Recurrent kyphosis after posterior stabilization of thoracolumbar fractures. 24 cases treated with a Dick internal fixator followed for 1.5-4 years.

24 patients with Th12-L1 fractures treated with a Dick internal fixator were analyzed to assess predictors of poor outcome. 4 patients had fixation without bone transplantation, 20 patients had a posterior fusion, and 12 of them had additional transpedicular spongioplasty. There were fractures of the transpedicular screws in 4 and screw migration in 2 cases. The increase in the local kyphosis angle was greater than the increase in the anterior compression angle and this did not correlate with spongioplasty or fusion. Fixation failure was in all cases related to a disproportionate increase in the local kyphosis angle. There was no difference between the patients with transpedicular spongioplasty and posterior fusion and the other patients with respect to results and complications. Bony collapse was not the major cause of failure and consequently there was no measureable contribution of transpedicular spongioplasty. We found that the Dick internal fixator for unstable fractures was associated with a higher complication rate than earlier reported.

A surgical approach in total shoulder arthroplasty.

The long deltopectoral approach promoted by Neer is the standard for performing a total shoulder arthroplasty. However, this exposure is inadequate for preparation and bone grafting of the glenoid cavity or repairing an associated large rotator cuff tear. In the anatomy laboratory we looked for an alternative approach to the glenohumeral joint which would accommodate these difficulties. Afterwards we used this approach in 7 of 13 patients in whom a Biomet Bio-modular shoulder arthroplasty was planned. The study is prospective with a 1-year follow-up of 12 cases.

Diagnostic external fixation of two carpal bones. A technical note.

Ulnar midcarpal instability can be treated by ligament repair or by a partial arthrodesis between the triquetrum and the hamate. If a partial arthrodesis is planned, we perform an ultimate diagnostic test to determine whether or not a subsequent definitive partial arthrodesis would be effective in controlling the feeling of weakness and instability.

Treatment of severe kyphosis in myelomeningocele by segmental spinal instrumentation with Luque rods.

Myelomeningocele leads to kyphosis of the dysplastic spine in 12-20% of cases, resulting in a severe gibbus. In three patients (at the age of 9, 13 and 16 years) with a thoracolumbar kyphosis (90 degrees, 120 degrees and 95 degrees respectively), and a compensatory thoracic lordosis (35 degrees, 105 degrees and 90 degrees) a resection or a wedge osteotomy of the gibbus was performed with segmental sublaminar wire fixation to Luque rods. In addition, a spondylodesis with autogenous bone and an allograft was performed. Correction of the kyphosis (to 30 degrees, 60 degrees and 50 degrees) and lordosis (to 15 degrees, 65 degrees and 55 degrees) was attained. This posterior procedure was sufficient for correction; there was no need for an anterior release. Cord and dura were left intact. During follow-up (27, 60 and 30 months) no progression of the curves has been noted. This one-stage posterior correction with L-rod fixation proved to be a method of choice for this difficult-to-treat spinal deformity.