The Harrington plus reconstruction for pelvic and acetabular metastases.

BACKGROUND: Surgical management of periacetabular bone metastases is challenging. The Harrington Plus reconstruction is a modification of the original Harrington rod technique. An intrapelvic suprapectineal plate is used, with the aim of reconstructing a disrupted anterior column and reducing the risk of failure in cases where there is extensive medial bone loss. METHODS: A retrospective review of the 13 patients who have undergone the Harrington Plus procedure to date was performed. Mobility status, EQ5D and Oxford Hip scores were assessed. RESULTS: There was a significant improvement in mobility status, EQ5D and Oxford Hip Scores at 6 months postoperatively (p < 0.05). Two patients returned to theatre for debridement of infection. There were no postoperative dislocations, cup medialisation or cases of loosening of the prosthesis. No patient required revision arthroplasty surgery. CONCLUSION: The Harrington Plus procedure produces a reliable construct that allows patients with extensive periacetabular metastatic defects to fully weight-bear. Careful patient selection and multidisciplinary management is essential.

Results of the Induced Membrane Technique in the Management of Traumatic Bone Loss in the Lower Limb: A Cohort Study.

OBJECTIVE: To present our technique and early results using the Masquelet technique. DESIGN: Retrospective cohort study. PATIENTS/PARTICIPANTS: Thirteen patients with 14 open fractures of the femur and tibia were included between November 2013 and December 2014. INTERVENTION: A Masquelet technique was used to manage the open fractures. MAIN OUTCOME MEASURE: Infection and union rate. RESULTS: The mean follow-up was 17 months. The mean bone defect was 56.6 mm. Eight fractures (57.1%) progressed to union at an average of 42.1 weeks. Infection developed in 3 fractures (21.4%). Overall, the induced membrane technique was abandoned in 5 (35.7%) cases. CONCLUSIONS: The induced membrane technique showed a substantial rate of failure in the acute trauma setting in the lower limb. In the absence of sound published evidence, the authors now use the technique in selected cases only. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparison of thermal spread with the use of an ultrasonic osteotomy device: Sonopet ultrasonic aspirator versus misonix bonescalpel in spinal surgery.

BACKGROUND: The development of high speed rotating burrs has greatly advanced spinal surgery in recent years. However, they produce unwanted frictional heat and temperature elevation during the burring process. We compare the misonix bone scalpel (MBS) and the Sonopet ultrasonic aspirator to assess which would be the safer device in terms of the risk of thermal injury following laminectomy. METHODS: We describe an experimental nonrandomized study comparing two ultrasonic osteotomy devices. We use the device tip temperature and temperature of inner cortex of the lamina, following laminectomy, as the primary outcome. Our secondary outcome is to assess which device is associated with a lower risk of osteonecrosis and potential thermal injury to surrounding dura and nerves. RESULTS: The average device tip temperature for the Sonopet ultrasonic aspirator following the process of laminectomy was 36.8 with a maximum temperature of 41.8°C. The average device tip temperature for the MBS following laminectomy was 48.6 with a maximum temperature of 85.3°C. CONCLUSION: Our results have demonstrated the safety of the Sonopet ultrasonic aspirator with the Nakagawa serrated knife with temperatures below the threshold for osteonecrosis and thermal neural injury. However, the MBS has shown to occasionally reach high temperatures above the threshold of potential thermal injury to surrounding nerves and dura for a very short period of time. We advise to withdraw and re-insert the ultrasonic tip repeatedly to re-establish adequate cooling and lubrication. Further studies should be carried out using cadaveric bone at body temperature to simulate more accurate results.

Bilateral lower limb ischaemia following acetabular reconstruction and arthroplasty.

The incidence of acetabular fractures has increased markedly in patients over 60 in the last quarter of a century, with open reduction and internal fixation being regarded to be the treatment of choice in most patients with displaced acetabular fractures. Lower limb ischaemia following acetabular fixation or arthroplasty is rare. However, such complications can be limb or life threatening, and therefore, it is important to recognise them as early as possible. We present the case of a 70-year-old man with no significant medical history who underwent acetabular fixation with simultaneous arthroplasty complicated with bilateral lower limb ischaemia. We highlight the importance of having a high degree of suspicion which allows early diagnosis and corrective measures to be implemented which can ultimately lead to excellent outcome.

Scoliosis and the Social Media: Facebook as a Means of Information Exchange.

