A variety of surgical methods and strategies have been demonstrated for Andersson lesion (AL) therapy. In 2011, we proposed and identified the feasibility of stabilizing the spine without curettaging the vertebral or discovertebral lesion to cure non-kyphotic AL. Additionally, due to the excellent reunion ability of ankylosing spondylitis, we further came up with minimally invasive spinal surgery (MIS) to avoid the need for both bone graft and lesion curettage in AL surgery. However, there is a paucity of research into the comparison between open spinal fusion (OSF) and early MIS in the treatment of AL. The purpose of this study was to investigate and compare the clinical outcomes and radiological evaluation of our early MIS approach and OSF for AL. A total of 39 patients diagnosed with AL who underwent surgery from January 2004 to December 2022 were retrospectively screened for eligibility. Patients with AL were divided into an MIS group and an OSF group. The primary outcomes were union of the lesion on radiograph and CT, as well as the visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores immediately after surgery, and at the follow-up (mean 29 months (standard error (SE) 9)). The secondary outcomes were total blood loss during surgery, operating time, and improvement in the radiological parameters: global and local kyphosis, sagittal vertical axis, sagittal alignment, and chin-brow vertical angle immediately after surgery and at the follow-up.Aims
Methods
Introduction. A 6cm femoral gain requires 5-Y during normal growth, but only 6–8-W surgically (x30–40 faster). In lengthening surgery, losses of muscle force (MF) and circumferences (MC) are major. Recovery is long, preventing sports till
Polyetheretherketone (PEEK) interbody fusion cages combined with autologous bone graft is the current clinical gold standard treatment for spinal fusion, however, bone graft harvest increases surgical time, risk of infection and chronic pain. We describe novel low-stiffness 3D Printed titanium interbody cages without autologous bone graft and assessed their biological performance in a pre-clinical in vivo interbody fusion model in comparison to the gold standard, PEEK with graft. Titanium interbody spacers were 3D Printed with a microporous (Ti1: <1000μm) and macroporous (Ti2: >1000μm) design. Both Ti1 and Ti2 had an identical elastic modulus (stiffness), and were similar to the elastic modulus of PEEK. Interbody fusion was performed on L2-L3 and L4-L5 vertebral levels in 24 skeletally mature sheep using Ti1 or Ti2 spacers, or a PEEK spacer filled with iliac crest autograft, and assessed at 8 and 16 weeks. We quantitatively assessed
Aim. External fixator knee arthrodesis is a salvage procedure mainly used in cases of end-stage infected total knee replacement (iTKR). A stable fixation combined with bone-ends compression is basic to achieve knee fusion in such a scenario but providing enough stability can be challenging in the presence of severe bone loss after multiple previous procedures. Compared with monoplanar configuration, a biplanar frame achieves improved coronal stiffness, while providing the advantages of good access to the wound and allowance of early ambulation. Our primary hypothesis stated that a biplanar frame would achieve higher and quicker fusion rate than a monolateral configuration. Method. We conducted a retrospective cohort study examining patients managed with biplanar external fixator knee fusion due to non-revisable iTKR between 2014 and 2018. We compared this group of patients with a historical cohort-control patient who had been previously published by our unit in 2013, since we switched from a monoplanar to a biplanar configuration for the management of this kind of complex end-stage iTKR. Primary end-points were fusion rate, time to achieve
Introduction: The mechanobiology and response of bone formation to strain under physiological loading is well established, however investigation into exceedingly soft scaffolds relative to cancellous bone is limited. In this study we designed and 3D printed mechanically-optimised low-stiffness implants, targeting specific strain ranges inducing bone formation and assessed their biological performance in a pre-clinical in vivo load-bearing tibial tuberosity advancement (TTA) model. The TTA model provides an attractive pre-clinical framework to investigate implant osseointegration within an uneven loading environment due to the dominating patellar tendon force. A knee finite element model from ovine CT data was developed to determine physiological target strains from simulated TTA surgery. We 3D printed low-stiffness Ti wedge osteotomy implants with homogeneous stiffness of 0.8 GPa (Ti1), 0.6 GPa (Ti2) and a locally-optimised design with a 0.3 GPa cortex and soft 0.1 GPa core (Ti3), for implantation in a 12-week ovine tibial advancement osteotomy (9mm). We quantitatively assessed
