ABSTRACT
Twenty-nine patients who incurred a transperitoneal low-velocity gunshot wound to their spine were evaluated for the occurrence of spinal infectious complications. All patients underwent an exploratory laparotomy to determine the extent of viscera involvement. No attempt was made to debride the involved spinal area, and the bullet was not removed unless it was easily accessible. Of the 21 patients with a parenchymal and/or noncolonic viscous injury, 17 (77%) were treated with intravenous (i.v.) antibiotics for a minimum of 5 days the remainder received treatment for a maximum of 48 h. All 8 patients with colonic injuries received a minimum of > or = 5 days of antibiotic treatment. Follow-up averaged 44.9 months (range 3-144 months). Only 1 (4.7%) patient with either a noncolonic or parenchymal perforation developed an infectious complication (subdiaphragmatic abscess); two patients (25%) with colonic perforations developed a psoas abscess. No patient developed a spinal infection. This study suggests that patients who sustain a transperitoneal low-velocity gunshot wound to their spine do not need to undergo spinal debridement and may be treated with parenteral antibiotics. Any course of broad-spectrum antibiotics for 5 days appears to minimize infectious complications. Bullet removal and missile tract debridement of the spine is not routinely necessary.
Subject(s)
Colon/injuries , Peritoneum/injuries , Spinal Injuries/etiology , Viscera/injuries , Wounds, Gunshot/therapy , Adolescent , Adult , Antifungal Agents/therapeutic use , Cefoxitin/therapeutic use , Child , Colon/microbiology , Colon/surgery , Discitis/prevention & control , Drug Therapy, Combination/therapeutic use , Female , Gentamicins/therapeutic use , Humans , Liver Abscess/drug therapy , Liver Abscess/etiology , Male , Meningitis/prevention & control , Middle Aged , Multiple Trauma/complications , Multiple Trauma/therapy , Osteomyelitis/prevention & control , Paralysis/etiology , Psoas Abscess/drug therapy , Psoas Abscess/etiology , Retrospective Studies , Spinal Cord Injuries/etiology , Spinal Injuries/complications , Spinal Injuries/therapy , Subphrenic Abscess/drug therapy , Subphrenic Abscess/etiology , Treatment Outcome , Vancomycin/therapeutic use , Viscera/surgery , Wounds, Gunshot/complicationsABSTRACT
This study evaluates the clinical result and fusion rate in 61 patients who underwent posterolateral spine fusions augmented with translaminar facet screw fixation at an average of 24 months after surgery. Sixty patients (98.4%) were judged to have a solid fusion by radiographic examination at an average of 5 months. Fifty-seven patients (93.4%) rated the result of their surgery as good to excellent; four patients (6.6%) rated their result as unsatisfactory. There were no patients with nerve root injury or other neurologic deficit. The 98.4% fusion rate compares favorably with other methods. The results of this study support the continued use of translaminar facet screw fixation to augment posterolateral fusion in the lumbar spine.
Subject(s)
Bone Screws , Lumbar Vertebrae , Orthopedics/methods , Spinal Fusion , Adolescent , Adult , Aged , Female , Humans , Lumbar Vertebrae/diagnostic imaging , Male , Medical Illustration , Middle Aged , Postoperative Complications , Radiography , Treatment OutcomeABSTRACT
Laboratory measurement of the tensile forces on the plate fixation screws of the sliding hip nail demonstrated that most of the force is borne by the proximal three screws in an intertrochanteric fracture model. Testing of an intact femur, which simulate a healed femur, demonstrated a proximal shift of the screw forces. Four screws appear adequate for fixation if screw torque is controlled.
