Complications associated with the technique of pedicle screw fixation in thoracic and lumbar spine in 100 consecutive cases

This was a prospective study done in the emergency centre of Mansoura university hospital. Ben ha university hospital and Zagazig university hospital where we reviewed the complications associated with the technique of pedicle screw fixation in 100 patients with spinal instabilities for different reasons where 520 pedicle screws were inserted by five different surgeons but with the same technique. The most common intraoperative problem was unrecognized screw misplacement [8.5% of the total screws inserted]. Fracturing of the pedicle and iatrogenic cerebrospinal fluid leak occurred in 3 patients [3%]. Neurological deficits occurred in 7% of the patients and in 4% reoperations were required. Infection occurred in 8 patients [8%] and required reoperations in 5%. Screw breakage occurred in 1.3% of the total screws inserted with no significant disabilities recorded. A careful analysis of our 100 patients shows that pedicle screw placement may be associated with significant intraoperative and postoperative complications. The intraoperative complications and inadequacies can be kept to a minimum, if attention is paid to careful planning, knowledge of anatomy and careful attention to the technique and details. Also familiarity with the technique and experience results in further diminution of morbidity as shown in our study of the first and second 50 consecutive patients

Extensile lateral approach in comminuted supracondylar intercondylar fractures of the femur

This study was conducted to evaluate the results of the operative treatment of the comminuted supra condylar intercondylar fractures of the distal end of the femur through the extensile lateral approach. This study included twenty two patients with a mean age of 39.8 years, presented to Mansoura Emergency hospital with simple fracture of the distal end of the femur treated operatively through extensile lateral approach through which the extensor mechanism of the knee was elevated with a block of bone removed from the tibial tuberosity. There were 8 female and 14 male. After an average follow up of 13.5 months the results were excellent or good in 81.8% of the patients and it were fair to poor in 18.2% of the patients. There were no delayed union nor non union in our study. There were 4 cases with malunion of varus or valgus deformity measuring less than 5°. As regard the range of motion, 14 patients [64%] had shown knee flexion up to 70°, 6 patients [27%] had knee flexion up to 95o, while 2 patients [9%] had knee flexion more than 125°. Out of the 22 patients, 20 patients had full knee extension, while the remaining 2 patients had extension lag of about 5°. We found the extensile lateral approach is a useful and a safe one to facilitate the operative treatment of severely comminuted intra-articular fractures of the distal end of the femur. Close attention to the surgical details is necessary to avoid the potential complication of this approach