International orthopaedics
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Comparative Study
Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery.
The expectations of both the patient and surgeon have been greatly revised in the last 10 years with the introduction of pedicle screws (PS) in spinal surgery. In this study, we have retrospectively evaluated and compared the results of PS instrumentation and the Hybrid System (HS), the latter consists of pedicle screws, sublaminar wire and hooks. The mean follow-up period was 60.1 months (range: 49-94 months) for the patients of the HS group and 29.3 months (range: 24-35 months) for those of the PS group. ⋯ This may indicate that anchor points are more important than the use--or not--of screws. Correction durability and AV de-rotation was better with PS instrumentation, while AVT was better corrected by HS instrumentation (p<0.05). We propose that the reason for the better correction of AVT with HS instrumentation is the forceful translation offered by the sublaminar wire at the apical region, while the reason for the better correction durability of the PS instrumentation may be due to the fact that multiple pedicle screws which afford three-column control are better at maintaining the correction and preventing late deterioration.
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Distal third tibial fractures are prone to non-union following tibial nail insertion. The purpose of this study was to assess the union of distal third tibial fractures in patients who have undergone intra-medullary (IM) tibial nailing with one versus two distal locking screws. ⋯ This is statistically significant (p<0.01). We therefore conclude that two distal locking screws are essential for distal third fractures.
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Five hundred orthopaedic surgeons and 336 anaesthetists were surveyed to assess current UK attitudes towards transfusion practice following arthroplasty surgery. Seventy-two percent of surgeons and 73% of anaesthetists responded to the survey. ⋯ This threshold Hb increased if the patient was symptomatic (surgeons 9.3 g/dL, anaesthetists 8.8 g/dL, p<0.05) or was known to have pre-existing ischaemic heart disease (surgeons 9.0 g/dL, anaesthetists 9.2 g/dL, p<0.05). A wide variability in attitudes and practices is demonstrated, and the development and adoption of consensus guidelines needs to be encouraged if efforts to reduce the use of blood products are to succeed.
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Multilevel laminectomy in children has a significant rate of postoperative spinal deformity. To decrease the incidence of this complication, the use of osteoplastic laminotomy is advocated to minimise the risk of spinal deformity by preserving the normal architecture of the spine. In this retrospective study, a 10-year series of a paediatric population undergoing multilevel osteoplastic laminotomy is reviewed to determine the incidence, especially in contrast to laminectomies, and to identify factors that affect the occurrence of spinal column deformity. ⋯ This study demonstrates that osteoplastic laminotomy was found to be very effective in decreasing the incidence of spinal deformities after spinal-canal surgery for spinal-cord tumours or congenital anomalies in children and adolescents. The choice of an anatomical reconstructive surgical technique such as osteoplastic laminotomy seems to be essential to minimise secondary problems due to the surgical technique itself. Nevertheless, growing patients should be followed up for several years after the initial operation for early detection and consequent management of any possible deformity of the spinal column.
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The aim of this study was to assess the value of direct magnetic resonance (MR) arthrography of the wrist for detecting full-thickness tears of the triangular fibrocartilage complex (TFCC). Twenty-four consecutive patients who had ulnar-sided wrist pain and clinical suspicion of TFCC tear were included in the study. All patients underwent direct MR arthrography and then wrist arthroscopy, and the results of MR arthrography were compared with the arthroscopic findings. ⋯ The overall accuracy of MR arthrography in detecting a full-thickness tear of the TFCC in our study was 79% (19/24). We believe that diagnosis of tears in the TFCC by direct MR arthrography is not entirely satisfactory, although MR arthrography has a high positive predictive value for detecting TFCC tears. Negative results of MR arthrography in patients with clinical suspicion of TFCC tear should be interpreted with caution.