Iliosacral screwing under navigation control: Technical note.

Percutaneous iliosacral screw fixation is an essential osteosynthesis technique for pelvic fractures and requires precise imaging tools to assist correct screw placement. 3D imaging coupled to navigation has significantly improved this technique. Several possibilities exist, depending on the instrument set used, with varying degrees of difficulty and very variable risk of error. The techniques traditionally described use a guide to navigate a drill bit, where a one-degree difference in trajectory can alter screw tip placement by several millimeters. The present article proposes a standardization of the procedure by using navigated pedicular screw instruments that have the advantage of navigating the instrument itself and not a projection. In a series of 90 screws implanted in 62 patients using this technique, only one path had to be repeated in the light of intraoperative control. No improperly positioned screws were found on postoperative control.

Minimally invasive treatment of thoracolumbar flexion-distraction fracture.

INTRODUCTION: Flexion-distraction fractures represent around 15% of all thoracolumbar fractures, with neurological deficit in 25% of cases. Optimal surgical strategy remains controversial. In neurologically intact patients, percutaneous fixation can offer quick stabilization with good deformity correction. If necessary, an additional minimally invasive anterior approach can complete the surgical strategy. We report results in a series of 28 thoracolumbar flexion-distraction fractures without neurologic deficit, treated using a minimally invasive approach. METHOD: A single-center retrospective study was conducted for the period 2008-2015. Patients over 16 years of age with a flexion-distraction fracture without neurologic deficit were included. Analysis was based on preoperative CT-scan and measurement of post-traumatic kyphotic deformity. Surgery comprised posterior percutaneous fixation, alone or associated to an anterior step in case of discal lesion on preoperative MRI or of severe vertebral comminution. Operative time, blood loss and postoperative complications were recorded. Residual segmental kyphosis and bone healing were evaluated on CT at 1 year. RESULTS: Seventeen males and 11 females were included (mean age, 29.2 years). An anterior approach was performed in 11 cases (39%): 5 for B1 fractures due to severe comminution (corpectomy and expandable vertebral cage with bone and BMP-2) and 6 for B2 fractures due to discal involvement on MRI (discectomy and iliac graft fusion). Regional kyphosis was significantly reduced (17.3° vs. 5.7°; p<0.05) and bone healing was obtained in all cases. There were no cases of postoperative infection. CONCLUSION: Patients with flexion-distraction fractures without neurologic deficit can be eligible for minimally invasive percutaneous posterior fixation, associated if necessary to a minimally invasive anterior approach. This technique provides excellent bone healing with low surgical trauma and bleeding. LEVEL OF EVIDENCE: IV.

Successful treatment of Pseudomonas aeruginosa osteomyelitis with antibiotic monotherapy of limited duration.

OBJECTIVES: The aim of this study was to present a 15-year experience and provide a comprehensive analysis of a large cohort of patients with Pseudomonas aeruginosa osteomyelitis. METHODS: We reviewed the medical records of patients admitted to a large French university hospital for P. aeruginosa osteomyelitis over a 15-year period. Patient outcome was assessed at follow-up after at least six months. RESULTS: Sixty-seven patients were included, comprising 57% with chronic osteomyelitis. Polymicrobial infection was predominant (63%), and an infected device was involved in 39% patients. The overall treatment success rate was 79.1%. All but one patient were treated with a combination of surgery and antibiotic therapy. The antibiotic treatment had a mean duration of 45 days (range, 21-90 days). Single-antibiotic therapy was preferred in nearly all cases. Treatment failure was reported for 14 (21%) patients and was due to the persistence of P. aeruginosa in four cases. No significant risk factor for treatment failure was identified, especially when treatment strategies were compared. CONCLUSIONS: We advocate optimal surgical debridement combined with initial parenteral antibiotics for a maximum of 15 days, followed by an oral fluoroquinolone. Total treatment duration should not exceed six weeks, and antibiotic treatment with two-drug combinations does not seem necessary.