Odontoid process pathologic fracture in spinal tuberculosis.

Craniovertebral junction tuberculosis is a rare lesion in which treatment remains controversial. Options range from conservative treatment to surgery, independently of any associated neurological threat. We here report the first case of pathologic odontoid fracture in a context of spinal tuberculosis, complicated by unusual neurological evolution. The patient presented with non-contiguous multifocal tuberculosis, of which there have previously been only 6 reported cases.

Pelvic ring fractures internal fixation: iliosacral screws versus sacroiliac hinge fixation.

INTRODUCTION: Pelvic ring fractures are severe injuries whose functional results depend on the quality of reduction. Numerous internal fixation alternatives have been described, but the biomechanical studies comparing them remain rare. HYPOTHESIS: This study compared the biomechanical behavior of iliosacral screws (ISS) with sacroiliac hinge type fixation (SIF) following unstable pelvic ring fractures fixation. MATERIALS AND METHODS: A lesion simulating sacroiliac disruption and pubic disruption was created on 14 cadaver pelves. After randomization, the fractures were internally fixed using an anterior plate associated with either an ISS or an SIF. The specimens were then submitted to forces applied vertically at the coxofemoral joints. Relative movements in vertical translation and in rotation between the iliac wing and the sacrum, as well as the stiffness and the forces at failure of the assemblies were measured and compared. RESULTS: The mean age of the bodies was 66 years (+/-8). No significant difference was demonstrated between the groups in terms of residual motion and stiffness in both vertical and rotational displacement. The results showed a slight residual mobility in rotation of the hemipelvis. The SIFs presented greater, although non significant resistance to failure. No fixation, however, restituted stiffness comparable to a healthy pelvis. DISCUSSION: The results of this study show that a Tile C.1.2-type injury to the pelvic ring can be treated as effectively with ISS or SIF when combined anterior and posterior fixations are performed. SIF therefore seems reliable and its continued use is justified. The long-term clinical outcomes should nevertheless be evaluated, notably on the younger population, more often affected by this type of injury.

[Spinal migration of a Kirschner wire after surgery for clavicular nonunion. A case report and review of the literature]. / Migration intrarachidienne d'une broche de Kirschner après une cure de pseudarthrose de la clavicule. Cas clinique et revue de la littérature.

Kirschner wires (K-wires) are often used for osteosynthesis particularly in the upper limb. Postoperative K-wire migration through the tissues is a well-recognised and significant complication of surgery of the clavicle, the wire ending up in the lungs, the oesophagus, the aorta, or the subclavian artery. Localisation of a K-wire migration into the spinal cord is very rare. We report the case of a 34-year-old man with K-wire migration into the spinal cord through the intervertebral foramen of T2, two months after surgery for nonunion of a fracture of the lateral clavicle. Apart from acute respiratory failure related to a pneumothorax, the patient initially had no neurological deficit. It was decided to operate on him immediately. Two therapeutic options are possible: simple K-wire removal via a supraclavicular approach, or the same but with direct visual control in the spinal cord after laminectomy. A postoperative check with an MRI scan is desirable after two days. Even if mechanism of K-wire migration is not known, the means of prevention are, namely strict postoperative immobilization, K-wire removal as soon as bone healing is achieved, and bending the external tip of each implanted wire.

[Preoperative selective embolization allowing a partial splenectomy for splenic hamartoma]. / Embolisation préopératoire sélective permettant une splénectomie partielle pour hamartome splénique.

PURPOSE OF THE STUDY: To underline value of the preoperative splenic embolization with haemostatic aim to facilitate partial splenectomy. MATERIAL: Observation of a 23-year-old woman, admitted for pain, anemia, and mass of the left hypochondrium. Sonography, helical CT and MRI showed that the bulky mass was developed from the upper pole of spleen, and dislodged the left kidney towards the pelvis. This mass had fibrous characteristics in favour of a primary lesion with recent bleeding and was compatible with a splenic hamartoma. METHODS: Selective partial splenic embolization with haemostatic aim using metal coils, immediately followed by surgery. RESULTS: Preoperative embolisation made possible to carry out under optimal surgical conditions a partial splenectomy with en-bloc resection of the splenic mass. Histologic diagnosis was splenic hamartoma of pulpar type. CONCLUSION: This case illustrates the interest of accurate characterization of splenic lesions by several imaging techniques allowing indication for conservative surgery, and of preoperative embolization facilitating a partial splenectomy.