Introduction. Frame HI is the #Days for device removal/cm. IM Nail HI is less relevant (31–45 D/cm). Albizzia HI was 33 D/cm (1991–2003). Patients felt fine approximately 1M after end of lengthening (EoL), resuming normal life and sports. This sometimes resulted in implants fractures (e.g. skying before bone fusion). Ideally, the full fusion should occur at the EoL. We decided to shorten the HI to reach this target, optimising all parameters. Materials & Methods. The evolution of care has been monitored over a 32-year clinical experience with a fully weight-bearing nails (Albizzia then G-nail). Monitoring was with X-rays, DEXA, blood bone activity, and in London with special 5G CBCT Scans. We implemented several changes in the Care of patients and measured them according to the ‘Five Principles’ (stability, function, ‘Roads-vascular supply’, ‘Materials-calories’ and ‘Workers-BFC’, with actions on food intake, activity levels and on muscle and bone vascular growths. Results. Preop: training (vascularity, muscle force). Op & Postop: spine morphine, IM sawing preserving BFC, controlled hypo-pressure, low hydration, 50 cm leg elevation, walking, resistance bike, full motion (drainage, muscle reactivation), discharge 3–4h postop (including bilateral). Postop daily intense gym training. POD07-21: Distraction increased to fight non-linear hyper-ossification (44–50 mm gain at POD30) +/- aided by NSAIDs. HI decreased to 12–20D/cm, sometimes 8D/cm with some ‘soft fusion’ during lengthening, hardening within 1W after EoL. Conclusions. The surgeon is not a passive X-rays observer, but has an active role in changing the healing speed and decreasing HI for patient safety. Electro/Magnetic nails (torque 1 Nm) may be clocked by
Background. Corrective fusion of a deformed / unstable Charcot neuroarthropathy (CN)of the midfoot and hindfoot is performed with the aim to prevent ulcers and maintain patient mobility. Methods. Between October 2007 and July 2018, 103 CN mid and hind foot corrections in 95 patients were performed. There were 34 hind-foot, 38 mid-foot and 31 combined hind and mid-foot surgeries. 83 feet had single stage corrections, whereas 20 required a staged operation. Results. Ninety-five patients were prospectively followed up. The mean patient age in our study was 57 years (21 – 85). Twenty-seven patients had type1 diabetes, 64 patients had type 2 and 4 patients had a neuropathy secondary to other conditions. Forty patients (42%) were offered a below knee amputation prior to attending our foot clinic. At a mean follow up of 56 months (12 – 140) we achieved 100% limb salvage with a 75% full
Purpose of the study: Arthrodesis is the treatment of choice for advanced-stage infection involving the tibiotarsal joint. In aseptic conditions, clinical and biomechanical experiments have shown that internal fixation can lead to a better rate of
Demineralized Bone Matrix (DBM) is currently used in various types of orthopaedic applications because of osteoconductive and osteoinductive properties. Fibrin glue is also used in cardiovascular and thoracic surgery due to its hemostatic, chemotactic and mitogenic properties. There is some possibility of being good biomaterial and biodegradable scaffold with DBM-fibrin glue mixture for bone void filler. After total hip replacement surgery, it takes long time to complete
The authors present their experience in
Purpose: Comparison of functional, anatomical and roenthgenological outcomes of subtalar arthrodesis technique: Ilizarov apparatus- EF and internal fixation IF. Materials and Methods: 41 patients (31 men, 10 women) , average age of 38.8 years (12–71) with 44 symptomatic feet underwent procedures for painful arthrodeses. In 28 (30 feet) we performed subtalar arthrodeses by lateral approach, rigid internal fixation with screws. 13(14 feet) others underwent minimal invasive intervention and compression arthrodesis using Ilizarov frame. Nonweightbearing for 4–6 weeks. Removal – 8–10 weeks after the procedure. Evaluation: subjective complaints, physical examination, postoperative radiographs. Patient suspected to have union problems underwent a CT. Results:. In IF union rate 90% (25 patients). Complications: Three re-arthrodeses for nonunion, entrapment of sural nerve – 2 patients, postoperative infection – 2 patients, postoperative infection – 2 patients. In one case intravenous antibiotic resolved the problem, another one needed surgical debridement. The IF overall results were excellent in 79%, good in 12%, fair in 9%. In group EF – solid
Aim. Prosthetic joint infections (PJI) after failed knee arthroplasty, especially in complicated courses with persisting or recurrent infections, may result in a considerable destruction of bone substance, the extensor apparatus and the surrounding soft tissue. In these cases reconstruction of a proper knee function may be impossible and the only solutions are: knee arthrodesis or above-the-knee amputation (AKA). However, both methods are associated with considerable functional deficits and high complication rates. The primary aim of the current study is to analyse the clinical course, outcome and complications in patients with knee arthrodesis and AKA after PJI and to compare these two methods in terms of the analysed parameters. Method. Patients treated with a knee arthrodesis or AKA after PJI in an 11-year time period were included in this study. Demographic data, comorbidities, infecting characteristics and operative procedures were recorded. Patients were seen in regular intervals and underwent physical and radiographic examination. Major complications such as: re-infection, implant-failure, revision surgeries or stump healing disorders were recorded. Functional outcome with use of the Lower-Extremity-Functional-Score was assessed and the patients reported general health status (SF-12-questionnaire) was recorded. Results. In total 87 patients with a knee arthrodesis and 32 patients with an AKA after PJI were included. Knee arthrodesis was performed in 81 patients with a modular system and in six cases with
