Meir Liebergall

Computerized Navigation for the Internal Fixation of Femoral Neck Fractures

BACKGROUNDnAccurate placement of cannulated screws is essential to ensure secure fixation of femoral neck fractures. We compared computerized navigation and conventional fluoroscopy with regard to the accuracy of screw placement for the fixation of femoral neck fractures.nnnMETHODSnWe retrospectively compared two groups of twenty consecutive patients with a femoral neck fracture who underwent internal fixation with three cannulated screws. Computer-based navigation was used to guide screw placement in one group, and conventional fluoroscopy was used in the other group. Radiographic evaluation included the measurement of screw parallelism and spread, the calibrated distance from the lesser trochanter, and joint penetration. The follow-up period was two years. The rates of complications in both groups were evaluated.nnnRESULTSnThe navigation-assisted group had better screw parallelism and greater spread of the screws. There was a tendency for fewer reoperations and significantly fewer overall complications in the patients in whom computerized navigation was used (p < 0.018).nnnCONCLUSIONSnComputerized navigation improves the accuracy of cannulated screw placement in the internal fixation of femoral neck fractures. It may provide better mechanical stability and improved fracture outcome.

Pyogenic vertebral osteomyelitis with paralysis. Prognosis and treatment.

In the interval between 1983 and 1988, 14 patients were treated for pyogenic spondylitis complicated by neurologic compromise. There were nine males and five females aged 39-80 years. The average time between onset of symptoms and diagnosis was 2.8 months. Predisposing factors were diabetes mellitus in four patients and urinary tract infections in five patients. The infection was blood borne in all 14 patients. In two patients, the infection was superimposed on a recent vertebral fracture. The cervical spine was involved in one patient; the thoracic spine in seven; and the lumbar spine in six patients. Six patients presented with a Frankel B paralysis, six with a Frankel C paralysis, and two with grade D paralysis. The neurologic symptoms lasted between one day and six weeks before surgery. Twelve patients had anterolateral decompression. Two of the 12 patients had a second stage posterior stabilization. Two patients were deemed inoperable. All surviving patients were managed by parenteral antibiotics for three to six weeks followed by enteral route for a total of three to six months. All 12 operated patients had a significant neurologic improvement (one grade or more on the Frankel scale) with solid interbody fusion.

Abnormalities of aggregation, thromboxane A2 synthesis, and 14C serotonin release in platelets of patients with idiopathic scoliosis.

Platelet functions were investigated in 16 patients with idiopathic scoliosis (IS), in seven patients with congenital scoliosis (CS), and in 12 healthy individuals who served as a control group. All were females, aged 11 to 22 years. Platelet aggregation anomalies were observed in all IS patients. These constituted an impaired platelet-release reaction when aggregation was induced with ADP or epinephrine, but not with collagen or arachidonic acid. A decreased thromboxane A2 synthesis and impaired 14C-serotonin release were also observed when platelets were stimulated with ADP or epinephrine. Platelet from CS patients and the controls did not show any functional abnormalities when stimulated with the above four aggregating agents. The platelet function anomaly in IS patients was not associated with prolongation of the bleeding time, spontaneous occurrence of hemorrhagic episodes, or increased bleeding during invasive procedures, including major spinal surgery. The above findings and the recently described platelet structural anomalies in IS may imply that the pathological process operative in idiopathic scoliosis involves not only the axial skeleton, but also cellular blood elements. The similarity between blood platelets and muscle cells, and the anomalies that have been found in both systems in IS, support the notion that a muscle disorder may be involved in the pathogenesis of the disease.

