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The purpose of this historic review is to summarize the life and work of Abulcasis (936–1013) and his contribution to surgery and orthopaedics. We conducted an extensive search in libraries as well as online in PubMed and Google Scholar. Abulcasis in his work combines the knowledge of ancient Greek and Roman physicians and surgeons with the extensive knowledge of Arabic medicine and pharmacology. He also pioneered surgical technique with the invention of numerous surgical instruments and with several revolutionary surgical techniques. Abulcasis made an impact with his medical writings in which he summarized the works of ancient Greek and Roman physicians like Hippocrates and Galen with the influence of medieval authors and the knowledge of the Arabic medicine and pharmacology. His descriptions and innovations in his work remained a work of reference in the West and East for many centuries to come.

The purpose of this historic review is to summarize the life and work of Avicenna (980–1037) and his contribution to the diagnosis and treatment of spinal deformities and trauma. We conducted an extensive search in libraries as well as online in Pubmed and Google Scholar. Avicenna in his work Canon of Medicine combines the knowledge of ancient Greek and Roman physicians and surgeons and he combines them with the extensive of Arabic medicine and pharmacology. Avicenna made an impact with his medical writings in which he summarized the works of ancient Greek and Roman physicians like Hippocrates and Galen with the influence of medieval authors and the knowledge of the Arabic medicine and pharmacology. His descriptions and comments in his work Canon of Medicine summarize and comment the work of his predecessors and it remained a work of reference until at least the sixteenth century.

Pierre Franco (1505-1578) was a brilliant surgeon of the Renaissance, a contemporary of Ambroise Paré. He made an impact on the history of surgery with his innovative approaches in the treatment of hernia, lithotomy, and the use of the suprapubic incision. The purpose of this study is to present a detailed account of his work, innovations, and achievements as well as the impact he made on the surgery of the Renaissance.

The objective of this article is to showcase the use of opium in ancient times, as well as the beliefs surrounding it, focusing on the opinion of Diagoras of Cyprus, a physician with great knowledge of pharmacology who probably practiced ophthalmology, composing a rose-based collyrium. Opium, a drug produced from poppy, used to have several uses such as in anesthesia, pain relief and ritualistic purposes. There is evidence of its creation since before 5000BC. In Greece, the first documentation dates back to around 2600-1100 BC in Crete. Many ancient medico-philosophers used to utilize it in their practice, mentioning it in the majority of the medical texts of that time. However, there were others that disapproved of its use due to the possible side effects. Diagoras was one of them, as he categorized opium as a lethal substance that could cause severe problems to the vision. He may even have thought of the possible addiction that it can cause because of the euphoric state it puts a person in. Some practitioners mentioned Diagoras’s opinion on opium, such as Erasistratus and Pliny the Elder. Despite his contributions in opium usage and ophthalmology, Diagoras is still unappreciated as a medical figure.

The purpose of this study was to summarise the life and work of the Cypriot physician Apollonius of Citium (first century BC). His overall work on medicine is presented, and special emphasis is given to his work on the treatment of joint dislocations. The most famous work of Apollonius is Treatise On Joints, which was preserved on the whole in a manuscript of the tenth century AD. In that manuscript, Apollonius is obviously influenced by the Hippocratic Corpus of Medicine. His description, diagnostic methods and reduction techniques are all based on those described by Hippocrates in his work "On Joints". Apollonius' contribution to this subject concerns accurate depiction in images of the reduction techniques he proposes. His simplifications describe the techniques of Hippocrates in a way they can be understood and used by athletes and nonphysicians in the Greek gymnasia. Perhaps his treatise is one of the earliest works of popularised medicine and surgery in the history of human civilisation.

The purpose of this historical review is to summarize the work of Paul of Aegina, especially his contribution to the treatment of neurosurgical disorders and trauma. Paul performed trephinations for head injuries in the tradition of the Egyptian and the Greek schools of medicine. However, he was an innovator in the treatment of several spine injuries, as his choice to perform laminectomies and his description of them as safe and successful is unprecedented in the history of the recorded medicine and surgery. Our search of the literature shows that Paul was the first to include in his practice such a surgical technique, and, in this way, he is an innovator, since Hippocrates described the results of spine surgery as disastrous for the patient. Thus, he may be considered the historic father of spine surgery for his pioneering surgical innovations. This shows clearly that innovation in science and medicine was significantly increased through the rise of Islam and the Arabic conquest of the Middle East. The so-called "Dark Ages" were not so dark after all.