The objective of this systematic review was to describe trapeziectomy outcomes and complications in the context of osteoarthritis of the base of the thumb after a five-year minimum follow-up. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide study design, and 267 full-text articles were assessed for eligibility. After exclusion criteria application, 22 studies were included, involving 728 patients and 823 trapeziectomies. Outcomes included pre- and postoperative clinical and radiological characteristics. Complications and revisions were recorded.Aims
Methods
Introduction. Scaphoid nonunions remain controversial with regard to optimal management. The objective of this article is to compare our clinical experience in the treatment of patients with scaphoid nonunion using distal radius non vascularised bone graft with that of iliac crest bone graft. Material & Methods. We conducted a prospective randomized study comparing the clinical, functional and radiographic results of 42 patients treated for scaphoid nonunion using a non-vascularised bone graft from the dorsal and distal aspect of the radius (group I), relative to 46 patients treated by means of a conventional non-vascularised bone graft from the iliac crest (group II). All nonunions were stabilized with single Herbert screw. Results.
Summary Statement. Treatment of non-union is a highly demanding field with respect to bone healing. BMP 7 is a useful, wide-ranged tool in treating non-union of the foot and benign bone tumors. It represents a low-risk procedure with a high level of reliability. Introduction. Treatment of non-union is a highly demanding field with respect to bone healing. Treatment of tibial fracture non-union with the bone morphogenetic protein 7 (BMP-7) has been successfully reported. BMP 7 is a recombinant human protein produced in ovary cells of the Chinese hamster. It is responsible for the differentiation of mesenchymal stem cells from the periost, muscle and sponious bone and stimulates bone formation. It is the aim of our study to investigate the use of BMP 7 for other locations than the tibia, such as the foot and benign bone tumors. We strive for union or revision in each medical case. Patients & Methods. At our clinic we applied BMP-7 to 13 patients (9 patients with non-union, 4 patients with benign bone cysts). 9 patients with non-union of the foot (4 forefoot, 1 midfoot, 3 hindfoot, 1 tibia) were surgically treated by resection, stabilisation, and application of BMP 7. The study included 5 men and 4 women at an average age of 58,4 years (range 33 – 80), 13 previous surgeries had been carried out. The period of follow up was on average 16.3 months (5 – 40 months). The indication for using BMP-7 instead of autologous bone graft was poor local blood supply, poor local soft tissue because of previous interventions and risk factors like smoking and diabetes. Following an indicated open biopsy, the 4 cases of benign bone tumors (1 juvenile bone cyst of the talus, 1 osteofibrose dysplasia of the proximal tibia and 2 juvenile bone cysts of the proximal humerus) were all treated with resection, followed by an application of BMP-7 and external or internal fixation. In addition two received bone grafting and two received cortisone. The average age of the tumor group was 16,75 years (11–24 years, 2 male, 2 female). Results. At follow-up all patients were satisfied with respect to pain and function, no operative complications had occurred and
Hind foot Charcot deformity is a disastrous complication of diabetic neuropathy and can lead to instability, ulceration and amputation. The treatment of these patients is controversial. Internal stabilisation and external fixation have demonstrated variable results of limb salvage and some authorities thus advise patients to undergo elective amputation. We report a series of 9 diabetic patients with severe hind foot deformity complicated by ulceration in 5/9, who underwent acute corrective internal fixation with successful correction of deformity, healing of ulceration in 4/5 patients and limb salvage in all cases. Conservative measures such as total contact casting were tried in 5 patients had predominant varus deformity, 2 with valgus deformity and 2 with unstable ankle joints. 5 patients had developed secondary ulceration. All patients underwent corrective hind foot fusion with tibio-talo-calcaneal arthrodesis using a retrograde intramedullary nail fixation and screws and bone grafting. One patient also with fixed planovalgus deformity of the foot underwent a corrective midfoot reconstruction. Patients were followed up in a diabetic/orthopaedic multidisciplinary foot clinic and were treated with total contact casting. (Mean follow up time was 15.6 ±6.9months) In all patients the deformity was corrected with successful realignment to achieve a plantigrade foot. Healing of the secondary ulcers was achieved in 4/5 cases and limb salvage was achieved in all cases. Three patients underwent further surgical procedure to promote
Introduction. Hind foot Charcot deformity is a disastrous complication of diabetic neuropathy and can lead to instability, ulceration and major amputation. The treatment of these patients is controversial. Internal stabilization and/or external fixation have demonstrated variable results of limb salvage and some authorities thus advise patients to undergo elective major amputation. However, we report a series of 9 diabetic patients with severe hind foot deformity complicated by ulceration in 5/9, who underwent acute corrective internal fixation with successful correction of deformity, healing of ulceration in 4/5 patients and limb salvage in all cases. Methods. We treated 9 diabetic patients attending a multidisciplinary diabetic/orthopaedic foot clinic with progressive severe Charcot hind foot deformity despite treatment with total contact casting, 5 with predominant varus deformity and 2 with valgus deformity and 2 with unstable ankle joints. Five patients had developed secondary ulceration. All patients underwent corrective hind foot fusion with tibiotalo-calcaneal arthrodesis using a retrograde intra-medullary nail fixation and screws and bone grafting. One patient also with fixed plano-valgus deformity of the foot underwent a corrective mid-foot reconstruction. Results. Patients were followed up closely in the diabetic /orthopaedic multidisciplinary foot clinic and were treated with total contact casting. (Mean follow up time was 15.6 ±6.9months) In all patients the deformity was corrected with successful realignment to achieve a plantigrade foot. Healing of the secondary ulcers was achieved in 4/5casesand limb salvage was achieved in all cases. Three patients underwent further surgical procedure to promote
To study the use of TSF system in treating trauma and bone deformities in children. To determine the difficulties of this process and the risk factors that lead to complications. From January 2004, in 61 children (37 male and 24 female), 67 extremities, with a mean age 8.9 years children a TSF external fixator was applied for the treatment of trauma or bone deformities. 21 children were operated for angular deformity, 19 for bone lengthening, 10 for rotational deformity, 6 for combined angular deformity and lengthening and 11 for pseudoarthrosis. Intra and postoperative difficulties were classified using the Palay method in problems, obstacles and complications. The rate of difficulties was 22.2 %. Problems were presented in 5.9% (4/67) consisting of 2 non-axial deformities, 1 pin fracture and 1 subluxation of the knee. Obstacles were presented in 10.4% (9/67) including 3 cases with delayed bone healing that needed infusion DBM, 1 peroneal nerve palsy due to hematoma formation treated with decompression of the region, 1 early
Purpose of the study: Surgical strategy for the treatment of pyogenic spondylodiscitis remains a controversial issue, mainly because of the low incidence. This retrospective review was undertaken to clarify current practices. Material and methods: Nineteen patients (11 male, 6 female)with pyogenic spondylodiscitis underwent surgery from 2003 to 208. Mean age at surgery was 62.7 years (41–100). The localisation was cervical (n=6), thoracic (n=8) and lumbar (n=3). Motor deficit was present preoperatively in 13 patients. There were no cases of complete paralysis. The indication for surgery was aggravation of the neurological deficit in 14 patients and kyphosic deformity in three. The release was achieved via an anterior access for the cervical cases and via a posterior access for the thoracic and lumbar cases. The circumferential procedure achieved complete bilateral arthrectomy. In all cases the instrumented fusion was followed by postoperative immobilisation for three months. Antibiotics were also given for three months. Functional and radiographic outcome were assessed at last follow-up. Results: Mean follow-up was months (12–26 months). There were no clinical or biological signs of recurrent infection despite implantation of osteosynthesis material. Irrespective of the delay to treatment, the 13 patients with a preoperative deficit presented signs of recovery. Eight of them recovered completely and the five others had a motor deficit rated at 4/5. Radiographically, there were no fusion failures at last follow-up. Two patients had revision surgery: one for recurrent tetraparesia due to a postoperative epidural haematoma, the other to achieve impaction of the graft in the vertebral body. Discussion: – This series emphasises the clinical impact of surgical treatment of pyogenic spondylodiscitis. Surgery enables a certain degree of neurological recover achieved by wide decompression. It enables
Purpose of the study: We report a case of type 1 neurofibromatosis (von Recklinghausen’s disease) of the lower cervical spine in a 13-year-old girl. Case report: There was no neurological deficit. Plain films showed dysplastic 82° kyphosis centered on the C4–C5 disc. Surgical treatment consisted in anterior multilevel interbody grafting and plate osteosynthesis combined with posterior arthrodesis. Good