Early results of percutaneous plate fixation of unstable fractures of the dorsolumbar spine

Standard techniques for lumbar pedicle screw fixation involve open exposures and extensive muscle dissection that is associated with extensive blood loss, lengthy hospital stays, and significant cost. Mini-invasive techniques are widely accepted as being the less aggressive procedure in any kind of surgery. Further attempts of development of percutaneous techniques in spinal surgery were reported, but little among them with a real success. The aim of the present study is to evaluate the early results of treatment of unstable fractures of the dorsolumbar spine using the WSH [world spine holding] percutaneous spine fixation system. From March 2005 to March 2006, fourteen patients aged 18 - 58 years with unstable fractures of the dorsolumbar spine without neurological impairment were treated in Mansoura Emergency Hospital with the WSH percutaneous spine fixation system. The range of follow-up of the patients was 6-18 months. The mean operative time was around one hour and blood loss was negligible. The mean hospital stay was two days. According to the modified Macnab criteria, excellent results are 78.6%, good results are 14.3% and fair results are 7.1%. Complications included only one patient with subcutaneous hematoma and the need for screw reposition in one case. No septic problem was encountered. We conclude that preliminary results of the percutaneous fixation of the dorsolumbar fracture were promising allowing the surgeon to perform biomechanically sound internal spinal fixation with minimal tissue trauma to minimize approach related morbidity while achieving the same result as more traditional, invasive approaches

Minimally invasive fixation for treatment of fracture dislocation of the proximal humeral epiphysis in children

Fracture dislocation of the proximal humeral epiphysis in children is rare and constitutes only 3% of all epiphyseal injuries. In dealing with such fractures, there is still much controversy in treatment modalities. In this study we try to evaluate the results of treatment of proximal humeral epiphyseal fracture dislocation with open reduction and internal fixation. From 2001 to 2004, fourteen children between the age of 4 to 15 years with unstable or irreducible types of fracture dislocation of the proximal humeral epiphysis were treated with minimal exposure, open reduction and internal fixation using Rush rods or K. wires. There were 11 boys and 3 girls. The mean follow-up was 22.7 months [12 - 36]. The union rate was 100% and the average duration of union was 5.9 weeks. According to Neer's scoring system, 13 children [92.9%] had excellent results, and one child [7.1%] had satisfactory results. Occasional pain was a complaint occurs in 2 children [14.3%] and superficial wound infection was detected only in one child [7.1%]. We think that open reduction through minimal exposure and fixation with Rush rods or K. wires is an effective way to manage these unstable or irreducible fractures of the proximal humeral epiphysis as it allows more rapid rehabilitation of the shoulder motion and function

Ilizarov technique as a salvage procedure in treatment of congenital pseudarthrosis of the Tibia

The study included six patients with dysplastic congenital pseudarthrosis of the tibia treated consecutively by Ilizarov technique as a salvage procedure after previously failed other surgical techniques. Two patients had associated neurofibromatosis. The average age was five years [range 2-10]. At an average follow up of 24 months [range 12-36 months], all cases of congenital pseudarthrosis of the tibia had healed [100% union] and simultaneous correction of deformity and shortening was achieved. The mean time for union was four months. The leg length discrepancy was corrected from an average of 4 cm preoperatively to an average of 0.5 cm after removal of the fixator. There were two minor complications of the Ilizarov fixator, which were treated conservatively and did not affect the outcome. The results showed that Ilizarov technique can be considered as a good option as a salvage procedure in treatment of congenital pseudarthrosis of the tibia with excellent results, avoiding amputation and achieving a well functioning limb