Pressure mapping as an outcome measure for spinal surgery in patients with myelomeningocele.

STUDY DESIGN: A retrospective analysis of prospectively collected data on a cohort of 19 myelomeningocele patients undergoing spino-pelvic deformity surgery. OBJECTIVE: To examine if greater curve correction with third generation spinal implants correlate with improved pressure distribution and resolution, or prevention of skin ulcerations in myelomeningocele patients. SUMMARY OF BACKGROUND DATA: Children born with myelomeningocele have often complex spino-pelvic deformities leading to skin ulcerations. METHODS: A cohort of 19 consecutive wheelchair dependent patients with myelodisplastic spinal deformities, who underwent spinal surgery, was prospectively followed with regular pressure mappings for a minimum of 2 years. Standard spino-pelvic radiologic measurements were obtained. Sitting pressure mappings were obtained over the study period using the Force Sensitive Applications from Vista Medical (Winnipeg, Manitoba, Canada). Statistical analysis was done using SAS (SAS Institute Inc, Cary, NC). Paired t-test and Wilcox on Signed Rank test was used where applicable. Significance was taken to be P<0.05. RESULTS: Surgery significantly corrected radiographic parameters, specifically, Cobb angle (52%), pelvic obliquity (89%), and to a lesser degree pelvic tilt. Stratifying the data based on fixation type showed that the M-W construct was able to significantly correct pelvic obliquity. While significant changes in radiographic variables were observed after surgery, this was not the case with the various pressure mapping variables. Only minor changes after surgery were observed in the average pressure, maximum pressure, and variable coefficient of pressure. What was observed was an improvement in the overall distribution from anterior/posterior and right/left. While the values only approached statistical significance (P=0.053) for right/left, however, this did not appear to be clinically significant regarding skin ulceration. CONCLUSION: Despite significant surgical corrections in radiographic parameters, these resulted in small changes in pressure distributions and do not appear to influence skin ulceration in the myelomeningocele patient. Pressure mapping may not be a useful tool in predicting outcome of spinal surgery. Factors which were proven to influence pressure distribution are the sagittal pelvic orientation and also achieving coronal spine balance.

Efficacy of different fixation devices in maintaining an initial reduction for surgically managed distal radius fractures.

BACKGROUND: Fracture of the distal radius is a common injury. Many treatment options exist for the surgical management of extra-articular and intra-articular distal radius fractures. The best method of treatment for these fractures remains controversial. We sought to examine radiographic outcomes of patients treated with non-spanning external fixator (NSEF), open reduction and internal fixation (ORIF) with locking plates and screws or closed reduction and percutaneous pinning (CRPP) and compare their ability to maintain radiographic parameters over the initial 6-week postoperative period. METHODS: We performed a retrospective review of radiographs showing 211 distal radius fractures treated with NSEF, ORIF or CRPP. We examined the images for a variety of radiological parameters. Measurements were taken immediately postoperatively and at 6-week follow-up to determine whether there was any loss of reduction. RESULTS: Of the 211 fractures, 104 (49.3%) were type-A fractures, 12 (5.7%) were type-B fractures and 95 (45.0%) were type-C fractures. The 3 treatments maintained the reduction obtained at surgery until healing. The CRPP and ORIF treatments failed to maintain correction in ulnar variance for the 6-week period; however, only ORIF actually changed the ulnar variance from presurgical values. CONCLUSION: Treatment with ORIF for comminuted, intra-articular distal radius fractures produces good radiographic results with maintenance of surgical radiographic parameters, whereas NSEFand CRPP of less complex fractures also provide good results. This suggests that fracture-specific fixation with CRPP or NSEF are sufficient for certain distal radius fractures.