In this historical review we summarize the work of the Dutch physician, chemist, and anatomist Gerard Blaes (Blasius). A detailed account of his life and work is presented with emphasis on his contribution to anatomy. In particular, special reference is made to his innovative description of the spinal cord and spinal nerves. Blasius's contributions to neuroanatomy are remarkable when taking into account the limited technology of his era. As a true man of his era, he made significant contributions in research and teaching of anatomy, botany, and chemistry. He published a detailed description of the spinal cord with its gray and white matter and the spinal nerve roots, which significantly increased the knowledge of neuroanatomy in his era. He also is considered one of the founders of comparative anatomy through his work in both humans and animals.

The purpose of this review article is to summarize the views presented in the Hippocratic Corpus of Medicine regarding injuries of the spine, their effect on the spinal cord and the optimal treatment modulus. It is shown that the treatment dilemmas of ancient times in these injuries remain modern since Hippocrates suggested that conservative treatment and letting nature take its course is preferable over a devastating surgical treatment if the spinal cord structural integrity is not compromised. There is also a detailed account of the conservative treatment suggested in the Hippocratic Corpus concerning devices and method of closed spinal relocations.

A morphometric analysis of the odontoid process of the A2 vertebra, in the Greek population, was conducted using CT scan. We aimed to determine the feasibility to use one or two screws when treating fractures of this anatomic element. One hundred and fifteen patients (57 men) of a mean age of 48 years (16–95 years) underwent a cervical spine CT scan examination. The anterior–posterior and transverse diameters of the odontoid process were measured from the base, at 1-mm interval upward on axial CT images. The length from the tip of the odontoid process to the anterior–inferior angle of the body of the axis was calculated. Data concerning the height and weight of the examined patients were collected. The mean transverse and anterior–posterior distances were found to be 11.46 and 10.45 mm, respectively, for the upper end of the odontoid process. At the neck level of the odontoid process, the equivalent mean values were 11.12 and 8.73 mm, respectively, while at the base, these distances were found to be 13.84 and 12.3 mm, respectively. The mean distance from the tip of the odontoid to its base was 17.25 and 17.28 mm, respectively, while the mean distance from the tip of the dens to the anterior–inferior corner of the axis’ body was 39.2 mm. Men showed greater values than women. In this study, it was shown that in the Greek population there is enough room for one 4.5-mm or one 3.5-mm cannulated screw to be used. The application of two 3.5-mm screws is feasible in 58.6 % of the male and 26.3 % of the female population. This confirms that the knowledge of the true dimensions of the odontoid process is of paramount importance before the proper management of fractured dens using the anterior screw technique.

The purpose of this historic review is to summarize the life, work, and contribution to anatomy of Charles Estienne (also known by the Latin name Carolus Stephanus). Charles Estienne was an early exponent of the science of anatomy in France. Although he remained under the influence of the Galenic tradition of medicine, anatomy, and surgery throughout his distinguished career, he had a significant influence on the scientific revolution and anatomy reformation of the 16th century. Nevertheless, he cannot be placed at the same level of contribution as Vesalius, because of his lack of discipline in his work, hesitation to diverge totally from traditional beliefs, and his hesitation for a total criticism of the Galenic tradition.

The purpose of our study was to summarize all the knowledge concerning the innovative pioneer in the field of orthopedic surgery and especially hip replacement, Alexandros Zaoussis (1923-2005). He was a pioneer in hip replacement, and he contributed to several fields of orthopedic surgery with his clinical work and his international publications. He was also an eminent historian of World War II and of the Greek Resistance to the Nazi occupation in which he played a significant part. A thorough study of texts, medical books, and reports in the field of history of medicine, together with a review of the available literature in PubMed, was undertaken. He was an eminent clinical director of orthopedics who had significant contribution in teaching, practicing, and expanding the horizons of orthopedic surgery in the 20th century. A thorough review of medical texts, books, and publications in the Greek academic press was undertaken to summarize his contributions and his turbulent life to commemorate the 10th anniversary of his death.

The anterior cruciate ligament (ACL) anatomy is very significant if a reconstruction is attempted after its rupture. An anatomic study should have to address, its biomechanical properties, its kinematics, its position and anatomic correlation and its functional properties. In this review, an attempt is made to summarize the most recent and authoritative tendencies as far as the anatomy of the ACL, and its surgical application in its reconstruction are concerned. Also, it is significant to take into account the anatomy as far as the rehabilitation protocol is concerned. Separate placement in the femoral side is known to give better results from transtibial approach. The medial tibial eminence and the intermeniscal ligament may be used as landmarks to guide the correct tunnel placement in anatomic ACL reconstruction. The anatomic centrum of the ACL femoral footprint is 43 % of the proximal-to-distal length of lateral, femoral intercondylar notch wall and femoral socket radius plus 2.5 mm anterior to the posterior articular margin. Some important factors affecting the surgical outcome of ACL reconstruction include graft selection, tunnel placement, initial graft tension, graft fixation, graft tunnel motion and healing. The rehabilitation protocol should come in phases in order to increase range of motion, muscle strength and leg balance, it should protect the graft and weightbearing should come in stages. The cornerstones of such a protocol remain bracing, controlling edema, pain and range of motion. This should be useful and valuable information in achieving full range of motion and stability of the knee postoperatively. In the end, all these advancements will contribute to better patient outcome. Recommendations point toward further experimental work with in vivo and in vitro studies, in order to assist in the development of new surgical procedures that could possibly replicate more closely the natural ACL anatomy and prevent future knee pathology.

