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Locum Tenens Orthopedics Job in Government: Great job for an Orthopedic Surgeon in Sacramento, CA. Any state license will work. California with CompHealth Inc

Job 1296907-0038 Any active, unrestrictive license Sports Medicine Specialized: Outpatient and Consults Board Certified or Board Eligible NPI and BLS required Monday-Friday 8a-4:30p Computer Literate

Locum Tenens Orthopedics Job in Great New Orthopedic Surgery Job in Wisconsin! Wisconsin with CompHealth Inc

Job 0078666-0200 Facility needs ongoing Orthopedic Surgery coverage. Come and enjoy Wiconsin's incomparable beauty, exiting attractions and thrilling medley of entertainment. Here you will find and abundance

Locum Tenens Orthopedics Job in Orthopedic surgery job North Carolina with CompHealth Inc

Job 1225846-0068 Call only Prefer candidates that can do a weekend a month We coordinate and pay for your travel, housing, and transportation You are covered under our professional liability insurance

Locum Tenens Orthopedics Job in Orthopedic Surgery Locums to Perm in Vermont Vermont with CompHealth Inc

Job 0069965-0155 If you are interested in relocating to Vermont please contact us. We offer competitive pay that may include incentives and bonuses We coordinate and pay for your travel, housing, and

Permanent Orthopedics Job in Orthopedic Surgeons needed in Florida's Upper Panhandle. Florida with CompHealth Inc

Job 917486 Come live and work where others love to vacation! Join a very progressive Multi-Specialty Group. Do general Orthopedics and/or develop any sub-specialty. Large need--Patients are waiting

Permanent Orthopedics Job in Orthopedic Surgeon Needed In Beautiful Sunny Florida Location Florida with CompHealth Inc

Job 917533 Do not miss this position. Located in one of the best locations in FL. Short drive to the Gulf Coast GeneralOrthopeics + any subspecialty Great place to raise a family Year round recreation

Locum Tenens Orthopedics Job in Orthopedic surgery job in Michigan Michigan with CompHealth Inc

Job 0275656-0041 Long term coverage needed We coordinate and pay for your travel, housing, and transportation You are covered under our professional liability insurance CompHealth offers thousands

Locum Tenens Orthopedics Job in Orthopedic Surgery Locums Opportunity in Wisconsin Wisconsin with CompHealth Inc

Job 0111388-0071 This client is looking for a physician who can cover full time clinic and call. They will accept candidates with 1-2 weeks of availability per month. We offer competitive pay that may

Permanent Orthopedics Job in 2 Orthopedic Surgeons needed in Tropical Texas Texas with CompHealth Inc

Job 917169 Practice Orthopedics 25 minutes from South Padre Island, located at the southern tip of TX 25 minutes inland from the Gulf of Mexico. Need is for 2 orthopedic surgeon to join the hospital and

Locum Tenens Orthopedics Job in Orthopedic Traumatologist Opportunity in Pennsylvania! Pennsylvania with CompHealth Inc

Job 0067867-0652 A well known healthcare group needs an Orthopedic Surgeon to provide ongoing coverage for them. This would be a great temporary to permanent opportunity. Call today for more details!

Permanent Orthopedics Job in ORTHOPAEDIC SURGEON - Upstate New York New York with CompHealth Inc

Job 917086 General Orthopaedics in Beautiful upstate New York Candidate may chose to be employed or set up private practice Hospital has 180 beds - Call will be 1 in 3 Pracitce 1 mile to Hospital MGMA

Permanent Orthopedics Job in Practice orthopedics on Long Island New York with CompHealth Inc

Job 916833 Beautiful Long Island Multi-specialty group Prestigious practice All metro amenities Lucrative salary plus benefits Instant referral base All benefits CompHealth offers thousands of physician

Locum Tenens Orthopedics Job in Fantastic Scenery and Outdoor Living Await You Wisconsin with CompHealth Inc

Job 0078666-0139 Facility is expanding their practice. They are looking for an Orthopedic Surgeon to provide coverage until they hire someone. Wisconsin has great touring adventures for every interest.

Permanent Orthopedics Job in Metro California Ortho opening California with CompHealth Inc

Job 914095 Close to the Bay! Mediterranean climate, unbelievable location. Join a group Call is 1:5 162 bed hospital Joints, Foot and Ankle or General No managed care Tons of recreational activities

Permanent Orthopedics Job in The Texas Coast Seeks an Orthopedic Surgeon Texas with CompHealth Inc

Job 914893 Immediate referral system Up to 75% of MGMA; big money opportunity Develop any subspecialty Salary plus production CompHealth offers thousands of physician jobs nationwide--permanent placement

Permanent Orthopedics Job in Trauma Orthopedic Surgeon Needed in Texas Texas with CompHealth Inc

Job 915822 Major health system Major city in Texas Low call MGMA based income Trauma mixed with general Orthopedics Full benefits package CompHealth offers thousands of physician jobs nationwide--permanent

Permanent Orthopedics Job in Employed Position in Mountainous Area of Virginia! Virginia with CompHealth Inc

Job 913939 Shared call General needed Mountainous area 135 bed facility salary Full benefits CompHealth offers thousands of physician jobs nationwide--permanent placement and locum tenens. Make the

Permanent Orthopedics Job in Practice Orthopedics Just Outside of D.C. Virginia with CompHealth Inc

Job 915220 90 minutes west of Washington, DC Beautiful location Huge earning potential Be a hospital employee Call 1:3 Strong financial package All benefits CompHealth offers thousands of physician

Permanent Orthopedics Job in Beautiful location! Washington with CompHealth Inc

Job 916111 Build your own group and live just minutes from Portland. Close to the mountains and beaches. Right on the lake and a major river. Beautiful location with excellent fishing. Great place to

Permanent Orthopedics Job in Lifestyle Ortho Practice in Washington Washington with CompHealth Inc

Job 913971 1.5 hours north of Seattle; on the coast!! Collegial group Great call schedule of 1:10 General position Gorgeous coastal location Outdoor paradise Great benefits Paid malpractice CompHealth

Permanent Orthopedic Foot and Ankle Job in Atlanta Georgia with Perimeter Outpatient Surgical Associates

Our North Atlanta Practice is looking to expand. We are seeking a fellowship trained orthopaedic physician (any specialty) to join our group and utilize our on site Ambulatory Surgical Center. Our

Permanent Orthopedic Foot and Ankle Job in Call for More Information Massachusetts with Medical Search International

Busy Medical Center with all sub specialties of Orthopedics is seeking a BC/BE Orthopedic Surgeon with Foot and Ankle training. Metropolitan area! Fellows are welcomed!! Great compensation including

Permanent Orthopedic Foot and Ankle Job in Call for Information Kansas with Inhouse Physician Recruiters Network

The In-House Physician Recruiter Network, composed of over 500 hospital recruiters, represents over 10,000 hospitals and clinics. Our Network's special feature is to showcase outstanding physicians (who

Secondary Soft Tissue Compromise in Tongue-type Calcaneus Fractures.

