Management of spine trauma in COVID-19 pandemic: A preliminary report

Background: COVID-19 was first identified in Iran in February 2020 and since then it spread rapidly through all over the country and soon after that it was reported as a pandemic. The current study presents a preliminary report of spine trauma management during COVID-19 pandemic. Methods: A cross sectional study was designed to evaluate patients admitted for vertebral fractures with diagnosis of COVID-19 infection on February and March 2020. Analysis was made based on clinical and laboratory data along with the imaging findings from chest HRCT. Results: Seven patients with spine trauma including five males and two females ranging from 14 to 59 years were diagnosed for COVID-19 infection through CT-scan findings. Except one, all other patients were asymptomatic for COVID-19 at the time of admission. In three cases the COVID diagnosis was made the day after arrival and in others after 10, 14 and 35 days. Five patients were treated surgically among whom four were admitted to ICU soon after the surgery. The mean ICU stay for operated patients were eight days and the mean hospital stay was 22.6 days. Conclusion: Proper diagnosis of COVID-19 is the keystone to protect both patients and health care providers. During the pandemic all admitted patients should be screened for COVID-19 infection. Unnecessary procedures for spine trauma patients should be avoided in order to reduce complications related to surgery and to preserve ICU beds. © 2020 BY THE ARCHIVES OF BONE AND JOINT SURGERY

Single-level anterior cervical discectomy and interbody fusion using PEEK anatomical cervical cage and allograft bone

BACKGROUND: In an effort to avoid the morbidity associated with autogenous bone graft harvesting, cervical cages in combination with allograft bone are used to achieve fusion. The goal of the current study was to assess the reliability and efficacy of anterior cervical discectomy and interbody fusion (ACDF) using a PEEK anatomical cervical cage in the treatment of patients affected by single-level cervical degenerative disease. METHODS AND MATERIALS: Twenty-five patients affected by single-level cervical degenerative pathology between C4 and C7 were enrolled in this study. The clinical findings were assessed using the Neck Disability Index and the Visual Analog Scale. Surgical outcomes were rated according to Odom's criteria at last follow-up. Fusion was graded as poor, average, good or excellent by assessing the radiographs. Cervical spine alignment was evaluated by sagittal segmental alignment and sagittal alignment of the whole cervical spine preoperatively, 6 months postoperatively and at the last follow-up. RESULTS: Twenty-five patients underwent ACDF using a PEEK anatomical cervical cage. All patients had a minimum 2 years of follow-up. The operative levels were C4-C5 in 5 patients, C5-C6 in 12 patients and C6-C7 in 8 patients. Preoperatively, average NDI was 34, 13 at 6 months, and 10 at latest follow-up. The mean preoperative VAS was 7; the mean postoperative VAS at latest follow-up was 3. Good or excellent fusion was achieved in all patients within 10 months (mean 5 months). Preoperatively, average sagittal segmental alignment (SSA) was 0.2\ub0 and average sagittal alignment of the cervical spine (SACS) 15.8\ub0. Six months after surgery, average SSA was 1.8\ub0 and average SACS 20.9\ub0, and at last follow-up, average SSA was 1.6\ub0 and average SACS 18.5\ub0. CONCLUSION: Anterior cervical discectomy and interbody fusion using PEEK anatomical cervical cages can be considered a safe and effective technique to cure cervical disc herniation with intractable pain or neural deficit in cases where conservative treatment failed

Congenital hip dysplasia treated by total hip arthroplasty using cementless tapered stem in patients younger than 50 years old: results after 12-years follow-up

