1/19. Operative stabilization of a flail chest six years after injury.We report a case of operative stabilization of an incompetent upper chest wall 6 years following flail chest. The indications for stabilization were chronic pain and dyspnea associated with rib malunion and loss of hemithorax volume. At operation, multiple pseudoarthroses were encountered and partial resection of ribs three and four was required. Malleable plates were used to bridge the gaps created by the resection and were secured in place with sternal wire. The patient reported a dramatic relief of symptoms and, at 18 months postoperatively, continues to work full-time on his cattle ranch essentially pain-free.- - - - - - - - - - ranking = 1keywords = plate (Clic here for more details about this article) |
2/19. Fracture of the clavicle after surgical treatment for congenital pseudarthrosis.BACKGROUND: Congenital pseudarthrosis of the clavicle is a rare disease. There are about 200 individual cases reported so far in world literature, mainly in the form of case reports. The majority of authors recommend surgical. An analysis of 103 cases published since 1980 shows only a few post-surgical complications. CASE REPORT: The authors present a female patient operated at the age of 4.5 years. During surgery both cartilaginous ends were resected and internal fixation was performed by a one-third semitubular plate fixed by 3.5 mm cortical screws. Ten days after hardware removal, a fracture occurred in the screw-hole following a minor impact. Surgery to heal the congenital pseudarthrosis was successful, but a new fracture occurred, resulting from bone weakening. This simple fracture was treated conservatively. At present (5 years after the first surgery) the patient's parents are completely satisfied with both the functional result and the cosmetic appearance. CONCLUSIONS: The authors have not found in the literature any reports of similar complications after surgical treatment of this condition. The use of more delicate osteosynthetic material might prevent the complication described here.- - - - - - - - - - ranking = 1keywords = plate (Clic here for more details about this article) |
3/19. Congenital pseudarthrosis.Five cases of congenital pseudarthrosis of the clavicle were treated with open reduction and fixation with appropriate-sized contoured plates and screws. Iliac bone grafts were used to bridge the gap in four patients; local bone graft was used in the fifth patient. Consolidation was noted an average of 3 months postoperatively in all five cases. The plate and screws were removed in all patients at an average of 16 months postoperatively. Average length of follow-up for the five patients is 4 years. Roentgenograms demonstrate that the clavicle has continued to grow normally. All five patients have pain-free full range of motion and are engaged in unrestricted activities.- - - - - - - - - - ranking = 2keywords = plate (Clic here for more details about this article) |
4/19. Surgical treatment of congenital pseudarthrosis of the clavicle: a report of three cases and review of the literature.Congenital pseudarthrosis of the clavicle is a rare entity of unknown aetiology with predominance of the right side. Our therapeutic concept is discussed with special reference to surgical therapy, histopathological findings and the most recent literature. Two girls and one boy, aged 4, 6, and 8 years, presenting with congenital pseudarthrosis of the clavicle were surgically treated between 1994 and 2000. A resection of the pseudarthrosis and internal fixation with a small reconstruction plate was performed. A bone graft from the iliac crest was used for restoration of clavicular length. Histological examination revealed a false joint with the ends of the clavicle covered by hyaline cartilage. The patients showed radiographic healing after 12 weeks. At follow-up (mean 44 months), all patients showed excellent clinical and radiological results without functional impairment. The clinical features and histological examination of the resected pseudarthroses clearly proved the diagnosis of a true congenital pseudarthrosis of the clavicle. According to our clinical and radiological results and considering the recent literature, we recommend surgical therapy with resection, bone grafting, and osteosynthesis with a reconstruction plate around the age of 4 - 6 years.- - - - - - - - - - ranking = 2keywords = plate (Clic here for more details about this article) |
5/19. Fracture of anterior cervical plate implant--report of two cases.Anterior cervical plate is a convenient and popular implant employed after corpectomy and bone grafting for traumatic or degenerative cervical spine disease. Although short-segment anterior cervical surgery may adequately be managed with anterior plate fixation alone, multilevel anterior cervical constructs exhibit a relatively high complication rate warranting a simultaneous posterior fusion. We report two patients undergoing two-level anterior corpectomy/fusion with a fixed anterior plate alone and exhibiting plate fracture in conjunction with pseudoarthrosis. The instrument failure was mainly attributed to pseudoarthrosis. However, improper contouring of the plate causing microstructural damage might create a weak point and contributed to this unusual hardware failure.- - - - - - - - - - ranking = 9keywords = plate (Clic here for more details about this article) |
