Lateral mass screw complications: analysis of 1662 screws.

STUDY DESIGN: Retrospective, consecutive patient series. OBJECTIVE: To quantify the risks and the complications associated with screw fixation devices of the cervical spine. SUMMARY OF BACKGROUND DATA: The usefulness of lateral mass internal fixation has been well documented in the clinical setting. However, there is a paucity of studies examining the complications associated with these devices in a degenerative clinical setting. METHODS: From 1999 to 2007, 225 consecutive patients underwent posterior cervical fixation using a screw-plate and polyaxial screw-rod implant systems. There were 105 women and 120 men (age range: 45 to 84 y; mean, 68 y). In all patients, the surgical indication was cervical spondylosis with myelopathy. Mean follow-up interval was 18 months (range: 12 to 72 mo). Screw position was evaluated by computed tomography scanning postoperatively in all patients. Clinical and radiographic outcome was assessed at each visit after surgery. RESULTS: Intraoperative complications include fracture of lateral mass in 27 screws placement and nerve irritation in 3 bicortical screws. Early complications include hematoma formation in 2 cases and C5 root palsy in 5 cases after spinal canal decompression. Late complications include pseudarthrosis in 6 cases and screw pull-out in 3 cases. There were no cases of spinal cord or vertebral artery injury, infections, deaths, or adjacent segment disease. All patients had radiographic union, and no patient developed mechanical implant failure requiring removal of instrumentation. Reoperation was required in 14 (6.2%) cases because of nerve injury, hematoma formation, pseudarthrosis, and screw pull-out. CONCLUSIONS: Our clinical findings indicate that lateral mass fixation can be used safely with minimal complications and low rate of morbidity for cervical myelopathy treatment.

Carotid Artery Temperature Reduction with Statin Therapy in Patients with Familial Hyperlipidemia Syndromes.

BACKGROUND: Microwave radiometry (MWR) assesses non-invasive carotid artery temperatures reflecting inflammation. In the present study, we aimed to investigate the impact of hypolipidemic therapy either with simvastatin or with combination simvastatin plus ezetimibe on carotid artery temperatures of patients with familial hyperlipidemia syndromes (FHS). METHODS: Consecutive patients with diagnosis of either familial heterozygous hypercholesterolemia (heFH) or familial combined hyperlipidemia (FCH) were included in the study. Patients were assigned to either simvastatin 40 mg or simvastatin 40 mg plus ezetimibe 10 mg, according to the discretion of the physician. FHS patients who refused statin therapy were used as a control group. Common carotid intima-media thickness (ccIMT) was measured and ΔΤ (maximum-minimum) temperature measurements were performed across each carotid during MWR evaluation. RESULTS: In total, 115 patients were included in the study. Of them, 40 patients received simvastatin (19 heFH and 21 FCH), 41 simvastatin + ezetimibe (31 heFH and 10 FCH), and 34 (21 heFH and 13 FCH) no statin. Carotid artery temperatures were significantly reduced at 6 months in FH patients who received hypolipidemic treatment (0.83 ± 0.34 versus 0.63 ± 0.24 °C, p = 0.004 for simvastatin, 1.00 ± 0.38 versus 0.69 ± 0.23 °C, p < 0.001 for simvastatin + ezetimibe), but no change was recorded in controls (0.72 ± 0.26 versus 0.70 ± 0.26 °C, p = 0.86). CONCLUSIONS: Hypolipidemic therapy reduced carotid temperatures in FHS patients.

External fixation versus "pi" plate for distal radius fractures.

BACKGROUND: Fractures of the distal radius are among the most common fractures in orthopedic practice. The purpose of our study was to explore the advantages and disadvantages of two methods of treatment for this type of fracture. METHODS: One hundred thirteen fractures of the distal radius have been operated; 49 fractures were treated with an external fixator and 64 fractures by internal fixation using a "pi" plate. The mean follow-up was 12 months. Clinical evaluation was performed using the modified Gartland and Werley's Functional Scoring System. Radiographic evaluation was performed using the modified Lidstrom Radiographic Scoring System. RESULTS: Clinical results were similar between the two groups of patients (p = 0.46). Radiographic parameters were superior in the group of patients treated with open reduction and internal fixation (p = 0.028). CONCLUSIONS: Final functional results are comparable between external fixation and dorsal "pi" plating.

Surgical outcome after spinal fractures in patients with ankylosing spondylitis.