Background Congenital hip dysplasia may lead to severe acetabular and femoral abnormalities that can make total hip arthroplasty a challenging procedure. We assessed a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using cementless tapered stem and here we report the outcomes at long-term follow-up. Materials and methods Twenty-eight patients (24 women and 4 men) aged between 44 and 50 years (mean 47 years) were observed. Clinical evaluation was rated with the Harris Hip Score. Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowe’s classification, 16 hips presented dysplasia grade 1, 14 grade 2, and 4 grade 3. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis). Six patients were operated bilaterally, with a totally of 34 hips operated. After surgery, the patients were clinically and radiographically checked at 3, 6, and 12 months and yearly thereafter until an average follow-up of 12 years (range 10–14 years). Results Average Harris Hip Score was 56 ± 9 (range 45–69) preoperatively, 90 ± 9 (range 81–100) 12 months after surgery, and 91 ± 8 (range 83–100) at last follow-up. Radiographic evaluation demonstrated excellent osteointegration of the implants. Signs of bone resorption were present in 6 hips, nevertheless no evidence of loosening was observed and none of the implants has been revised. Conclusions Even in dysplasic femur, the tapered stem allowed adequate stability and orientation of the implant. We consider tapered stem a suitable option for total hip arthroplasty in developmental hip dysplasia, also in case of young patients, thanks to the favourable long-term results

Art. 1.1475/ringraziamenti

Abstract. -We describe a case of isolated proximal tibiofibular joint dislocation in a 20 years old girl following trauma. Dislocation was reduced through a new and simple reduction technique after failure of classic reduction maneuver. This technique by using isokinetic movements lead to relax the fibular collateral ligament and allow the biceps tendon to snap the proximal end of the fibula back into the anatomical position. This technique propose simple maneuver to reduce isolated proximal tibiofibular joint dislocation. Key Words: Isolated proximal tibiofibular joint dislocation. Introduction Isolated proximal tibiofibular joint dislocation (PTFD) is associated with a severe twisting, inversion and plantar flexion of the foot, simultaneously with knee flexion and external rotation of the leg 1,2 ; it may also occur following direct high energy trauma to the knee 1,3,4 . Dislocation of the proximal end of the fibula is not always an isolated injury, as it is usually described. According to the literature, it may be associated with tibial fractures, femoral-shaft or head fracture, dislocation of the knee, fibular fracture and anterior fracture-dislocation of the distal femoral epiphysis. The patient usually present with pain along the lateral side of the knee and leg. This could be elicited by direct pressure over the fibular head (pushing it either forward or medially). Antero-posterior radiographs of the knee usually show the proximal fibula and tibia overlain 5 . In the majority of the cases, comparison between anterior and lateral radiographs on the two knees helps to confirm the diagnosis of fibular head dislocation Classification Understanding the mechanism of dislocation and classifying it, are critical for diagnosis, manage- . Type III -Posteromedial; this occurs in 10% of the cases and is frequently associated with direct trauma to the fibular head Most of these anterolateral dislocations occurred during athletic activity (especially violent, twisting motion). Several were associated with other skeletal injury: type-IV fracture-dislocation of the hip, crush injury of the proximal and distal ends of the tibia, fracture-dislocation of the ankle, proximal tibial fracture and fracture-dislocation of the distal femoral epiphysis. Case Report Here we report a case of 20 years old girl, arrived to our attention for right knee pain following the breaking of the heel tip of her high heel shoes. The mechanism of trauma was inversion and plantar flexion of the foot with simultaneous knee flexion and external rotation of the leg. She presented a 2014; 18(Suppl 1): [93][94][95

Use of homologous bone graft in the treatment of aseptic forearm nonunion

The dyaphyseal nonunion of forearm bones is a complication that changes the normal interaction between radius and ulna, which may lead to forearm malfunction. We reviewed 14 patients treated by surgical technique included a homologous bone graft in combination with a plate. The mean age was 31 years (range, 18-45 years) at the time of surgery. Minimum follow-up was 2 years (mean, 5 years; range, 2-13 years). There were no intraoperative or postoperative complications. At last follow-up, all forearm bones had remodelled. The mean visual analogue pain scale was 1 (range, 0-4). There was a high success rate regarding forearm alignment and functional results; all patients recovered daily and working activities quickly. This surgical technique in treatment of aseptic forearm nonunion by combining homologous bone graft with a plate led to bone healing, improved forearm function, and a durable outcome with long-term follow-up

Cuboid osteotomy associated with plantar medial release in severe untreated clubfoot

