Long-term results in surgically treated acetabular fractures through the posterior approaches.

BACKGROUND: The long-term results of surgically treated displaced acetabular fractures using the posterior approaches and the possible role of the greater trochanteric osteotomy in the development of heterotopic ossification (HO) are still somehow controversial despite extensive publications. METHODS: Seventy-five patients with an acetabular fracture and displacement of at least 3 mm were surgically treated during a 6-year period. The duration of the follow-up was from 10 to 15 years, with a mean of 12.5 years. RESULTS: The over-all satisfactory clinical result, grouping together the excellent and good results, was 80%. There was a good correlation between clinical and radiologic results. The most common complication was HO, observed in 19 patients (25.3%). The extended iliofemoral approach had the greater incidence of HO (40%), whereas the least was observed in the Kocher-Langenbeck approach with osteotomy of the greater trochanter (21.4%). Moreover, posttraumatic osteoarthrosis was observed in eight patients (10.7%) and osteonecrosis of the femoral head in six (8%). CONCLUSIONS: Surgical treatment of the acetabular fractures aiming at anatomic reduction of the acetabulum and congruency with the femoral head is the prerequisite for a favorable functional outcome in the long term. In most cases, the Kocher-Langenbeck approach is adequate. Trochanteric osteotomy is indicated only for fractures extending toward the anrerior column and this facilitates exposure, anatomic reduction, and fixation. No statistically significant difference was found between the surgical approach and heterotopic bone formation.

Functional outcome of surgical treatment for multilevel lumbar spinal stenosis.

BACKGROUND: There is no consensus regarding the best treatment of patients with multilevel lumbar stenosis. We evaluated the clinical and radiological findings in 41 patients with complex degenerative spinal stenosis of the lumbar spine who were treated surgically. METHODS: Between 1997 and 2003, 41 patients suffering from degenerative lumbar spinal stenosis were included in a prospective clinical study. The spinal stenosis was multilevel in all patients and in 13 of them there was degenerative scoliosis, in 18 there was degenerative spondylolisthesis, and in 10 there was segmental instability. Plain radiographs, MRI and/or CT myelograms were obtained preoperatively. The patients were assessed clinically with the Oswestry disability index (ODI) and visual analog scale (VAS). Surgery included wide posterior decompression and fusion using a trans-pedicular instrumentation system and bone graft. RESULTS: After a mean follow-up of 3.7 (1-6) years, the patients' clinical improvement on the ODI and VAS was statistically significant. Recurrent stenosis was not observed, and 39 of 41 patients were satisfied with the outcome. 3 patients with improvement initially had later surgery because of instability. INTERPRETATION: The above-mentioned technique gives good and long lasting clinical results, when selection of patients is done carefully and when the spinal levels that are to be decompressed are selected accurately.