Cause of this enquiry is the research and the analysis of sport injuries during the conduction of boxing games in ancient Greece. The methodology of the study was included the use of systematic review of the writings in the Greek and the world literature. We visited museums, sports clubs, libraries and open-air archaeological sites. Furthermore, we conducted a systematic examination of the items, which are preserved in the creations of antiquity (sculpture, art angiography and angioplasty). According to the main findings of the study in boxing game, various sports injuries were recognised, such as scratches, lacerations, bleeding under the conjunctiva, skin oedema, ‘cauliflower ear’, nose bleeding and fractures of the nasal bones. After the fight, the athletes had deformities of the face, nose bleeding, fractures of the nose, ripped ears and swollen eyes. We concluded that the cases where the boxing athletes were wounded were usual in this era.

We present a case of a young woman with multilevel spinal injuries. The injury includes a rotational atlantoaxial dislocation associated with concomitant injury at C5 and at the sacrum. Rotational dislocation at C1–C2 level is not frequently encountered in young adults, and the presence of associated lesions to the spine makes this condition a challenging one. The medical record of a patient who sustained three spinal injuries at different levels of the spine was evaluated. The prevalence of this type of injury, the diagnosis, the clinical behavior, and the applied treatment are evaluated. The patient was treated non-operatively, and a satisfactory clinical outcome was recorded at the last follow-up visit.

The treatment of tibial condylar fractures requires the preparation of personalized treatment, customized to the needs of the patient, that will take into consideration his or her personal activities. The purpose of the present study was (1) the development, by using the finite elements method, of a 3-dimensional, highly discrete, simulation model of the knee-tibia, (2) the creation of 6 types of fractures in this model according to Schatzker's classification, (3) the insertion of materials for internal and hybrid external fixation, (4) the recording of the model's biomechanical behavior during the load, and (5) the discovery of findings regarding the stability of the internal and hybrid external treatment methods. The results from the resolution procedure showed that the values of maximum displacements in every fracture type except type III were reduced in the models with internal fixation. This means decreased stiffness and therefore diminished stability of the hybrid external-bone complex in these types of fractures. Internal fixation provides postoperative stability, a basic precondition for accelerated fracture healing.

Tumor-induced or oncogenic osteomalacia is a rare paraneoplastic syndrome characterized by overproduction of fibroblast growth factor-23 as a phosphaturic agent and renal phosphate wasting. A range of predominantly mesenchymal neoplasms have been associated with tumor-induced osteomalacia and classified as phosphaturic mesenchymal tumor mixed connective tissues. However, phosphaturic mesenchymal tumor mixed connective tissues could be nonphosphaturic in the first stage of the disease, either because the tumors are resected early in the clinical course or because the patient’s osteomalacia was attributed to another cause. This article presents a case of a 42-year-old woman with a 2-year history of low back and right leg pain. Laboratory examinations including serum and urine calcium and phosphorous were within normal values. Imaging of the lumbar spine and pelvis showed an osteolytic lesion occupying the right sacral wing. Histology was unclear. Reverse-transcription polymerase chain reaction analysis for fibroblast growth factor-23 was positive and confirmed the diagnosis of phosphaturic mesenchymal tumor mixed connective tissues. Preoperative selective arterial embolization and complete intralesional excision, bone grafting, and instrumented fusion from L4 to L5 to the iliac wings bilaterally was performed. Postoperative recovery was uneventful. Neurological deficits were not observed. A lumbopelvic corset was applied for 3 months. At 12 months, the patient was asymptomatic. Serum and urine values of calcium and phosphorous were normal throughout the follow-up evaluation.

Juxta-articular osteoid osteomas of the ankle are rare and tend to have an atypical presentation. Because of the proximity to the joint, patients experience symptoms that may delay or mislead the diagnosis. This article presents a 33-year-old man with juxta-articular osteoid osteoma of the talar neck. The correct diagnosis was delayed for 2 years; the patient was initially misdiagnosed and treated for ankle sprain and anterior ankle impingement. Surgical excision of the lesion was performed with excellent results. Juxta-articular osteoid osteomas should be considered in the differential diagnosis of persistent ankle pain in teenagers and young adults who do not respond to treatment directed at more common conditions.

