Posterior spinal fixation with pedicle screws and rods system in thoracolumbar spinal fractures

To determine the effectiveness of posterior spinal fixation in maintaining the stability of spine and to determine mortality in 6 months after posterior spinal fixation. Quasi experimental study. Department of Orthopaedics, Jinnah Postgraduate Medical Centre, Karachi and Department of Orthopaedics, Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from April 2006 to April 2009. Fifty patients with unstable thoracolumbar spinal fractures from T7 - L4 were included. All the patients were operated by posterior approach using pedicle screws and rods. Effectiveness of the fixation was measured at 6 months postoperatively in terms of relief of pain and improvement in mobility using Oswestry disability index, range of motion of spine using Schobar Test/sign, reduction in deformity by measuring Cobb angle, local kyphosis angle [LKA], thoracolumbar angle, anterior and posterior vertebral heights [AVH and PVH respectively], evidence of union was made using plain radiographs and by computer assisted measurement using " OSIRIS " software. The data was then analyzed using SPSS software version 13 and presented in the form of tables and charts. Twenty-eight patients were operated within first week. In 38 patients, 4 screws were used and in 12 patients, 8 screws were used with 2 rods. Pain and disability showed improvement, with mean 71.98% score pre-operatively to 44.96% mean at last visit [p = 0.001]. Mean range of motion increased 0.5 - 2 cms postoperatively in all directions [p = 0.001]. Mean kyphosis angle, Cobb angle and thoracolumbar angle improved postoperatively. Anterior and posterior vertebral body heights increased postoperatively with resultant decrease in anterior vertebral body compression. Ninety six percent patients showed signs of postoperative union on last visit and only 3 people died of unrelated causes till last visit. Posterior spinal fixation with pedicle screws and rods is an effective surgical technique in maintaining stability of spine by improvement in pain and mobility, range of motion of spine, correction of deformity and bone union

Total hip arthroplasty for childhood fused hip

The conversion of a painless fused hip of a long standing duration to a mobile hip is usually not demanded due to a number of per-operative problems, iatrogenic complications and a high demanding procedure. The conversion is, however, required when a patient develops chronic back pain or a painful pseudoarthrosis of the hip. Conversion due to pseudoarthrosis in a recent fracture through femoral neck of previously fused painless hip has never been reported. We are reporting this unique indication for conversion

Influence of age on the outcome of single stage reconstructive surgery for congenital dislocation of the hip joint

This study was conducted to assess the effect of age on the ultimate outcome measures following single stage surgical procedure of soft tissue release, relocation, capsulorrhaphy, femoral shortening with varus/derotation osteotomy and pelvic osteotomy. A case series. The study with two groups of pretest-posttest design was conducted at Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre [JPMC], Karachi, from 1993 to January 2008. Patients included were having neglected, congenital dislocation of the hip joint, aged over 3 years. Patients with failed previous surgery, paralytic, teratological, traumatic or septic dislocations and patients with less than 5 years follow-up were excluded from the study. The patients were divided into two groups, 3-7 years [37 hip joints] and over 7 years [13 hip joints]. The single stage surgical procedure of open relocation, femoral shortening/derotation/ varus osteotomy and pelvic osteotomy was the dependent variable; whereas, the final clinico-radiological results based upon Tonnis grading, Severin's clinical/radiological grading, Klisic's overall rating and acetabular index were the independent variables of the study. Pre- and postoperative data was assessed for overall improvement and the difference in outcome measures between the two age groups. Significant overall improvement on all parameters was achieved after surgery. When results were compared between two age groups, there was no significant difference in the final outcome as per Tonnis grading and Severin's clinical typing as modified by Gibson [97.3% versus 84.4% normal hip joints or Tonnis grade 1 and 78.37% versus 53.85% Severin's type 1] but the results based upon Severin's radiological grading [62.16% versus 15.38%] and Klisic's overall rating [62.16% versus 15.38%] were significantly better in 3-7 years as compared to those over 7 years. There was no significant difference between the two age groups when compared for improvement in acetabular index. On further analysis, a progressive deterioration of results with increasing age was observed, yet the results in those aged over 7 years were reasonably justified surgical correction of congenital dislocation of the hip joint. Majority of the complications were seen in children operated at the age of 4-5 years. There were 7 cases [14%] of redislocation/subluxation and 6 were in 3-7 years age group. There were 4 cases [8%] of the avascular necrosis of the femoral head. Three patients had residual coxa vara and 2 had significant limb shortening. Limb lengthening was done in these 2 cases. The final results displayed progressive deterioration of clinical, radiological and functional outcome measures with aging after single stage reconstructive surgery for the congenital dislocation of hip joint. However, despite this, the results in children over 7 years were also good/excellent in most of the cases justifying surgery

