Functional outcome of wide resection and autologous avascular proximal fibular graft arthroplasty in distal radius GCT

Background: Giant cell tumor (GCT) of distal radius usually presents in late stages with aggressive progression. Extended curettage alone is usually inadequate and wide resection is the most common surgery performed. Reconstruction of the resulting defect poses significant challenges.Methods: 11 patients with distal radius GCT treated with wide resection and autologous avascular proximal fibular graft arthroplasty were studied retrospectively. One patient was Campanacci grade II and the rest 10 were Campanacci grade III. All patients underwent a standard preoperative workup and underwent a standard procedure. Patients were followed up for a mean period of 33 months (range: 1 year–7 years). Wrist movements were documented and functional outcome was scored using revised musculoskeletal tumor society scoring (MSTS).Results: Of the 11 patients, eight had excellent outcome, two had good outcome and one had satisfactory outcome according to MSTS scoring. Mean dorsiflexion, palmar flexion, supination and pronation was 44 degrees (range 10-80), 34 degrees (range 10-70), 60 degrees (range 20-80), 54 degrees (range 15-70) respectively. The complications encountered were fibulo-ulnar diastasis in 3 patients, fibulo-carpal subluxation in 2 patients, soft tissue recurrence in 1 patient and graft site non-union in 1 patient. Despite fibula-ulnar and fibula-carpal instability functional outcomes were seen to be excellent (4 patients) or good (1 patient).Conclusions: Avascular autologous proximal fibular arthroplasty provides for excellent to good functional outcomes after wide resection in distal radius GCT even if radiological appearances are suboptimal

Incidence and management of incidental durotomy during thoracic and lumbar spine surgeries: a retrospective review in a tertiary care centre

Background: Incidental durotomy is among the most common complications of spine surgery with reported incidence ranging from 1.7% to 16%. Various management options including primary repair, fascial or fat graft, epidural blood patch, fibrin glue sealant, etc., have been proposed. The purpose of this study is to evaluate the incidence of incidental durotomy and the efficacy of different management options during a five year period at a tertiary care center.Methods: All patients who underwent various surgical procedures in thoracic and lumbar spine from January 2006 - December 2010 in our centre were retrospectively reviewed. Data on demographics, primary diagnosis, associated co morbidities, details of surgical procedure, training level of the operating surgeon, details of the incidental durotomy, the treatment, complications and the postoperative stay were recorded.Results: Of 2270 patients, 1401 patients were included in the study. The incidence of incidental durotomy was 3.49% (49 patients). We found a very high incidence of 33.33% incidental durotomies among patients who underwent revision procedures as compared to 3.23% for patients who underwent primary surgeries. 5.10% of incidental durotomies were caused by fellows under training, 4.27% by junior consultants and 2.92% by senior consultants. Of 49 durotomies, complication were 5 cases of intracranial hypotension, 5 postoperative neurological deficits, 2 deep wound infection, 2 pseudomeningocele and 1 meningitis.Conclusions: The risk of incidental durotomy in thoracolumbar surgeries is high in revision surgeries and when performed by fellows in training. Intraoperative identification and primary repair with suturing or sealant reduces postoperative complications

The “Skipped Segment Screw” Construct: An Alternative to Conventional Lateral Mass Fixation–Biomechanical Analysis in a Porcine Cervical Spine Model

Study DesignCadaveric biomechanical study.PurposeWe compared the “skipped segment screw” (SSS) construct with the conventional “all segment screw” (ASS) construct for cervical spine fixation in six degrees of freedom in terms of the range of motion (ROM).Overview of LiteratureCurrently, no clear guidelines are available in the literature for the configuration of lateral mass (LM) screwrod fixation for cervical spine stabilization. Most surgeons tend to insert screws bilaterally at all segments from C3 to C6 with the assumption that implants at every level will provide maximum stability.MethodsSix porcine cervical spine specimens were harvested from fresh 6–9-month-old pigs. Each specimen was sequentially tested in the following order: intact uninstrumented (UIS), SSS (LM screws in C3, C5, and C7 bilaterally), and ASS (LM screws in C3–C7 bilaterally). Biomechanical testing was performed with a force of 2 Nm in six degrees of freedom and 3D motion tracking was performed.ResultsThe two-tailed paired t-test was used for statistical analysis. There was a significant decrease in ROM in instrumented specimens compared with that in UIS specimens in all six degrees of motion (p<0.05), whereas there was no significant difference in ROM between the different types of constructs (SSS and ASS).ConclusionsBecause both configurations provide comparable stability under physiological loading, we provide a biomechanical basis for the use of SSS configuration owing to its potential clinical advantages, such as relatively less bulk of implants within a small operative field, relative ease of manipulating the rod into position, shorter surgical time, less blood loss, lower risk of screw-related complications, less implant-related costs, and most importantly, no compromise in the required stability needed until fusion

An Unusual Complication in Osteonecrosis of Femoral Head: A Case Report

We report a case of fracture of femoral head occurring in the setting of underlying osteonecrosis following a low-energy trauma in a middle-aged male. Patient also has underlying pelvic pathology from a previous trauma. The possible mechanism of injury is discussed. Extensive literature search reveals that this is the first report of a fracture in an osteonecrotic femoral head