The idiopathic congenital clubfoot or equinovarus consists of a deformity of the foot in equinus, varus and supination, that appears at birth. If it is detected until 3 years of age, the deformity can be successfully treated conservatively; if it is detected until 6 years, it can be treated by plantar medial release. If the deformity is observed later, it is usually more stiff and non reducible: the lateral column of the foot (calcaneous and cuboid) grows faster than the medial column (talus, navicular and cuneiform). The aim of this video is to show the treatment of neglected congenital equinovarus by plantar medial release associated with cuboid osteotomy in a 6 Y/O patient. In neglected congenital equinovarus in patients from 6 years of age, the posterior and medial tendons and capsules are retracted; the correction consists in lengthening of medial and posterior tendons, associated with the talonavicular capsulotomy. On the lateral aspect, by an oscillating saw, the osteotomy of the cuboid bone is performed. A little wedge with the base on the supero-lateral aspect is removed. The wedge osteotomy of the cuboid bone will lead to the shortening of the lateral column; this process permits the complete reduction of the varus and the adduction deformity of the foot. In neglected congenital equinovarus in patients from 6 years of age, the posterior and medial tendons and capsules are retracted, and the lateral column is longer than the medial; the plantar medial release associated with cuboid osteotomy is a good technique to correct the deformity without stiffness of the joints. The young patient can regain the neutral position of the foot; so he can wear shoes, stand up and walk correctly

Pedicle screw insertion techniques: an update and review of the literature

Pedicle screw construct have become one of the most practiced procedure in spinal surgery. Despite commonly used, questions remain about their safety especially for the thoracic spine and in deformity where difficulty in positioning can lead to pedicle breach and adjacent structures injury. Misplacement rates have been reported to be from 5 to 41% in the lumbar spine and from 3 to 55% in the thoracic spine. Hence, various procedures have been described in order to improve pedicle screw insertion accuracy. Aim of this study is to evaluate current concepts on pedicle screws placement techniques to better understand recent attitude and clarify some doubts when selecting the most proper method

Single level cervical fusion by an anterior approach using autologous bone graft influences the adjacent levels degenerative changes: clinical and radiographic results at 10-year minimum follow-up.

Introduction Cervical degenerative pathology can produce pain and disability and, in case of failure of conservative treatment surgery is indicated. Materials and methods 107 patients affected by single level cervical degenerative pathology were surgically treated by Cloward procedure. On radiographs, the sagittal segmental alignment (SSA) of the affected level and sagittal alignment of the cervical spine were measured. Results Preoperatively, mean SSA was 0.6° and at the last follow-up 1.8°. In particular, adjacent-level degeneration occurred more frequently in Group A than in Group B. Conclusion Lordotic SSA angle can be considered a protective factor against adjacent-level degeneration

Unilateral Transforaminal Posterior Lumbar Interbody Fusion.

Several lumbar interbody fusion techniques were described to eliminate motion and restore physiological lordosis in case of severe spinal stenosis, degenerative scoliosis, spondilolistesis or instability. The aim of this scientific exhibit is to describe the unilateral transforaminal posterior lumbar interbody fusion (UTPLIF) in a series of 54 patients. Clinical evaluation of pain associated with MRI, CT-scan and plain films of the lumbar spine were used to decide the extension of the posterior stabilization, the levels and the side of interbody fusion. Twelve patients were operated at 1 level, 27 at 2 levels, 15 at 3 levels or more. Through a standard posterior approach to the lumbar spine, pedicle fixation was performed and the segment was placed in distraction. Through a unilateral transforaminal approach discectomy was performed and a PEEK (poli-ether-ether-ketone) cage filled with autologous bone graft was implanted and placed in compression by pedicle fixation with the aim of restore the physiological lordosis maintaining open the neuroforamina. Mean follow-up time was 5 years. No general complications were observed. Three dural tears occurred. Preoperative segmental lordosis was 10\ub0\ub17 and at follow-up was 19\ub0\ub18 (p=0,05). Mean VAS score was 7.5\ub13 preoperatively and 2.9\ub12 (p<0.005) at follow-up. Thirty patients were scored as excellent, 17 good, 5 fair and 2 poor. UTPLIF is an effective procedure for the treatment of severe lumbar stenosis and instability, consequent of different spinal disorders. A precise evaluation of clinical symptoms and a strict correlation with imaging, is crucial in order to plan a correct surgical treatment