1/6. Closed reduction with CT-guided screw fixation for unstable sacroiliac joint fracture-dislocation.BACKGROUND: Unstable posterior pelvic ring fractures and dislocations are uncommon but potentially life-threatening injuries in children. Early definitive management reduces risk of immediate complications as well as chronic pain and gait dysfunction. Conventional operative therapy carries substantial risk of extensive blood loss and iatrogenic neurological and vascular injury. Minimally invasive image-guided intervention may further reduce immediate risk and improve long-term outcome. OBJECTIVE: To describe CT-guided closed reduction and internal fixation (CRIF) and review outcomes of unstable fracture-dislocation of the sacroiliac (SI) joint in children. MATERIALS AND methods: Between 2000 and 2003, three children (two girls, one boy) age 8-14 years were referred to interventional radiology for treatment of unstable SI joint fracture-dislocation not adequately treated with anterior external fixation alone. RESULTS: The three affected SI joints (two left, one right) were treated in a combined approach by pediatric interventional radiologists and orthopedic surgeons, using a percutaneous approach under CT guidance. Over a threaded guiding pin, 7.3 mm cannulated screws were used to achieve stable reduction of the affected SI joints. One screw was removed after slight (2 mm) migration. No neurovascular or other complications occurred. All patients had satisfactory healing with near-anatomic reduction, although recovery of the youngest was delayed by associated spinal injury. CONCLUSIONS: Compared to open surgical alternatives, CRIF under CT guidance reduces operating time, decreases blood loss, and allows early definitive fixation and immediate non-weight-bearing mobilization with a low rate of complication for unstable posterior pelvic ring fractures. In addition, CT-guided placement of the guide pin may allow safer screw positioning and may minimize the total number of screws needed to achieve pelvic stability.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/6. Otolaryngologic manifestations of the mucopolysaccharidoses.A retrospective review of 45 children with mucopolysaccharidoses was performed to determine the frequency of complications related to the head and neck. In this series, every patient had at least one complication involving the head and neck region, and in over half, operative intervention by the otolaryngologist was required. Upper airway obstruction occurred in 17 (38%) and necessitated a tracheostomy in 7 (16%). Cervical spine instability occurred in 8 (18%), making airway management difficult. Recurrent respiratory infections occurred in 17 (38%), and chronic recurrent middle ear effusions were noted in 33 (73%). This review demonstrates that children afflicted with the mucopolysaccharidoses frequently have otolaryngologic-related complications that are common throughout their life span and often the primary management issue in their continuing care. The otolaryngologic management of these patients is outlined based on the results of this study and review of the relevant literature.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
3/6. Iliotibial band friction syndrome after anterior cruciate ligament reconstruction using the transfix device: report of two cases and review of the literature.The use of hamstrings is increasing as a treatment for anterior cruciate ligament (ACL) injuries. There are a lot of new devices and techniques that try to fix the graft without causing further injury or increased morbidity. We report two cases in relation to the transfix device for reconstructing the ACL. The first case is a 38-year-old female who was treated with an autologous hamstring graft for chronic ACL instability brought on by a sport trauma. The patient developed iliotibial band friction syndrome 3 months after the operation. MRI showed incorrect positioning and a rupture of the femoral bio-absorbable cross-pin. The hamstring graft always had good fixation and did not produce instability of the knee. We removed the cross-pin fragment in a second surgery and the patient returned to her daily lifestyle after 3 weeks. The second case is a 52-year-old female with a painful and unstable knee due to a previous lateral meniscectomy and failure of an ACL reconstruction. We performed an ACL reconstruction with an autologous hamstring graft and a lateral meniscus transplantation. Some months after the procedure she also developed this syndrome. MRI showed the same features as shown in the first case and a second surgery was needed. To our knowledge this clinical and technical problem has not been previously described.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