TREATMENT OF PATHOLOGICAL HUMERAL SHAFT FRACTURES WITH UNREAMED HUMERAL NAIL

PurposeThe purpose of this study is to analyze the results of intramedullary fixation of pathological humeral shaft fractures using an unreamed humeral nail (UHN).Patients & MethodsTwenty-one consecutive patients with 24 humeri fractured secondary to metastatic disease were retrospectively reviewed. The primary tumors included carcinomas of breast (11), kidney (2), multiple myeloma (2), colon (2), prostate (1), thyroid (1), lymphoma (1) and unknown origin (1). All fractures were stabilized with antegrade unreamed humeral nailing. Cemented technique was performed in 5 procedures. The mean age was 64 (range, 40–86), male to female ratio 6:15.ResultsBlood loss was unremarkable in 19 patients (22 procedures). Two patients who underwent fixation of additional pathological fractures during the same operation were given a total of 3 units of PC perioperatively. Mean postoperative hospitalization period due to one UHN procedure alone was 3xa0days (range, 2–7xa0days). Two patients died of their disease within 3xa0weeks of surgery. The remaining 19 patients returned to nearly normal function within 6xa0weeks after nailing. One patient developed postoperative local wound cellulitis. Relief of pain was rated as good in all but one patient. Adjuvant therapy was given in 20 procedures. Bony union was achieved in 88% (15/17) of all the cases where the patient had survived a minimum of 3xa0months.ConclusionUnreamed humeral nailing of the pathological humeral shaft fractures provides immediate stability and pain relief, minimum morbidity and early return of function to the extremity.

Functional, Biochemical, and Structural Anomalies in Platelets of Patients with Idiopathic Scoliosis

Idiopathic scoliosis (IS) is the most common type of lateral curvature of the spine, the etiology of which is unknown. Among the various pathological changes that have been reported in IS are platelet anomalies. Since the platelets are not involved mechanically in the spinal deformity, platelet disorders may reflect a basic cellular pathology and not a secondary change attributed to the spinal curvature. In the present review, a summary of the platelet anomalies in idiopathic scoliosis is presented. The accumulated data indicate the existence of profound functional anomalies in platelets of patients with IS. An attempt is made to clarify the different anomalies and to try to link them together.

Long Term Results of Liner Polyethylene Cementation Technique in Revision for Peri-acetabular Osteolysis

Patients with peri-acetabular osteolysis around a well fixed cementless acetabular component may be treated with liner exchange. When the locking mechanism is unreliable or unavailable, cementing the liner into the fixed acetabular component is a feasible option. The purpose of this study was to evaluate the clinical and radiographic long term results of this technique. Forty hip revisions with liner cementation in 37 patients were performed. The minimum follow up was 10 years. Modified Harris Hip Score and recent x rays were reviewed. Four hips were re-revised. Two patients were diagnosed with exacerbation of osteolysis but refused revision. Dislocation rate was relatively high (16%). Liner cementation technique in revision hip surgery is useful in patients with a well fixed metal backed acetabular component.

Improving compliance to osteoporosis workup and treatment in postmenopausal patients after a distal radius fracture

OBJECTIVEnDistal radius fracture (DRF) in postmenopausal women is often the first clinical sign of osteoporosis (OP). Despite the availability of effective treatments, only a minority of patients who sustain a fragility fracture are tested for OP. The purpose of this study was to examine whether a simple intervention by the hospital staff increases rates of OP workup.nnnMATERIALS AND METHODSnWe conducted a prospective randomized clinical trial. Ninety nine patients after DRF were randomized to two groups. Both groups were contacted after their fracture and were asked to answer a questionnaire and were informed about the possible relationship between DRF and OP. In the intervention group, patients were sent an explanatory pamphlet and a letter to their primary care physician. An additional survey was conducted to establish whether the intervention improved the number of patients who undergo OP workup.nnnRESULTSnThe intervention increased the proportion of patients who turned to their primary care physician from 22.9% to 68.6%, and increased the proportion of patients undergoing OP workup from 14.3% to 40% (pxa0<xa00.001).nnnCONCLUSIONnWomen with DRF who receive an explanation about possible OP implications and are sent explanatory materials are more likely to undergo OP workup.