Improvement in JOA score of treatment for complex atlas-axis fractures

The aim of this study was to explore the role of treatment for complex Atlas-Axis fractures, and compare the JOA score of surgical and conservation methods. From June 2008 to May 2012, 33 patients suffering from Atlas-Axis fracture were included in our study. Fifteen patients received posterior cervical pedicle screw fixation, and 18 patients received the conservation treatment. All the patients were followed up for 12 months after discharge. The mean operative time was about 128 minutes [ranged: 92 to 165 minutes], the mean hospital stay time was 15.5 days [ranged: 8-21 days], and the mean follow-up of all the patients was 27months [ranged: 7 to 43 months]. All patients gained a solid fusion, and no one showed any disability at the end of the follow-up. The JOA scores before treatment were 6.4 +/- 0.3 and 7.1 +/- 0.4 before and after treatment, and they significantly increased to 13.8 +/- 0.8 and 13.7 +/- 0.9 when following up for 12 months [P < 0.05]. Posterior cervical pedicle screw fixation is a feasible, effective and safe method for complex atlantoaxial fractures. This technique could achieve high JOA score, decreased blood loss and post-operative complications

Clinical outcome of endoprosthetic replacement for failed treatment of intertrochanteric fractures: a retrospective case series

Objective: The treatment methods for the failed internal fixation in elderly patients suffering from several osteoporostic fractures are still inconclusive. We aimed to evaluate the clinical effects of endoprosthetic replacement for failure treatment of intertrochanteric fracture

Methodology: A total of 13 patients with failed internal fixation for intertrochanteric fracture were collected between January 2002 and October 2009. All of them were treated with endoprosthetic replacement and followed up till October 2010. Four of them received total hip replacement and the remained nine received artificial bipolar femoral head replacement. Clinical and functional outcomes of patients were assessed

Results: Of 13 patients, nine were females and four were males with the mean age of 76.5 years [SD, 11.7, range, 58-92 years] at the time of fracture. The average time of operation and follow-up was 124 minutes [89-187minutes] and 31 months [14-68 months], respectively. The average blood loss during the operation was 631 ml [450-1560 ml]. All patients showed good pain relief and functional improvement. Final postoperative Harris and WOMAC scores were significantly improved from pre-operative levels [P < 0.05]. Only five patients showed operative complications

Conclusions: Our finding indicated that endoprosthetic replacement is an effective salvage procedure for failed internal fixation of intertrochanteric fracture in elderly patients with effective pain relief and functional improvement as well as few serious complications