Radial Neck Osteotomy for Malunion of Radial Neck Fracture in Childhood.

In a case of a neglected radial neck fracture in childhood, the management of initial fracture and its complications are subjected to discussion. In children, open reduction should be avoided but an angulation less than 30° must be obtained. Several techniques exist to manage symptomatic malunion in adults, including resection, prosthesis, and osteotomy. When performing an osteotomy, it is important first to preserve an intact osseous hinge to avoid avascular necrosis and second to align the edge of the radial head articular surface with the lateral edge of the coronoid process, in order to avoid overstuffing elbow joint.

Anterolateral minimally invasive total hip arthroplasty: a prospective randomized controlled study with a follow-up of 1 year.

Anterolateral minimally invasive hip surgery (ALMIS) is a challenging procedure that is thought to offer a more expedient and a better functional outcome. Seventy-nine patients receiving primary hip arthroplasty were randomized. Röttinger ALMIS technique was used for 42 patients, whereas 41 received the standard lateral transgluteal Hardinge approach. Operative time was longer with ALMIS (P = .000078), whereas blood loss was less (P = .008). Surgical and postoperative complication rates, morphine consumption, and length and cost of hospitalization were similar. At 1 year, Harris, Postel and Merle d'Aubigné, and Short Form-36v1 scores were similar. Gait analysis revealed similar results. Computed tomographic analysis revealed no significant difference in implant position, heterotopic ossification, and loosening. Röttinger ALMIS is a valid approach for hip arthroplasty. However, it offers no advantages at 1 year.

Direct repair of defects in lumbar spondylolysis with a new pedicle screw hook fixation: clinical, functional and Ct-assessed study.

Spondylolysis is a common entity, a minority of people affected by this disease need medical care, and only a few require surgery. Reconstruction of the pars interarticularis is an interesting alternative to segmental fusion; this technique has the advantage of preserving segmental motion. Most authors report good results for young patients without intervertebral disk or facet degenerative changes. Moreover Louis also showed good to excellent results with his technique carried out among people who presented a satisfactory disk height (equal to two thirds of normal height). This could extend the number of patients for whom pars interarticularis repair could be proposed. In this study, the limit of reconstruction was set at grade 3 of the Pfirrmann's classification. The fixation of the isthmus was done with a new kind of pedicle screw hook system. This stable and strong device is easy to use, allows an anatomic pars interarticularis reconstruction of spondylolysis and avoids a postoperative bracing. Twenty-three patients were assessed in this study, the mean age at operation was 34 (range 16-52 years) and the average follow-up was for 59 months (range 6-113 months). Eight patients showed moderate degenerative disk disease before the surgery and 12 patients had a grade 1 spondylolisthesis. The visual analogical scale, the Oswestry disability index (ODI) and the modified Prolo score were used for assessment of pain and clinical outcome before and after surgery. The results were from "excellent" to "good" for twenty patients (87%) and "fair" for three of them (13%). The consolidation of the isthmus was assessed at the end of the study (CT-scan); the fusion rate was observed in 91%. Among patients aged less than 30 years results are from "good", to "excellent" in all cases and consolidation was always observed. All of them showed normal disc signal before the surgery. In the group aged more than 30 years, the results varied from "good" to "excellent' in 73% and fusion of the defect was discovered in 82% of cases. Eight of them (73%) had moderate disk signal modification before the surgery. All people with fair results displayed moderate disk degeneration signs at MRI before surgery; but two of those three patients had a failure of defect consolidation too and it is also associated with poor results by several authors. No complication was found in this series. According to the good results reported by Louis and upto the current finding, the authors believe that pars interarticularis repair can be carried out on patients with moderate degenerative disk disease; the stage 3 of Pfirrmann's classification seems a good limit. The Bone and joint research (B.J.R. system) is readily usable by any surgeon using pedicle screw systems and having a short learning curve. No device failure has been observed in this series.

Spondylodiscitis after transvaginal oocyte retrieval for in vitro fertilisation.

The frequency of iatrogenic spondylodiscitis is clearly increasing, which may reflect the increasing number of aggressive interventional procedures which may cause it. One of these is oocyte retrieval for in vitro fertilisation. The authors describe a case of Streptococcus faecalis L5-S1 spondylodiscitis. Conservative treatment is the rule, but surgery may be indicated in specific cases such as the one presented.