Intra pelvic total migration of sliding screw in intertrochanteric fracture

A type of fixation failure of Dynamic Hip Screw system [DHS] is presented following a collapse of intertrochanteric fracture fixation. The patient presented three months after DHS fixation with severe lower abdominal pain, painful stiff hip and an uncontrolled diabetes mellitus. The radiographic examination of pelvis revealed intrapelvic presence of DHS sliding screw. The intrapelvic total migration of sliding screw has never been reported so far

Clinico-radiological presentation and post excision prognosis of complicated solitary osteochondromas

This is a descriptive observational study based on review of cases of solitary osteochondroma [OC] excised in the last 20 years at JPMC Karachi. The purpose of this study was to evaluate the clinico-radiologicalpresentation and the complications that warranted excision of these benign tumours and also to know the number of malignant transformation. The material included case sheets, available x-rays, histopathology reports. Excluded were the cases of multiple osteochondromatosis, diaphyseal achalasia, enchondromas and patients', age <5 years. Patient whose report showed malignant transformation were called by special messenger. A total of 78 solitary osteochondroma were excised. Age range of these patients was 7-30 years except one whose age was 60 years. Average age was 17.30 years in males and 16.1 years in females. Male vs. female ratio was 2:1. Flat bones [Ilium and scapula] were involved in 8 cases and long bones in 63 cases. Other rare site included phalanges [2], metacarpals [2], clavicle [1], greater trochanter [1] and talus [1]. Malignant transformation warranted excision in 5[6.41%] cases that was in elder age group. The rapid growth of tumour during growth spurt period was the commonest [78.2%] presentation warranting excision in teenagers and adolescents. The other common presentation [38.46%] that warrant early excision in younger age group was development of deformity when tumour occurred in either of two distal radius / ulna or distal tibia/fibula. The other presentation warranting excision was neurovascular complications that were mostly around knee joint [16.66%], distal radius and upper humerus. All the patients remained well following excision and none has reported recurrence

Salmonella spondylitis. A case report

Salmonella infection is common in the tropics, but osteomyelitis of the spine due to salmonella is rare. We are reporting a case of 23 years old house wife, who presented with fever and backache and was subsequently diagnosed to have salmonella spondylitis

Frequency, presentation and postintervention prognosis of chondroblastoma

To evaluate the frequency of clinico-radiological presentation and the prognosis after treatment of chondroblastoma. Design: A descriptive, observational study. Place and Duration of Study :The study was carried out at the Department of Orthopaedic Surgery, JPMC, Karachi over the period of 16 years, January 1986 to June 2002. Methodology: Patients in teenage, presenting with signs and symptoms of a primary bone tumours, were included by retrospectively reviewing the tumour registry record. Detailed scrutiny of clinical record was carried out to analyze the clinico radiological presentation and posttreatment prognosis criteria of healing was symptom-free centripetal and homogenous ossification. Seven [1.24%] out of 563 primary bone tumour cases were chondroblastoma. The clinico-radiological presentation in the 2 out of 7 [28.57%] cases was classical, 2 simulated osteomyelitis and other 3 as chondromyxoid fibroma, aneurysmal bone cyst and giant cell tumour. Lesions were treated with curettage and bone grafting. One patient [14.28%] developed recurrence within 2 years after curettage and healed after re-curettage and bone grafting. Five out of 7 [71,42%] tumours showed good response and 2 out of 7[28.57%] showed satisfactory response. Chondroblastoma is very rare benign primary bone tumour with high local recurrence rate. The lesions confined to epiphysis of weight-bearing bone present early with symptoms of mild arthritis. Lesions in non-weight -bearing bones often present late and simulates epiphysio-metaphyseal tumours. Lesions heals with centripetal healing and need more than 2 years follow-up to achieve recurrence-free healing