Page: 439DOI: 10.1097/BOT.0b013e31817ace7eAuthors: Gardner, Michael J MD; Nork, Sean E MD; Barei, David P MD; Kramer, Patricia A PhD; Sangeorzan, Bruce J MD; Benirschke, Stephen K MD

Biomechanical Comparison of Expandable and Locked Intramedullary Femoral Nails.

Page: 446DOI: 10.1097/BOT.0b013e318178d999Authors: Oliveira, Miguel L R MRCS *; Lemon, Michael A FRCS(Tr&Orth) +; Mears, Simon C MD, PhD *; Dinah, A Feroz MRCS(Eng) *; Waites, Matthew D FRCS(Tr&Orth) *; Knight, Trevor A BS *; Belkoff, Stephen M PhD *

Treatment Protocol for Open AO/OTA Type C3 Pilon Fractures With Segmental Bone Loss.

Page: 451DOI: 10.1097/BOT.0b013e318176b8d9Authors: Gardner, Michael J MD *; Mehta, Samir MD +; Barei, David P MD *; Nork, Sean E MD *

Length Determination in Midshaft Clavicle Fractures: Validation of Measurement.

Page: 458DOI: 10.1097/BOT.0b013e318178d97dAuthors: Smekal, Vinzenz MD *; Deml, Christian MD *; Irenberger, Alexander MD *; Niederwanger, Christian MD +; Lutz, Martin MD *; Blauth, Michael MD *; Krappinger, Dietmar MD PhD *

Semitubular Plates for Acutely Displaced Midclavicular Fractures: A Retrospective Study of 111 Patients Followed for 2.5 to 6 Years.

Page: 463DOI: 10.1097/BOT.0b013e31817996fcAuthors: Chen, Chung-Hwan MD *+++[S][P]; Chen, Jian-Chih MD *+; Wang, Chihuei PhD **; Tien, Yin-Chun MD *+; Chang, Je-Ken MD *+++; Hung, Shao-Hung MD *+++[S]++++++

Volar Plate Fixation of AO Type C2 and C3 Distal Radius Fractures, A Single-Center Study of 55 Patients.

Page: 467DOI: 10.1097/BOT.0b013e318180db09Authors: Gerald, Gruber MD *; Karl, Gruber MD +; Christian, Giessauf MD +; Heimo, Clar MD *; Max, Zacherl MD *; Florentine, Fuerst MD ++; Alexander, Bernhardt G MD [S]

The Influence of the Number of Cortices of Screw Purchase and Ankle Position in Weber C Ankle Fracture Fixation.

Page: 473DOI: 10.1097/BOT.0b013e31817ae635Authors: Nousiainen, Markku T MD, FRCS(C) *[P]; McConnell, Alison J MSc(Eng) +; Zdero, Rad PhD +; McKee, Michael D MD, FRCS(C) *[S]; Bhandari, Mohit MD, FRCS(C) ++; Schemitsch, Emil H MD, FRCS(C) *[S]

The Current Status of Locked Plating: The Good, the Bad, and the Ugly.

Page: 479DOI: 10.1097/BOT.0b013e31817996d6Authors: Strauss, Eric J MD; Schwarzkopf, Ran MD; Kummer, Frederick PhD; Egol, Kenneth A MD

Surgical Exposure and Fixation of Displaced Type IV, V, and VI Glenoid Fractures.

Page: 487DOI: 10.1097/BOT.0b013e31817d5356Authors: Nork, Sean E MD; Barei, David P MD; Gardner, Michael J MD; Schildhauer, Thomas A MD; Mayo, Keith A MD; Benirschke, Stephen K MD

Simultaneous Anterior and Posterior Approaches for Complex Acetabular Fractures.

Page: 494DOI: 10.1097/BOT.0b013e3181830d2aAuthors: Harris, Anthony M MD; Althausen, Peter MD; Kellam, James F MD; Bosse, Michael J MD

Bilateral Luxatio Erecta Humeri Associated With a Unilateral Brachial Plexus and Bilateral Rotator Cuff Injuries: A Case Report.

Page: 498DOI: 10.1097/BOT.0b013e31818050f3Authors: Musmeci, Enrico MD; Gaspari, Diego MD; Sandri, Andrea MD; Regis, Dario MD; Bartolozzi, Pietro MD

Delayed Femoral Shaft Fracture Secondary to Nail Gun Injury: A Case Report.

Page: 501DOI: 10.1097/BOT.0b013e318180def1Authors: Harris, Eric B MD; Booher, Kermit MD; Flotten, Andrew S MD

Posteromedial Fracture Fragments of the Tibial Plateau: An Unsolved Problem?

Page: 504DOI: 10.1097/BOT.0b013e3181846ca2Authors: Stahel, Philip F MD; Smith, Wade R MD; Morgan, Steven J MD

In Response:.

Page: 504DOI: 10.1097/01.bot.0000247086.86160.0fAuthors: Barei, David P MD, FRCSC; O'Mara, Timothy J MD; Taitsman, Lisa A MD, MPH; Dunbar, Robert P MD; Nork, Sean E MD

Retrospective review of outcome after surgical treatment of enchondromas in the hand

