Idiopathic chondrolysis of the hip: a case report.

Idiopathic chondrolysis of the hip is a rare condition occurring mainly in adolescents and is characterised by a rapidly progressive destruction of the articular cartilage in the coxofemoral joint. Patients report intense pain, motion restriction and often limping due to shortening of the limb. The aetiology is not elucidated. Medical imaging techniques form the cornerstone for differential diagnosis. Additionally biological markers for inflammation and infections should be studied. Conservative treatment focuses on pain control and preservation of joint mobility. Because published results of surgical treatment are not conclusive and arthroplasty in young patients is controversial, there is up till now no consensus on the treatment algorithm. Some authors advocate conservative treatment until spontaneous fusion. A case of idiopathic chondrolysis conventionally managed is reported.

Early removal of a Maverick disc prosthesis: surgical findings and morphological changes.

We report the case of a patient who underwent explantation of a Maverick total disc prosthesis at the L5S1 level because of severe persisting pain one year after initial implantation. Dynamic radiographic imaging studies showed good position and size of the prosthesis and no evidence of loosening. Intraoperatively residual mobility at the proximal bone-prosthesis interface was detected, as well as gross metallosis around the articulation of the total disc prosthesis. A safe and straightforward technique for the extraction of a Maverick prosthesis using a hooked instrument to hook-on the keel of the device is reported. After removal of the device, an anterior lumbar interbody fusion with subsequent posterior pedicle screw fixation and posterior bone grafting with autologous iliac bone was performed (360 degrees fusion). During this posterior procedure, severe L5S1 facet joint arthrosis was observed. Early clinical and radiographic results were good with excellent patient satisfaction.

Treatment of high-grade spondylolisthesis by posterior lumbosacral transfixation with transdiscal screws: surgical technique and preliminary results in four cases.

In high-grade spondylolisthesis, the surgical treatment should be aimed at achieving good stability to allow solid fusion in the face of high biomechanical forces at the lumbosacral junction. A 360 degrees fusion seems to be able to provide this stability. This is however extensive surgery and many problems and complications have been reported. In order to overcome these difficulties, various new procedures have been published. Most of these techniques aim for a good anterior column support, allowing primary stability and a large bony surface area for fusion. Transfixation of the lumbosacral disc space using a fibular strut graft was published decades ago. Several modifications have been reported since, including the use of threaded cages filled with bone graft. In contrast to the number of these surgical techniques, only few biomechanical test results and small-size clinical studies have been reported in the literature. An interesting technique of lumbosacral transfixation includes the use of transdiscal pedicle screws, described by Abdu et al in 1994. This allows for the use of standard instruments and implants, while biomechanical testing recently has shown improved stability equal to classic PLIF constructs by providing three-column support. Moreover, in high-grade slips this technique is easier to perform than other methods. We have treated four consecutive patients according to this technique with good clinical and radiographic results. The surgical technique is described in detail and a review of the literature is provided.

Percutaneous plate fixation of fractures of the distal tibia.

Minimally invasive plate osteosynthesis (MIPO) of the distal tibia offers several theoretical advantages compared to classic open reduction and internal fixation. A mechanically stable fracture-bridging osteosynthesis can be obtained without significant dissection and surgical trauma to the bone and surrounding soft tissues. In this retrospective study we looked at the results and complications in ten consecutive patients treated with percutaneous plating for fractures of the distal tibia and plafond with a minimum follow-up period of one year. No significant soft tissue problems occurred. The need for bone grafting should be carefully evaluated in every case as we encountered two delayed unions. All fractures healed within one year; there was no fracture malunion. The use of indirect reduction techniques and small incisions to insert hardware is technically more demanding and requires strict radioscopic control throughout the procedure, but it considerably decreases surgical trauma to the soft tissues.