group, only hooks were used, and for the others group pedicular screws and lateral offset hooks were used together at the same segment. Therefore, the purpose of this study is to anlyze the correctability following long segmental fixation and to compare one segmental fixation using both screws and lateral offset hook systems with two segmental fixation using hook systems for distal fixation. There was an overall correction of kyphosis at follow-up of 6.9degrees (27.1%) after a loss of 4.3degrees from operative correction. Overall correction of deformity angle was 8.2degrees (32.2%). Loss of vertebral height at final follow-up was 4.4%. And loss of intervertebral angle was 2.0degrees at follow-up. There was no difference of overall results between the hook group and the pedicular screw with lateral offset hook group. However, there was a significant improvement of the correction of kyphosis and restoration of vertebral height in patients who underwent operation within 7 days after injury, as compared to delayed operation. Therefore, the timing of surgery is the most important factor in order to correct the deformity caused by unstable thoracolumbar fractures. There was no significant loss of correction and no metallic failure. Therefore, rodding long with the method of one segment distal fixation using screws and lateral offset hook together can provide excellent correctability, maintenance of correction, preservation of distal lumbar joints, prevention of implant failure and complication.
Subject(s)
Humans , Congenital Abnormalities , Follow-Up Studies , Joints , KyphosisABSTRACT
Congenital vertical talus is dufficult to correct and tends to recur. Reduction of the deformed talon-avicular joint is rarely possible by conservative means alone and consequently surgical reduction is usually necessary. The technique of Kumar, Cowell and Ramsey(TAL, capsular release, open reduction of navicular, and K-wire fixation) was combined with or without tendon transfer using Tibialis anterior(Grice operation) in 11 feet of seven children(bilateral in four) under the age of four(2 girls and 5 boys), and followed them for average 41 months. Three of them were combined with cerebral palsy, syringomyelia, and multiple joint stiffness with camptodactyly. In preoperative radiograms, all of their tali are so distorted plantarward and medially as to be almost vertical. The talus was in an equinus position also but to a lesser degrees. The forefoot was dorsiflexed at the midtarsal joint and the navicular lay on the dorsal aspect of the talar head. Seven feet are corrected normally after operation, but four feet were recurred and soft tissue releasing techniques combined with extraarticular subtalar arthrodesis or triple arthrodesis were planned after their skeletal maturity.