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Study Design: A new surgical technique of cervical osteotomy to correct an extension deformity of the cervical spine is described, and a case is reported., Objectives: To emphasize the disparate effect of osteotomy level on sagittal balance and gaze angle in surgical correction of global kyphotic deformity, and to describe a new surgical technique., Summary of Background Data: Previous reports of cervical osteotomy essentially have described extension osteotomy for correction of severe flexion deformity. To the authors' knowledge, flexion osteotomy to correct extension deformity of the cervical spine has not been described previously., Methods: A 44-year-old woman with global kyphotic deformity caused by ankylosing spondylitis underwent corrective lumbar osteotomy at another institution. Ten years later, she experienced further development of the kyphosis, predominantly at the thoracic level, with resultant restriction of forward gaze. Thoracic corrective osteotomy was performed, which resulted in an upward deviation of her visual field. A flexion osteotomy was performed at C7-T1, using two separate posterior and anterior approaches, in one-stage, in the lateral decubitus. The use of transparent drapes permitted direct visualization of the chin-brow angle during operation. Anterior plate fixation prevented any translation at the osteotomy site., Results: The osteotomy united; the gaze angle was fully corrected (45 degrees to -30 degrees ). No deterioration was noted at 2-year follow-up., Conclusions: Osteotomy at a higher level in the spine for correction of global kyphotic deformity may result in a significant overcorrection of the gaze angle upward. The authors believe that the new technique described in this report is a technically demanding but adequate and safe approach for correcting such a rare deformity.

Osteonecrosis of the femoral head is common complication in renal transplant recipients. Despite the young age of these patients, replacement arthroplasty is often used in treating symptomatic individuals. Between 1983 and 1990, 22 cemented biarticular hemiarthroplasties were performed in 16 consecutive patients with advanced osteonecrosis of the hip. The average interval from initial transplant to arthroplasty was 28 months (range, 11-63 months). The mean age at the time of arthroplasty was 40 years (range, 21-66 years), and all patients were treated with steroids and immunosuppressants at the time of surgery. The average preoperative Harris hip score was 27 points (range, 4-46 points). The mean follow-up period was 40 months (range, 24-71 months). All patients had improvement in pain. Eighty percent of the patients reported a slight or mild limp, although only 25% demonstrated a positive Trendelenburg sign. The average postoperative Harris hip score was 88 points (range, 71-96 points), with 9 hips rated excellent, 12 good, and 1 fair. One patient fractured her acetabulum 26 months after arthroplasty, which resulted in progressive subluxation of the prosthesis. It was revised to a total hip arthroplasty. Another patient developed symptomatic aseptic loosening after 30 months. Apart from this patient there was no other radiologic evidence of loosening in the remainder of the series. Only one patient had demonstrable acetabular protrusion. Twenty percent of the hips had asymptomatic heterotopic ossification. The early results of using a cemented, biarticular hemiarthroplasty in this young group of renal transplant recipients appear encouraging. There was no evidence that this prosthesis causes accelerated acetabular erosion or early loosening.(ABSTRACT TRUNCATED AT 250 WORDS)

In a prospective trial, 10 patients underwent inter-fragmentary screws and external fixation for unilateral tibial shaft fractures. Anatomical reduction was achieved in all cases and uncomplicated bone union occurred in nine patients with a mean time to union of 122 (SD 20) days. One patient had delayed union and the fracture malunited. A 20% pin tract sepsis rate was encountered. The high risk of infection, the demanding follow-up and availability of better methods, does not allow this technique to be recommended in the routine treatment of closed tibial diaphysial fractures.

We present the results of a prospective study comparing the accuracy of magnetic resonance imaging with arthroscopy in the assessment of knee complaints. Using a low field strength magnet, MRI was able to achieve a high diagnostic accuracy within the setting of a district general hospital.