4/6. Aneurysmal bone cyst of the second cervical vertebrae causing multilevel upper cervical instability.OBJECTIVE: Aneurysmal bone cyst (ABC) is a rare expansile osteolytic lesion of bone comprising proliferating vascular tissue lining blood-filled cystic cavities. ABCs occur most frequently in patients under age 20 and are uncommon after 30 years of age. Three to 20% of cases occur in the spine, and upper cervical involvement is rare. Lesions may grow rapidly and attain considerable size. When involving the spine, ABCs may result in instability and neurologic compromise, making prompt diagnosis and treatment imperative. We present a report of a 6-year-old child with an ABC of the second cervical vertebrae causing atlantoaxial and C2-C3 instability, treated successfully with curettage, decompression, and anterior and posterior arthrodesis with posterior instrumentation. methods: The patient underwent a staged procedure consisting of posterior instrumentation from occiput to C4 and curettage of the lesion followed by anterior cervical discectomy and fusion of C2-C4. The diagnosis, surgical treatment, and outcome of the case are described and relevant literature reviewed. RESULTS: The patient sustained no lasting neurologic deficits and was disease-free at 3 years of follow-up. CONCLUSIONS: ABC is a rare but potentially devastating cause of upper cervical spine instability. Prompt detection and treatment with curettage, decompression, and fusion can produce a satisfactory result and prevent spinal cord injury.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
5/6. The hung up shoulder: anterior subluxation locking in abduction.The hung up shoulder, or anterior subluxation locking in abduction, is a bizarre clinical picture which is not frequently seen. It is probably due to the fact that, in the subluxed position, the subscapularis muscle becomes an abductor, rather than an internal rotator. External rotation might shift the subscapular muscle fibres towards the proximal aspect of the humeral head, while joint laxity favors subluxation. It is possible that the hung up shoulder is just one aspect of multidirectional shoulder instability, given the tendency to generalised joint laxity, the frequent autoreduction, the positive sulcus sign, and initiation of subluxation by either abduction-external rotation or extension. In this series three out of four patients were treated conservatively and performed well in daily life; however, only the fourth patient had almost unlimited access to sports, thanks to surgical stabilization.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
6/6. Occipito-cervical fusion with the cervical Cotrel-Dubousset rod system.Diseases and conditions which cause instability of the craniocervical junction and the adjacent upper cervical spine are relatively common and potentially life-threatening. Direct internal occipitocervical fusion (OCF) is a modern means of surgical treatment in such cases, and has some advantages over simple immobilization of the affected segments. The present study was designed to evaluate surgical handling, results, and complications with a recently developed instrumentation for OCF, the Cotrel-Dubousset rod-and-hook system (CD). Fourteen consecutive patients with occipito-cervical instability due to fractures, degenerative or neoplastic disease or malformations underwent OCF with the CD system. Autologous or allogeneic bone and bone substitutes such as hydroxyapatite were used to augment the CD fusion. patients were followed clinically and neuroradiologically for 1 to 4 years (mean 20 months). Assessments were routinely performed at 1 week, 1 month, 3 months, 1/2 year, and every year after surgery. There was no immediate surgery-related morbidity or mortality, and no major late complications due to hardware failure. A stable bony fusion according to radiological criteria was achieved in all cases. No implant breaks or loosening and dislocation of the hooks or the screws were encountered. In no case did neurological deterioration occur after surgery. Short-term evaluation at 1 week after surgery showed no difference with respect to neurological symptoms as compared with the pre-operative findings, except for a patient reporting improvement of paraesthesia on the first postoperative day. The long-term effects were, however, beneficial to most patients, as the fusion alleviated neck pain in 13 cases and improved neurological deficits in 3 of the 4 cases with pre-operative motor weakness or paraesthesia. In conclusion, internal OCF with the CD system, an implant which is easy to handle and safe for the patient, is a technique with a high rate of successful bony fusion. Since no halo placement is needed after surgery, patients have considerable gain of quality of life as compared to other standard surgical techniques.- - - - - - - - - - ranking = 2keywords = life (Clic here for more details about this article) |