Abstract Background Tumours of the skeleton of the hand are rare. While the majority of bone tumours are benign (89.4%), a small number show signs of malignancy (4.4%). Among the benign bone tumours of the skeleton of the hand, enchondromas are the most common, at 35–65%. Methods In the period from 1998 to 2005, a total of 35 enchondromas on the hand were diagnosed at the Trauma Center Lorenz Boehler. These were 16 women and 19 men with an average age of 36 years (age range 16–66). The most common site of an enchondroma was the proximal phalanx in 17 cases, followed by the metacarpal bone in 8 cases and the middle phalanx in 5 cases. In five patients, an enchondroma was found in the carpal bones. Twenty-nine patients underwent surgery. Results The follow-up findings (average follow-up time, 47 months) were assessed in accordance with the formula outlined by Wilhelm and Feldmaier. Twenty-five of 27 patients who underwent follow-up examination showed an excellent result. In two patients, the result was assessed as good on account of restricted mobility caused by increased scar formation. No recurrence was detected in X-ray controls. Conclusion Enchondromas of the hand are usually detected after a bagatelle trauma. For accurate diagnosis, conventional X-ray examination and if necessary, a contrast medium MRI should be performed. Histological investigation is compulsory due to the risk of malignancy. Depending on its spread, the defect in the extirpation cavity should be filled with autogenous spongy bone. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-008-0715-6Authors Markus Figl, Trauma Center Lorenz Boehler Donaueschingenstrasse 13 1200 Vienna AustriaMartin Leixnering, Trauma Center Lorenz Boehler Donaueschingenstrasse 13 1200 Vienna Austria Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Sublaminar wiring stabilization to prevent adjacent segment degeneration after lumbar spinal fusion

Abstracts Introduction Adjacent segment degeneration (ASD) is a complication of lumbar spinal fusion. There are some reports on the cause of this degeneration but none concerning its prevention. We performed sublaminar wiring stabilization to prevent ASD after posterolateral lumbar spinal fusion with instrumentation. The purpose of this study was to prospectively evaluate the efficacy of this procedure. Patients and methods Between 2003 and 2004, 54 consecutive patients with lumbar spinal canal stenosis and multilevel instability of the lumbar spine underwent posterior decompression and posterolateral fusion with instrumentation. The mean age at the time of surgery was 66.7 ± 1.3 years, and the mean follow-up period was 40.0 ± 1.1 months, with a minimum of 29 months. Twenty-seven of the patients underwent conventional sublaminar wiring stabilization at the cephalad segment adjacent to the site of fusion to prevent ASD (group A), and the other 27 patients did not (group B). Some items were assessed, including clinical outcome using Japanese Orthopaedic Association (JOA) score, sagittal global lumbar alignment, and segmental motion in flexion–extension radiographs of the cephalad vertebral body adjacent to the site of fusion. Results There were no significant differences in JOA scores between two groups, but 2 patients in group B underwent subsequent surgery due to ASD. Sagittal lumbar alignment did not change in group A but was significantly decreased in group B. With respect to segmental motion in flexion–extension radiographs, group A showed a significant decrease from 6.9° before surgery to 3.4° after surgery, on the other hand group B showed a significant increase from 5.6° before surgery to 8.4° after surgery. Conclusions In this study, it was suggested that sublaminar wiring stabilization significantly reduces the range of motion of the adjacent segment and preserves sagittal lumbar alignment, which lead to prevention of ASD. The clinical outcome of the subsequent surgeries is relatively poor, so it is important to prevent ASD by any prevention such as sublaminar wiring stabilization. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-008-0725-4Authors Hiroyasu Ogawa, Gifu University School of Medicine Department of Orthopaedic Surgery 1-1, Yanagido Gifu Gifu 501-1194 JapanHirohiko Hori, Hikone Municipal Hospital Department of Orthopaedic Surgery Shiga JapanHidefumi Oshita, Ohta Hospital Department of Orthopaedic Surgery Gifu JapanAtsushi Akaike, Kizawa Memorial Hospital Department of Orthopaedic Surgery Gifu JapanYoshinari Koyama, Hikone Municipal Hospital Department of Orthopaedic Surgery Shiga JapanTakashi Shimizu, Gifu University School of Medicine Department of Orthopaedic Surgery 1-1, Yanagido Gifu Gifu 501-1194 JapanKazunari Yamada, Hikone Municipal Hospital Department of Orthopaedic Surgery Shiga JapanDaich Ishimaru, Gifu University School of Medicine Department of Orthopaedic Surgery 1-1, Yanagido Gifu Gifu 501-1194 Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Outcome of stemmed shoulder hemi-arthroplasty revision

Abstract Introduction We report our experience of revision of failed stemmed shoulder hemi-arthroplasty for causes other than infection. Material/method Seventeen revisions were followed for a minimum of 2 years. Fifteen cases were revised for symptomatic glenoid erosion. Sixteen were revised to a total shoulder arthroplasty and one to a cuff tear arthropathy head. Result The mean visual analogue pain score following revision surgery was reduced from 6.7 to 3.2 (P = 0.008). However the Constant–Murley and the Association of Shoulder and Elbow Surgeons scores failed to improve significantly. Conclusion We conclude that revision surgery for failed stemmed shoulder hemi-arthroplasty improves pain but not function. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-008-0728-1Authors M. Ravenscroft, Stepping Hill Hospital Shoulder Unit Poplar Grove Stockport SK2 7JE UKC. P. Charalambous, Wrightington Hospital Upper Limb Unit Appley Bridge Wigan Lancashire WN6 9EP UKJ. F. Haines, Wrightington Hospital Upper Limb Unit Appley Bridge Wigan Lancashire WN6 9EP UKI. A. Trail, Wrightington Hospital Upper Limb Unit Appley Bridge Wigan Lancashire WN6 9EP UK Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Quantification of acromioclavicular reduction parameters after the Weaver–Dunn procedure