Resumen Hombre de 52 anos que sufrio un accidente de trafico mientras conducia una motocicleta. Las radiografias simples de pelvis tomadas a su ingreso evidenciaron una amplia diastasis de la sinfisis pubica, una fractura mediosagital del sacro y otra fractura de la apofisis transversa derecha de la quinta vertebra lumbar. Presentamos el tratamiento utilizado para abordar esta inusual lesion.

Type D fractures of the odontoid process are rare and usually occur in the elderly. The mechanism of fracture is unclear. Non-operative treatment is indicated provided that adequate immobilization using skull traction followed by either a collar or a halo vest can be achieved. The prognosis is usually favorable for this type of fractures. We present 6 patients with complex (type D) fractures of the odontoid process admitted and treated at our institution since 1970. There were five men and one woman with a mean age of 57.7 years (range, 16–81 years). Although there were concomitant injuries no neurological deficits due to the odontoid process fracture was detected. All patients were treated non-operatively using skull traction or a halo vest for 8 to 12 weeks. One patient deceased two days after the injury. At the latest examination, all the remaining five patients had complete union of the odontoid process fracture; three of them had excellent range of motion and two had painful or restricted range of motion of the upper cervical spine.

Children with spastic cerebral palsy commonly acquire lower extremity musculoskeletal deformities that at some point may need surgical correction. The authors present 58 children with spastic cerebral palsy who underwent selective percutaneous myofascial lengthening of the hip adductor group and the medial or the lateral hamstrings. All the patients were spastic diplegic, hemiplegic, or quadriplegic. The indications for surgery were a primary contracture that interfered with the patients' walking or sitting ability or joint subluxation. Gross motor ability and gross motor function of the children were evaluated using the gross motor function classification system (GMFCS) and the gross motor function measure (GMFM), respectively. The mean time of the surgical procedure was 14 minutes (range, 1 to 27 minutes). All patients were discharged from the hospital setting the same day after the operation. There were no infections, overlengthening, nerve palsies, or vascular complications. Three patients required repeat procedures for relapsed hamstring and adductor contractures at 8, 14, and 16 months postoperatively. At 2 years after the initial operation, all the children improved on their previous functional level; 34 children improved by one GMFCS level, and 5 children improved by two GMFCS levels. The overall improvement in mean GMFM scores was from 71.19 to 83.19.

The AO-Magerl classification is widely accepted for the appropriate management of patients with thoracolumbar burst fractures; however, it fails to assess the ability of the injured spine to withstand compressive loading and cannot predict instrumentation failure after short-segment posterior fixation. The load-sharing classification depends on the degree of comminution and apposition of bony fragments. We retrospectively classified according to both classifications 100 consecutive patients with 1-level thoracolumbar burst fractures treated nonoperatively or operatively within a 7-year period. Sixty neurologically intact patients (60%) were treated nonoperatively, 15 (15%) had short posterior instrumentation, 15 (15%) had short anterior instrumentation, and 10 (10%) had combined short posterior instrumentation and anterior strut grafting. Twenty-five of the 40 (60%) surgically treated patients had neurological impairment on admission. Clinical outcome was assessed using a pain and working ability scale. Mean follow-up was 52 months (range, 24–70 months). Function was satisfactory in 55 (92%) nonoperatively treated patients and in 33 (83%) surgically treated patients. Neurological improvement by American Spinal Injury Association (ASIA) grade was observed in patients with incomplete paraplegia (70% of neurologically impaired patients) who were treated operatively. The combination of AO-Magerl and load-sharing classifications provides for accurate selection of treatment, surgical approach, and length of instrumentation, and can guide the decision for additional anterior surgery.

Calcification of the ligamentum flavum secondary to calcium pyrophosphate dihydrate (CPPD) deposition may be a rare cause of cervical myelopathy. We present a 56-year-old man with spinal stenosis secondary to CPPD disease and subacute cervical myelopathy following minor trauma. The patient had no history of CPPD disease. Posterior C4-C6 decompression and instrumented fusion were performed. Intraoperative findings were densely thickened ligamentum flavum and distortion of the cervical dura mater due to impingement. Histological sections of discs and ligamentum flavum specimens showed CPPD crystals. Postoperatively, neck pain and paresthesias improved immediately. At 2 weeks after spinal surgery, the patient experienced acute right knee swelling. Standard radiographs showed chondrocalcinosis of the knee menisci.

