Is the Cage an Additional Hardware in Lumbar Interbody Fusion for Low Grade Spondylolisthesis? A Prospective Study.

INTRODUCTION: Lumbar interbody fusion has become the standard of care for the management of lumbar instability, where fusion is achieved using bone grafts, cages, etc. AIM: The aim of the study was to compare the outcomes of the interbody fusion using interbody cage technique and stand alone local bone graft technique. MATERIALS AND METHODS: A total of 30 patients, operated for single level instability with low grade lytic and degenerative spondylolisthesis of L4-5/L5-S1, were selected and grouped into two groups: Group I (stand alone grafts) and Group II (interbody cage and graft) based on computer generated random numbers. All patients who underwent interbody fusion through conventional open posterior approach were included in the study. Data regarding the time taken for interbody fusion, formaninal height maintenance, disc height restoration, translation, functional scores (VAS,ODI) and operative complications were analysed using in both the groups was collected and a student's-t test was performed to evaluate the difference. RESULTS: The mean age of patients in Group I was 46.7 years whereas, the mean age of patients in Group II was 43.5 years with mean age of 46.7 years and 43.5 years respectively. Interbody fusion, was achieved in seven and eight months in Group I and II respectively (p>0.05). The clinical results of both groups were comparable and there was no significant difference between the two groups in VAS score (p-0.147) and ODI score (p-0.983). Radiological parameters were also comparable and there was no significant difference between the postoperative measurements of the two groups (p=0.348 for translation, p=0.310 for intervertebral disc height and p=0.135 for foraminal height). One patient in Group I had transient foot drop which recovered, while one in Group II had infection, wound was managed with wound wash and antibiotics and another patient in Group II had pseudoarthrosis. CONCLUSION: Lumbar interbody fusion with standalone local bone grafts is sufficient in single level low grade spondylolisthesis treated by conventional open surgery.

Chronic Osteomyelitis of Clavicle in a Neonate: Report of Morbid Complication of Adjoining MRSA Abscess.

Osteomyelitis of clavicle is rare in neonates. Acute osteomyelitis of clavicle accounts for less than 3% of all osteomyelitis cases. It may occur due to contiguous spread, due to hematogenous spread, or secondary to subclavian catheterization. Chronic osteomyelitis may occur as a complication of residual adjoining abscess due to methicillin resistant staphylococcus aureus (MRSA) sepsis. We report a newborn female with right shoulder abscess that developed chronic clavicular osteomyelitis in follow-up period after drainage. She required multiple drainage procedures and was later successfully managed with bone curettage and debridement. We report this case to highlight that a MRSA abscess may recur due to residual infection from a chronic osteomyelitis sinus. It may be misdiagnosed as hypergranulation tissue of nonhealing wound leading to inappropriate delay in treatment. High index of suspicion, aggressive initial management, and regular follow-up are imperative to prevent this morbid complication.

An unusual case of partial Anterior Cruciate ligament (ACL) tear secondary to a glass foreign body in an adolescent knee joint.

INTRODUCTION: Various types of foreign bodies have been removed from the knee joint. We report an unusual case of partial anterior cruciate ligament (ACL) tear secondary to a glass foreign body in an adolescent knee joint. CASE REPORT: A 13-year-old boy presented with pain, swelling and deformity of the left knee since 4 days. X-Ray revealed a foreign body in the left knee joint. The glass foreign body remained in the subcutaneous tissue for few days and later migrated into the knee joint. Arthroscopy revealed partial tear in the ACL at the femoral attachment with about 10-20 % of fibres being involved. The glass piece was removed arthroscopically and the ACL fibres were trimmed. CONCLUSION: Arthroscopic removal of foreign bodies from the knee is a very simple procedure and has the advantages of avoiding large incision, shorter stay in the hospital, faster recovery and reduced infection rates. Glass foreign bodies were previously implicated in cartilage damage and meniscal injuries but a foreign body resulting in ACL tear has not been reported in literature.

Predebridement wound culture in open fractures does not predict postoperative wound infection: A pilot study.

BACKGROUND: There is confusion in the current literature regarding the value of obtaining predebridement wound cultures in the management of open fractures with several studies reporting contrasting results. We undertook a pilot study to determine the initial bacterial flora of open fractures in our environment and determine the correlation between subsequent wound infection if any, and the initial bacterial flora. MATERIALS AND METHODS: Initial/predebridement wound swabs were obtained for 32 patients with open fractures. Patients underwent a debridement of the open wound and preliminary stabilization of fracture in the operating room within 24 h. Postdebridement wound cultures were obtained at 48 h and repeated subsequently, if indicated, during the follow-up period. The antibiotic therapy was modified based on the culture reports. RESULTS: Initial wound swab culture showed bacterial contamination in 18 patients (56%); 14 patients (44%) developed an infection in the immediate postoperative period or during follow-up. Age, gender, co-morbid medical condition, delay in presentation, and grade of open fracture were not found to be predictors of postoperative infection. No patient had an infection with the same organism, which was present in the initial culture. CONCLUSION: The findings of this study suggest that the initial flora are not the infecting organisms in the open fracture wounds, and predebridement wound cultures have no value in predicting postdebridement wound infection.

Use of intramedullary fibular strut graft: a novel adjunct to plating in the treatment of osteoporotic humeral shaft nonunion.

Humeral shaft fractures respond well to conservative treatment and unite without much problem. Since it is uncommon, there is not much discussion regarding the management of nonunion in the literature, and hence this is a challenge to the treating orthopaedic surgeon. Osteoporosis of the fractured bone and stiffness of the surrounding joints compounds the situation further. The Ilizarov fixator, locking compression plate, and vascularised fibular graft are viable options in this scenario but are technically demanding. We used a fibular strut graft for bridging the fracture site in order to enhance the pull-out strength of the screws of the dynamic compression plate. Six patients in the study had successful uneventful union of the fracture at the last follow-up. The fibula is easy to harvest and produces less graft site morbidity. None of the study patients needed additional iliac crest bone grafting. This is the largest reported series of patients with osteoporotic atrophic nonunion of humerus successfully treated solely using the combination of an intramedullary fibular strut graft and dynamic compression plate.

Giant cell tumour of talus--a case report.

Giant cell tumour of the talus bone is rare and is usually seen in skeletally mature adults. Here a case of giant cell tumour of the talus in a skeletally immature boy of 15 years is reported. The patient presented with swelling and tenderness of the left ankle with an osteolytic lesion seen in the talus on x-ray. A trephine biopsy followed by left talar excision was done. Following the biopsy report the patient underwent arthotomy and joint clearance. There was no recurrence noted at six months follow-up.

Secondary aneurysmal bone cyst of the patella: a case report.

A 20-year-old man presented to our clinic with pain and swelling in the right knee of one year's duration. Biopsy of the patella revealed an aneurysmal bone cyst secondary to a giant cell tumor. He was treated by curettage and bone cement to fill the defect. The rarity of this lesion in the patella and its treatment modalities are discussed.

Multifocal skeletal tuberculosis: a report of three cases.

Tuberculosis of the bone is a well-recognized clinical condition that can be diagnosed and managed by physicians and orthopaedic surgeons, often with an excellent outcome. However, the occurrence of multifocal skeletal involvement in immunocompetent patients is rare, even in countries where tuberculosis is endemic. Patients with multifocal skeletal tuberculosis may present with multiple vague somatic symptoms. We report three cases of multifocal skeletal tuberculosis in non-immunocompromised patients. All three patients were effectively treated with antituberculous drugs.