Extensive spinal epidural abscess

Spinal epidural abscess [SEA] is a rare clinical entity associated with a high morbidity and mortality. It usually spans 3-4 levels. The literature contains very few reports of extensive or panspinal epidural abscesses and hence there is no consensus on management of such cases. We describe a case of 56 years old male presenting with a posteriorly located SEA extending from the Foramen Magnum to thoracolumbar junction. The abscess had led to quadriparesis for the last 24 hours. This abscess was treated operatively by performing noncontiguous minimally invasive decompressions of the cervical and thoracic spine. The patient showed progressive improvement in neurologic status and was walking with minimal support at 4 months of follow-up

Vertebral body reconstruction for thoracolumbar spinal metastasis - a review of techniques

The spine is the most common site of skeletal metastases with its involvement occurring in up to 40% of patients. Metastatic spinal involvement can cause a number of sequelae like pain, instability and neurologic compression. About 10% of patients with involvement of the vertebral column will subsequently develop neurologic compression. The metastatic spinal lesions mostly affect the vertebral body and pedicle [85%]. Management of spinal metastases remains controversial. Recent reports attest to the beneficial role of surgery. The role of decompressive laminectomy without stabilization, has been questioned. The Involvement of Vertebral Body and anterior compression had led to an increasing attention to anterior decompressive procedures, reconstruction and Stabilization. We Review here the Techniques described in literature for anterior reconstruction after vertebral corpectomy

Revision knee arthroplasty

Total knee arthroplasty [TKA] is a satisfactory procedure regarding functional outcome and pain relief. The ever increasing number of total knee arthroplasties and expanding indications have led to a high number of revisions. The principles of revision arthroplasty are to understand the cause of failure, adequate surgical exposure, restoration of limb alignment, achieving appropriate soft tissue balance, correct implant alignment, restoration of joint line and a good range of motion. The literature on revision TKA is diverse and is not conclusive in many aspects. The results of revision surgery are not as good as the primary TKA with main causes being increased polyethylene wear, aseptic loosening, malalignment of components, instability, extensor mechanism problems, infection and stiffness. Revision knee Arthroplasty is not a repeat primary Arthroplasty but it is a technically and economically demanding procedure and its successful performance requires thorough preoperative planning, adherence to the principles of revision knee arthroplasty, availability of diverse implant options and adequate bone graft

Retrograde femoral nailing: a modified technique for unusual femoral shaft fractures

To evaluate the results of modified retrograde femoral nailing using conventional AO antegrade femoral nailing system. Retrospective analysis of data was done at the department of orthopedics, Aga Khan University Hospital, Karachi from July 2002 to September 2003. Five patients [3 males and 2 females] under went retrograde femoral nailing; the indications were ipsilateral proximal femoral and shaft fractures, morbid obesity, hip abduction contracture and in situ ipsilateral internal fixation device at the hip. Mean age of the patients was 55 years [range of 20 - 86 yrs] Patients were followed over 24 - 64 weeks [mean 38 weeks]. All cases had clinical and radiological union within 12 weeks and all except one patient had full range of motion at the knee. No patient had wound infection or anterior knee pain. Using the modified technique retrograde femoral nailing was found to be a safe and effective treatment option in well selected patients

Neurologic compression by tharacic disc in a case of scheuremann kyphosis - an infrequent combination

Scheuermann disease is a rigid kyphosis due to vertebral wedging in the thoracic or lumbar spine. It is very rarely associated with neurologic compromise. Thoracic disc herniation leading to dural sac compression is also an infrequent pathology. We describe here a young man with Scheuermann disease who presented with symptoms and signs of neural compression. The cause of compression was a thoracolumbar disc, rendering him non-ambulant without support. He required transthoracic surgical decompression. The neurological status of the patient improved rapidly after surgery. At his latest follow-up he was independently ambulant with full restoration to activities of daily living

Fixation of bilateral pelvic osteotomies with external fixator in exstrophy bladder complex

To present the early results of pelvic osteotomies performed for repair of exstrophy bladder. Five cases of exstrophy bladder were treated with closure following bilateral iliac osteotomies. Three patients underwent closure of pubic symphysis diastasis by use of external fixator, one by screws and cerclage wires, and one by use of K-wires and suture. The patients were followed up by the pediatric urologist and orthopedic surgeon. All patients achieved a closure of diastasis and a tension free repair after the index surgery. The average follow-up was 3.6 years with range of 4 months to 6 years. All osteotomies healed within two months and had closure of the diastasis, except one which had a partial failure with loss of 50% correction. No patient had any wound dehiscence or breakdown of the bladder repair. Preoperative mean diastasis of symphysis pubis was 6 cm [range; 4.5 cm to 7 cm] and post operative mean diastasis was 3.5 cm with the range of 2.5 cm to 4 cm at 12 months follow up. All patients achieved urinary continence post operatively and were passing urine per-urethra with satisfactory urinary control as followed-up with the pediatric urologists. Bilateral iliac osteotomies and use of external fixator in our series was found to be helpful in achieving a tension free closure and preventing dehiscence of the repair

Postfixation pseudoaneurysm of the superficial Femoral artery in Femoral shaft Fracture

This case report describes a young female child presenting with a painful, expansile swelling at the medial aspect of her right thigh which had followed an open reduction internal fixation of a closed fracture of midshaft of right femur. An angiogram confirmed pseudoaneurysm of the superficial femoral artery probably caused by overpenetration of the drill bit or any sharp instrument while applying dynamic compression plate. It was treated surgically by resection of the aneurysm, reconstruction with inter-positional sephanous vein graft and removal of the hardware