Bio-Derived Apatite As a Bone Graft for Vertebral Trauma.

INTRODUCTION: Traumatic spinal injury presents the potential for significant morbidity and mortality, and posterior fixation and fusion with bone grafts is a primary treatment for many vertebral fractures. While iliac crest autograft (ICBG) is considered the gold standard in bone grafting, this carries risks of morbidity at the donor site as well as prolonging surgery time. Bone graft substitutes (BGS) may provide a viable alternative to autograft but there is little published data concerning its use in trauma. Therefore, we conducted this retrospective review to evaluate the outcomes for fusion among patients who have received a BGS during posterolateral fusion (PLF) for vertebral trauma. MATERIALS AND METHODS: This was a retrospective, consecutive patient cohort. Over a six-month period, we identified 27 patients who had undergone PLF for spine trauma and in whom a BGS comprised of bovine-derived apatite was used. All patients had followed the standard of care. The postoperative plain film radiographs at three, six, 12, and (optionally) 24 months were independently assessed by an orthopedic surgeon who was not affiliated with the hospital. RESULTS: We documented a radiographically observed fusion rate of 85% and a successful treatment rate of 92%. There were no adverse events related to the BGS. Patients who received a BGS with ICBG spent significantly longer in surgery than other patients. There were no adverse events related to the BGS. CONCLUSIONS: The spondylodesis rate following surgery in which the BGS was used in PLF, whether alone, mixed with local bone, or mixed with ICBG is comparable to the rates that have been reported for iliac crest autograft in these indications. The data indicates that the BGS provides a useful adjunct in PLF for the treatment of traumatic spine vertebral injuries. The use of BGS also allows for shorter time in surgery, which may reduce resource utilization and thus lower the total costs of the procedure. CLINICAL RELEVANCE: Posterolateral fusion can be obtained with the use of a bio-derived BGS while reducing the time in surgery by avoiding the second procedure necessary to harvest ICBG. This may be advantageous in cases where the surgeon wishes to minimize operating time or when the availability of autograft is limited.

Prospective clinical and radiostereometric analysis of the Fitmore short-stem total hip arthroplasty.

INTRODUCTION: Uncemented short, curved femoral stems may help save proximal bone stock during total hip arthroplasty (THA) and facilitate insertion in minimal invasive surgery. The aim of this 2 year, prospective, single-center study was to examine the stability and migration of the Fitmore (®) stem in THA using model-based radiostereometric analysis (RSA), and thus predict the implant's long-term survival. In addition, we evaluated the stem's clinical performance using standard clinical measures. PATIENTS AND METHODS: We conducted a prospective cohort study of 34 THA patients who received the short Fitmore Hip Stem (Zimmer, Winterthur, Switzerland). At 3, 6, 12 and 24 months postoperatively, the patients underwent clinical evaluation and radiostereometric analysis (RSA) to measure stem migration. RESULTS: RSA analysis revealed a mean subsidence of -0.39 mm (95 % CI -0.60 to -0.18) at 3 months with no further migration after 2 years. Mean internal rotation along the longitudinal axis was 1.09° (95 % CI 0.52-1.66) at 2 years, versus 0.85° (95 % CI 0.44-1.26) at 3 months. The Harris hip score improved from 60 (range 30-80) preoperatively to 99 (range 83-100) after 2 years. Three patients underwent revision due to deep infection, non-specific thigh pain and aseptic loosening in one case. CONCLUSION: We conclude that the Fitmore Hip Stem stabilizes after 3 months and achieves good short-term clinical results in most cases.

Vertebral body stenting versus kyphoplasty for the treatment of osteoporotic vertebral compression fractures: a randomized trial.

BACKGROUND: In the treatment of vertebral compression fractures, vertebral body stenting with an expandable scaffold inserted before application of the bone cement was developed to impede secondary loss of vertebral height encountered in patients treated with balloon kyphoplasty. The purpose of this study was to clarify whether there are relevant differences between balloon kyphoplasty and vertebral body stenting with regard to perioperative and postoperative findings. METHODS: In a two-armed randomized controlled trial, patients with a total of 100 fresh osteoporotic vertebral compression fractures were treated with either balloon kyphoplasty or vertebral body stenting. The primary outcome was the post-interventional change in the kyphotic angle on radiographs. The secondary outcomes were the maximum pressure of the balloon tamp during inflation, radiation exposure time, perioperative complications, and cement leakage. RESULTS: The mean reduction (and standard deviation) of kyphosis (the kyphotic correction angle) was 4.5° ± 3.6° after balloon kyphoplasty and 4.7° ± 4.2° after vertebral body stenting (p = 0.972). The mean pressures were 24 ± 5 bar (348 ± 72 pounds per square inch [psi]) during vertebral body stenting and 16 ± 6 bar (233 ± 81 psi) during balloon kyphoplasty (p = 0.014). There were no significant differences in radiation exposure time.None of the patients underwent revision surgery, and postoperative neurologic sequelae were not observed. Cement leakage occurred at twenty-five of the 100 vertebral levels without significant differences between the two intervention arms (p = 0.230). Intraoperative material-related complications were observed at one of the fifty vertebral levels in the balloon kyphoplasty group and at nine of the fifty levels in the vertebral body stenting group. CONCLUSIONS: No beneficial effect of vertebral body stenting over balloon kyphoplasty was found among patients with painful osteoporotic vertebral fractures with regard to kyphotic correction, cement leakage, radiation exposure time, or neurologic sequelae. Vertebral body stenting was associated with significantly higher pressures during balloon inflation and more material-related complications.

Minimal Invasive PHILOS(®)-Plate Osteosynthesis in Proximal Humeral Fractures.

INTRODUCTION: The anterior delto-pectoral approach is the standard approach for the fixation of proximal humeral fractures with the PHILOS(®)-Plate system. However, this approach can impair the vascular supply and can increase avascular necrosis. The objective of this study was to evaluate the results and complexity of surgery of proximal humeral fractures with a minimal invasive (MIPO) approach. METHODS: All PHILOS(®)-plate osteosynthesis operated between Januray 2003 and June 2006 were evaluated prospectively. A minimal invasive antero-lateral deltasplit-approach was performed in all two to four fragment instable fractures meeting the indication for osteosynthesis according to Neer. An open approach (ORIF) was chosen in all other fractures mainly dislocated fractures and particularly in fractures with major subcapital displacement. RESULTS: A cohort of 68 patients suffered a proximal humerus fracture and qualified for a minimal invasive approach with a PHILOS(®)-plate osteosynthesis. Of these 68 patients, 41 were locally resident. Eight patients refused a follow-up, two patients were in constant care, and two patients died; 29 patients (71%) (20 females, 9 males) could be documented entirely with a median age of 64 years. The median operation time amounted to 75 min with a fluoroscopic time of 160 s. The median Constant score was 78 after 12 months. All fractures healed in adequate time. One patient showed a lesion of the ventral part of the axillary nerve. No patient suffered an avascular necrosis. DISCUSSION: The minimal invasive PHILOS(®) plate osteosynthesis through an antero-lateral delta-split approach proved to be an elegant procedure for selected fractures of the proximal humerus with a low morbidity and good functional outcome.