Vascularized pedicled graft from distal radius for scaphoid nonunion with double stabilization: A long term follow up study.

PURPOSE: The aim of the present study is to present the long-term efficacy of the graft of the distal radius based on the 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) for the treatment of scaphoid nonunion with a proposed treatment of double stabilization with Kirschner wires and external fixator. METHODS: Between 2007 and 2013 we retrospectively reviewed 11 patients who were operated for established scaphoid nonunion with pedicled vascularized distal radius graft based on the 1,2 ICSRA in our department. Stabilization of the graft was achieved with Kirschner wires and the wrist was immobilized with a transarticular external fixator. All patients were evaluated pre- and post-operatively both clinically and radiologically. The DASH score was also completed by the patients before and after the operation. The minimum follow-up of the patients was 5 years. RESULTS: The mean age of the patients was 28.64 years (range, 18-49 years). Ten patients were males (90.91%) and one female (9.09%). In all patients, union was achieved. The mean time of union was 11.2 weeks (range, 8-18 weeks). The mean follow-up was 61.32 months (range, 60-72 months). Compared to the contralateral hand there was noticed 14° lack in flexion and 18° in extension. The mean DASH score showed also significant improvement from 23.1 (range, 9.4-50.6) preoperatively to 4.72 (range, 0-22.8) during the last follow-up. CONCLUSION: The 1,2 ICSRA distal radius graft consists a trustworthy pedicled vascularized graft for the treatment of nonunion presenting very promising long-term outcomes.

Clinical outcomes after lumbar spine microdiscectomy: a 5-year follow-up prospective study in 100 patients.

BACKGROUND: To evaluate the effect of lumbar microdiscectomy (LM) in pain, disability and quality of life in a 5-year period and to identify potential demographic and clinical risk factors. METHODS: One hundred patients who underwent LM by the same surgeon participated in this prospective study. Clinical assessment was made with validated questionnaires preoperatively and up to 5 years postoperatively. Subsequently, associations between clinical outcomes and demographic data were recorded. RESULTS: In every assessment questionnaire, there was a significant improvement in the first postoperative month, which lasted up to 1 year post-discectomy. After that, improvement was statistically significant (p < 0.05) but without clinical importance. Women reported more pain preoperatively and 1 month after surgery. Urban residents also presented more pain preoperatively. Older patients had more pain, disability and worse quality of life 1-5 years postoperatively. Similarly, patients with lower education presented the worst scores in every questionnaire at the same time. Smokers reported less pain 1.5-4 postoperative years. Higher alcohol consumption and obesity were associated with lower levels of preoperative pain. However, obese patients had worse SF-36 and ODI scores after the 6th postoperative month. Patients with heavy jobs presented the worst preoperative ODI scores. CONCLUSION: Significant clinical improvement was recorded from the first postoperative month to the first postoperative year; stabilization was noticed later on. Feminine gender, urban residency, older age, low level of education, obesity and heavy physical occupation were negative prognostic factors. Oddly smoking and alcohol were correlated with less pain.