BACKGROUND: Ankylosing spondylitis is a rheumatic disease in which spinal and sacroiliac joints are mainly affected. There is a gradual bone formation in the spinal ligaments and ankylosis of the spinal diarthroses which lead to stiffness of the spine.The diffuse paraspinal ossification and inflammatory osteitis of advanced Ankylosing spondylitis creates a fused, brittle spine that is susceptible to fracture. The aim of this study is to present the surgical experience of spinal fractures occurring in patients suffering from ankylosing spondylitis and to highlight the difficulties that exist as far as both diagnosis and surgical management are concerned. METHODS: Twenty patients suffering from ankylosing spondylitis were operated due to a spinal fracture. The fracture was located at the cervical spine in 7 cases, at the thoracic spine in 9, at the thoracolumbar junction in 3 and at the lumbar spine in one case. Neurological defects were revealed in 10 patients. In four of them, neurological signs were progressively developed after a time period of 4 to 15 days. The initial radiological study was negative for a spinal fracture in twelve patients. Every patient was assessed at the time of admission and daily until the day of surgery, then postoperatively upon discharge. RESULTS: Combined anterior and posterior approaches were performed in three patients with only posterior approaches performed on the rest. Spinal fusion was seen in 100% of the cases. No intra-operative complications occurred. There was one case in which superficial wound inflammation occurred. Loosening of posterior screws without loss of stability appeared in two patients with cervical injuries. Frankel neurological classification was used in order to evaluate the neurological status of the patients. There was statistically significant improvement of Frankel neurological classification between the preoperative and postoperative evaluation. 35% of patients showed improvement due to the operation performed. CONCLUSION: The operative treatment of these injuries is useful and effective. It usually succeeds the improvement of the patients' neurological status. Taking into consideration the cardiovascular problems that these patients have, anterior and posterior stabilization aren't always possible. In these cases, posterior approach can be performed and give excellent results, while total operation time, blood loss and other possible complications are decreased.

Vascular inflammation and metabolic activity in hematopoietic organs and liver in familial combined hyperlipidemia and heterozygous familial hypercholesterolemia.

BACKGROUND: Familial dyslipidemias of either heterozygous (heFH) or combined (FCH) type lead to accelerated atherogenesis and increased cardiovascular risk. OBJECTIVE: The aim of this study was to investigate in statin-naïve adult patients with familial dyslipidemias whether inflammatory activation and liver, spleen and bone marrow metabolic activity differ compared with normolipidemic subjects and between dyslipidemic groups. METHODS: Fourteen patients with FCH, 14 with heFH, and 14 normolipidemic individuals were enrolled. Serum lipids, high-sensitivity C-reactive protein, and fibrinogen levels were measured, followed by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography imaging. Radiotracer uptake in the aortic wall, spleen, bone marrow, and liver was quantified as tissue-to-background ratio (TBR). RESULTS: Patients with heFH had significantly higher low-density lipoprotein levels compared with those with FCH and controls (P < .001). However, aortic TBRs were higher in FCH compared with heFH patients and controls (P = .02 and P < .001, respectively). FCH patients exhibited higher FDG uptake in the spleen compared with controls (P = .05). In addition, FCH exhibited higher bone marrow FDG uptake compared with heFH patients and controls (P = .03 and P = .02, respectively). FCH had higher liver uptake compared with heFH patients and controls (P < .001 for both). Significant correlations were observed between inflammatory biomarkers and imaging indices as well as between aortic TBR and FDG uptake of hematopoietic organs and liver. CONCLUSIONS: Systemic, as well as vascular inflammation and spleen, bone marrow, and hepatic metabolic activity are increased in patients with FCH despite lower levels of low-density lipoprotein.

Pigmented villonodular synovitis of the distal tibiofibular joint: a case report.

Pigmented villonodular synovitis (PVNS) is a proliferative disorder of the synovium. Monoarticular involvement is the more common process. This article presents a case of PVNS with rare location at the distal tibiofibular joint and discusses the current concepts of diagnosis and treatment of this disease.

Foot and ankle injuries during the Athens 2004 Olympic Games.

BACKGROUND: Major, rare and complex incidents can occur at any mass-gathering sporting event and team medical staff should be appropriately prepared for these. One such event, the Athens Olympic Games in 2004, presented a significant sporting and medical challenge. This study concerns an epidemiological analysis of foot and ankle injuries during the Games. METHODS: An observational, epidemiological survey was used to analyse injuries in all sport tournaments (men's and women's) over the period of the Games. RESULTS: A total of 624 injuries (525 soft tissue injuries and 99 bony injuries) were reported. The most frequent diagnoses were contusions, sprains, fractures, dislocations and lacerations. Significantly more injuries in male (58%) versus female athletes (42%) were recorded. The incidence, diagnosis and cause of injuries differed substantially between the team sports. CONCLUSION: Our experience from the Athens Olympic Games will inform the development of public health surveillance systems for future Olympic Games, as well as other similar mass events.