We present the technique of combined posterior decompression and spinal instrumentation, and surgical (open) vertebroplasty using a novel system called vertebral body stenting (VBS) during a single session in a patient with metastatic vertebral and epidural cauda equina compression. J. Surg. Oncol. 2010; 101:253–258. © 2010 Wiley-Liss, Inc.

A 52-year-old male sustained a road traffic accident riding a motorcycle. On admission, plain radiograph of the pelvis showed wide diastasis of the pubic symphysis, a midsagittal fracture of the sacrum and a fracture of the right transverse process of the fifth lumbar vertebra. We discuss the treatment of this rare injury.

We present the clinical and radiographic outcomes of the cementless low-contact-stress (LCS) rotating-platform total knee arthroplasty. Overall, 423 prostheses were implanted in 393 consecutive patients (30 patients had bilateral total knee replacement) for primary varus gonarthrosis (381 patients) and rheumatoid arthritis (12 patients). There were 81 men and 312 women with a mean age of 73 years (range, 58-85 years). Patella replacement was not performed in any case. Clinical and radiographic evaluation was performed using the Knee Society Score (KSS) and the Knee Society Assessment Form, respectively. The mean follow-up was 10 years (range, 5-15 years). Three patients were lost to follow-up. Survival of the prostheses was 98% at 10 years; three prostheses required revision for deep infection, bearing dislocation, and periprosthetic fracture. The mean KSS improved significantly, from 42 and 44 points preoperatively to 90 and 79 points, respectively, at the latest evaluation (P < 0.001); results were excellent in 278 cases, good in 106, fair in 27, and poor in nine. Radiolucent lines were observed in 80 cases; revision arthroplasty was not performed in any of these cases. Complications included deep infection in one patient, bearing dislocation in one, skin necrosis in four, and a supracondylar fracture in one. The cementless LCS rotating-platform total knee arthroplasty is associated with excellent mid- and long-term results for patients with osteoarthritis and rheumatoid arthritis of the knee.

A clinical study was performed to evaluate a new classification for odontoid process fractures. The external and internal anatomy of the axis has been studied. The files of 97 patients with a fracture of the odontoid process admitted to our institution were reviewed and classified according to the proposed new classification. The method was tested for reliability and validity. The patients were followed for a mean period of 14 years, in order to evaluate the outcome of these fractures and to correlate it to the fracture type. Intraobserver and interobserver agreement was excellent with intraclass correlation coefficients at levels of 0.98 and 0.85, respectively. Four types of odontoid process fractures are distinguished. Type B fractures are associated with high risk of pseudarthrosis. Existing classifications are inadequate and misleading since they do not include all types of odontoid process fractures, nor they consider the internal anatomy of the odontoid process. Classification of the odontoid process fractures has to be reconsidered as novel-imaging technology has shown new patterns of fractures. The analysis of the imaging data in the present study justifies the new classification.

Brucellosis is a common zoonosis, which still remains as a major health problem in certain parts of the world. Spondylodiscitis is the most frequent osteoarticular complication of brucellosis. Herein is reported an uncommon case of a middle-aged male treated for brucellosis who developed 2 years after the treatment brucellar spondylodiscitis complicated by a psoas muscle abscess, an infected abdominal aorta aneurysm and deep venous thrombosis of IVC, common iliac, external iliac and common femoral veins. CT and CT angiography were the imaging modalities depicting the findings. After an endovascular stent graft placement in abdominal aorta aneurysm, a CT guided drainage of retroperitoneal abscess revealed Brucella melitensis as the pathogen microorganism. Diagnosis of spondylodiscitis and contiguous psoas abscess is usually simple but aortic involvement is difficult to identify and can be easily overlooked. A high degree of suspicion is essential to reduce the delay for the treatment.

Chordomas are rare bony tumors, usually involving the skull base and sacrococcygeal spine, while least presented in cervical and thoracic spine. Chordomas of the cervical spine may cause variable neurological symptoms. Adult patients presenting with neck pain, paresthesias or limb paresis are further investigated. The history of progressive tetraparesis, however, implies a long-standing disease. Clinical presentation and imaging investigation of the cervical spine chordoma aims to alert the physicians for its early detection. Herein is reported the clinical presentation of two chordomas with progressive tetraparesis in two patients involving in both cases the third cervical vertebra. Plain radiographs, bone scintigraphy, CT and MR scanning were the imaging modalities depicting the mass, its prevertebral and intraspinal extension.

