Scoliosis surgery has moved towards all posterior correction, as modern implants are perceived to be powerful enough to overcome stiffer and more severe curves. However, shortening of the anterior spinal column remains most effective in creating thoracic kyphosis, and may still have a role in correcting both coronal and sagittal deformities. Furthermore, anterior correction of lumbar and thoracolumbar curves can theoretically reduce the distal fusion level, and may have significant impact on patients' post-operative function.

A single surgeon series of 62 patients with idiopathic scoliosis were examined retrospectively. Radiographs and operation notes were examined by 2 spinal surgeons, sagittal and coronal parameters were measured before and after the operation. The patients were divided into 4 groups: 16 anterior and posterior fusions (AP), 16 anterior thoracolumbar fusions (A), 5 anterior thoracic releases and posterior fusions (AR), and 25 posterior fusions only (P).

The mean age was 15.3 (range 10 – 20). The mean main thoracic Cobb angle pre-operatively was: 54° (AP), 43° (A), 63° (AR), and 50° (P). The mean thoracolumbar Cobb angle was: 55° (AP) and 51° (A). There was no significant difference in lumbar lordosis.

The mean post-operative main thoracic Cobb angle was: 9° (AP), 13° (A), 9° (AR) and 15° (P). There was significant difference between AR and P groups. The mean post-operative thoracolumbar Cobb angle was: 8° (AP) and 6° for (A). There was a significant difference in the post-operative thoracic kyphosis between AP (mean 14°), A (mean 38°), AR (mean 19°) and P (mean 14°). Overall, the lumbar lordosis for all 4 groups reduced from a mean of 67° to 50°, with no significant difference between the groups.

The distal level of fusion for A and AP groups were L3 for all cases, whereas 2 cases had to extend to L4 in the P group.

Anterior release improved both coronal and sagittal correction when compared to posterior only surgery, however it is of unknown clinical significance. Anterior thoracolumbar fusion with or without posterior spinal fusion appeared to produce adequate coronal correction if fused to L3. No difference was found between all groups in post-operative lumbar lordosis.

Aims: The purpose of the study was to analyse the early experience of the technique of transitory percutaneous pinning to manage three and four part proximal humeral fractures. Methods: An independent review of 66 consecutive patients with proximal humeral fractures treated in our unit over a three-year period was carried out. The patients underwent closed reduction under image intensiþer guidance with percutaneous pinning using an average of 3.5 wires (range 3–4). A standard three dose prophylactic antibiotic regime was used. A protective collar and cuff was the used for 4 weeks, and a physiotherapy program of pendular movements going on to assisted active exercises started after this. The wires were typically removed in an outpatient setting at 4 to 6 weeks. Results: The postoperative radiographs were deemed satisfactory with good overall alignment by two external observers in all cases. Our þndings were however remarkable for a very high early complication rate. This included pin migration (50%), stiffness (41%), pain (33%), infection (25%), nonunion (8%) and radial nerve palsy (8%). The complication rate increased dramatically in those over the age of 50 or those with osteopenia. Conclusions: The technique of transitory percutaneous humeral pinning is technically demanding. Our early experience would suggest high rates of early complications and readmissions. This technique should be applied with caution in older patients with osteopenia.

Introduction

Lateral ligament reconstruction of the ankle for chronic symptomatic mechanical instability is a relatively common procedure for Foot and Ankle surgeons to undertake. The following method has been undertaken by the Senior Author for the past ten years.

Materials and Methods

We studied 26 patients (26 feet). The average age was 32 years with 16 males and 10 females. Duration of follow up was from 11 months to 11 years.

Preoperative Investigations

Functional instability and alternative diagnoses such as tendonopathy and previously unrecognised fractures were excluded, sometimes by extensive investigations. All patients undergoing surgery had a period of conservative treatment which had failed. Stress radiographs confirmed instability in two planes and was either undertaken preoperatively or just prior to surgery under anaesthesia.

Surgical Technique

Through a small oblique lateral incision, the lateral capsule, ligaments and periosteum were advanced over the tip of the fibula in a proximal and posterior direction and re-anchored tightly to the bone, usually with Mitek (titanium) bone anchors.

Postoperative Management

The patients were casted for six weeks whilst weight bearing, followed by six weeks of physiotherapy.

Results

The success rate was over 85%. The complications were scar tenderness, recurrent instability and ankle spurring. There were no complications caused by the metallic anchors.

Conclusion

This procedure has a comparable success rate with similar anatomical ligament reconstructive procedures and can be recommended.