Abstract Background The combination of the reconstruction of the coracoclavicular ligaments with the resection arthroplasty of the distal end of the clavicle is a commonly used technique in acromioclavicular separations. Hypothesis The purpose of the current study was to quantify the reduction parameters using 3-D CT and to analyze their effects on clinical outcomes. Study design Case series. Methods The patients with chronic symptoms after acromioclavicular dislocation (type III) were treated with reconstruction of the coracoclavicular ligaments. The average follow-up was 69.5 months. The patient group consisted of 21 men and 8 women. The initial treatment at the time of injury was nonoperative in 26 of 29 patients. CT was used to document anteroposterior (APD), craniocaudal (CCD) and mediolateral (MLD) acromioclavicular reduction parameters. Constant Shoulder scoring system was used. Results The mean preoperative Constant score was 56.62 ± 18.63 points while the postoperative score was 89.93 ± 10.79 points. The mean APD was 9.2 mm, the mean CCD was 1.1 mm and the mean MLD was 8.4 mm. There was no correlation between the APD, MLD and the Constant Scores. However, an inverse correlation between the CCD and the postoperative Constant Scores was found. Conclusions CCD plays an important role on the postoperative function. If the CCD is larger, the Constant score is lower. Clinical relevance The reduction loss is a distinctive parameter of the functional outcome, even when the reconstructed coracoclavicular ligament is intact. Secure fixation may be achieved with techniques preserving CCD. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-008-0723-6Authors Murat Bezer, Marmara University Department of Orthopaedic Surgery, Faculty of Medicine Istanbul TurkeyBaransel Saygi, TCSB Fatih Sultan Mehmet EA Hospital Department of Orthopaedic Surgery Oguzhan Cad, Celik Sok, No: 10-9 Adatepe-Maltepe Istanbul TurkeyNuri Aydin, Marmara University Department of Orthopaedic Surgery, Faculty of Medicine Istanbul TurkeyFatih Kucukdurmaz, Marmara University Department of Orthopaedic Surgery, Faculty of Medicine Istanbul TurkeyGazanfer Ekinci, Marmara University Department of Radiology, Faculty of Medicine Istanbul TurkeyOsman Guven, Marmara University Department of Orthopaedic Surgery, Faculty of Medicine Istanbul Turkey Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Redislocation after treatment of traumatic dislocation of hip in children: a report of two cases and literature review

Abstract From August 1998 to June 2005, we treated five children (age range 2–9 years) with traumatic dislocation of hip. The mean follow-up period was 4.1 years (range 1–8 years). There was acceptable reduction in all cases by single attempt at closed reduction. Two patients aged 2 and 3 years, respectively, had redislocation. Other complications like nerve injuries, avascular necrosis, growth disturbance, ectopic ossification and post-traumatic arthritis were not seen till the last follow-up (mean 4.1; range 1–8 years). Closed reduction is an effective treatment method for traumatic dislocation of hip in children, but adequate immobilization and protection from weight bearing is needed in children aged less than 10 years to prevent redislocation. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-008-0735-2Authors Jajodia Nirmal Kumar, Korea University Department of Orthopaedic Surgery, Guro Hospital, College of Medicine 80 Guro-dong, Guro-gu Seoul 152703 South KoreaSunit Hazra, Korea University Department of Orthopaedic Surgery, Guro Hospital, College of Medicine 80 Guro-dong, Guro-gu Seoul 152703 South KoreaHo Hyun Yun, Korea University Department of Orthopaedic Surgery, Guro Hospital, College of Medicine 80 Guro-dong, Guro-gu Seoul 152703 South Korea Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

An unusual case of gonococcal arthritis of the finger

Abstract Gonococcal arthritis is the most common acute septic arthritis in sexually active young adults. It is caused by the gram-negative diplococcus Neisseria gonorrhoeae. In 0.5–3% an untreated mucosal infection disseminates throughout the system and affects mostly big joints like the knee, elbows, and ankles. N. gonorrhoeae is a fragile microorganism which is difficult to culture. Penicillin resistance has developed worldwide in recent years, therefore, patients should be treated by a third generation Cephalosporin. In this article, we describe the unexpected finding of septic arthritis in the proximal interphalangeal joint of a 50-year-old patient. The septic arthritis was caused by N. gonorrhoeae. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-008-0727-2Authors Susanne B. Thomas, University Erlangen Department of Plastic and Hand Surgery Krankenhausstrasse 12 91054 Erlangen GermanyFrank Unglaub, University Erlangen Department of Plastic and Hand Surgery Krankenhausstrasse 12 91054 Erlangen GermanyAdrian Dragu, University Erlangen Department of Plastic and Hand Surgery Krankenhausstrasse 12 91054 Erlangen GermanyAndré Gessner, University Erlangen Department of Microbiology Erlangen GermanyRaymund E. Horch, University Erlangen Department of Plastic and Hand Surgery Krankenhausstrasse 12 91054 Erlangen Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Migration of hip revision stems into the knee joint: alternative treatment modalities: technical note

Abstract We report two unusual cases of stem penetration of long shaft femoral prosthesis into the knee joint after revision total hip arthroplasty. In both patients, the protruded tip of the stem interfered with the tibial plateau and averted the knee joint from full range of motion. To avoid further extensive surgery, the tips of the femoral stem were excised using a high speed-cutter. Both patients had immediate improvement in range of motion postoperatively, fast and uncomplicated rehabilitation, immediate pain relief, and good radiological results. If this rare complication occurs, we recommend for a primary intervention to cut the tip of the stem because replacement of the prosthesis would be a long lasting and very exhaustive surgery for affected patients. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-008-0716-5Authors Martin Thaler, Medical University Innsbruck Department for Orthopaedic Surgery Anichstr. 35 6020 Innsbruck AustriaM. Krismer, Medical University Innsbruck Department for Orthopaedic Surgery Anichstr. 35 6020 Innsbruck AustriaM. Nogler, Medical University Innsbruck Department for Orthopaedic Surgery Anichstr. 35 6020 Innsbruck AustriaC. M. Bach, Medical University Innsbruck Department for Orthopaedic Surgery Anichstr. 35 6020 Innsbruck AustriaE. Mayr, Medical University Innsbruck Department for Orthopaedic Surgery Anichstr. 35 6020 Innsbruck Austria Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

A modification of the McLaughlin procedure for persistent posterior shoulder instability: technical note

Abstract We describe a modification of the McLaughlin procedure for persistent posterior shoulder instability following posterior glenohumeral dislocation with a large antero-medial reverse Hill-Sachs lesion. In the original McLaughlin description, the subscapularis was divided close to its insertion to the lesser tuberosity and sutured into the reverse Hill-Sachs lesion using bone drill holes. In our newly described technique, the subscapularis tendon is not divided but is instead plicated into the reverse Hill-Sachs lesion using suture anchors inserted in the humeral head defect. We present the case of a patient with persistent posterior instability following traumatic posterior glenohumeral dislocation, successfully treated with our new technique. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-008-0721-8Authors C. P. Charalambous, Stepping Hill Hospital Department of Shoulder Surgery Poplar Grove, Hazel Grove Stockport SK2 7JE UKT. K. Gullett, Stepping Hill Hospital Department of Shoulder Surgery Poplar Grove, Hazel Grove Stockport SK2 7JE UKM. J. Ravenscroft, Stepping Hill Hospital Department of Shoulder Surgery Poplar Grove, Hazel Grove Stockport SK2 7JE UK Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Posterolateral corner anatomy and its anatomical reconstruction with single fibula and double femoral sling method: anatomical study and surgical technique

