Anterior instrumentation and correction of congenital spinal deformities under age of four without hemivertebrectomy: a new alternative.

STUDY DESIGN: Retrospective clinical and radiologic evaluation of a single-stage partial corpectomy of the hemivertebra with anterior instrumentation and simultaneous posterior noninstrumented fusion. OBJECTIVE: To determine the safety and efficacy of a new technique in the management of progressive congenital spinal deformities due to failure of formation in the very young age. SUMMARY OF BACKGROUND DATA: Several techniques have been reported for the surgical treatment of young children with congenital spinal deformities. There have been concerns regarding epidural bleeding, neurologic complications, pedicle screws placement, implant failure, and prominence of posterior constructs in this very young age group. A single-stage partial corpectomy of the hemivertebra with anterior instrumentation and simultaneous posterior noninstrumented fusion can offer a new alternative which can avoid these concerns. METHODS: Twelve patients with progressive congenital spinal deformities due to failure of formation were retrospectively reviewed after adopting the above mentioned technique. All patients included in the study presented with a single hemivertebra. The mean age at time of surgery was 2 years 7 months (range, 1 year and 9 months to 3 years and 10 months). The average follow-up period was 3 years and 1 month (range, 2 years to 4 years and 5 months). RESULTS: There were no cases of intra or postoperative neurologic or implant related complications. There was 1 superficial infection. All patients showed solid radiologic fusion. The mean scoliosis angle improved from 48.3° (range, 34°-58°) preoperative to 17.2° (range, 11°-25°). The mean angle of kyphosis improved from 23.2° (range, 16°-57°) before surgery to 11.7° (range, 4°-16°). CONCLUSION: A single-stage partial corpectomy of the hemivertebra with anterior instrumentation and simultaneous posterior noninstrumented fusion offers a safe alternative method in treating patients with congenital hemivertebra under the age of 4 years.

Pharmacological treatment of heterotopic ossification following hip and acetabular surgery.

Heterotopic ossification is a common complication following total hip arthroplasty and surgery following acetabular trauma. It is associated with pain and a decreased range of movement. Prophylaxis is achieved by either non-steroidal anti-inflammatory drug treatment or localised irradiation therapy. The objective of this study was to evaluate the evidence for pharmacological agents used for the prophylaxis of heterotopic ossification following hip and acetabular surgery. The study used a comprehensive literature search to identify all major clinical studies investigating the pharmacological agents used in the prophylaxis of heterotopic ossification following hip and acetabular surgery. It was concluded that indometacin remains the 'gold standard' for heterotopic ossification prophylaxis following total hip arthroplasty and is the only drug proven to be effective against heterotopic ossification following acetabular surgery. Following total hip arthroplasty, other non-steroidal anti-inflammatory drugs, including naproxen and diclofenac, are equally as effective as indometacin and can be considered as alternative first-line treatments. Celecoxib is also of equal efficacy to indometacin and is associated with significantly fewer gastrointestinal side effects. However, serious concerns were raised over the safety of selective cyclooxygenase-2 inhibitors for the cardiovascular system and these should be used cautiously.

Grafting for periprosthetic femoral fractures: strut, impaction or femoral replacement.

Peri-prosthetic fractures are technically demanding to treat, as they require the skills of revision arthroplasty as well as those of trauma surgery. [Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 2005;20:857-65.] reporting on 1049 periprosthetic femoral fractures found that the annual incidence varied between 0.045% and 0.13% for all THAs performed in Sweden and that the accumulated incidence for the primary hip arthroplasties was 0.4% while for the revision arthroplasties was 2.1% [Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 2005;20:857-65.]. The elderly population is particularly vulnerable to low energy periprosthetic fractures attributed to osteopenia or osteoporosis leaving limited reconstruction options to the hip revision surgeon. Bone grafting in the form of autograft has well recognized limitations and allograft represents the gold standard of bone augmentation in the majority of the cases. Allograft can be used as morselised in the form of impaction grafting, reconstructing the bone from within out, or in the form of structural allograft. In the latter case, strut onlay plates or whole proximal femoral allografts can be used to augment the deficient bone or to totally replace it respectively. Immune reaction and disease transmission along with delayed revascularization of the cortical allograft can cause failure of the construct in the long term; however, the results to date from their use are promising. We here present an overview of the literature on the use of available bone grafts in the treatment of periprosthetic femoral fractures.