Acta Orthop Belg
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Debridement is warranted for the treatment of nontuberculous spondylodiscitis in case of neurological compromise, deformity, instability, abscess formation, extensive destruction, intractable pain or failure of medical management. The additional use of instrumentation is still controversial, but might fight infection and yield stability. The purpose of this retrospective study was to evaluate the outcome of 16 cases of non-tuberculous thoracic or lumbar spondylodiscitis treated with anterior debridement and reconstruction (tricortical graft or titanium mesh cage), combined with single-stage posterior instrumentation and grafting. ⋯ There were two superficial infections, which healed with debridement and antibiotics. A single iliac vein injury was primarily repaired. In conclusion, the proposed technique is an effective and safe treatment for pyogenic spondylodiscitis, if surgery is mandatory.
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Traumatic amputations are important causes of acute stress disorder and post-traumatic stress disorder. In this study, we aimed to find out the occurrence rate of symptoms of acute and post-traumatic stress disorder after traumatic amputations and according to this, to assess the psychiatric status of the patients in the postoperative period. Twenty-two patients with traumatic limb amputation who were treated in our institution were retrospectively evaluated. ⋯ After the 6th month (6 months to 5 years), 17 (77.2%) had chronic and delayed post-traumatic stress disorder and needed psychiatric supportive treatment. Patients who have sustained a traumatic amputation may need psychiatric supportive treatment in the late period after the trauma. As we orthopaedic surgeons treat these patients surgically, we should be aware of their psychiatric status.
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The authors reviewed eight patients treated with an Ilizarov frame for a non-infected delayed union or non-union after reamed intramedullary nailing of the femoral diaphysis. The hardware was completely removed in all cases but two, in which the distal fragment of a broken nail was left in situ. ⋯ All patients achieved a good consolidation, with an average time to healing of 32 weeks and restoration of length and alignment if necessary. Bone grafting was never required, illustrating the sufficient biological potential for repair in non-infected femoral non-union.
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The objective of the present study was to investigate whether transpedicular bone grafting as a supplement to posterior pedicle screw fixation in thoracolumbar fractures results in a stable reconstruction of the anterior column, that allows healing of the fracture without loss of correction. Posterior instrumentation using an internal fixator is a standard procedure for stabilizing the injured thoracolumbar spine. Transpedicular bone grafting was first described by Daniaux in 1986 to achieve intrabody fusion. ⋯ Mean Cobb's angle improved from +7.16 degrees (SD 12.44) preoperatively to -5.48 degrees (SD 11.44) immediately after operation, with a mean loss of correction of 1.00 degrees (SD 3.04) at two years. Reconstruction of the anterior column is important to prevent loss of correction. In our experience, the use of transpedicular bone grafting has efficiently restored the anterior column and has preserved the post-operative correction of kyphosis until healing of the fracture.
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We systematically reviewed published evidence regarding foot compartment syndrome with regards to causes, methods of diagnosis, number of incisions used for fasciotomy, wound closure techniques, complications, and functional outcomes. Publications were collected using PubMed and OVID databases, and were reviewed as above. All were retrospective case series (evidence-based medicine level IV). ⋯ Sixty-five percent of cases required split-thickness skin grafts for wound closure after fasciotomy. Neurological deficits were the most common complication (52%). Thirty-nine percent of the patients reported residual pain and stiffness while ten percent could return to work or their pre-injury activity state after fasciotomy.