Tear-drop fractures, as described by Schneider and Kahn, are by definition unstable injuries, since both bony and ligamentous elements are involved in such lesions. Fifty-four patients having sustained the above-mentioned injury were treated in our Orthopaedic Department during the last 36 years, representing the 8.1% of all cervical spine injuries. Those patients, 45 men and 9 women, of a mean age of 34.3 years, were injured following a RTA (63%), or a fall from the height (22.2%). Fifty-five percent of those patients suffered spinal cord injury. These injuries were classified in four types (I, II, III, IV) according to the severity of the lesions and were treated accordingly. The whole spectrum of the medical records were analysed and discussed in relation to the available bibliography. Attention was paid to the presence of neurological lesions and the severity of the injury. It was shown that Type I lesions respond satisfactory to conservative treatment, while Types III and IV have an absolute indication for surgical treatment.

High-energy tibial plateau fractures are often the result of blunt trauma and are associated with severe soft-tissue injury. Fixation techniques demand considerable surgical skill and mature judgment. The available surgical options do not always guarantee a favourable outcome. Operative treatment includes internal and external fixation, hybrid fixation and arthroscopically assisted techniques. Operative management of high-energy fractures remains difficult and challenging and may be associated with serious complications, such as knee stiffness, ankylosis, deep infection, post-traumatic arthritis, malunion and nonunion. Prevention of the complications can optimise the clinical outcome in these patients.

A 28-year old medical doctor presented with a hand injury caused by a broken mercury thermometer .The extensor digiti minimi tendon was ruptured. Operative treatment included debridement and removal of the mercury followed by repair of the tendon. Reoperation was required to excise wound granulomatous reaction from residual droplets of mercury. There were no signs and symptoms of mercury intoxication. To prevent mercury intoxication after subcutaneous metallic mercury injection, complete surgical removal of the mercury and serial monitoring of blood and urine mercury concentrations is mandatory.

Background context Diving injuries are the cause of potentially devastating trauma, primarily affecting the cervical spine. Purpose Our purpose was to describe our experience with diving injuries treatment. Study design Retrospective review. Patient sample Twenty patients with diving injuries. Outcome measures Using the American Spinal Injury Association (ASIA) impairment scales as the primary outcome measure, the patients' neurological status before and after treatment was assessed. In this way we were able to draw conclusions about neurological improvement or deterioration in response to conservative or operative treatment. Methods We retrospectively reviewed 20 patients with diving injuries of the cervical spine who were admitted to our institute over a 34-year period from 1970 until 2004. Results The typical patient profile was of a young, healthy, athletic male who suffered an injury to the cervical spine after diving into shallow water. The number of cases corresponds to 2.6% of all admitted cervical spine injuries. All injures occurred between May and September. The most commonly fractured vertebrae were C5 and C6. Four patients were treated operatively and 16 conservatively. The indications for surgical treatment were posttraumatic instability and persistent neurological deficit. The mean follow-up of the patients was 17 years. Five patients died within the first month of their hospitalization and 1 patient died 1 year after his injury. Of the 14 patients who were available for follow-up 5 years past injury time, 6 improved neurologically and 8 remained unchanged in relation to their neurology upon admission. Of the 11 patients who were available for follow-up 10 years past injury time, 9 remained neurologically unchanged, 1 deteriorated, and 1 improved in relation to their neurology in the 5-year follow-up. Conclusion Diving injuries of the cervical spine demonstrate high mortality and morbidity rates. Recovery depends on the severity of the initial neurological damage. Conservative treatment is justified in specific patients and can lead to improvement of the initial neurological deficit.

Introduccion Las fracturas del axis son las mas communes del raquis cervical y ofrecen un interes especial por sus caracteristicas anatomicas. Los principales problemas de estas fracturas vienen dados por la posible inestabilidad residual y el riesgo vital de los pacientes lesionados. Pueden dividirse en cuatro grupos, con la incidencia que se cita entre parentesis: a) fracturas de la apofisis odontoides (49,4%); b) fracturas del arco vertebral (37,4%); c) fracturas del cuerpo vertebral (10,6%), y d) fracturas del macizo lateral (1,6%). Revision de la bibliografia En este articulo hemos revisado los conceptos mas actuales del tratamiento de este tipo de lesiones. Conclusiones Esixten una serie de aspectos que influyen en el pronostico de estos factores: edad del paciente, tipo de fractura, desplazamiento inicial, tiempo hasta el tratamiento, intensidad de la traccion, consecucion o no de la estabilidad y posibles lesiones asociadas.

Spondyloepiphyseal dysplasia is a heterogeneous group of disorders characterized by growth abnormalities in the epiphyses and spine. The purpose of this study is to present a rare case of three patients with a congenital type of spondyloepiphyseal dysplasia, all members of a single family spanning three generations. Interestingly, each one presented with variable radiographic severity and clinical picture. Spondyloepiphyseal dysplasia is a disorder that should always be taken into consideration during investigations of short stature. The relevant literature is presented and discussed.

