Minimally Invasive Surgery Transpedicular Intrabody Cage Technique for the Management of Kummell Disease.

BACKGROUND: The treatment of Kummell disease remains controversial, with a wide variety of options proposed in the literature. This study aims to introduce a unique and minimally invasive approach for the treatment of Kummell disease and present the clinical results of this technique. METHODS: Twenty patients underwent surgery using the minimally invasive surgery transpedicular intrabody cage (MISTIC) technique from 2014 to 2016. Postoperatively, patients were seen at 3, 6, and 12 months after surgery. Visual analog scale and Oswestry Disability Index scores were collected, and patient outcomes were graded according to the modified MacNab's criteria. Radiological outcomes were assessed through measurements of the anterior vertebral height (AH), mean vertebral body height (BH), and segmental angle (SA) on standing lateral radiographs pre- and postoperatively. RESULTS: There was significant improvement in the SA, AH, and BH postoperatively. The SA improved from 15.2 ± 8.7° of kyphosis to 1.2 ± 5.2° (P < 0.01) in the immediate postoperative period. The AH increased from 13.3 ± 14.6 to 22.6 ± 12.2 mm (P < 0.01), and at the final follow-up, it was 21.9 ± 12.6 mm (P < 0.01). Similarly, the BH increased from 18.5 ± 6.8 to 25.6 ± 7.6 mm (P < 0.01) postsurgery, and at the final follow-up, it was 23.6 ± 4.4 mm (P < 0.01). CONCLUSIONS: The MISTIC technique offers significant correction of kyphosis and restoration of the vertebral anatomy following surgery. These results were maintained at 12 months postoperation, with a 100% union rate of the fractures. Additionally, patients experienced significant pain relief and improvement in their ODI scores that were maintained at 12 months.

Reverse shoulder arthroplasty: The Singapore General Hospital experience and a simple method of measuring change in the center-of-rotation.

INTRODUCTION: This study reviews the outcomes of reverse shoulder arthroplasty (RSA) and introduces a novel method of measuring changes in the center-of-rotation (COR) of the shoulder joint post-operatively. METHODS: We performed 10 reverse shoulders in 2011. Patients were evaluated pre-operatively and post-operatively using the Constant Score. The COR of the shoulder was determined pre- and post-operatively on radiographs and the differences were analysed. RESULTS: There was significant improvement in Constant Scores post-operatively with reduction in pain and increase in strength. Medialisation but not distalisation of the COR was achieved. DISCUSSION: Longer follow-up studies and studies on survivalship are required.

Reducing allograft contamination and disease transmission: intraosseous temperatures of femoral head allografts during autoclaving.

INTRODUCTION: The Singapore General Hospital Bone Bank, which exclusively stores femoral head allografts, relies on flash sterilisation to prevent allograft-related disease transmission and wound infection. However, intraosseous temperatures during autoclaving may be lower than required to eliminate human immunodeficiency virus, and hepatitis B and C viruses. The aim of this study is to determine the intraosseous temperatures of femoral head allografts during autoclaving and to assess the adequacy of autoclaving in preventing disease transmission. METHODS: Six femoral heads were acquired from patients who underwent hip arthroplasty. The specimens were divided into two groups. The first group underwent flash sterilisation with a sterilisation time of 4 min, while a longer sterilisation time of 22 min was used for the second group. RESULTS: The highest core temperature in the first group was 130°C, while the core temperatures in the second group plateaued at 133°C for all allografts. In the first group, only smaller allografts maintained temperatures sufficient for the inactivation of the clinically relevant viral pathogens. In contrast, all allografts in the second group were terminally sterilised. CONCLUSION: There is an inverse correlation between the size of allografts and intraosseous temperatures achieved during autoclaving. Therefore, we recommend dividing large allografts into smaller pieces, in order to achieve intraosseous temperatures adequate for the elimination of transmissible pathogens during flash sterilisation. Allografts should not be terminally sterilised, as the resulting allografts will become unusable. Despite modern processing techniques, stringent donor selection remains vital in the effort to prevent allograft-related infections. Autoclaving is an economical and efficacious method of preventing allograft-related disease transmission.

Simple novel bone bank storage: the Singapore General Hospital experience.

INTRODUCTION: Since 1981, the Singapore General Hospital (SGH) bone bank has proven to be a safe, reliable, and economical source of bone allografts. Femoral heads are used exclusively and are procured from patients undergoing hip arthroplasty. Screening for HIV, hepatitis B, and hepatitis C is carried out prior to surgery. Patients with ongoing infection and past history of malignancy are excluded. The bone graft procured is washed and autoclaved to 134°C for 3 minutes. It is then stored in saline solution containing penicillin and streptomycin at -80°C. Based on our experience, such a system can be readily duplicated in developing nations with minimal cost and equipment. This article presents our experience in the procurement and storage of femoral head allografts with clinical results to support the safety profile. METHODS: Ten femoral heads were harvested from patients who underwent hip arthroplasty. The femoral heads were autoclaved and stored at -80°C in an antibiotic solution. Bone chips were sent for culture immediately after autoclaving and at 3 and 6 months. RESULTS: All specimens passed the initial sterility testing and remained sterile up to 6 months. A retrospective study of 9 patients who had 13 allografts implanted between 2008 and 2010 showed that none of the recipients acquired an infection or transmissible disease due to the allografts. CONCLUSION: This study showed that our protocol allows for procurement of femoral head allografts with minimal contamination and that they can maintain sterility for up to 6 months. This finding is further supported by our clinical results. Hence, this protocol will be useful for bone banks in developing nations where sterility conditions are suboptimal and cost is an issue.

A fan-shaped axillopectoral muscle: an unusual variant of the axillary arch.

The axillary arch is a vestigial muscle in the axilla, which originates from the latissimus dorsi and inserts into the pectoralis major tendon. The aim of this article is to describe a fan-shaped variant of the axillary arch and its clinical implications. We present a patient who underwent an axillary node dissection during which, a fan-shaped axillopectoral muscle measuring 8 cm by 6 cm was encountered. It was disinserted to provide exposure of the axilla.