BACKGROUND CONTEXT: Over the last decade, the emergence of social networking websites such as Facebook have revolutionized information dissemination and broadened opportunities to engage in discussions. In particular, having been widely adopted in the younger generation, the use of this medium has become more prevalent in health disorders such as scoliosis in the adolescent population. However, the quality of information on Facebook is unregulated and variable, which may mislead patients in their decision making. PURPOSE: To document the various types of information available and assess the quality of information on Facebook discussion boards using recognized scoring systems. STUDY DESIGN: To evaluate the quality of information on the social network. PATIENT SAMPLE: A search for the keyword "scoliosis" on Facebook was performed and the first 100 pages generated were reviewed. OUTCOMES MEASURED: SCSS and DISCERN score. METHODS: Content analysis was performed on discussion boards and personal blogs. Two independent examiners evaluated each site according to scoliosis-specific content score (SCSS) and the DISCERN criteria, both previously used instruments to judge the quality of information on the Internet pertaining to scoliosis. The SCSS range from 0 to 32 (higher score better) and the DISCERN 16 to 80 (higher score better). RESULTS: Of the 100 sites reviewed, 33 were discussion boards and personal blogs. Of these, the overall average SCSS was 5.7 (SD 5.8, range 0-20) and the DISCERN was 22.5 (SD 7.6, range 16-45), indicating that using general scoring systems the quality of information provided was overall poor. CONCLUSION: Using recognized scoring systems to analyze Facebook pages used as discussion forums or blogs, we showed that the quality in general was poor. For modern practices to adapt to an era of information exchange via the social network, the orthopedic community should develop ways to incorporate the social media in future patient education.

Occipitocervical fusion - An epidemiological drift experienced in an Irish tertiary spinal referral center: Twenty-year follow-up study.

BACKGROUND: Occipitocervical disease is common in the elderly population, and is on the rise due to an increasingly aging population. METHODS: We retrospectively reviewed all patients who underwent occipitocervical fusion in our institution over a 20 year period (1996-2016) at a tertiary spinal referral centre. Patients were divided in 2 groups. Group A included all patient who underwent OCF in the first decade between 1996 and 2005. Group B was all patients who underwent OCF in the second decade between 2006 and 2016. RESULTS: A total of 23 patients underwent occipitocervical fusion between 1996 until 2016 at our institution. Instability secondary to Rheumatoid arthritis was the leading factor in group A, responsible for 43 percent of cases. In group B, trauma was the leading burden accounting for 44 percent of the cases. In contrast to Group A however, only 19 % of OCFs occurred secondary to RA in group B. Our fusion rate was 96 percent with a survival rate of 67 percent. CONCLUSION: We noticed a clear epidemiological drift in the cervical spine pathologies requiring OCF during the first and second decade of study period with an increase in prevalence of pathological fractures secondary to metastatic disease. In addition, a drop in rheumatoid cervical disease requiring OCF has been noted.

A Rare Case of Bilateral Patellar Tendon Ruptures: A Case Report and Literature Review.

Bilateral patellar tendon ruptures are rare. The majority of case reports describing bilateral patellar tendon ruptures have occurred in patients with predisposing factors to tendinopathy. We describe a case of bilateral patellar tendon rupture sustained following minimal trauma by a patient with no systemic disease or history of steroid use. Due to the rarity of this injury, clinical suspicion is low. It is reported that 38% of patellar tendon ruptures are misdiagnosed initially. Therefore careful history taking and physical examination is integral in ensuring a diagnosis is achieved for early primary repair. We discuss the aetiology of spontaneous tendon rupture and report a literature review of bilateral patellar tendon ruptures.

Renal allograft loss in the first post-operative month: causes and consequences.

Early transplant failure is a devastating outcome after kidney transplantation. We report the causes and consequences of deceased donor renal transplant failure in the first 30 d at our center between January 1990 and December 2009. Controls were adult deceased donor transplant patients in the same period with an allograft that functioned >30 d. The incidence of early graft failure in our series of 2381 consecutive deceased donor transplants was 4.6% (n = 109). The causes of failure were allograft thrombosis (n = 48; 44%), acute rejection (n = 19; 17.4%), death with a functioning allograft (n = 17; 15.6%), primary non-function (n = 14;12.8%), and other causes (n = 11; 10.1%). Mean time to allograft failure was 7.3 d. There has been a decreased incidence of all-cause early failure from 7% in 1990 to <1% in 2009. Patients who developed early failure had longer cold ischemia times when compared with patients with allografts lasting >30 d (p < 0.001). Early allograft failure was strongly associated with reduced patient survival (p < 0.001). In conclusion, early renal allograft failure is associated with a survival disadvantage, but has thankfully become less common in recent years.