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Summary: The number of hip fractures worldwide has been estimated to increase from 1.22 million in 1990 to an estimated 2.6 million in 2006.1,19 With union rates greater than 95%, the sliding hip screw and plate construct represents the current standard of treatment for peritrochanteric femur fractures. However, complications associated with sliding hip screw and plate systems have generated a considerable amount of interest in the use of intramedullary implants for these common fractures. Limited open techniques offer the potential for less blood loss and soft tissue insult, thus decreasing the potential for perioperative complications while allowing rapid mobilization and return to preinjury function. Intramedullary implants also represent biomechanical improvements from conventional sliding hip screw and side plate constructs, theoretically reducing the incidence of screw cutout, excess collapse at the fracture site, and implant failure. This article discusses the rationale for treatment with the intramedullary hip screw over the sliding hip screw and side plate, describes the techniques of reduction as well as percutaneous adjuncts to treatment, examines some of the special situations that strongly support its use, and reviews the early and recent outcomes of this treatment.

Better understanding of surgical timing, improved surgical technique, and advanced rehabilitation protocols has led to decreased incidence of motion loss after anterior cruciate ligament injury and reconstruction. However, motion loss from high-energy, multiligament injuries continues to compromise functional outcome. Prevention, consisting of control of inflammation and early motion, remains the key element in avoiding motion loss. However, certain techniques, such as manipulation under anesthesia in conjunction with arthroscopic lysis of adhesions, are reliable treatment options. Open surgical débridement is rarely necessary and should be considered only as a salvage procedure. A greater understanding of the pathogenesis of arthrofibrosis and related inflammatory mediators may result in novel therapies for treating the patient with motion loss.

Questionnaire study presented to practicing spine surgeons.To evaluate surgeon preference and availability of selected electrophysiologic neuromonitoring for different spine surgeries.Maximizing the safety of spinal procedures and limiting potential iatrogenic neurologic injury has made intraoperative neuromonitoring an attractive option.We distributed a questionnaire to 180 orthopedic spine surgeons and neurosurgeons at a clinically oriented spine meeting asking surgeon preference and availability of various types of intraoperative neuromonitoring modalities for different types of surgical procedures. Demographic data were also gathered.Somatosensory evoked potentials (SSEPs) were the most available neuromonitoring modality, followed by electromyographies and motor-evoked potentials. In both anterior and posterior cervical surgery, SSEPs were the most preferred modality. MEPs were frequently preferred in myelopathic cervical cases. Almost 70% preferred some neuromonitoring for anterior thoracic/thoracolumbar cases and 55% for posterior thoracic/thoracolumbar cases. Surgeon satisfaction was related to the number of available neuromonitoring modalities. No significant differences were found between orthopedist and neurosurgeon preferences. Fellowship-trained surgeons were more likely to use neuromonitoring for specific indications.SSEPs remains the most widely available and preferred type of neuromonitoring for spine surgeons. The type of case and neurologic status of patient (eg, presence of myelopathy) affects these choices. Surgeons were more satisfied with greater neuromonitoring availability, and were more likely to use neuromonitoring if they had a fellowship background.

STUDY DESIGN Posterolateral lumbar spine fusions in New Zealand white rabbits. OBJECTIVE To evaluate the efficacy of recombinant human growth and differentiation factor-5 (rhGDF-5) lyophilized to a Healos carrier (cross-linked type I collagen with hydroxyapatite coating; DePuy Spine, Inc., Raynham, MA) in inducing fusion. SUMMARY OF BACKGROUND DATA Bone graft substitutes have become an area of considerable interest. rhGDF-5 is one such product. Limited lumbar preclinical studies have been performed with this product. METHODS Single-level, intertransverse process fusions were performed in 67 rabbits using iliac crest autograft (n = 13), Healos alone (n = 13), or 0.5, 1.0, or 1.5 mg/cc rhGDF-5 lyophilized to Healos (n = 13 per group). At 8 weeks, the rabbits were euthanized. Fusion masses were assessed. RESULTS There were 2 animals (3%) lost to complication. Manual palpation revealed fusion rates for autograft of 38% (5/13), Healos alone of 0% (0/13), and each of the Healos/rhGDF-5 groups of 100% (13/13). Histologic analyses were 95% sensitive and 95% specific for confirming fusion. Histologic differences were found among the treatment groups. CONCLUSIONS In this rabbit fusion model, Healos/rhGDF-5 induced fusion in 100% of the rabbits studied. This rate was significantly higher than the fusion rate induced by autograft (38%). Overall, these results support continued research of Healos/rhGDF-5 as a potential bone graft alternative.