Single level cervical arthroplasty with the Discocerv prosthesis: a preliminary report.

The authors conducted a prospective nonrandomised study about a new cervical disc prosthesis: the Discocerv Cervidisc Evolution. Fourteen patients (10 men and 4 women) were treated at a single mobile level, between July 2006 and November 2008. Their mean age was 40.8 years (range 31-56), and the mean clinical follow-up period was 12.8 months (range 9-18). Diagnosis was disc herniation (n = 12) and stenosis (n = 2). The VAS for neck pain, the VAS for radiating pain and the Neck Disability Index decreased significantly at last followup (p <0.05). According to Odom's criteria 81.6% of the patients had a good or excellent outcome. The range of movement of the cervical spine as a whole and of the treated functional segmental unit were preserved at final follow-up, which suggests that the disc prosthesis might prevent osteoarthritis at adjacent levels. The neutral sagittal alignment of the cervical spine as a whole and of the functional spinal unit showed kyphosis shortly after surgery, but lordosis was practically restored at final follow-up.

Early results of distal metatarsal osteotomy through minimally invasive approach for mild-to-moderate hallux valgus.

A prospective study was performed on 24 patients to evaluate the early results of our experience with minimally invasive distal metatarsal osteotomy to treat mild-to-moderate hallux valgus deformities in adults. After failure of conservative treatment and persistence of footwear-related pain, a percutaneous distal first metatarsal osteotomy was performed, stabilized by a Kirschner wire, followed by immediate weight bearing. At final follow-up, clinical assessment showed that 31 of 36 patients were satisfied with their results. At a mean of 21 months, weight-bearing foot radiographs showed significant change compared with the preoperative status : the average corrections of hallux valgus angle and first intermetatarsal angle achieved were 13.10 and 5.40, respectively (p < 0.001). No cases showed nonunion, malunion, overcorrection, transfer metatarsalgia or osteonecrosis. The technique appeared in this study to be an effective, safe and simple option for correction of a painful mild-to-moderate hallux valgus deformity.

Percutaneous Kirschner-wire fixation for displaced distal forearm fractures in children.

A prospective study was conducted to evaluate the efficacy of percutaneous Kirschner-wire fixation for the management of high-risk distal forearm fractures in children. Thirty two children (22 boys & 10 girls) with displaced fractures of the distal third of the radius with or without ulnar fractures were managed by closed reduction and percutaneous Kirschner-wire fixation. Their average age was 10.1 years (4-16 years). The fracture was open (Grade 1) in two cases (6.3%). Antegrade intramedullary Kirschner-wire fixation was done for distal radial fractures in 71.9% of cases. Patients were evaluated clinically and radiologically after an average duration of follow-up of 28.6 months. Patients with residual angulation more than 15 degrees, limitation of forearm or wrist movement more than 20 degrees, persistent pain or clinical deformity were considered to have unsatisfactory results. Satisfactory results were obtained in 87.5% of all cases. The residual radioulnar and dorsovolar angulations were significantly related to the decrease in forearm rotation and the unsatisfactory results. High-risk distal forearm fractures in children should be treated by primary percutaneous Kirschner-wire fixation supplemented by cast immobilisation.

Titanium elastic nail fixation for paediatric femoral and tibial fractures.

The aim of this prospective study was to evaluate the results of treatment of paediatric femoral and/or tibial diaphyseal fractures with titanium elastic nails (TENs). Sixty six patients with 48 femoral and 25 tibial fractures were followed-up for 15 to 24 months. The outcome rating system proposed by Flynn et al was used to evaluate the final results. Most patients (56.1%) were operated between 2 to 4 days after injury; a traction table was used in 54.8% of cases. The average operative time was 28 minutes, and the average hospital stay was 5.7 days. Postoperative immobilisation was used in 30% of cases, mostly with femoral fractures. The fractures united in an average time period of 85 days; 89% had united within 3 months. The nails were removed in 87.8% of cases after an average of 5.9 months. The following complications were noted: soft tissue and skin problem (9.1%) in relation to nail ends at the entry points, limb-length discrepancy (9.1%), malunion (4.5%). Based on Flynn et al's outcome rating system, 75.8% of the results were excellent, 24.2% were satisfactory and there were no poor results. With good knowledge of the technique of TEN fixation for paediatric femoral and tibial fractures, excellent and satisfactory results were achieved in all cases, with few minor complications. TENs can give stable fixation allowing early mobilisation and shorter hospitalisation with less disruption of patient and family life.

Telescoping versus non-telescoping rods in the treatment of osteogenesis imperfecta.

A retrospective study was undertaken to evaluate and compare the results of telescoping (group I) versus non telescoping rods (group II) in the treatment of osteogenesis imperfecta. Thirty-three lower limb segments in ten patients were studied (14 segments in group I and 19 segments in group II). The surgical techniques of Sofield and Miller (1959) and Lang-Stevenson and Sharrard (1984) for rod insertion were used. All cases were assessed clinically regarding mobility status, growth and limb-length, refracture, and infection. They were also assessed radiologically regarding rod migration, bone outgrowing the rod, incorrect T-piece placement, breakage and bending of rods. The average duration of follow-up was 86.2 months (range: 6 to 8 years). Mobility status and bone growth were better in group I than in group II patients. The overall implant related complication rate was 28.6% in group I in comparison to 68.4% in group II. Rod migration was twice more common in group II than in group I. Bone outgrowing the rod and breakage of rods with fracture was seen in group II only. The three-year survival rate for telescoping rods was 92.9% in contrast to 68.4% for non telescoping rods. The reoperation rate was 7.2% in group I and 31.6% in group II. From this comparative study it was clear that the results were significantly better after Sheffield rods with regard to mobility status, longevity of the rod, and the frequency of complications requiring reoperations. Also most of the complications were related to the technique of rod insertion and the type of rod.

Biphasic ceramic bone substitute mixed with autogenous bone marrow in the treatment of cavitary benign bone lesions.

A prospective study was performed on 34 patients to evaluate the efficacy and safety of a composite bone substitute formed of hydroxyapatite and tricalcium phosphate (Ceraform) with or without gentamycin sulphate (Ceraform-Genta) plus autogenous bone marrow aspirate in the treatment of cavitary bone defects related with benign bone lesions. At the end of the follow-up period, all patients were evaluated clinically for pain and a daily living activity score, and radiologically regarding the time and quality of bone healing, using a modified Neer grading system. Satisfactory clinical outcome without pain or impairment of daily living activities was seen in 97.1% of patients. Radiologically, 70.6% of the lesions were completely healed and 26.5% showed partial healing; one patient had local recurrence according to the modified Neer grading system. The average time to healing was 19.9 weeks and all reported complications were minor, unrelated to the composite graft itself, and did not affect the functional outcome. The composite ceramic used in this study proved to be a safe and effective bone graft substitute; its use appeared at least as effective as other treatment modalities for benign bone lesions.