Revision pedicle screws with impaction bone grafting: a case series.

BACKGROUND: Pedicle screw fixation in spinal constructs can be subject to failure requiring revision surgery. In cases of aseptic loosening various salvage techniques have been described. Revision screws augmented with cement have become popular but are not without risks. Larger diameter screws are often used but result in reducing bone stock or expanding the pedicles. We present a novel technique of pedicle screw revision by impaction bone allografting and a case series. METHODS: The failed screws are removed. The screw track is probed to check its integrity. Milled bone allograft is funneled into the screw hole and sequentially impacted, before insertion of a replacement screw. We report a case series and describe a single case where this method has been used. Information was gathered from the electronic patient record in our hospital. RESULTS: Ten screws were revised in 7 patients. Mean age at first surgery was 60.86 (48-76) years. Average time between first surgery and revision was 12.6 (4.7-49.9) months. Average follow-up was 26.2 (5.7-62.2) months and no screws showed any signs of loosening. CONCLUSIONS: Impaction grafting with bone allograft is a technique for pedicle screw salvage that can be used safely and effectively as an alternative to cemented screws, when pedicle screws have failed by aseptic loosening. It avoids the risks associated with cemented screws and in our series was successful.

Complex shoulder girdle injuries following mountain bike accidents and a review of the literature.

BACKGROUND: Mountain and road bike accidents are particularly common with the increased popularity of the sport. We reviewed the attendances in our emergency department over a 4-year period looking at cycling injuries to detect the level and grade of these injuries and their outcomes. METHOD: Royal Blackburn Hospital caters for a population of 550 000. A search through the Hospital information system revealed 104 patients with fractures following mountain bike injuries. These were looked at in more detail. We present a series of 5 severe shoulder girdle injuries following mountain bike accidents in this cohort, to highlight the serious level of injury sustained in this sport. We searched MEDLINE and EMBASE databases over the past 10 years using the keywords, mountain, biking and fracture. This yielded 7 papers. We compared our series with the literature. RESULTS: 104 fractures following mountain bike accidents between 2008 and 2011. Fractures of the upper limb were the most common (88.5%) with the clavicle being the most commonly fractured bone (28.8%). CONCLUSIONS: Major scapular injuries with destruction or disruption of the four bar linkage of the shoulder girdle are very common following mountain accidents. Clavicular fractures are the commonest upper limb injury. It is easy to miss a disruption to the four-bar linkage associated with a clavicular injury. This paper highlights the severity of the injuries sustained in mountain bike accidents of the upper limb and requirement of adequate protection in this exhilarating sport.

Osteochondral lesion of the hip treated with partial femoral head resurfacing. Case report and six-year follow-up.

INTRODUCTION: This case describes a case of an osteochondral lesion in the femoral head and its treatment by partial resurfacing of the femoral head using the HemiCAP (Contoured Articular Prosthetic) hip resurfacing system. CASE HISTORY: A 19-year-old patient who complained of 15 months of worsening left hip pain. X-rays and MR scan revealed a large osteochondral lesion. SURGERY: A Ganz approach to the hip in the lateral position was used. The osteochondral lesion was identified, lying superiorly and centrally on the head, in the weight bearing zone. The osteochondral fragment was removed and HemiCAP prosthesis applied. OUTCOME: At six-year follow-up the patient remains pain free clinically. And radiographic follow-up shows no evidence of loosening. CONCLUSION: There are multiple methods of treatment described in the literature for osteochondral lesions; but treatments for defects of the femoral head are few. We conclude that partial hip resurfacing using the HemiCAP prosthesis is an effective treatment for osteochondral defects of the femoral head.

Arthroscopic medial capsular plication using the suture anchor technique.

PURPOSE: The suture anchor technique for medial capsular plication has been previously described. We present our technique and its medium-term results. METHODS: A single surgeon's experience (senior author) of the suture anchor technique for medial capsular plication was reviewed in 14 knees in 14 patients. All patients underwent arthroscopic stabilisation for patello-femoral instability. The method used was the suture anchor technique for medial capsular plication (full technique described in paper). The primary outcome measure used was further dislocation or instability. The validated Kujala score was used pre- and post-op to assess functional outcome. RESULTS: There were nine male and five female patients (M:F, 64%:34%). Median age was 25 (range 16-65). Mean follow-up was 52 months (95% CI 44-56 range 24-72). The mean pre-op Kujala score was 54.6 (SD 24.4). The mean post-op Kujala score was 78.2 (SD 20.5). The mean increase in Kujala score was 23.6 (95% CI 7.9-39.4). There was a statistically significant increase in Kujala score, P=0.006. Only 1 of 14 patients had a further dislocation (7%), and there were no further episodes of instability. CONCLUSION: This is the first paper to describe the results of this technique in the literature. There was a statistically significant improvement in the patients' functional outcome and 13/14 patients did not re-dislocate or experience instability. It was concluded that this technique is a successful mode of treatment for patello-femoral instability. LEVEL OF EVIDENCE: Case series, Level IV.