Correlative analysis of the sagittal profile of the spine in patients with beta-thalassemia and in healthy persons.

This prospective study compares several roentgenographic parameters of the thoracic and lumbar spine in patients with beta-thalassemia and in healthy persons who served as controls. Eighty-four patients with beta-thalassemia and 84 age- and gender-matched healthy persons were examined clinically and radiologically (thoracic kyphosis, lumbar lordosis, and vertebral and sacral inclination). Although there was a significant difference in the vertebral inclination from T6 to L1, L4, and L5 between patients and controls, thoracic kyphosis and lumbar lordosis did not differ in the two groups. The apical vertebra of the thoracic kyphosis in patients and controls was T7 and T6, respectively, whereas L4 was the apical vertebra of the lumbar lordosis in both groups. There were no age- or gender-related differences in the magnitude of sacral inclination, thoracic kyphosis, or lumbar lordosis in the patients with beta-thalassemia compared with controls. Lumbar lordosis was significantly correlated with sacral inclination in both patients with beta-thalassemia and controls. Beta-thalassemia does not affect sagittal profile of the thoracic and lumbar spine but it is associated by structural changes on the frontal plane of the spine that are expressed as a high prevalence of scoliosis.

The use of sonography for evaluation of the integrity and healing process of the tibiofibular interosseous membrane in ankle fractures.

This study evaluates the value of sonography in the diagnosis of the rupture and healing process of the interosseous membrane in Weber type B and C ankle fractures. In 90 such fractures a rupture of the interosseous membrane was intraoperatively observed in 35 cases (38.8%). All Weber type C fractures showed a rupture of the interosseous membrane, whereas only 23% of the Weber type B fractures were associated with a rupture of the interosseous membrane (p < 0.001). In the vast majority of the cases (77%), particularly in all Weber type B fractures (p < 0.01), the rupture of the interosseous membrane extended above the proximal fracture line of the fibula. By means of sonography, in the acute posttrauma period a rupture of the interosseous membrane was found in 37.4% of the cases. Thus, in our series the results of sonography and the operative findings coincided in 88.6% of the cases concerning location, type, and extent. Sonography was performed by three unbiased observers, and the results were compared with the intraoperative findings. Thus, the sensitivity of the sonography in the diagnosis of the rupture of the interosseous membrane was 88.8%, the diagnostic value of the method 92.2%, and specificity 94.5%. The sonographic findings of the healing process of the interosseous membrane were in absolute (100%) agreement with the intraoperative observations at the time of removal of the osteosynthesis material. Complete healing occurred within 3-5 months after trauma in 70% of the cases of ruptured interosseous membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

Spontaneous fracture of the sternum in a child being treated in a Boston brace for kyphoscoliosis. A case report and review of the literature.

We report a child who suffered from short stature of unknown aetiology and rigid thoracolumbar kyphoscoliosis and developed a symptomatic spontaneous fracture of the sternum while being treated in a Boston brace. Modification of the brace was followed by uneventful healing of the sternal fracture. To our knowledge no mention has been previously made of this extremely rare complication, but the spine surgeon who treats complex spinal deformities in early childhood with braces should be aware of this potential complication, particularly if they are associated with rigid rotational kyphosis.

Acetabular roof reinforcement rings.

A series of 30 total hip arthroplasties was performed in 29 patients with the use of the Mueller roof reinforcement ring (RRR). The mean follow-up observation time was 30 months (standard deviation [SD] = 7.6). The clinical and radiologic results were evaluated according to the Mayo Clinic scoring system. The overall preoperative clinical score of 21.963 (SD = 18.776) points improved to a follow-up examination score of 69.533 (SD = 11.599), a correction of 68.41%. The authors' goal in this series was to implant the ring together with the polyethylene socket as close to the anatomic position of the acetabulum as possible. There was no loosening of the RRR or the polyethylene sockets, nor was there material failure in the last evaluation of the hips. No statistically significant difference was found when the differences between the follow-up scores of the primary versus the revisionary procedures were compared. The roof replacement ring has been helpful for primary and revision arthroplasties of acetabular deficiencies occurring within five years after operation.

Open tibial shaft fractures: a comparative analysis of different methods of fixation in southwestern Greece.

A change in the method of managing open-grade-III tibial shaft fractures provided a new opportunity for a comparative study. One series of patients was treated exclusively by internal fixation and compared with another series treated with external fixation solely as well as with a series treated initially by external skeletal fixation and later by "Sarmiento walking plaster." The latter method was found to be a successful treatment and a good alternative to internal fixation for open grade-II and grade-III tibial shaft fractures when soft-tissue healing was completed. The supplementary use of the Sarmiento walking plaster had dramatically decreased the duration of hospital stay, saving the patient from an additional operation. There were no nonunions in this series. In open grade-I-II tibial shaft fractures, the deep infection rate in the cases in which internal fixation was used was significantly higher (5.4%), than that observed in the cases treated with external fixation, in which there was no deep infection. The nonunion rate was higher (22%) in the external fixation group compared with the internal fixation group (9%). The functional impairment of the ankle joint of the affected limb was less (15%) by using internal fixation than that of either the external fixation group (20%) or the group where the external fixation was changed to a Sarmiento walking plaster (35%).

Abdominal-hip joint fistula. Complicated revision of total hip arthroplasty for false aneurysm of external iliac artery. A case report.

A 76-year-old woman developed an abdominal-to-right hip joint fistula following repair of an aneurysm of the right iliac artery. The aneurysm appeared as a complication of an intraarticular (protrusio acetabula) fracture six years after bilateral hip arthroplasty. Prompt recognition and effective treatment saved the patient's life.