Minimally invasive plate osteosynthesis (MIPO) in AO/OTA type B displaced clavicle fractures.

INTRODUCTION: Open reduction and plate fixation is known to reduce chances of malunion and symptomatic nonunion in displaced middle-third clavicle fractures. However, this treatment modality is also associated with several complications, such as hardware irritation, numbness around the surgical scar, infection, nonunion and implant failure. The minimally invasive plate osteosynthesis (MIPO) technique may reduce these complications. OBJECTIVE: To study clinical, radiological and functional outcomes of MIPO in AO/OTA type B displaced clavicle fractures and report any complications. MATERIALS AND METHODS: A total of 22 patients underwent internal fixation of acute displaced AO/OTA type B clavicle fractures from Jan 2014 to Dec 2015 by MIPO using locking compression plates. Patients were followed up at a regular interval and assessed clinically and radiologically. The clavicle length difference was measured. Functional assessment was done at the end of 2 year using constant shoulder score (CSS) and disability of the arm, shoulder and hand score (Quick DASH) and complications if any were noted. RESULTS: All fractures united at a mean of 12.5 weeks. One (4.5%) patient had numbness around the surgical scar. None of the patients had wound-related complications. In four patients, hardware irritation was noted. The difference in clavicle length was not significant. All patients had excellent CSS and Quick DASH score at the final follow-up. CONCLUSION: Internal fixation of displaced AO/OTA type B clavicle fractures by MIPO showed high fracture union rates and good functional outcomes.

Cervical spinal cord injuries without radiographic evidence of trauma: a prospective study.

STUDY DESIGN: Prospective study. OBJECTIVES: In a prospective study, 45 consecutive cases of cervical spinal cord injury without radiographic evidence of trauma (SCIWORET) who were treated non-operatively were analyzed to correlate the magnetic resonance image findings with the initial neurological deficit and the extent of neurological recovery at 2 years. SETTING: University tertiary-care teaching hospital in South India. METHODS: The neurological status of patients who did not have any radiographic or computerized tomographic abnormality at the time of admission was assessed by ASIA Impairment Scale (AIS) modification of Frankel's grading. The spinal cord abnormality seen in the magnetic resonance imaging was noted. The neurological status at the end of 2 years was recorded. RESULTS: Twenty-seven of the 45 patients (60%) had cord oedema, 8 (17.77%) had cord contusion, 8 (17.77%) patients had a normal cord and 2 (4.44%) patients had cord swelling on the magnetic resonance image. Out of 27 patients who presented with cord oedema, 14 (31.11%) patients recovered from AIS D to AIS E and 6 (13.33%) patients did not recover and remained at AIS D. Seven (15.55%) patients who had a normal cord recovered completely to AIS E. Five (11.11%) patients who had contusion of the cord recovered up to AIS D. CONCLUSION: The initial neurological status correlates with magnetic resonance imaging findings. Subsequent neurological recovery is dependent on the type of cord damage and initial neurological status. The rate of recovery and the final motor outcome are inversely related to the length of cord involvement.

Neurological deficit and canal compromise in thoracolumbar and lumbar burst fractures.

PURPOSE: To assess whether canal compromise determines neurological deficit in thoracolumbar and lumbar burst fractures. METHODS: 105 patients aged 17 to 60 (mean, 34) years who had burst fractures in the thoracolumbar (n=82) and lumbar (n=23) regions were included. Fractures were classified according to the Denis classification. The extent of spinal canal compromise was assessed by computed tomography, and the neurological status according to the modified Frankel grading for traumatic paraplegia. RESULTS: 19 (18%) of the patients had no neurological deficit. Of the remaining 86 (82%) with a deficit, 26 had complete paraplegia. The correlation between the type of the burst fracture and the severity of neurological deficit was not significant (Chi squared=10.57, p=0.835). The mean extent of spinal canal compromise in patients with deficits was 50%, whereas in patients with no deficit it was 36%. The difference between the extent of canal compromise and the severity of neurological deficit at the thoracolumbar and lumbar spine was not significant (p=0.08). Further subanalysis revealed a significant correlation at T11 and T12 (p=0.007) but not at the L1 (p=0.42) level. CONCLUSION: When studying neurological deficit, T11 and T12 injuries should be analysed separately from L1 injuries.