Gaston Camino Willhuber

Arthroscopic Fixation of Os Acetabuli Technique: When to Resect and When to Fix

Acetabular rim fractures, or os acetabuli, are hypothesized to occur as a result of an unfused ossification center or a stress fracture from repetitive impingement of an abnormally shaped femoral neck against the acetabular rim. When treated surgically, these fragments are typically excised as part of the correction for femoroacetabular impingement. However, in some patients, removal of these fragments can create symptoms of gross instability or microinstability of the hip. In these cases, internal fixation of the fragment is necessary. The purpose of this technical note is to describe indications, the arthroscopic technique, and postoperative care for fixation of acetabular rim fractures.

Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients

PurposeThe authors describe a percutaneous technique to treat advanced degenerative disk disease in elderly patients.MethodA step-by-step technical description based on our experience in selected cases.ResultPostoperative imaging results are presented as well as indications and recommendations.ConclusionPercutaneous discoplasty can result as an alternative minimal invasive strategy for the treatment of advanced degenerative disk disease.

Short-term complication rate following orthopedic surgery in a tertiary care center in Argentina

Introduction: Registration of adverse events following orthopedic surgery has a critical role in patient safety and has received increasing attention. The purpose of this study was to determine the prevalence and severity of postoperative complications in the department of orthopedic unit in a tertiary hospital. Methods: A retrospective review from the postoperative complication registry of a cohort of consecutive patients operated in the department of orthopedic surgery from May 2015 to June 2016 was performed. Short-term complications (3 months after surgery), age gender, types of surgery (elective, scheduled urgency, non-scheduled urgency, and emergency), operative time, surgical start time (morning, afternoon or evening), American Society of Anesthesiologists score and surgeons experience were assessed. Complications were classified based on their severity according to Dindo-Clavien system: Grade I complications do not require alterations in the postoperative course or additional treatment; Grade II complications require pharmacological treatment; Grade III require surgical, endoscopic, or radiological interventions without (IIIa) or with (IIIb) general anesthesia; Grade IV are life-threatening with single (IVa) or multi-organ (IVb) dysfunction(s), and require ICU management; and Grade V result in death of the patient. Complications were further classified in minor (Dindo I, II, IIIa) and major (Dindo IIIb, IVa, IVb and V), according to clinical severity. Results: 1960 surgeries were performed. The overall 90-day complication rate was 12.7% (249/1960). Twenty-three complications (9.2 %) were type I, 159 (63.8%) type II, 9 (3.6%) type IIIa, 42 (16.8%) type IIIb, 7 (2.8%) type IVa and 9 (3.6%) were grade V according to Dindo-Clavien classification (DCC). The most frequent complication was anemia that required blood transfusion (27%) followed by wound infection (15.6%) and urinary tract infection (6%). Discussion: The overall complication rate after orthopedic surgery in our department was 12.7%. The implementation of the DCC following orthopedic surgery was an important tool to measure the standard of care.

Analysis of Postoperative Complications in Spinal Surgery, Hospital Length of Stay, and Unplanned Readmission: Application of Dindo-Clavien Classification to Spine Surgery

Study Design: Retrospective study. Level of evidence III. Objective: Postoperative complications in spine surgery are associated with increased morbidity, hospital length of stay, and health care costs. Registry of complications in orthopedics and the spine surgery is heterogeneous. Methods: Between July 2016 and June 2017, 274 spinal surgeries were performed, the presence of postoperative complications was analyzed at 90 days (according to the classification of Dindo-Clavien, grades I-V), hospital length of stay, surgical complexity (low, medium, and high), unplanned readmission, and risk factors were evaluated. Results: A total of 79 patients suffered a complication (28.8%), of them 21 (26.7%) were grade I, 24 (30.3%) were grade II, 4 (5.7%) were grade IIIA, and 29 (37.3%) were grade IIIB. There were no IV and V grade cases. The most frequent complication was excessive pain followed by deep wound infection and anemia. Surgical complexity and surgical time were significantly associated with the risk of developing a complication. The average number of hospital length of stay in patients without and with complications were 2.7 and 10.6, respectively, and the unplanned readmission rate was 11%. Conclusions: Registry of postoperative complications allows the correct standardization and risk factors required to establish measures to decrease them, the application of Dindo-Clavien classification was useful for the purpose of our study.

