Ilizarov lengthening in centralized fibula.

Tibial hemimelia often produces major limb length problems (1,6,9,15) as well as foot deformity. The decision to perform reconstructive surgery depends on the expected leg-length discrepancy, the anomalies of the foot, and the status of the knee (4,6,8,15). Congenital bone deficiencies usually have a constant rate of growth inhibition (8), and leg lengthening is often associated with more complications (5,13). The complication rate is also increased with the increased leg-length discrepancy (5). In tibial hemimelia with functioning quadriceps (types I and II) and a functional foot, centralization of the fibula onto the talus and synostosis with the proximal tibia is an accepted reconstructive procedure (1,4,6,7,9,15). However, when the transplanted fibula produces a functional limb for the patient, the correction of leg-length inequality would be a challenge. This is a report of such a case.

Surgical management of low-grade lytic spondylolisthesis with C-D instrumentation in adult patients.

In this retrospective study, 45 patients with low-grade (I-II) isthmic spondylolisthesis are reported. Spinal decompression, stabilization and fusion were performed in 19 patients (group I). Stabilization and fusion without decompressive laminectomy were performed in 26 patients (group II). The results, which are mostly encouraging, show no significant difference between the two groups.

Intraosseous schwannoma of T12 with burst fracture of L1.

Intraosseous schwannoma of T12 with burst L1 fracture is extremely rare. Here we present a report of the successful treatment and 18-month follow-up of a 46-year-old man with this complication.

Lumbar spine fusion and pedicle fixation with C-D screws for lumbar iatrogenic instability.

In this retrospective study, ten patients with lumbar iatrogenic instability are reported who were treated by pedicular fixation and bone grafting with an average follow-up of 18 months. Early results, which are mostly encouraging, show relief of symptoms, solid fusion of spine, and maintenance of lumbar curve with no major complications.

Surgically treated acetabular fractures in adult patients.

In this retrospective study, 27 acetabular fractures treated by open reduction and internal fixation with an average follow-up of 3.7 years (1.5-4.0) are reported. Reduction leaving a displacement of < or = to 2 mm was achieved in 9 hips (30%). Good or excellent results were obtained in 22 hips (82%), and in 2 patients who were referred to us after 3 weeks, we performed supra-acetabular osteotomy to obtain congruent joints with fairly good results. The most common complication was heterotopic ossification in 59% of the patients, which led to poor results in 2 patients with grade IV. Avascular necrosis of the hip occurred in 2 patients, and 1 patient developed a late deep infection, which led to osteomyelitis and fused hip.

Supra-acetabular osteotomy in a 3-week-old acetabular fracture.

We report on a patient with a 3-week-old acetabular fracture and pelvic ring disruption, in whom supra-acetabular osteotomy was performed for reduction and internal fixation of the fracture. Fourteen months after surgery, the results are satisfactory and the patient is walking without aids.