Bilateral treponema periostitis

Symmetrical exuberant periostitis is a rare disease caused, by variety of infectious and non-infectious causes. Treponematosis is one of the rare causes of this condition. We report a patient who presented with left arm swelling, secondary to onion peel periostitis of the humerus, which was caused by Treponema species

Olecranon fractures treated by Weber Vasey technique

This prospective study is based on 36 patients with displaced olecranon fracture managed with open redaction and internal fixation [ORIF] by tension band wiring [TBW] to evaluate the functional results, to compare the results with published literature and to formulate future plan for this type of fracture management. Out of 36 patients, 29 [80 percent] scored good to fair results, seven [20 percent] scored poor including one non-union. We encountered higher than expected rate of minor complications like superficial infection in three [3.4 percent] patients, pain due to irritation by implant in 12 [33 percent], skin breakage in 6 [16.5 percent] and proximal migration of K wires in 4 [11 percent]

Herniation through iliac crest bone graft donor site: case reports

Herniation through Iliac crest bone graft donor site is one of the rare acquired hernias. Only few hundred individual case reports have been published world wide. Left over rigid bony rim of remaining ala of ilium has been labelled as the main factor in development of the hernia. We are reporting our experience employing synthetic mesh for repair in two cases of herniation through large defects in iliac bone produced after use of a full thickness bone graft from that site. Creation of diaphragm by Merseline mesh and soft tissue imbrication over that resulted in satisfactory repair. No recurrence is seen during the two years followup

Gleno-humeral arthrodesis in paralytic shoulders

This study is based on results of arthrodesis of paralytic shoulders in eight adult patients. The arthrodesis was performed by using A.O. technique. The cause of paralysis was poliomyelitis in six and brachial plexus injury in two patients. Good hand and elbow function per see or achieved after treatment was a prerequisite for shoulder arthrodesis. In five patients reconstructive procedure for hand, elbow and wrist were performed. A combination of Yeoman's and Cofield's assessment scale was used to evaluate the results. We achieved satisfactory results in all six patients with post polio weakness, whereas, in brachial plexus injuries fair results achieved in one patient, the result in the other patient was rated poor. However, functionally both patients were better post-operatively. We conclude that arthrodesis of shoulder is good salvage procedure for paralytic shoulders, as it provides stable shoulder to make better use of distal joints i.e. elbow and hand

Femoral neck fracture in children and adolescents

Femoral neck fractures in children and adolescents are rare injuries with poor prognosis due to a high rate of complications. During last 10 years, 100 cases of these fractures were seen in children under 17 years of age. Their ages ranged from 3.5 to 16 years [means age 11.43 +/- 3.81]. Sixty one children sustained fracture with severe trauma and thirty nine with moderate to mild trauma. Twenty three fractures were undisplaced while 77 were displaced. Sixty two children underwent internal fixation of fracture fragments while thirty eight were managed conservatively. Overall complication rate was 59% which included avascular necrosis of femoral head [35%], coxa vara [22%], non-union [8%] and premature fusion of capital femoral epiphysis [21%]. Other minor complications were pin tract infection and implant failure. Sixty children had good, 19 fair and 21 poor results [p< 0.001]. The results were poor among 11-13 years age group, in type I fractures and in fractures that were fixed with open reduction. The follow up duration extended from 18 months to 8 years. The aim of this study was to discuss natural history of femoral neck fractures in children, to evaluate different methods of treatment and to highlight difficulties faced during handling these cases thereby helping to evolve a management plan with minimum complications

Tumoral calcinosis

Two cases of Tumoral Calcinosis are reported. It is a rare condition, hence the key to diagnosis lies in increased awareness of such lesions amongst orthopaedic surgeons and pathologists. Precise histopathological diagnosis is crucial, as the management of such a tumor is successful if appropriately treated. Advances in radiology and histology have helped immensely in the diagnosis of this condition. Complete excision of the mass has conferred very good results and is recommended

Intercalary resection of the knee joint for osteogenic sarcoma of distal femur with salvage of the univolved leg

Bony lesions especially osteosarcomas are usually dealt with by limb ablation. Advanced techniques to determine and establish a localized tumor with uninvolved tissue above and below the lesion have led to limb saving procedures