Kristian Herrlin

Posterolateral lumbar fusion. Outcome of 71 consecutive operations after 4 (2-7) years

We report the outcome of 71 consecutive posterolateral lumbar fusions without spinal instrumentation. The indication for the operation was spondylolysis-olisthesis, degenerative disc disease/facet joint arthrosis, or pain after prior laminectomy. Concerning pain relief, 29/43 patients with spondylolysis-olisthesis were classified as good. The corresponding figures in the group with degenerative disc disease and/or facet joint arthrosis were 8/16 patients and in the group with pain post-laminectomy, 6/12 patients. No surgical complications were noted. In the total material 54 patients had a solid fusion, as defined by radiographic osseous trabecular bridging at all intended levels. One-level fusions tended to heal solidly in a higher frequency than two-level fusions. For the spondylolysis-olisthesis group, healed fusion correlated with a good clinical result. Such a correlation could not be verified for the other diagnostic groups. We conclude that non-instrumented posterolateral lumbar fusion is a valid method for treating low-grade spondylolysis-olisthesis, especially when the aim is to fuse a single level. Improved patient selection methods are required in fusion for degenerative disc disease and pain after laminectomy.

Spinal canal remodeling after thoracolumbar fractures with intraspinal bone fragments: 17 cases followed 1–4 years

The long-term fate of nonreduced intraspinal bone fragments in 17 thoracolumbar fractures--three not operated on and 14 stabilized with Harringtons rods or a Hartshill rectangle--was studied with CT. The reduction of the spinal canal area was measured in conjunction with the trauma in the nonoperated on cases and immediately after surgery in the other cases. The mean reduction was 29 (10-70) percent. The reduction had decreased to 14 (0-30) percent at the follow-up examination 31 (12-44) months later. The restitution of the spinal canal did not differ in the nonoperated and operated on patients. Our findings indicate that stable thoracolumbar fractures with intraspinal bone fragments, but without neurologic symptoms, can be treated nonoperatively, irrespective of the size of the fragment, without risk of subsequent symptomatic neural compression.

Pseudomalignant myositis ossificans: Clinical, radiologic, and cytologic diagnosis in 5 cases

In five cases of pseudomalignant myositis ossificans a benign diagnosis was suggested by fine-needle aspiration cytology and confirmed by radiographs and the clinical course. Hence, the need of biopsy to exclude malignancy was obviated. The symptoms rapidly resolved in all the patients. Thus, surgery may not be indicated in pseudomalignant myositis ossificans.

External fixation of femoral fractures: experience with 15 cases.

We report our experience with external fixation in 15 femoral fractures in 14 patients. Follow-up times ranged from 4 to 56 months. Thirteen patients had multiple injuries. All but two fractures healed. In one patient with a supracondylar fracture, a knee arthrodesis had to be performed. One septic osteomyelitis of the femur led to amputation. The range of active knee joint motion was ≥0–90° in 13 knees. Only six knees, however, regained a flexion of ≥120°. Pin tract infection occurred in one case and resolved uneventfully after revision and systemic antibiotics. External fixation should not be routinely used for fixation of femoral fractures, but may be considered in multiply injured and critically ill patients or in case of extensive soft tissue injury.

Traumatic hip joint tamponade: Two cases with femoral head ischaemia

Two elderly patients had pain after hip trauma with no radiographic evidence of fracture. Computed tomography demonstrated capsular haematoma. Scintimetry revealed femoral head ischaemia. Intracapsular hip joint pressure in extension was 240 and 176 mm Hg, respectively, in neutral position and 280 and 360 mm Hg in internal rotation. The hip joints were aspirated for 8 ml and 5 ml of blood, respectively, leading to pain relief and regained radiotracer uptake in the femoral head. It is concluded that traumatic hip joint tamponade may cause femoral head ischaemia which may be reversed by aspiration.

Replacement of the os trapezium by polyurethane implants

Twenty-five patients with arthrosis of the first carpometacarpal joint had the os trapezium replaced by a polyurethane implant (Tecoflex), and the results were evaluated after three years (range 28-47 months). There were three failures in which the implants had been removed because of dislocation with pain. The clinical results in the remaining 22 cases in terms of relief of pain and thumb function were comparable with previous series of silicone implants. Radiographic examination showed no signs of bone resorption or other unfavourable tissue reactions around the implants, but subluxation of the implants was seen in half of the cases. Implant subluxation might be caused by poor design of the implant or the limited amount of fibrous foreign-body reaction around the polyurethane material that resulted in less firm encapsulation than occurred around silicone implants.

Incidence and Stability of Trochanteric Femoral Fractures

Sex, age and stability were recorded in 376 cases of trochanteric femoral fractures. In 168 cases the age and sex specific incidence was determined. When comparing our results with those in previous studies from the same region there was no increase that could not be related to age. This is in contrast to other reports from Scandinavia where investigators have found an increase in fracture incidence that could not be explained by the increasing number of old people. We, as others, have found a high proportion of unstable fractures. The unstable fractures did not occur more frequently in the oldest age groups.

Deep-seated soft tissue leiomyomas

The radiologic and histologic findings of four deep-seated, soft tissue leiomyomas are reported. Clinically and radiologically, they mimicked soft tissue sarcomas because of their location and rich vascularization.

Chronic progressive osteoblastic osteomyelitis: a new approach to treatment.

The clinical, histologic and radiographic picture in 16 cases in 15 patients with nonfistulating chronic progressive osteoblastic osteomyelitis of a long tubular bone which started in childhood is presented. All patients had severe pain at rest or weightbearing. Histology showed an increase of active osteoblasts. Low virulent bacteria were found in one-fourth of the patients. To reduce the osteoblastic activity, nonsteroidal antiinflammatory treatment was combined with surgical and antibiotic treatment. Eleven patients were pain-free at follow-up (average 47 months), 3 had reduced pain, and 1 patient did not respond to treatment.

Complications after trochanteric fractures: A comparison between Ender and nail-plate osteosynthesis

Three hundred and forty-one trochanteric femoral fractures operated with intramedullary nailing (Ender) or nail-plate osteosynthesis (McLaughlin) were followed up for 4 months and reoperations were recorded at 18 months. Both methods had an unacceptably high frequency of complications, radiographically in one third and reoperations in one tenth of the total material. The greatest number of operative technical problems was encountered in the Ender group. The 4-month radiographic follow-up showed more complications in unstable than in stable fractures for both methods. In stable fractures, the Ender group had more radiographic complications. There was a slightly better walking capacity at 4 months and fewer reoperations at 18 months in the McLaughlin group.