Abstract This paper reports a novel method for reconstructing the posterolateral structures [lateral collateral ligament (LCL), popliteus tendon, popliteofibular ligament] based on an anatomical study of a cadaveric dissection. The popliteus tendon was found to always be attached to the anterior–inferior portion of the femoral attachment site of the LCL, and the average distance from the origin of the popliteal tendon in the femoral side to that of the LCL was 18.5 mm (17–20). The insertion site of the LCL in the fibular side was located anterior–inferior-superficially and the popliteofibular ligament was inserted into the posterior–superior-deep portion around the styloid process. Two femoral tunnels and one fibular head tunnel were made at the proximal and distal portion of the anatomical insertion sites. Content Type Journal ArticleCategory Arthroscopy and Sports MedicineDOI 10.1007/s00402-008-0722-7Authors Jin Goo Kim, Seoul Paik Hospital, Inje University Department of Orthopedic Surgery Seoul KoreaJeong Gu Ha, Seoul Paik Hospital, Inje University Department of Orthopedic Surgery Seoul KoreaYong Seuk Lee, Korea University Ansan Hospital Department of Orthopaedic Surgery 516 Gozan-1-dong, Danwon-gu 425-707 Ansan South KoreaSang Jin Yang, Seoul Paik Hospital, Inje University Department of Orthopedic Surgery Seoul KoreaJae Eun Jung, Seoul Paik Hospital, Inje University Department of Orthopedic Surgery Seoul KoreaSoo Jin Oh, Seoul Paik Hospital, Inje University Department of Orthopedic Surgery Seoul Korea Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft

Abstract Since biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the main restraint against lateral patella displacement, reconstruction of the MPFL has become an accepted surgical technique to restore patellofemoral stability. Recently, various procedures have been described that address reconstruction of the medial patellofemoral complex. We present a technique, where the MPFL is reconstructed anatomically to restore physiological kinematics and stability, using a free gracilis tendon autograft. Content Type Journal ArticleCategory Arthroscopy and Sports MedicineDOI 10.1007/s00402-008-0712-9Authors Philip Schöttle, Klinikum rechts der Isar, Technical University of Munich Department of Orthopaedic Sports Medicine Connollytrs. 32 80809 Munich GermanyArno Schmeling, Zentrum für spezielle Gelenkchirurgie, Berlin Oranienburger Str. 70 13437 Berlin GermanyJose Romero, Klinik Hirslanden Endoclinic, Zentrum für Endoprothetik und Gelenkchirurgie Witellikerstr. 40 8029 Zürich SwitzerlandAndreas Weiler, Zentrum für spezielle Gelenkchirurgie, Berlin Oranienburger Str. 70 13437 Berlin Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Bi-unicompartmental versus total knee arthroplasty: a matched paired study with early clinical results

Abstract Introduction The authors performed a matched paired study between two groups: bi-unicompartmental (Bi-UKR) versus total knee replacements (TKR) for the treatment of isolated bicompartmental tibio-femoral knee arthritis with an asymptomatic patello-femoral joint. The Authors believe that Bi-UKR could achieve comparable outcomes than TKR, but with a real less invasive surgery and maintaining a higher joint function. Materials and methods A total of 22 patients with bicompartmental tibio-femoral knee arthritis, who underwent Bi-UKR between January 1999 and March 2003, were included in the study (group A). In all the knees the arthritic changes were graded according to the classification of Älback. All patients had an asymptomatic patello-femoral joint. All patients had a varus deformity lower than 8°, a body-mass index lower than 34, no clinical evidence of ACL laxity or flexion deformity and a preoperative range of motion of a least 110°. At a minimum follow-up of 48 months, every single patient in group A was matched with a patient who had undergone a computer assisted TKR between August 1999 and September 2002 (group B). In the Bi-UKR group, in two cases we registered intraoperatively the avulsion of the treated tibial spines, requiring intra-operative internal fixation and without adverse effects on the final outcome. Statistical analysis of the results was performed. Results At a minimum follow-up of 48 months there were no statistical significant differences in the surgical time while the hospital stay was statistically longer in TKR group. No statistically significant difference was seen for the Knee Society, Functional and GIUM scores between the two groups. Statistically significant better WOMAC Function and Stiffness indexes were registered for the Bi-UKR group. TKR implants were statistically better aligned with all the implants positioned within 4° of an ideal hip–knee–ankle (HKA) angle of 180°. Conclusions The results of this 48 months follow-up study suggest that Bi-UKR is a viable option for bicompartmental tibio-femoral arthritis at least as well as TKR but maintaining a higher level of function. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-008-0713-8Authors N. Confalonieri, C.T.O. Hospital, Istituti Clinici di Perfezionamento Ist Orthopaedic Department Milan ItalyA. Manzotti, C.T.O. Hospital, Istituti Clinici di Perfezionamento Ist Orthopaedic Department Milan ItalyP. Cerveri, Politecnico di Milano Bioengineering Department Milan ItalyE. De Momi, Politecnico di Milano Bioengineering Department Milan Italy Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Growth patterns of osteosarcoma predict patient survival