Multiple fractures of the axis are not common lesions. A retrospective study was performed to identify the different fracture patterns and to analyze the incidence of these injuries and their long-term behavior. The medical records of 674 consecutive patients with fractures of the cervical spine were reviewed. Nine (1%) of 674 patients (6 men and 3 women) had multiple fractures of the axis. Mean patient age was 48 years. The most common lesion was a combination of traumatic spondylolisthesis with either an odontoid process or a teardrop fracture of the axis body. All patients were treated conservatively with an excellent or good outcome at mean 12-year follow-up (range: 2-18 years). Computed tomography was the imaging modality of choice for the correct diagnosis of these rare lesions.

The authors present a 45-year-old man with bone marrow edema syndrome (BMES) of the medial condyle of the knee. Early diagnosis of BMES was based upon clinical, bone scintigraphy and magnetic resonance (MRI) findings. After failure of the conservative treatment, core decompression was performed. Histological examination showed no evidence of osteoporosis or osteonecrosis. Within 2 months after the operation, the patient was pain-free and he resumed his previous activities. At 1-year follow-up examination, MRI showed complete resolution of all signal abnormalities; at 3-year follow-up the patient remained symptom-free and with no functional limitations.

Objectives The aim of this study was to examine whether asymmetric loading influences macrophage elastase (MMP12) expression in different parts of a rat tail intervertebral disc and growth plate and if MMP12 expression is correlated with the severity of the deformity. Methods A wedge deformity between the ninth and tenth tail vertebrae was produced with an Ilizarov-type mini external fixator in 45 female Wistar rats, matched for their age and weight. Three groups were created according to the degree of deformity (10°, 30° and 50°). A total of 30 discs and vertebrae were evaluated immunohistochemically for immunolocalisation of MMP12 expression, and 15 discs were analysed by western blot and zymography in order to detect pro- and active MMP12. Results No MMP12 expression was detected in the nucleus pulposus. Expression of MMP12 in the annulus progressively increased from group I to groups II and III, mainly at the concave side. Many growth plate chondrocytes expressed MMP12 in the control group, less in group I and rare in groups II and III. Changes in cell phenotype and reduction of cell number were observed, together with disorganisation of matrix microstructure similar to disc degeneration. ProMMP12 was detected at the area of 54 kDa and active MMP12 at 22 kDa. Conclusions Expression of MMP12 after application of asymmetric loading in a rat tail increased in the intervertebral disc but decreased in the growth plate and correlated with the degree of the deformity and the side of the wedged disc. Cite this article: Bone Joint Res 2014;3:273–9.

This prospective study analyzed the long-term effects of horse riding on the cervical and lumbar spine of jockeys. Thirty-two jockeys were observed for 13 years. All jockeys had clinical and radiographic evaluation of the spine; three consecutive age groups were studied. Results were compared to age-matched, normal population control groups. The incidence of degenerative changes of the spine was higher in the jockeys compared with the control groups and was more prominent in the older age group for both the lumbar and cervical spine. These findings suggest that equestrian sports, particularly professional horse riding, apart from the increased risk of direct spinal injury caused by a fall from the horse, can lead to progressive spine degeneration as a result of repetitive trauma and increased physical stress on the spine.

Fifty patients with an average age of 47 years received epidural steroid injections for lumbosacral radicular pain due to disk herniation or spinal stenosis. All patients had failed previous conservative treatment. Mean follow-up was 24 months (range: 12-36 months). Immediately after injection, all 50 patients reported various degrees of relief from leg and back pain. At the last follow-up examination, 68% of patients were asymptomatic, 20% had no change in preinjection radicular symptoms, and 12% had various degrees of relief. No significant correlation was found between pain relief, age, or number of injections. Early pain relief may be anticipated after epidural steroid injections in 80% of patients with radicular symptoms due to disk herniation or spinal stenosis.

Medical science is as old as human history and the need for disease treatment. Archivists, researchers and historians are collaborating in the project to preserve the documentary inheritance and make the medical science useful to the public. This research aims to identify and analyze the first registered sport injuries in the history of medicine. After a review of the literature, the Homeric epics, the texts of the first historical period of ancient Greece, were identified and analyzed as the texts which contain the first sport injuries in world history.