6/19. Congenital pseudoarthrosis of the clavicle: case report.A case of a 20-year-old medical student with pseudoarthrosis of the right clavicle is presented. Open reduction, bone grafting and plating were done. The pseudoarthrosis healed and the plate was removed after two years. This case is presented to highlight the treatment of this rare condition.- - - - - - - - - - ranking = 1keywords = plate (Clic here for more details about this article) |
7/19. Congenital pseudarthrosis of the clavicle: the role of CT-scanning.Congenital pseudarthrosis of the clavicle is a rare entity. It presents on the right side in 90% of the patients, and bilaterally in up to 10%. The authors report the case of a 4-year-old boy who presented with a painful deformity over his right mid-clavicular area. Plain radiographs were inconclusive, although the opposite is true in most cases. A computed tomography (CT) 3-D reconstruction showed a pseudarthrosis of the clavicle, and excluded a neoplastic, infective or traumatic origin. Treatment involved excision of the pseudarthrosis, internal fixation with a contoured reconstruction locking plate, and bone grafting. The authors prefer operative treatment, but this is not universally accepted.- - - - - - - - - - ranking = 1keywords = plate (Clic here for more details about this article) |
8/19. Survivorship analysis of pedicle spinal instrumentation.Between 1985 and 1989, the senior author performed 120 consecutive pedicle instrumentation cases--78 Steffee (VSP) procedures and 42 procedures using Cotrel-Dubousset instrumentation. Posterolateral or posterior fusions using autogenous iliac bone graft were performed across the instrumented vertebrae in all cases. Survivorship analysis was used to calculate a predicted cumulative rate of success for this series of patients over 10 years postoperative follow-up. The criteria of failure of pedicular instrumentation or "death" of an implant were defined as 1) screw bending, 2) screw breakage, 3) infection, 4) loosening of implants, 5) any rod or plate hardware problems, or 6) removal of hardware due to a neurologic complication. Out of 526 pedicle screws (175 Cotrel-Dubousset screws, 351 VSP screws) there were 22 problem screws (22/526 = 4.18%). Six screws had bent, none were infected, 16 screws had broken, and none were loose. The 22 problem screw events occurred in 12 patients. In seven patients, the instrumentation failure was an incidental radiographic finding, in that patients had a solid posterolateral fusion. The remaining five patients had screw breakage in association with a pseudarthrosis. life table calculations predicted the survivorship of instrumentation without complications would be 80% at 10 years postoperative follow-up. actuarial analysis predicted the survivorship of solid posterolateral fusion at 90% at 10 years follow-up. This survivorship rate is similar to those predicted at 10 years follow-up for other more widely used orthopedic surgical implants such as total hip arthroplasty components.- - - - - - - - - - ranking = 1keywords = plate (Clic here for more details about this article) |
9/19. Nonunion of a complex tibial plateau fracture.Nonunion of tibial plateau fractures are uncommon; only five cases have been reported in the literature. This report presents the sixth nonunion and highlights the management of an angulated, periarticular pseudoarthrosis. Pitfalls in the initial fracture treatment that contributed to the development of the pseudoarthrosis are reviewed.- - - - - - - - - - ranking = 5keywords = plate (Clic here for more details about this article) |
10/19. Revision arthrodesis for tibiotalar pseudarthrosis with fibular onlay-inlay graft and internal screw fixation.pseudarthrosis after failed tibiotalar arthrodesis was successfully treated surgically in nine of 11 patients between 1980 and 1987. The indication for the initial attempted arthrodesis was traumatic arthrosis in seven patients, traumatic arthrosis with osteonecrosis of the talus in two patients, degenerative arthrosis in one patient with cavovarus foot (Charcot-Marie-tooth), and myelodysplasia with progressive valgus deformity of the foot and ankle in one. The surgical technique planned for revision arthrodesis provided firm coaptation of tibia to talus with internal fixation that maintained the foot at right angles to the tibia with the forefoot in neutral position. Seven feet in 11 patients were treated using a transfibular approach that allowed excision of fibrous tissue and sclerotic bone, decortication of the media malleolus, fixation of the tibia to the talus with cancellous screws, and onlay/inlay fibular graft. Of the remaining four patients, one was treated with medial compression plate, a second was treated using an anteromedial cortical graft, a third was treated by a combination of sliding anteromedial corticocancellous graft and tibiotalar compression screw, and a fourth was treated with tibiotalar compression screw. Clinical and roentgenographic union occurred in nine of 11 patients. One patient developed a painless, fibrous union and one patient with persistent pseudarthrosis had myelodysplasia and severe valgus deformity and required amputation. Adequate exposure was possible through the transfibular approach to provide cancellous bone opposition, to excise the pseudarthrosis membrane and sclerotic bone, and to remove necrotic segments of the talus. In addition, supplemental bone graft, internal fixation, and postoperative cast immobilization were also helpful in obtaining union.- - - - - - - - - - ranking = 1keywords = plate (Clic here for more details about this article) |
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