Abstract Introduction In this retrospective study, we assessed tumor growth patterns as visualized on MR images, and examined whether tumor growth patterns correlate with clinicopathologic variables. In addition, we also evaluated the relationship between patient outcome and tumor growth pattern in the whole study cohort and in subsets of AJCC IIA and IIB patients. Materials and methods We retrospectively reviewed 347 patients with Enneking stage IIB and AJCC stage II osteosarcoma that was treated with surgery and neoadjuvant chemotherapy at our institute. Patients were divided into three groups based on tumor growth pattern, namely, concentric, eccentric, and longitudinal groups. Fisher’s exact test was performed to analyze correlations between tumor growth patterns and clinicopathological variables. Five-year metastasis-free survival and overall survival were evaluated using univariate and multivariate analyses. Results In terms of tumor growth patterns, 225 patients (64.8%) had a concentric, 71 (20.5%) an eccentric and 51 (14.7%) a longitudinal tumor. Eccentric tumors were usually small and responded well to chemotherapy, whereas concentric tumors were large and responded poorly. The prognostic significances of tumor growth patterns were confirmed by univariate and multivariate analyses. Among AJCC stage IIA patients, no survival difference was found according to growth pattern, whereas in AJCC stage IIB patients, longitudinal tumors were associated with significantly better survival than concentric tumors. Conclusions Tumor growth pattern was found to be an independent prognostic factor in stage II osteosarcoma. Moreover, longitudinally growing tumors were associated with better survival in AJCC stage IIB patients. Our results suggest that tumor growth pattern could be used as an indicator of risk-adapted therapy when combined with other prognostic factors. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-008-0714-7Authors Min Suk Kim, Korea Cancer Center Hospital Department of Pathology Seoul South KoreaSoo-Yong Lee, Korea Cancer Center Hospital Department of Orthopedic Surgery 215-4, Gongneung-dong, Nowon-gu Seoul 139-706 South KoreaWan Hyeong Cho, Korea Cancer Center Hospital Department of Orthopedic Surgery 215-4, Gongneung-dong, Nowon-gu Seoul 139-706 South KoreaWon Seok Song, Korea Cancer Center Hospital Department of Orthopedic Surgery 215-4, Gongneung-dong, Nowon-gu Seoul 139-706 South KoreaJae-Soo Koh, Korea Cancer Center Hospital Department of Pathology Seoul South KoreaJun Ah Lee, Korea Cancer Center Hospital Department of Pediatrics Seoul South KoreaJi Young Yoo, Korea Cancer Center Hospital Department of Radiology Seoul South KoreaDuk Seop Shin, Yeungnam University College of Medicine Department of Orthopedic Surgery Daegu South KoreaDae-Geun Jeon, Korea Cancer Center Hospital Department of Orthopedic Surgery 215-4, Gongneung-dong, Nowon-gu Seoul 139-706 South Korea Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Efficacy of an aiming device for the placement of distal interlocking screws in trochanteric fixation nailing

Abstract Introduction Locked intramedullary nailing continues to be the surgical treatment of choice for most long bone fractures. Performing distal interlocks can be a technical challenge. Free hand (FH) technique remains to be most popular. Radiation exposure, particularly to the surgeon still remains a concern with this technique. Method A prospective randomized analysis of 20 patients undergoing operative fixation with long trochanteric fixation nailing for intertrochanteric or subtrochanteric fractures was performed. The groups were randomized into (1) aiming arm group (AA) and (2) FH group by computer generated randomization technique. Two distal interlocking screws were placed in every case. Various parameters were analyzed including total operating time, distal interlocking time, total fluoroscopy time, distal fluoroscopy time and nail dimensions. The variables in two groups were compared to each other using Fischer’s exact test. Result The mean distal interlock time was 7.1 ± 2.4 and 12.1 ± 3.2 min for AA and FH techniques respectively. There was a 41.3% decrease in the distal interlock time with the device, which was statistically significant (P < 0.001). The distal interlock fluoroscopy time was 9.2 ± 4.9 and 28.9 ± 16.4 s with AA technique and the FH technique respectively. This 68.2% reduction in time taken for distal fluoroscopy was statistically significant (P < 0.001). However, the reduction in the total fluoroscopy time was statistically not significant. Conclusion The AA is very efficient and user friendly and also reduces the radiation exposure. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-008-0710-yAuthors Sreevathsa Boraiah, Hospital for Special Surgery Orthopedic Trauma Service 535 east 70th street New York NY 10021 USAJoseph U. Barker, Hospital for Special Surgery Orthopedic Trauma Service 535 east 70th street New York NY 10021 USADean Lorich, Hospital for Special Surgery Orthopedic Trauma Service 535 east 70th street New York NY 10021 USA Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Two-stage revision of infected hip arthroplasty using a shortened post-operative course of antibiotics

Abstract Introduction We present a series of 30 consecutive patients with 31 infected total hip arthroplasties treated by a single surgeon over a 4-year period in whom a shortened post-operative course of antimicrobial chemotherapy was used. Methods The treatment protocol consisted of a two-stage exchange with removal of infected components, insertion of an interim antibiotic eluting cement spacer and re-implantation of an extensively coated uncemented prosthesis on the femoral side. Systemic antibiotic treatment following each stage consisted of an abridged course of 5 days post-operative intra-venous administration followed by complete cessation of anti-microbial therapy. Results At a mean follow-up of 35 months (minimum 24 months), there were no cases of recurrent prosthetic infection and no patient had required revision for aseptic loosening or mechanical instability on the femoral side. The combination of effective-staged surgical joint debridement, a shortened post-operative course of systemic antibiotic treatment and an adequate latent period before re-implantation has led to encourage early results in this series of revised chronic hip joint prosthetic infections. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-008-0683-xAuthors Paul B. McKenna, Mid-Western Regional Orthopaedic Hospital Department of Orthopaedic Surgery Croom IrelandKeiran O’Shea, Mid-Western Regional Orthopaedic Hospital Department of Orthopaedic Surgery Croom IrelandEric L. Masterson, Mid-Western Regional Orthopaedic Hospital Department of Orthopaedic Surgery Croom Ireland Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Nonunion of distal radius fracture and distal radioulnar joint injury: a modified Sauvé–Kapandji procedure with a cubitus proradius transposition as autograft

Abstract The Sauvé–Kapandji (SK) procedure is indicated in distal radius nonunion or malunion and distal radioulnar joint (DRUJ) instability. It can also be used to treat the rheumatoid wrist with severe degenerative changes in the DRUJ. The main objective is to allow a pain-free range of movement. We present a patient with rheumatoid arthritis and distal radius nonunion who, after three operations, was treated with the SK procedure. The clinical and radiological results were excellent. A 53-year-old woman diagnosed with rheumatoid arthritis fell on her forearm at home 2 years ago. Examination at an outpatient clinic revealed a distal radius fracture classified as type V according to the Frykman classification. She had been operated three times with open reduction internal fixation using a plate, screws, and bone allograft. She came to our institution with a distal radius nonunion, positive post-traumatic ulnar variance, and ulnar nerve paresis. The range of movements was 20°–10° flexion-extension and 40°–30° pronation–supination, and she needed daily fentanyl. We performed a modified SK procedure with an autologous iliac crest bone graft and ulnar bone graft from the osteotomy area (cubitus proradius), bone morphogenetic protein, and a low profile distal radius plate. After 1 year of follow-up, the distal radius fracture has healed and the wrist is pain-free with a complete range of movement in flexion-extension and pronation-supination. The main indication for the SK procedure is post-traumatic positive ulnar variance and associated ulnocarpal impaction. The cubitus proradius bone graft transposition is an interesting technical note that makes this case a challenge for skilled orthopedic hand surgeons. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-008-0708-5Authors Angel Villamor, IQTRA Medicina Avanzada Orthopaedic Department Madrid SpainAntonio Rios-Luna, Hospital Virgen del Mar Orthopaedics and Traumatology Department Bayárcal 22, 1º 1, El Ejido Almería SpainManuel Villanueva-Martínez, HGU Gregorio Marañón Orthopaedic Department Madrid SpainHomid Fahandezh-Saddi, Hospital De Alcorcón Orthopaedic Department Madrid Spain Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Fibula and tibia fusion with cancellous allograft vitalised with autologous bone marrow: first results for infected tibial non-union

