S rod fixation to the sacrum in patients with neuromuscular spinal deformities.

A new form of pelvic fixation has been designed for use in patients with neuromuscular spinal deformities to overcome the problems imposed by the Galveston technique. One end of a Luque rod is prebent into an S shaped configuration and placed over the sacral ala supplying firm fixation across the lumbosacral junction without crossing the sacroiliac joint. It fixes firmly against the sacral ala by distracting against a hook or screw in the lumbar spine. A 12 year retrospective review of 67 patients with severe neuromuscular spinal deformities was accomplished. All surgeries were performed by one surgeon. All patients had good deformity correction with an average followup of 6 years and 2 months. Complications included: recurrence of pelvic obliquity (one patient), skin break-down over hardware (one patient), migration of hardware at sacrum (two patients), and rod breakage (five patients). The S rod is recommended for all patients with neuromuscular spinal deformities who require instrument fixation to the pelvis. Its ease of insertion and decreased operative time allow for a safe and dependable alternative fixation to the sacrum without crossing the sacroiliac joint.

Luque fixation to the sacral ala using the Dunn-McCarthy modification.

The Galveston-Luque technique of fixation to the pelvis requires solid bone and a strong pelvis. Because the majority of neuromuscular patients who require fixation to the pelvis have a weak and thin illum, an alternative to the Galveston technique was sought. A technique of rod contouring was developed that takes advantage of the reliable, stout bone of the sacral ala for fixation. Twenty-four patients have been instrumented with Luque rods and fused to the sacrum over the past 4 years using the technique. There have been no complications in this short follow-up.

Skeletal trauma in children.

In the area of skeletal injuries, i.e., fractures, as in all areas of care, children should not be treated as small adults. The immature, growing skeleton of the child results in both injuries and patterns of healing that are unique to this age group. These aspects of the immature skeleton and its effect on trauma in children are discussed in this article.

A locking collar for Luque rods.

The migration of hardware has been a problem in the Luque system of segmental spinal instrumentation. To prevent this migration, a device was designed to slip on the 3/16th inch or 1/4 inch Luque rod. This prevents movement between the wire-rod interface, stopping both distal and proximal rotation of the rod. This article reports 21 patients with neuromuscular scoliosis on whom this technique was used. There was no migration of hardware and only one wire breakage in an area separate from the locking collar. These results are a marked improvement from patients of previous reports who did not receive the new device. Laboratory testing on the locking collar determined the best location on the "L" rod to be in the middle third of the rod. Rod migration has essentially been eliminated with this technique.

Simultaneous bilateral avulsion fracture of the tibial tuberosity. A case report.

Bilateral avulsion fracture of the tibial tuberosity is a rare injury. A 14-year-old male gymnast sustained simultaneous tibial tuberosity displaced fractures while attempting a forward flip. The recommended treatment was open reduction and internal fixation. Functional results were excellent one year after surgical treatment.