This experimental study compared the long-term (12 months) mechanical stability of the morselized graftcement interface with the conventional bone-cement interface in both femoral bones of 1 0 adult dogs. For mechanical testing, three-point bending and push-out loading tests of composite bone-cement beams were used, while the incorporation of the graft was assessed by serial radiographs. Although the parameters fracture load and interface failure load showed inferior values in the specimens with a morselized graft-cement interface compared to those in specimens with a conventional bone-cement interface, no statistically significant differences were found between groups. Radiographic reconstitution of the lateral femoral cortex was observed in all animals at 3 months while signs of advanced remodeling were apparent at 6 months. These results indicate the long-term mechanical stability of the impacted morselized graft-cement interface is comparable to that of the conventional bone-cement interface created in primary total hip replacements provided the grafted area is protected from early heavy loading.

We describe the case of a 60-year-old patient who presented a pre-patellar mass for a period of 2 months, which did not respond to NSAIDs and antibiotic treatment. At physical history, the patient mentioned a recent direct hit at the pre-patellar region. Moreover, he stated that the lesion was painful and fast progressing. Clinical examination revealed the presence of the pre-patellar mass. At palpation, the pre-patellar area was found solid, warm and swollen. No other signs of systemic inflammation were detected. Aspiration of the pre-patellar area with fine needle did not revealed the nature of the lesion. Therefore, we proceeded to a surgical resection of the mass, at healthy margins. Pathologoanatomic examination set the diagnosis of gout. Such an early manifestation of gout is extremely rare and should always be taken into account when one is dealing with painful syndromes of the pre-patellar region.

To present the 18 year survival and the clinical and radiological outcomes of the Müller straight stem, cemented, total hip arthroplasty (THA).Between 1989 and 2007, 176 primary total hip arthroplasties in 164 consecutive patients were performed in our institution by the senior author. All patients received a Müller cemented straight stem and a cemented polyethylene liner. The mean age of the patients was 62 years (45-78). The diagnosis was primary osteoarthritis in 151 hips, dysplasia of the hip in 12 and subcapital fracture of the femur in 13. Following discharge, serial follow-up consisted of clinical evaluation based on the Harris Hip Score and radiological assessment. The survival of the prosthesis using revision for any reason as an end-point was calculated by Kaplan-Meier analysis.Twenty-four (15%) patients died during the follow-up study, 6 (4%) patients were lost, while the remaining 134 patients (141 hips) were followed-up for a mean of 10 years (3-18 years). HSS score at the latest follow-up revealed that 84 hips (59.5%) had excellent results, 30 (22.2%) good, 11 (7.8%) fair and 9 (6.3%) poor. There were 3 acetabular revisions due to aseptic loosening. Six (4.2%) stems were diagnosed as having radiographic definitive loosening; however, only 1 was revised. 30% of the surviving stems showed no radiological changes of radiolucency, while 70% showed some changes. Survival of the prosthesis for any reason was 96% at 10 years and 81% at 18 years.The 18 year survival of the Müller straight stem, cemented THA is comparable to those of other successful cemented systems.

Several variations of the bony and vascular anatomy around the first and second cervical vertebrae have been reported. Failure to recognise these variations can complicate operations on the upper cervical spine. We present a patient with recent onset of cervical myelopathy due to stenosis at the C3–4 level. Preoperative evaluation identified Klippel-Feil syndrome with cervical fusion of C2–3, aplasia of posterior arch of C1, anomalous vertebral artery course and a “ponticulus posticus” of C2. The combination of these variations in a Klippel-Feil syndrome patient has never been reported. Thus, we recommend a thorough preoperative imaging evaluation, with CT scan and CT angiography or DSA, in addition to plain radiographs. This evaluation is imperative, before a cervical spine surgery, allowing a better understanding of the anatomy, in order to minimise the risks of misplacement of cervical instrumentation especially in such patients.

Synovial spinal cysts are typically found in the lumbar spine, most often at the L4-L5 level. Magnetic resonance imaging is the diagnostic imaging of choice in the workup of suspected synovial cysts. This study consisted of 24 patients with lumbar synovial cysts treated by cyst excision and nerve root decompression through partial or complete facetectomy and primary posterolateral fusion. The most common location of the cysts was the L4-L5 segment. Synovial tissue was found in histological sections of 18 cysts. At a mean follow-up of 12 (range, 8 to 24) months, 20 patients (83%) had excellent or good results; two patients (8.3%) had fair and two patients (8.3%) had poor improvement. Operative complications included dural tear in two patients and postoperative wound dehiscence in one patient, which were treated accordingly. To eliminate the risk of recurrence synovial cyst excision through partial or complete facetectomy is required. In addition, since synovial cysts reflect disruption of the facet joint and some degree of instability, primary spinal fusion is recommended.

Description of the different types of fractures involving the axis vertebra are described; their mechanism, their diagnosis and treatment are presented.