Abstract Background and aims Autogenous bone grafting has been used in reconstructing bone defects and in stimulating fracture healing, producing high healing rates in the treatment of infected tibial non-unions. A novel therapeutic alternative is now available known as “vitalised allograft”, a cancellous bone graft procured from femoral heads from living human donors and “vitalised” through the injection of autologous bone marrow. The aim of this study is to summarise the initial results of the fibula and tibia fusion using vitalised cancellous allograft in the treatment of infected tibial non-unions. Patients and methods We initiated a follow-up of 15 prospective non-randomized patients who received a vitalised allograft in the treatment of infected tibial non-unions in order to produce bony union. The patients included 13 men and 2 women with an average age of 48 years. All patients received a multi-stage surgical approach. After establishing an infection-free environment, allogenic cancellous bone grafting was performed, intended as the final surgical procedure in fibula and tibia fusion. Our follow-up included a clinical and radiographic investigation of the calf in four planes. We analysed union-rate and time required for bony consolidation, as well as recurrent infections, re-fractures, potential graft-resorption, and time needed for graft and bone remodelling. Results With an average follow-up of 17.1 months, infection control was obtained in 14 of 15 patients, producing an infection arrest rate of 93.3%. Radiographs indicated consolidation in 11 out of 15 cases, with a union rate of 73.3%. Bone union was achieved on average in 17.1 weeks. Conclusions Fibula and tibia fusion with allogenic cancellous bone grafting, vitalised through autogenic bone marrow, could well become an innovative treatment option for infected tibial non-unions. We need, however, to analyse a higher number of cases over a longer follow-up period in order to assess more accurately recurrent infections and re-fractures. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-008-0699-2Authors Atesch Ateschrang, Berufsgenossenschaftliche Unfallklinik Tübingen der Eberhard-Karls Universität Tübingen, Abteilung für Unfall- und Wiederherstellungschirurgie Schnarrenbergstr. 95 72076 Tübingen GermanyBjörn Gunnar Ochs, Berufsgenossenschaftliche Unfallklinik Tübingen der Eberhard-Karls Universität Tübingen, Abteilung für Unfall- und Wiederherstellungschirurgie Schnarrenbergstr. 95 72076 Tübingen GermanyMartin Lüdemann, Orthopädische Universitätsklinik Tübingen Hoppe-Seyler-Str. 3 72076 Tübingen GermanyKuno Weise, Ärztlicher Direktor und Ordinarius für Unfallchirurgie der Berufsgenossenschaftlichen Unfallklinik Tübingen der Eberhard-Karls Universität Tübingen Schnarrenbergstr. 95 72076 Tübingen GermanyDirk Albrecht, Berufsgenossenschaftliche Unfallklinik Tübingen der Eberhard-Karls Universität Tübingen, Abteilung für Unfall- und Wiederherstellungschirurgie Schnarrenbergstr. 95 72076 Tübingen Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

The efficacy of Biobon™ and Ostim™ within metaphyseal defects using the Göttinger Minipig

Abstract Introduction To compare bio, osteocompatibility, rate of resorption and remodeling dynamics of two clinically used bone substitutes. Materials and methods In a randomized fashion Biobon™ and Ostim™ were implanted bilaterally into the proximal metaphyseal tibiae of 18 Göttinger Minipigs in a direct right versus left “intra-individual” comparison. Fluorescent labelling was used. Microradiographic, histological and morphometric evaluation was carried out at 6, 12 and 52 weeks. Results Both bone substitutes showed good biocompatibility, bioactivity and osteoconductivity. The degradation dynamics of both materials differed. Degradation of Ostim™ stopped after 6 weeks postoperatively, whereas Biobon™ was degraded slowly but evenly over the time intervals. Only at 6 weeks a significant (P < 0.05) difference in resorption rate was detected. Both Biobon™ and Ostim™ showed incomplete resorption after a year. Conclusion After 1 year no “restitutio ad integrum” could be observed in either group. Similar to ceramics, a thorough osseous incorporation seemed to inhibit further degradation of both bone substitute materials. Content Type Journal ArticleCategory Basic ScienceDOI 10.1007/s00402-008-0705-8Authors Christian K. G. Spies, Universitätsklinikum Aachen Klinik für Orthopädie und Unfallchirurgie Pauwelsstr. 30 52074 Aachen GermanyStefan Schnürer, Ruprecht-Karls Universität Heidelberg Orthopädische Universitätsklinik Schlierbacher Landstr. 200a 69118 Heidelberg GermanyTobias Gotterbarm, Ruprecht-Karls Universität Heidelberg Orthopädische Universitätsklinik Schlierbacher Landstr. 200a 69118 Heidelberg GermanySteffen Breusch, The Royal Infirmary of Edinburgh at Little France Department of Orthopaedics Edinburgh University Old Dalkeith Road Edinburgh EH16 4SU UK Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Intramedullary screw fixation in proximal fifth-metatarsal fractures in sports: clinical and biomechanical analysis

