Search

The authors conducted a retrospective study on 183 cases of spondylodiscitis, treated conservatively (44%) or surgically (56%) between November 1991 and June 2006. The male/female ratio was 99/84, and the mean age 62.6 years. The mean follow-up period was 12 years (range 4-19). Interesting from a clinical viewpoint: temperature, white blood cell count, and CRP were sometimes normal, while pain varied from slight to unbearable. The commonest risk factor was diabetes mellitus, and the most frequent pathogen was Staphylococcus aureus. Methicillin resistant Staphylococcus aureus (MRSA) was found in 6 patients, and 3 or 50% of these died, in sharp contrast with the overall mortality rate of 8.7%. A neurological deficit was seen in 43.7% of the patients; complete recovery occurred in 71% of the patients with a Frankel D stage, but in only 15.4 to 222% of those with a stage A, B or C.

This is a retrospective analysis of the clinical and radiological outcome in 24 patients with acute or chronic posttraumatic elbow instability, who were treated with open reduction, internal fixation and a hinged external fixator. The instability was acute after elbow fracture dislocation in 11 cases; the other 13 had chronic posttraumatic instability of the elbow. Concentric stability and a sufficient range of motion of the elbow joint were achieved in all cases. The addition of a hinged external fixator in noncompliant patients, who underwent open reduction and internal fixation of an acute or chronic posttraumatic unstable elbow, allows early intensive mobilisation and can improve the clinical outcome after these complex elbow injuries.

The treatment of atlantoaxial instability by means of posterior transarticular screw fixation combined with a Gallie fusion is an established method when direct anterior odontoid screw fixation is not indicated or has failed. In this retrospective study, the results of a modified percutaneous mini-open transarticular C1-C2 screw fixation are presented. Between February 1998 and March 2006, 47 patients with acute or late (after failed conservative treatment) atlantoaxial instability were treated with the modified technique. Their average age was 74.9 years. There were no intraoperative injuries to neural structures or blood vessels; 96.8% of the screws were placed correctly. A revision operation was necessary in one patient because of infection at the graft donor site. No patient experienced a neurological complication. Three patients died during hospitalisation, 6 others later on; 6 could not be traced, leaving thirty-two patients or 68% available for follow-up. The average clinical follow-up was 42 months (range: 12 to 91). The results with respect to the pain and activity status were good or excellent in more than 90% of cases. The radiographic follow-up averaged 25 months (range: 12 to 75). Bony fusion was documented in all cases. The modified technique of transarticular screw fixation presented here is a safe and functionally satisfactory method of achieving stabilisation of the atlantoaxial complex. Special cannulated instruments are not required. This mini-open transcutaneous technique is an alternative to the conventional open procedure, and reduces operation time as well as blood loss.

This is a retrospective study of the results of angle-stable plating of displaced 3- or 4- part fractures of the proximal humerus in 92 geriatric patients treated between 2/2000 and 2/2004. At final follow-up patients were clinically evaluated using the Constant-Murley score and were examined radiologically. The mean non-age-related Constant-Murley score was 69.8 points. A clear correlation was found between the final score and the quality of reposition of the tuberosities and/or plate position. Accurate reduction and plate positioning led to a significantly better functional result. For 28 patients (30.4%), sinkage of the humeral head into the shaft occurred despite angle-stable anchoring. The currently celebrated angle-stabilising plates did not lead to a significant improvement in functional outcome, compared with other established osteosynthesis procedures.