Analysis of Risk Factors for New Vertebral Fracture After Percutaneous Vertebroplasty

Study Design: Retrospective analysis. Level of evidence III. Objectives: Low-energy vertebral compression fractures are an increasing socioeconomic problem among elderly patients. Percutaneous vertebroplasty has been extensively used for the treatment of painful fractures because of its effectiveness. However, some complications have been described; among them, new vertebral compression fractures, whether adjacent or not to the treated vertebra, are commonly reported complications (8% to 52%). Methods: We retrospectively analyzed epidemiological and technical variables presumably associated with new vertebral compression fractures. To determine the relationship between new vertebral compression fracture and percutaneous vertebroplasty, 30 patients (study group) with this complication were compared with 60 patients treated with percutaneous vertebroplasty without this condition (control group). Results: A higher cement percentage was found in the study group (40.3%) compared with the control group (30.5%). Initial vertebral kyphosis was significantly higher in the first group (15°) compared with the control group (9°). Epidemiological factors were similar in both groups. Conclusions: In our study, increased cement percentage injected and a higher kyphosis were associated with new vertebral compression fractures.

Letter to the Editor concerning “Proposal for a new trajectory for subaxial cervical lateral mass screws” by S. Amhaz-Escanlar et al. (Eur Spine J; 2018: doi:10.1007/s00586-018-5670-5)

I read the paper by Amhaz-Escanlar et al. [1] with deep interest. I appreciate the author’s work on this topic. It is a well-performed description; however, I have some comments about this paper. This is a technical proposal to improve screw lateral mass purchase in the subaxial cervical spine by increasing the screw length trajectory based on the lateral mass shape. The authors observed a significant increase in length trajectory with theoretically lower risk of neurovascular injury compared to standard techniques [2, 3]. One of my concerns is related to the entry point proposed by the authors, which is lower and medial compared to the standard techniques, they mention a technical difficulty due to the spinal processes, this could be a potential limitation of this promising technique, especially if no decompression is associated. How the authors address this problem? Is there any level more difficult than another? I can imagine that C6 level can be more challenging due to prominent C7 spinal process. Another question is related to the facet joint violation risk by lowering the entry point, has the authors analyzed this topic? It would be interesting to observe a lateral X-ray to assess the screw-facet joint relationship. In addition, the authors mentioned as a limitation of their study the use of drill tip wire instead of screws; it would be important to show the screw construct and analyze the risk of facet violation or fracture with screws instead of guide wires. Considering that the risk of neurovascular damage and the screw pull-out with the standard techniques are relatively low, what is the real benefit of this technical report that could drive the surgeons to choose this new technique over the standard ones? It would be interesting to observe a screw construct and also analyze screw-rod connection with the new and standard entry points in case you have to change the entry point in a real scenario. As the authors mentioned, further studies are warranted to determine the usefulness of this new trajectory technique and this paper is the start point. I look forward to read clinical and imaging studies about this new procedure to better understand the above-mentioned questions.

Craniocervical spinal instability after type 1 Arnold Chiari decompression: a case report.

To present and describe an unusual case of spinal instability after craniocervical spinal decompression for a type-1 Chiari malformation. Type-1 Chiari malformation is a craniocervical disorder characterized by tonsillar displacement greater than 5 mm into the vertebral canal; posterior fossa decompression is the most common surgical treatment for this condition. Postoperative complications have been described: cerebrospinal fluid leak, pseudomeningocele, aseptic meningitis, wound infection, and neurological deficit. However, instability after decompression is unusual. A 9-year-old female presented with symptomatic torticollis after cervical decompression for a type-1 Chiari malformation. Spinal instability was diagnosed; craniocervical stabilization was performed. After a 12-month follow-up, spinal stability was achieved, with a satisfactory clinical neck alignment. We present a craniocervical instability secondary to surgical decompression; clinical and radiological symptoms, and definitive treatment were described.

Osteosintesis directa en espondilolistesis traumática del axis. Reporte de un caso y revision bibliografica.

La espondilolistesis traumatica del axis representa un 5% de las fracturas cervicales y es definida por una fractura de la pars interarticularis de la segunda vertebral cervical. El mecanismo de esta fractura usualmente implica fuerzas de hiperextension. Los aspectos mas importantes realcionados al pronostico y tratamiento son el compromiso discal C2-C3, el compromiso neurologico y la presencia de luxacion facetaria. En relacion al tratamiento conservador o quirurgicos en patrones no desplazados, el tratamiento quirurgico podria resultar en una recuperacion precoz. Por otro lado se han descrito buenos resultados con el uso de Halo chaleco. A continuacion se presenta un caso de espondilolistesis traumatica del axis tratado con osteosintesis directa a traves de un abordaje posterior en un paciente que rechazo el tratamiento conservador.