Closed reduction and percutaneous pinning in three-part fractures of the proximal humerus

Three and four- part fractures of the proximal humerus occurring in the elderly population usually result from low energy trauma in osteoporotic patients. Closed reduction and percutaneous fixation of three- part fractures may offer a stable fixation to allow early rehabilitation. An attempt is made to study the results of this minimally invasive procedure. Thirty patients with three- part fractures of the proximal humerus were treated with closed reduction and percutaneous pinning of the shoulder. All patients were above 50 years of age. They were seventeen women and thirteen men. Patients were followed for a minimum of six months after surgery. Physiotherapy was initiated on the second day after surgery. The results were evaluated radiographically for union and clinically for pain and range of motion. The results were evaluated using the Constant score and the complications were minimal. The average Constant score was 80 at six months postoperatively. The procedure is minimally invasive in this old age group and offers an alternative to the more invasive open procedures. This study demonstrates that this procedure provides very good results with very little complications

Indirect spinal decompression in burst thoracolumbar fractures

This study was performed on 70 patients with fractures of the thoracolumbar spine and had a single staged surgical procedure for the stabilization and indirect decompression of their fractures. Both plain X-rays and CT scan were done for all patients pre- and postoperatively. All patients had a short level instrumentation and fusion. The patients were followed up for an average of 16 months. The canal compromise was reduced from an average of 46% [ranged from 28%-85%] to an average of 22% [ranged from 0%-51%]. Overall, there was no deterioration in the neurological state following surgery in any patient. 90% of neurologically compromised patients improved 1-2 grades. Thus, this procedure seems to be effective for stabilizing and decompressing the spine in thoracolumbar fractures

Surgical management of low to moderate grade isthmic spondylolisthesis

In this study, 50 patients with low to moderate grade lytic spondylolisthesis underwent a single staged surgical procedure. The average age at surgery was 43 years. Both plain X-rays and an MRI were done for all patients. All patients had a wide decompression, pedicle screw instrumentation and posterolateral fusion. The patients were followed up for an average of 2.5 years. Forty patients had a favorable outcome. The fusion rate was 92%. There was no permanent deterioration in the neurological state postoperatively in any patient. The study demonstrated that an instrumented posterolateral arthrodesis in combination with a wide laminectomy and nerve root decompression results in a high rate of fusion and satisfactory clinical success

Hemiprosthetic replacement in four-part fractures of the proximal humerus

Fifteen patients with four-part fractures of the proximal humerus were treated by hemiarthroplasty of the shoulder. They were followed up for a minimum of 12 months. The shoulder was protected for four weeks before the initiation of physiotherapy. The results were evaluated clinically for pain and range of motion and radiographically for the union of the greater tuberosity. The average constant score was 60 points at 12 months postoperatively and the complications were acceptable. The study demonstrated that this procedure results in a satisfactory clinical success

Anterior cervical interbody fusion with PEEK cages

Thirty seven patients with degenerative cervical disc disease were treated surgically by anterior discectomy and fusion using PEEK cages packed with autogenous bone graft. The study included nineteen males and eighteen females and the mean age at surgery was 41y. All patients improved neurologically postoperatively. The complications were acceptable. Patients were placed in a Philadelphia Collar for 3 months and then gradually weaned of it. All patients regained a stable cervical spine

Surgical management of traumatic spondylolisthesis of the axis

Twelve patients with fractures of the neural arch of the axis [Hangman's fracture] were treated surgically by internal fixation. All patients were neurologically free preoperatively and no patient suffered from any neural deficit postoperatively. The complications were acceptable. Patients were placed in a Philadelphia Collar for 2 months and then gradually weaned of it. All patients regained a stable cervical spine

Two staged surgical correction of Scheuermann's disease

Twelve patients with Scheuermann's disease had a two-staged surgical procedure for the correction of their deformity. The age at surgery averaged 18 years + 5 months. The deformity measured an average of 86 degrees. All patients had an anterior release and fusion followed one week later by posterior correction, instrumentation and fusion. The average curve immediately after surgery was 43 degrees. The patients were followed up for an average of 3.5 years, with an average loss of correction of 4 degrees. Generally, there was no postoperative neurological deficit and no metal failure

Single stage osteotomy for congenital lumbar spine deformities

This study included 15 patients who had congenital spinal deformities due to hemi-vertebrae in the lumbar spine. The average age at surgery was 15 years. The mean preoperative Cobb angle for scoliosis was 57.7 degrees [ranged from 15-90 degrees] and that for kyphosis was 53.2 degrees [ranged from 9-118 degrees]. These patients had a single staged spinal osteotomy with posterior excision of the hemi-vertebra. The patients were instrumented and fused. Postoperatively, the index angle was 25.3 degrees, resulting in an average correction of 56% and the kyphosis was corrected to an angle of 27.9 degrees [ranged from 9-63 degrees]. The patients were followed up for an average of 28 months. There were no neurological complications and the complications were acceptable

Multiple osteotomies and segmental instrumentation for revision surgery in scoliosis

In this study, 20 patients who had previous surgeries performed to correct their spinal deformities were revised. The age at surgery had an average of 18 years. The dorsal curves ranged from 38-98 degrees with an average of 59.6 degrees. The lumbar curves ranged from 26-70 degrees with an average of 39.7 degrees. These patients had a double staged procedure. All patients had an anterior release performed as a first stage. On a second stage, the old implants were removed and correction was achieved by performing multiple level osteotomies in the fusion mass. The patients were re-instrumented and fusion was performed. Postoperatively, the curves were corrected to an average of 31.3 and 23.1 degrees, respectively. The patients were followed up for an average of three years. There was no postoperative neurological deficit and the complications were minimal