Abstract Introduction and purpose Intramedullary screw fixation (ISF) of proximal fifth-metatarsal fractures is known as first treatment option in young, sports active patients. No study analyzed functional and biomechanical outcome before. Hypothetically ISF leads to (1) a high bony union rate within 12 weeks, (2) normal hindfoot eversion strength, and (3) normal gait and plantar pressure distribution. Methods Fourteen out of 22 patients were available for follow-up with an average follow-up of 42 months; clinical and radiological follow-up, and biomechanical evaluation by isometric muscular strength measurement (inversion, eversion strength) and dynamic pedobarography, comparing to the non-affected contralateral foot. Level of significance: 0.05. Results Subjective result: Excellent or good result in 14 patients, none fair or poor. AOFAS midfoot score: 100 points in 13 patients and 87 points in 1 patient. The same sports activity level (0–4) was reached in 13 out of 14 patients. Radiologic examination: consolidation after 6 weeks in 9 patients and after 12 weeks in another 4 patients, one partial union. Average maximal eversion strength 59 N (ratio to the contralateral foot: 0.92, not significant). Dynamic pedobarography showed ratios of 0.99–1.01 to the contralateral side for ground reaction force, ground peak time, peak pressure and contact area (not significant). Interpretation A very-high patient-satisfaction, a fast bony healing and complete return to sports were documented. Muscular strength measurement and dynamic pedobarography showed complete functional rehabilitation. Therefore, ISF in proximal fifth-metatarsal fractures can be recommended as a secure procedure. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-008-0709-4Authors André Leumann, University Hospital of Basel Orthopaedic Department, Lower Extremity Orthopaedics Spitalstr. 21 4031 Basel SwitzerlandGeert Pagenstert, Kantonsspital Liestal Orthopaedic Department Liestal SwitzerlandPeter Fuhr, University Hospital of Basel Neurologic Department Basel SwitzerlandBeat Hintermann, Kantonsspital Liestal Orthopaedic Department Liestal SwitzerlandVictor Valderrabano, University Hospital of Basel Orthopaedic Department, Lower Extremity Orthopaedics Spitalstr. 21 4031 Basel Switzerland Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Parecoxib has non-significant long-term effects on bone healing in rats when administered for a short period after fracture

Abstract Introduction Selective and non-selective cyclo-oxygenase (COX) inhibitors impair bone healing by inhibiting prostaglandin synthesis. The purpose of this study was to evaluate the long-term effect of parecoxib, a selective COX-2 inhibitor, on bone healing in rats, when it is applied in a pattern similar to clinical treatment patterns, that is, in a high dose and for a short period after bone fracture. Method Closed non-displaced mid-diaphyseal fractures in the middle of the left femoral shaft were generated in each animal. In the study group, parecoxib sodium (1.06 mg/kg) was administered intra-peritoneally every day for 7 days. In the control group, normal saline was administered intra-peritoneally every day for 7 days. In both groups fracture healing (bone union and callus formation) was evaluated with X-rays 28 and 42 days after surgery. Results Bone healing was lower in the study group (60 vs. 80% in the control group 28 days after fracture and 80 vs. 90% 42 days after fracture) but this difference was not statistically significant (P > 0.05). Conclusion Parecoxib does not have a significant long-term effect on bone healing in rats, when it is administered in a high dose and for a short period after bone fracture. Content Type Journal ArticleCategory Basic ScienceDOI 10.1007/s00402-008-0707-6Authors Panagiotis Akritopoulos, Aristotle University of Thessaloniki Department of Pharmacology, Medical School Thessaloniki GreeceParaskevi Papaioannidou, Aristotle University of Thessaloniki Department of Pharmacology, Medical School Thessaloniki GreeceIppokratis Hatzokos, Aristotle University of Thessaloniki 1st Department of Orthopaedics, Medical School Thessaloniki GreeceAfroditi Haritanti, Aristotle University of Thessaloniki Department of Radiology, Medical School Thessaloniki GreeceEirini Iosifidou, Aristotle University of Thessaloniki 1st Department of Orthopaedics, Medical School Thessaloniki GreeceMaria Kotoula, Aristotle University of Thessaloniki Department of Pharmacology, Medical School Thessaloniki GreeceVassiliki Mirtsou-Fidani, Aristotle University of Thessaloniki Department of Pharmacology, Medical School Thessaloniki Greece Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Bilateral atlas laminar hook combined with transarticular screw fixation for an unstable bursting atlantal fracture

Abstract Introduction The unstable atlas burst fracture (“Jefferson fracture”) is a fracture of the anterior and posterior atlantal arch with rupture of the transverse atlantal ligament and an incongruence of the atlanto-occipital and the atlanto-axial joint facets. The posterior atlantoaxial fusion is frequently used to reconstruct the stability of atlantoaxial joint. Conventional posterior atlantoaxial fixations are associated with high rates of pseudoarthrosis and chronic atlantoaxial instability. As a modified three-point fixation the bilateral C1-2 transarticular screws combined with C1 laminar hook and bone grafts can provide best biomechanical stability, but no standard protocol has been reported for the use of this fusion technique. A retrospective review of clinical series should be conducted to evaluate the clinical outcome of bilateral atlas laminar hook combined with transarticular screw fixation for unstable bursting atlantal fracture. Materials and methods From March 2002 to March 2006, there were total 12 cases of unstable atlantal bursting fractures, 10 males and 2 females, age ranging 18–54, with mean of 36 years old. All patients were operated on posterior atlantoaxial fusion using bilateral atlas laminar hook combined with transarticular screw fixation after atlantoaxial joint were reduced and followed up for 12–24 months. The medical records and radiographs of the 12 patients were reviewed. Each patient underwent a complete cervical radiograph series including lateral flexion-extension view and a computed topographic scan. The Frankel grades and ASIA scores were applied to assess the neurologic status. Results In all patients, a good bony fusion of the atlanto-axial segment was achieved. All patients showed significant improvement of the neurologic defect and no instability on their follow-up plain radiographs and computerized tomography in follow-up interval. Conclusions For the patients who suffer from the unstable bursting atlantal fracture, the nonoperative methods could carry some clinical complications including infection, nerve injury, etc. and is frequently failure, Posterior atlantoaxial fusion using bilateral atlas laminar hook combined with transarticular screw fixation is an effective treatment. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-008-0706-7Authors Xiang Guo, Changzheng Hospital Department of Orthopaedics 415 Fengyang Road, Huangpu District Shanghai People’s Republic of ChinaBin Ni, Changzheng Hospital Department of Orthopaedics 415 Fengyang Road, Huangpu District Shanghai People’s Republic of ChinaMingfei Wang, Changzheng Hospital Department of Orthopaedics 415 Fengyang Road, Huangpu District Shanghai People’s Republic of ChinaJian Wang, Changzheng Hospital Department of Orthopaedics 415 Fengyang Road, Huangpu District Shanghai People’s Republic of ChinaSongkai Li, Changzheng Hospital Department of Orthopaedics 415 Fengyang Road, Huangpu District Shanghai People’s Republic of ChinaFengjin Zhou, Changzheng Hospital Department of Orthopaedics 415 Fengyang Road, Huangpu District Shanghai People’s Republic of China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051