Journal of surgical orthopaedic advances
-
The United States forces in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) are primarily engaged in counterinsurgency operations within an irregular war. The US combat medical experience has reported new injury patterns secondary to the enemy's reliance on explosive mechanisms, particularly improvised explosive devices (IEDs), and the widespread use of individual and vehicular body armor. Musculoskeletal extremity injuries have been reported to comprise approximately 50% of all combat wounds for OIF/OEF. ⋯ Explosive mechanisms of injury, with IEDs being the most common, account for over 75% of all combat casualties. The lethality of IEDs coupled with the protection of the thorax and abdomen provided by individual body armor has resulted in increasingly severe orthopaedic injuries. Collection and careful examination of orthopaedic combat casualties will allow for improved military personnel protective measures and treatment of injured soldiers.
-
The purpose of this retrospective study was to evaluate the radiographic and clinical efficacy of uninstrumented facet fusion in elderly patients undergoing lumbar laminectomy for spinal stenosis due to a single-level degenerative spondylolisthesis. Several studies have clearly demonstrated the beneficial effects of concomitant spinal fusion with laminectomy in degenerative spondylolisthesis. Controversy, however, persists regarding the virtues of fusion in this patient population. ⋯ The overall postoperative radiographic stabilization rate and improved patient outcomes were higher in group 1 than in group 2. In patients undergoing laminectomy for a grade I or II fixed or mobile degenerative spondylolisthesis, concomitant facet fusion decreases motion and stabilizes the spine via a bony fusion or a stable pseudarthrosis. In general, patients with less motion on postoperative flexion/extension radiographs had a better clinical outcome than those with more motion.
-
Comparative Study
Biomechanical comparison of two headless compression screws for scaphoid fixation.
This study compared compression generation between two headless compression screws: the Synthes 3.0-mm and the Acutrak standard. Twenty scaphoids were harvested from 10 pairs of fresh cadaveric forearms. A washer-shaped load cell was inserted between the halves of each scaphoid created by a simulated fracture via osteotomy. ⋯ Differences in parameters of interest were checked for significance (p < .05) with paired t tests. No significant differences were shown in mean (+/- standard deviation) peak torque (57 +/- 28 Ncm vs. 55 +/- 32 Ncm; p < .84), compression immediately after insertion (119 +/- 54 N vs. 91 +/- 37 N; p < .15), or compression 5 min after insertion (32 +/- 30 N vs. 38 +/- 24 N; p < .61) between the Synthes and Acutrak screw fixations, respectively. The choice between these two screws to stabilize scaphoid waist fractures should be based on parameters other than compression generation, such as size, availability, cost, and ease of use of the implant.
-
Patients with spastic quadriplegia secondary to cerebral palsy manifest with severe spasticity and often with neuromuscular scoliosis. In order to optimize treatment and minimize morbidity in selected cases, the authors present a surgical option concurrently addressing these problems. This study reviews one case and describes the surgical technique in detail where intrathecal baclofen pump implantation and posterior spinal fusion are concomitantly performed to manage spasticity and scoliosis, respectively.
-
A retrospective review was performed to analyze the radiographic and functional outcomes of two different surgeries to repair a pseudarthrosis following a transforaminal lumbar interbody fusion (TLIF) procedure. Although there are several published reports on the results of the TLIF procedure, there are no reports on how to salvage a failed TLIF. A total of 38 consecutive patients with failed TLIF procedures (at 50 levels) were repaired by either a direct anterior approach only (21 patients) or by a combined direct anterior approach coupled with a posterior exploration and pseudarthrosis repair (17 patients). ⋯ The authors' center's satisfaction questionnaire also showed similar results. The outcomes, both radiologic and functional, were equal in both groups. There was very little improvement in functional outcomes comparing prerepair to postrepair based on the authors' questionnaire.