To compare the clinical outcomes of instrumented fusion for single level degenerative spondylolisthesis with local bone versus iliac crest bone graft. Fifty patients (32 female, 18 males) operated on by the author over a 3 year period were reviewed. All cases had a single level decompression and instrumented fusion for a degenerative spondylolisthesis. 25 patients had iliac crest graft and 25 had morcelised local bone graft. Patients were followed up for 6 months. Pre and postoperative visual analogue pain scores and Roland disability scores were recorded. Inpatient notes were reviewed for duration of surgery and duration of stay. There was no difference in age, sex and severity of pre operative symptoms between the two groups. There was no significant difference in improvement in Roland score between the two groups but pain scores were lower in the local graft group although this was not statistically significant. Duration of surgery (140 vs 175min) and hospital stay (4.3 vs 5.1 days) were lower in the local bone graft group.6 patients in the iliac crest graft group complained of donor site pain vs none in the local graft group at 6 months. Usage of morcelised local bone graft resulted in clinical outcomes comparable to iliac crest bone graft in patients undergoing decompression and fusion for a single level degenerative spondylolisthesis. Duration of surgery, hospital stay and donor site pain are reduced when local bone was utilised

Intraoperative fractures during primary total hip arthroplasty (THA) can occur on either the acetabular or the femoral side. A range of risk factors including smaller incision surgery, uncemented components, prior surgery, female sex, osteoporosis, and inflammatory arthritis have been identified. Acetabular fractures are rare but when they do occur often are underrecognised. It is not uncommon for intraoperative acetabular fractures to be discovered only postoperatively. Intraoperative acetabular fractures are associated with cementless implants and a number of identified anatomic risk factors. Factors related to surgical technique, including excessive under-reaming, excessive medialization with aggressive reaming, and implant designs such as an elliptical cup design are associated with higher risk. Treatment of acetabular fractures is dependent on whether they are diagnosed intraoperatively or postoperatively. When discovered intraoperatively, supplemental fixation should be added in the form of additional screw fixation, placing a pelvic plate, or using an acetabular reconstruction cage and morselised allografts. Acetabular reamings, obtained during preparation of the acetabulum, can be used for local bone graft. The goal should be stability of both the fracture and acetabular cup. Postoperatively, weight bearing and mobilization protocols may require modification, with many surgeons choosing a period of toe-touch weight-bearing in such cases. Acetabular fractures found postoperatively require the surgeon to make a judgement on the relative stability of the implant and the fracture to determine if immediate revision surgery or protected weight-bearing alone is appropriate. On the femoral side intraoperative fractures can occur around the greater trochanter, the calcar, or in the diaphysis. Fractures of the greater trochanter are problematic because of their tendency to displace due to the attachment of the abductors and the strong force they apply. Tension band wiring techniques will work for many greater trochanteric fractures while a trochanteric plate may be occasionally called for. With either form of fixation strong consideration should be given to 6–8 weeks of protected weight bearing postoperatively. Short longitudinal cracks in the medial calcar region are not rare with uncemented implants. Calcar fractures that do not extend below the lesser trochanter can often be managed with a single cerclage cable. Calcar fractures extending below the lesser trochanter should be scrutinised with additional intraoperative xrays; longer longitudinal cracks can be managed with 2 cables while more complex fractures that exit the diaphysis demand a change to a distally fixed implant and formal fracture reduction. Distal diaphyseal fractures are relatively uncommon in the primary setting, but not rare in the revision setting. When recognised intraoperatively, distal diaphyseal fractures can be treated effectively with cerclage cables. Distal diaphyseal longitudinal cracks noted postoperatively do not typically mandate a return to the OR and instead can be managed with 8 weeks of protected weight bearing

Purpose. Bone morphogenic protein (BMP-2) is used in spinal arthrodesis to induce bone growth. Studies have demonstrated that it achieves similar fusion rates compared to iliac crest bone graft when used in instrumented fusions. Our study aims at evaluating the requirement for instrumentation in one and two-level spinal arthrodeses when BMP-2 is used in conjunction with local bone to achieve fusion. Method. 50 patients were recruited and randomized to instrumented versus non-instrumented spinal arthrodesis. BMP-2 with local autologous bone was used in all patients. Patients are evaluated at 3-months, 6-months, 12-months, and 24-months postoperatively with questionnaires to assess clinical outcome (ODI, VAS and SF-36), and PA and lateral x-rays of the spine to assess radiographic fusion (Lenke score). At 24 months, a thin-cut (1mm) CT scan was performed. Results. Two-year data is available on 40 patients. There were no statistically significant differences between the two groups based on the clinical outcomes measured. The ODI 22.55.1 for the instrumented group vs. 13.733.57 for the non-instrumented group (p=0.2)). The VAS for the instrumented group was 2.110.61 vs. 1.530.61 for the non-instrumented group (p=0.49). The SF-36 (physical) was 62.316.71 for the instrumented group vs 54.665.43 for the study group (p=0.8). The operating time was 105.85.91 minutes for the instrumented group versus 88.63.61 minutes for the non-instrumented group (p=0.01). Blood loss was 339.139.38 cc for the instrumented group vs 273.133.8 cc for the non-instrumented group (p=0.1). Preliminary radiographic analysis showed similar fusion rates for the two groups. Two-year follow-up on all patients will be completed by February 2010. Final clinical and radiographic data analysis will be presented at the meeting. Conclusion. BMP-2 and local bone graft demonstrated functionally equivalent clinical outcomes when used with or without instrumentation in lumbar spinal fusions while offering potential reduction in operative time and blood loss