The circulatory effects of multilevel balloon kyphoplasty (BK) are not adequately addressed, neither the effectiveness of egg shell
Purpose of the study: Treatment of calcaneal fractures is specific because of the fact that these fractures dis-organise the subtalar joint, requiring precise reduction. The clinical result is not always satisfactory considering the efforts made to obtain reduction and fixation. Functional treatment often gives acceptable clinical results, but leaves important anatomic and functional sequelae. We developed a technique for percutaneous balloon reduction and
A recurrent fracture rate after vertebroplasty and balloon kyphoplasty is as high as 20%. Biomechanically, it has not been proven that refracture rate is due to the cement stiffness alone. This finite-element study investigated effects of cement-stiffness, bone-quality, cement-volume and height-restoration in treatment of vertebral compression fractures using balloon kyphoplasty. A finite-element model of the lumbar spine was generated from CT-scans. The model comprised of two functional spinal-units, consisting of L2-L4 vertebral bodies, intervertebral-discs, and spinal ligaments. Cement volumes modelled were in the order of 15% and 30% of total vertebral body (VB) volume. Spinal fracture was modelled as being reduced and height of VB was restored. Kyphoplasty was performed. Three different bone qualities were modelled: healthy, osteopenic, osteoporotic. A compressive load was applied to the proximal endplate of L2. An anterior shift of the centre-of-gravity of upper body was simulated by increasing the moment arm of the applied load. All results of the analysis were compared back to an intact spinal model of the same region under the same loading regime. All parameters affected the mechanical behaviour of the spine model, although changing the bone quality from normal to osteoporotic resulted in the least change. The cement stiffness was initially modelled with an elastic modulus between 0.5GPa and 2GPa. The results showed small differences relative to intact case in the lower modulus cement. A much higher cement stiffness of 8GPa resulted in larger changes in the stresses. The most significant parameter in this study was found to be the changed load path as a result of partial height restoration. This induced a moment in the construct and increased the stresses and strains in the anterior compartments of each vertebra as well as marked in the adjacent (upper and lower) vertebrae. The factor of safety calculation showed the centre of the L3 vertebra to be the most failure prone in all cases, with the osteoporotic bone models showing higher fracture tendencies. This study indicates that healthier bone has a better chance of survival. Cement properties with lower cement elastic moduli induce stresses/strains which are more similar to the intact model. The best way to reduce the likelihood of failure is to restore the vertebral height.
The August 2013 Oncology Roundup. 360 . looks at: spinal osteosarcoma: all hope is not lost; intralesional curettage for low-grade chondrosarcoma?; isolated limb perfusion is a salvage option; worryingly high infection rates in patients with endoprostheses; how bad is endoprosthetic infection?; operatively treated metastatic disease; and
Purpose of the study: The treatment of thoracolumbar fractures has evolved over the last five years with
Periprosthetic femoral fractures around total knee arthroplasty present a challenge in octogenarians with advanced osteoporosis. We describe a salvage technique combining retrograde intramedullary nailing augmented with polymethylmethacrylate (PMMA) cement in five patients followed up for a median time of 12 months. The nail/cement construct bridges the femoral canal tightly and behaves like a stemmed cemented revision component. All patients had an uncomplicated recovery and returned to their pre-injury functional status within four months. This procedure does not disrupt the soft tissue envelope facilitating periosteal callus formation, is easy to perform and permits immediate full range of movement. When standard retrograde nailing or plating alone is inadequate in maintaining severely osteoporotic fracture reduction in octogenarians unfit for lengthy procedures, nailed
Purpose: Instrumentation and
Kyphoplasty is an efficient tool in the treatment of primary tumours (plasmocytoma) and osteolytic metastasis. Especially in plasmocytoma the current chemotherapy has increased life expectancy significantly. Therefore minimal-invasive stabilisation is not only a palliative treatment but really increases quality of life in those cases. Kyphoplasty offers several special tools and techniques to lower the leakage rate which is especially high with other
Introduction: It is commonly admitted that for any joint fracture in the human body, a perfect anatomical reduction before stabilization is the only manner to biomechanically restore a joint and avoid late complications by early mobilization allowance. But, there is no evidence of anatomical fracture reduction when using vertebroplasty or balloon kyphoplasty in case of traumatic vertebral compression fractures (VCF). Materials &
Methods: A new procedure was proposed using titanium permanent vertebral cranio-caudal expandable implants (VCCEI) in combination with PMMA
Purpose: The purpose of this study is to evaluate the safety of methylmethacrylate cement balloon kypho-plasty (BK) when applied to five or six levels in the same sitting and the incidence and location of cement leakage. Methods: Eighty nine patients (215 vertebral bodies-VBs) with osteoporotic compressive fractures (OCF), and 24 with osteolytic tumors (OT) (72 VBs) were treated with BK. Of patients with OCF, 27 were treated at one level, 26 at two, 21 at three, 7 at four, 6 at five, 2 at six levels. Of OT patients, 3 were treated at one level, 5 at two, 9 at three, 3 at four, and 4 at five. Results: A drop in blood pressure of more than 25mmHg during cement injection was observed in four patients, and was not associated with the number of VB treated. The procedure was aborted in two patients. Otherwise no significant drop in arterial O2 was noted. One patient treated for 5 levels developed fever and tachepnoea for 24 hours after surgery. Arterial O2 and chest x-rays were normal. Pain significantly improved in 95% of patients with OCF and 98% of patients with tumors. In the osteoporotic group, kyphosis correction was achieved in 91% with a mean correction of 7.89°. Cement leakage occurred in 21/215 VBs (9.7%); Epidural: two (0.9%), intraforaminal: 1 (0.5%), intradiscal: 7 (3.2%) while through the anterior or lateral vertebral wall: 11 (5.1%). In the OT group leakage occurred in 6 VBs (8.3%), including 9 (7.0%) through the anterior or lateral wall and one (1.3%) intradiscal. None of the patients had any clinical consequences associated with cement leakage. Conclusions: BK is a safe and effective procedure, even when applied for 5 or 6 levels. End plate fracture or vertebral wall lytic destruction can effectively be managed by eggshell balloon
Antibiotic resistance represents a threat to human health. It has been suggested that by 2050, antibiotic-resistant infections could cause ten million deaths each year. In orthopaedics, many patients undergoing surgery suffer from complications resulting from implant-associated infection. In these circumstances secondary surgery is usually required and chronic and/or relapsing disease may ensue. The development of effective treatments for antibiotic-resistant infections is needed. Recent evidence shows that bacteriophage (phages; viruses that infect bacteria) therapy may represent a viable and successful solution. In this review, a brief description of bone and joint infection and the nature of bacteriophages is presented, as well as a summary of our current knowledge on the use of bacteriophages in the treatment of bacterial infections. We present contemporary published in vitro and in vivo data as well as data from clinical trials, as they relate to bone and joint infections. We discuss the potential use of bacteriophage therapy in orthopaedic infections. This area of research is beginning to reveal successful results, but mostly in nonorthopaedic fields. We believe that bacteriophage therapy has potential therapeutic value for implant-associated infections in orthopaedics. Cite this article: