Functional Outcome Of Surgical Treatment Research Articles

Diaphyseal humeral fractures: A prospective study on the functional outcome of surgical treatment by open reduction and internal plate fixation technique

Diaphyseal humeral fractures: A prospective study on the functional outcome of surgical treatment by open reduction and internal plate fixation technique

Functional outcome following surgical management of proximal humerus fracture in elderly

Proximal humerus fracture accounts to about 4-5% of all the fractures and is the third most common fracture in the elderly population. Though several modalities of treatment exist there are no clear guidelines or consensus to the optimal method of treatment of these fractures especially in the elderly population. This study was based in a tertiary hospital with the objectives to assess the functional outcome of surgical treatment of proximal humerus fractures in the elderly population. Patients with proximal humerus fracture aged above 51 years and fulfilling the inclusion criteria were included in the study. The fractures were classified using Neer’s classification of proximal humerus fracture. Patients were treated surgically by [ORIF] and post-operatively limb is immobilized in arm pouch; mobilization was started at the second week as per patient’s tolerance. Patients were then followed up at 3 months, 6months and 12 months.They were assessed for functional outcome using Constant scoring system [Pain, activities of daily living and range of motion]. A total of 37 patients were included in the study. The mean age of the patients was 65.2 years. The study included 18 2-part fracture, 11 3-part fractures and 8 4-part fracture. The mean Constant score at 12-month follow-up in 2-part fracture was 66.2, in 3-part fracture was 59 and in 4-part fracture was 51.4. The overall mean Constant score was 60.2. In conclusion we areof opinion that treatment of proximal humerus fractures in the elderly population is a challenge and one should not deny them a good functional outcome. Patients with 2-part fracture fared better and has a satisfactorily good functional outcome. Whereas in 3-part and 4-part fractures the outcomes do not vary significantly and patients with 4-part fracture had higher incidence of surgery related complication.

FUNCTIONAL RESULTS OF SURGICAL TREATMENT OF CERVICAL SPONDYLOTIC MYELOPATHY

ABSTRACT Objective: To analyze the functional outcome of surgical treatment of cervical spondylotic myelopathy. Methods: A retrospective study involving 34 patients with CSM, operated from January 2014 to June 2015. The neurological status was assessed using the Nurick and modified Japanese Orthopedic Association (mJOA) scales preoperatively and at 12 months. Sex, age, time of evolution, affected cervical levels, surgical approach and T2-weighted magnetic resonance hyperintense signal were also evaluated. Results: A total of 14 men and 20 women participated. The mean age was 58.12 years. The average progression time was 12.38 months. The preoperative neurological state by mJOA was mild in 2 patients, moderate in 16 and severe in 16, with a mean of 11.44 points. The preoperative Nurick was grade II in 14 patients, grade III in 8, grade IV in 10 and grade V in 2. The T2-weighted hyperintense signal was documented in 18 patients (52.9%). The functional outcome according to the mJOA recovery rate was good in 15 patients (44.1%) and poor in 19 (55.9%). The degree of Nurick recovery was good in 20 (58.8%) and poor in 14 (41.2%). Conclusions: Decompressive surgery of the spinal cord has been shown to be effective in the treatment of cervical spondylotic myelopathy in well-selected patients. Although it is suggested that there are certain factors that correlate with functional outcome, we believe that more prospective randomized studies should be conducted to clarify this hypothesis.

Study of functional outcomes of surgical treatment of tuberculosis of spine with debridement and spinal fixation

Background: Spinal tubercular infection is the most common and dangerous form of skeletal tuberculosis. It constitutes 1/3 to 1/2 of all bone and joint tuberculosis. Even today tb spine is a life threatening condition inspite of advances in diagnostic procedure surgical techniques and effective tuberculostatic drugs. Delay in establishing diagnosis and surgically reliving the spinal cord compression can lead to progression of neurological deficit and spinal deformity thereby diminishing the likelihood of recovery. The goals of surgery in Pott's spine are adequate decompression, adequate debridement, maintenance and reinforcement of stability and correction and prevention of deformity. The aim of present study is to evaluate the clinical, radiological and functional outcome of surgical treatment of tuberculosis of spine. The aim of present study is to evaluate the clinical, radiological and functional outcome of surgical treatment of tuberculosis of spine. Materials and Methods: All patient with tubeculosis of spine treated surgically at NCH, Surat using various operative methods were evaluated during the hospital stay and the clinical, radiological and functional outcomes were assessed. Hematological investigation, Plain radiography, computerized tomography (CT), and magnetic resonance imaging (MRI) studies were conducted before surgery for all patients. Immediately post-surgery, routine lateral and anteroposterior radiographs were done to assess the extent of decompression and placement of graft and instrumentation. All patients were evaluated at 1, 3, 6, 9, and 12 months after surgery. At each followup evaluation, clinical examination, necessary hematological investigation and plain radiographic studies were obtained to determine the fusion status, development or progression of deformity after surgery, and instrumentation failure. Final fusion assessment done according to Bridwell criteria. Neurological deficit graded according to Frankel system. Pain assessed according to the following scale: Severe, moderate, mild, and no pain. Functional outcome assessed according to Prolo scale. Results: Mean age of the paients was 39 years with maximum numbers of the patients belonging to the age group of 20-40 years. 5 patients recovered from Frankel A TO Frankel grade D, 1 patient recovered from grade B to grade E, 3 patients recovered from grade C to grade E, 2 patients recovered from grade D to grade E and 5 patients has retained Frankel grade E. Mean preoperative kyphosis was 30.5” (12-44) preoperatively, which was corrected to mean of 18” in immediate post-operative radiographs and at final follow up mean kyphotic angle was 20”. 5 (30%) had excellent outcome, 8 (48%) had good outcome, 3 (18%) patients had fair outcome and no patient had poor outcome. Conclusion: Spinal tuberculosis heals with sequelae of spinal deformities with consequent long term biomechanical consequences. Even if biological control of disease is achieved, the biomechanical damage of the skeleton keeps on adding morbidities and reduction in the functional performance in future life. Paraplegia is the most crippling neurological complication of spinal TB. In developing countries like India, we still see a significant proportion of patients with spinal TB presenting late after onset of disease with advanced paraplegia. Destruction of the vertebral body by the tuberculous foci will induce kyphosis deformity by collapse of vertebral body. Surgical treatment may be necessary when risk of kyphotic deformity is higher. For successful results, anterior radical surgical debridement of the tuberculous focus and the replacement with a bone graft was essential for correction of kyphosis. Operative procedures provide adequate and fast removal of the disease process, added stability to the diseased part of the spine, with additional reconstructive procedure provide an ideal environment for healing and fusion to take place rapidly and abundantly and additionally reduces the further chances of neurological compromise.

Effect of Sagittal Balance on Risk of Falling after Lateral Lumbar Interbody Fusion Surgery Combined with Posterior Surgery.

PurposeTo demonstrate the impact of correcting sagittal balance (SB) on functional outcomes of surgical treatment for degenerative spinal disease and actual falls via utilization of new minimally invasive lumbar fusion techniques via a lateral approach.Materials and MethodsFrom November 2011 to March 2015, we enrolled 56 patients who underwent minimally invasive lateral lumbar interbody fusion (LLIF) and matched 112 patients receiving decompression/postero-lateral fusion (PLF) surgery for lumbar spinal stenosis. According to SB status using C7-plumb line-distance (C7PL) and surgery type, patients were divided into three groups: SB PLF, sagittal imbalance (SI) PLF, and LLIF groups. We then compared their outcomes.ResultsThe mean C7PL was 6.2±13.6 mm in the SB PLF group, 72.9±33.8 mm in the SI PLF group, and 74.8±38.2 mm in the LLIF group preoperatively. Postoperatively, C7PL in only the LLIF group improved significantly (p=0.000). Patients in the LLIF group showed greater improvement in fall-related functional test scores than the SI PLF group (p=0.007 for Alternate-Step test, p=0.032 for Sit-to-Stand test). The average number of postoperative falls was 0.4±0.7 in the SB PLF group, 1.1±1.4 in the SI PLF group, and 0.8±1.0 in the LLIF group (p=0.041). Oswestry Disability Index and the Euro-QoL 5 dimension visual analogue scale scores also showed greater improvements in the LLIF group than in the SI PLF group at postoperative 1 year (p=0.003, 0.016).ConclusionSurgical correction of SI in patients with lumbar spinal stenosis using a combination of minimal invasive LLIF and posterior surgery achieved better surgical outcomes and a lower incidence of actual falls than PLF surgery.

Distal radius fractures-Design of locking mechanism in plate system and recent surgical procedures.

Recently, many studies have emphasized the importance of the comprehension of detailed functional anatomy of the distal forearm and wrist joint, and their biomechanics. A significant contribution which yields good functional outcomes of surgical treatment was the development of the locking plate technology; this technology has facilitated the improvement of the surgical technique for the fixation of fractures. This article reviews the locking mechanism and design of the fixation screws and plate, and the details of the surgical technique including the double-tired subchondral support procedure as it is applied to common fractures. Arthroscopic-assisted surgical procedures can be used to reduce the intra-articular fracture fragments after realignment of the distal radius with the locking plate. This technique is also useful at the time of fixation to assess soft tissue injury. The combination of arthroscopic-assisted reduction and locking plate fixation is now indicated for AO type C2 and C3 intra-articular comminuted fractures.

Systematic review of the articles devoted to hip and knee arthroplasty and published in Korean, Russian and Ukrainian journals over the 2005–2014 years

The aim: to identify the peculiarities of the study and publications concerning the hip and knee arthroplasty in the articles that were published in the major Korean, Russian and Ukraine orthopedic journals over the last decade. Methods: the authors studied 615 Korean and 361 Russian articles that were published Korean, Russian and Ukrainian journals («Clinics in Orthopedic Surgery», «Journal of the Korean Orthopaedic Association», «The Journal Hip & Pelvis», «The Journal Knee Surgery & Related Research», «Traumatology and orthopedics of Russia», «Reporter of Traumatology and Orthopedics named Priorov», «Genij Ortopedii», «Orthopaedics, Traumatology and Prosthetics») from 2005 to 2014 years. The articles were divided into three groups: 1st — hip arthroplasty, 2nd — knee arthroplasty, 3rd — the articles devoted to the general issues concerning both of theme. Statistical analysis was performed with SPSS software for Windows (version 20.0, SPSS Inc., Chicago, IL). Results: the authors revealed that among 615 Korean articles 305 papers (49.6 %) concerned hip arthroplasty, 288 (46.8 %) — knee arthroplasty and 22 (3.6 %) covered both topics or were based on the common questions of arthroplasty. The number of article surveying both hip and knee joints or the general problems of the arthroplasty were equal to 50 articles (13.8 %), hip arthroplasty — 235 articles (65%), knee arthroplasty — 76 articles (21.2 %) among of 361 articles in Russian database. There are some versatile features of studies depending upon the region. Implant and arthroplasty equipment peculiarities were mainly studied in the articles published in Russian journals, while the revision problems were fundamentaly studied in the articles published in Korean journals. Conclusions: the differences in the research topic and versatile features of hip and knee arthroplasty depending upon the country (Korea or Russia) were revealed. The accurate definition of the etiopathogenetic indications for hip and knee arthroplasty can provide better functional outcomes of surgical treatment and require further investigation.

INTRAMEDULLARY EPENDYMOMAS: LONG-TERM RESULTS OF SURGICAL TREATMENT

Objective. To study the long-term results of surgical treatment of intramedullary ependymomas. Material and Methods . Spinal ependymomas were detected in 91 (20.2 %) cases of a total number of operated patients. Intramedullary location of the tumor was diagnosed in 41 (45.0 %) patients. Ependymoma was benign in 78.1 % of cases and anaplastic in 9 cases (21.9 %). Radical removal of the tumor was achieved in 36 (87.8 %) patients, subtotal resection was performed in 5 cases (12.2 %). Results . Gross neurological symptoms persisted in the long-term period in 6 (24.0 %) patients. Structural changes in the spine associated with surgical intervention was found only in 12.0 % of cases, relapses and continued growth of the tumor - in 16.1 %. Early postoperative mortality was 4.8 % (2 patients out of 41 died). In the late postoperative period, four more patients died, so that the overall mortality was 14.6 %. Five-year survival rate of patients corresponded to 80.6 %. Conclusion . Radical surgery is an effective treatment for intramedullary ependymomas. The prognosis of intramedullary ependymoma may be considered as favorable in case of radical removal of the tumor, its benign nature, and good functional outcome of surgical treatment.

Traitement chirurgical des lésions de la coiffe des rotateurs du sujet de moins de 50 ans

BackgroundRotator cuff tears are classically considered to result from a degenerative process. Many studies have reported satisfactory outcome for surgical treatment in older patients. Information is scarce however on partial or total cuff repairs, using arthroscopic or open procedures, in younger populations. The purpose of this work was to analyze the literature on rotator cuff repair in patients aged less than 50 years. MethodsA bibliography search of Pubmed and Google scholar was conducted using the keywords “rotator cuff tears”, “rotator cuff repairs”, and “younger patients”. The last search was performed on April 15, 2014. Inclusion criteria were studies written in English or French, concerning chronic or acute cuff tears in patients aged less than 50 years, level of proof 1–4, and clinical results in at least 10 patients. Exclusion criteria were reviews of the literature, expert opinions, early studies published more than 15 years ago and non-clinical studies. The main endpoint was clinical outcome of rotator cuff repair in young subjects aged less than 50 years. ResultsTen studies published between 1999 and 2013 were retained. Together, these studies provided outcomes for 306 operated patients. Mean follow-up was 48 months (range 18–71). A good subjective outcome is reported in more than 85.3% of patients (range 55–97) who were satisfied or very satisfied. Patients were able to resume their occupational or sports activities in 91% of cases, within a mean delay of 4.8 months. ConclusionRotator cuff tears in young subjects are most often trauma or sports related. Male gender predominates. Functional outcome of surgical treatment of these lesions has been good.

儿童腓骨远端肿瘤的临床处理

目的：观察9例儿童腓骨远端肿瘤患者手术治疗后的临床疗效和功能评定。方法：2011年6月~2014年9月期间9例儿童腓骨远端肿瘤患者获得术后随访。PubMed搜索使用术语“腓骨”，“下肢肿瘤(癌症)”，“肉瘤”、“尤文氏肉瘤”、“腓骨的”、“腓骨转移”。结果：所有患者均为单侧病变并获得随访，平均随访3.6 ± 1.5年；所有患者诉有疼痛，其中9例患者中5例出现疼痛及跛行。除了1例接受放疗外其他患者均进行手术处理。在6位患者中，1例为良性的肿瘤或肿瘤样变。2例恶性肺腺癌转移及1例多病灶的间质肿瘤。腓骨治疗性病灶清除后进行植骨，然后进行内固定处理术后没有恶变。在恶性或活动期病变中进行腓骨瘤段切除。文献检索中无论是案例报告还是小案例系列，均反映出腓骨远端的肿瘤较为罕见。在所有良性病变患者中手术治疗是成功的，而恶性肿瘤的成功率为40%~100%。结论：腓骨远端肿瘤的发病率低，最佳手术治疗方案存在争议。无症状的良性病变应进行临床观察及定期影像学检查随访。在非恶性肿瘤出现疼痛，跛行，病理骨折及恶性肿瘤时建议手术治疗。最后，在无症状患者或疾病诊断不确定时应进行穿刺活检或病理组织学检查。 Objective: To study the clinical and functional outcomes of surgical treatment in a case series of nine patients with distal fibular tumours. Method: Nine patients with distal fibular tumours were followed up and observed between June 2011 and September 2014. A PubMed search was per-formed using the terms “fibula”, “lower limb tumour (cancer)”, “sarcoma”, “Ewing”, “peroneal”, “fibular metastasis”. Result: All cases were followed-up for 3.6 ± 1.5 years. In all our patients, lesions were unilateral. All patients complained of pain; limping was present in 5 of 9 patients. Patients were managed surgically, except one who underwent local radiotherapy. In six patients, a benign or tumor-like lesion was detected. Malignancies consisted of metastatic lung adenocarcinoma (two cases) or multifocal mesenchymal cancer (one case). Non-malignant lesions were treated by curettage and filling, followed by internal fixation when needed. In malignant or locally aggressive lesions, metadiaphyseal fibular resection was performed. The literature search retrieved either case reports or small case series, reflecting the rarity of distal fibular tumours. Surgical treatment was successful in all patients with benign lesions, whereas the rate of success was 40% - 100% in case of malignancies. Conclusion: Given the low incidence of distal fibular tumours, controversies exist about the optimal surgical management. Clinical observation and imaging should be reserved to asymptomatic benign lesions. In non-malignant tumours causing pain,, limping, and pathological fractures and malignancies, surgery is recommended. Finally, in patients with asymptomatic lesions of uncertain nature, biopsy and histological examination should be performed to plan appropriate management.

Hip Pathology in Majewski Osteodysplastic Primordial Dwarfism Type II

Majewski osteodysplastic primordial dwarfism type II (MOPDII) is characterized by severe prenatal and postnatal growth failure with microcephaly, characteristic skeletal dysplasia, an increased risk for cerebrovascular disease, and insulin resistance. MOPDII is caused by mutations in the pericentrin (PCNT) gene and is inherited in an autosomal-recessive manner. This study aimed to determine the incidence of hip pathology in patients with molecularly confirmed MOPDII and to describe the functional outcomes of surgical treatment. Thirty-three enrolled patients had a clinical diagnosis of MOPDII. Biallelic PCNT mutations or absent pericentrin protein was confirmed in 25 of these patients. Twelve patients (7 female) had appropriate clinical and radiographic records at this institution and were included in this study. The data collected included age at presentation, age at surgery, sex, body weight and height, weight-bearing status at diagnosis, and the clinical examination. Four patients (31%) had coxa vara: 3 unilateral and 1 bilateral. Three unilateral patients had in situ pinning at a mean age 4 years. The patient with bilateral coxa vara had valgus osteotomy at the age of 5 years. Two children had bilateral hip dysplasia and subluxation with no surgery. One patient had bilateral developmental hip dislocations. The patient was treated by open reduction-spica cast and 2 years after surgery, coxa valga was noted. Another patient was diagnosed at an age of 12 years with bilateral avascular necrosis of the hips. Four patients did not have hip pathology. Hip pathology is common among children with MOPDII; coxa vara is the most frequent diagnosis. Routine clinical and radiographic hip evaluation is important. The capital femoral epiphysis appears to slip down along the shaft, giving the appearance of a proximal femoral epiphysiolysis. A hip diagnosed with slipped capital femoral epiphysis in early life may progress to severe coxa vara. Level IV.

Total mesorectal excision with water‐jet dissection in patients with rectal cancer: surgical and morphological aspects

This publication will describe our own experience of using the ERBEJET2(®) water-jet dissector during surgical interventions for rectal cancer. We utilized the water-jet dissection technique to obtain tissue specimens in 10 patients with rectal cancer. All patients thus underwent nerve-sparing low anterior resection of the rectum along with para-aortic lymphadenectomy. No intraoperative complications were registered. The postoperative period went uncomplicated in all patients. No dysuria was observed. Obtained tissue specimens were examined morphologically. Macroscopic examination included assessments of the preservation of the rectal fascia propria and the amount of cellular tissue along the anterior, posterior, and lateral surfaces of the rectum. We performed microscopy of the circumferential resection margin to characterize the surgical clearance and the intensity and depth of damage to the mesorectal tissue. On morphological examination, the quality of mesorectal excision was found to be good (Grade 3) in all 10 patients. As the results of our study demonstrate, the depth of lateral tissue damage is minimal with the water-jet dissector. Water-jet dissectors have their own place in the long list of armamentarium used in surgical interventions performed for rectal cancer and contribute to improving oncological and functional outcomes of surgical treatment in this patient population.

Neurologic and Functional Outcomes after Traumatic Central Cord Syndrome

Purpose: The purpose of this study was to determine the direction for treatment and to evaluate factors influencing improvement by comparison of neurologic and functional outcomes of surgical treatment and conservative treatment for traumatic central cord syndrome. Materials and Methods: A total of 28 patients, who were available for follow-up for at least more than one year from January 2005 to December 2008, who were diagnosed as traumatic central cord syndrome were analyzed retrospectively. Fifteen patients underwent surgical treatment (group 1), and 13 patients received conservative treatment (group 2). Maximum canal compromise (MCC), and maximum spinal cord compression (MSCC) were used for radiologic assessment, and American Spinal Injury Association (ASIA) motor score, Japanese Orthopaedic Association (JOA) score, and neck disability index (NDI) were used for assessment of functional outcomes. Results: The mean MCC was 47.2%, mean MSCC was 20.0%, and mean ASIA motor scale was 92.0 (group 1: 92.9, group 2: 90.9) at the final follow-up. The mean JOA score was 12.8 (group 1: 14.0, group 2: 11.4) and mean NDI was 25.0 (group 1: 25.7, group 2: 24.3) at the final follow-up. Conclusion: It is concluded that if a patient with traumatic central cord syndrome is young, with a high energy injury combined with fractures, and has severe spinal compression and mild initial neurologic defect, early surgical treatment would be needed as soon as possible.

Proximal fractures of the humerus in patients older than 75 years of age: should we consider operative treatment?

BackgroundOver 75 % of patients presenting with a proximal humerus fracture are 70 years or older. Very little is known about the outcome after operative treatment of these fractures in very old patients. This study was performed to gain more insight in safety and functional outcome of surgical treatment of proximal humerus fractures in the elderly.Materials and methodsIn this observational study, we analyzed all operatively treated patients, aged 75 or older, with a proximal humerus fracture between January 2003 and December 2008 in our center. Patient selection was on clinical grounds, based on physical, mental, and social criteria. Complications were evaluated. We used the DASH Questionnaire to investigate functional outcome, pain, and ADL limitations.ResultsSixty-four patients were treated surgically for a displaced proximal fracture of the humerus: 15 two-part, 32 three-part, and 17 four-part fractures. Mean DASH scores were 37.5, 36.9, and 48.6, respectively. Regarding the operative methods, overall good results were obtained with the modern locked plate osteosynthesis (mean DASH 34.4). Prosthetic treatment, mostly used in highly comminuted fractures, often resulted in poor function (mean DASH 72.9). Persistent pain and ADL limitations were more present in more comminuted fractures (64 and 50 % in patients with 4-part fractures vs. 14 % in 2-part fractures). There were no postoperative deaths within 3 months of surgery, and fracture-related and non-fracture-related complication rates were low (non-union 3 %; 1 myocardial infarction).ConclusionThis study shows that it is safe and justifiable to consider surgical treatment of a severely dislocated proximal humerus fracture in selected patients aged 75 and older.Level of evidenceAccording to OCEBM Working Group, Level IV.

THE EFFECT OF SPINAL CORD INJURY LEVEL ON THE INTENSITY AND DYNAMICS OF ELECTRIC NEUROPHYSIOLOGICAL CHARACTERISTICS OF SENSORIMOTOR DISORDER SEVERITY

Objective. To compare electroneuromyography (ENMG) characteristics of sensomotor innervation status of lower limb muscles in patients with different level injuries in the thoracic and lumbar spine. Material and Methods. Findings of global (maximal voluntary muscle tension) and stimulated (M-response, Н-reflexes) ENMG were analyzed in 48 patients aged 11 to 55 years. All patients were divided into three groups depending on the injury level. Results. The most marked ENMG signs of functional insufficiency in pre- and postoperative periods were registered in patients with spinal cord injuries at the D9 through D12 levels, which topologically correspond to localization of segmental neuronal populations responsible for formation of spinal motor centres controlling voluntary and reflex activity of lower limb muscles. Conclusion. Consideration of the study results can be useful in predicting functional outcomes of surgical treatment and rehabilitation of patients with consequences of spinal cord injury.

Resection of gliomas in the cingulate gyrus: functional outcome and survival

Functional outcome after resection of tumors arising from the gyrus cinguli (GC), part of the limbic system, is not well analyzed. The purpose of this study was to evaluate the feasibility and functional outcome of surgical treatment for a series of 65 patients with gliomas involving the GC. Preoperative data, extent of resection, functional outcome (Karnofsky performance index, KPI, and the National Institute of Health Stroke Scale, NIHSS), and survival of 65 patients with gliomas arising from the GC were analyzed on the basis of a prospectively conducted database of gliomas between 06/1999 and 07/2010. Extent of resection (complete, subtotal, or partial) was based on early postoperative MRI. Eighty-six percent of the gliomas were located in the anterior part of the GC and 14 % in the posterior part. Fifty-five percent of the patients presented with seizures and 17 % with hemiparesis (mean preoperative KPI = 86 ± 17, NIHSS = 1.4 ± 1.7). Histologically, the tumors were WHO Grade II in 25 %, Grade III in 26 %, and Grade IV in 49 %. Complete resection was achieved for 59 %, subtotal resection for 32%, and partial resection for 9 %. Postoperative transient deficits included SMA lesion (14 %) and new or worsened hemiparesis (8 %), which resolved within 30 days (NIHSS early postoperatively 1.7 ± 1.4, late postoperatively 0.8 ± 1.4, and after 6 months 0.6 ± 1.4). According to histopathological grading, median survival was 67 months (WHO°II), 87 months (WHO°III), and 16.5 months (WHO°IV), and overall survival was 34 months. Microsurgical resection of gliomas arising from the GC is feasible; gross total resection can be achieved for 90 % of gliomas arising from the GC with 5 % long-term morbidity.

Clinical management and surgical treatment of distal fibular tumours: a case series and review of the literature

Study reports clinical and functional outcomes of surgical treatment in a case series of nine patients with distal fibular tumours. Nine patients with distal fibular tumours were observed between 2005 and 2010. A PubMed search was performed using the terms "fibula", "lower limb tumour [cancer]", "sarcoma", "Ewing", "peroneal", "fibular metastasis", and "limb-salvage surgery". In all our patients, lesions were unilateral. All patients complained of pain; limping was present in 5 of 9 tumours. Patients were managed surgically, except one who underwent local radiotherapy. In six patients, a benign or tumor-like lesion was detected. Malignancies consisted of metastatic lung adenocarcinoma (two cases) or multifocal mesenchymal cancer (one case). Non-malignant lesions were treated by curettage and filling, followed by internal fixation when needed. In malignant or locally aggressive lesions, metadiaphyseal fibular resection was performed. The literature search retrieved either case reports or small case series, reflecting the rarity of distal fibular tumours. Surgical treatment was successful in all patients with benign lesions, whereas the rate of success was 40-100 % in case of malignancies. Given the low incidence of distal fibular tumours, controversies exist about the optimal surgical management. Clinical observation and imaging should be reserved to asymptomatic benign lesions. In non-malignant tumours causing pain, limping, and pathological fractures; in malignancies, surgery is recommended. Finally, in patients with asymptomatic lesions of uncertain nature, biopsy and histological examination should be performed to plan appropriate management.

Fourth-generation spinal instrumentation: experience with adolescent idiopathic scoliosis at a tertiary care hospital in Pakistan

ObjectiveTo evaluate the radiological and functional outcome of surgical treatment of adolescent idiopathic scoliosis using fourth-generation posterior spinal instrumentation at The Aga Khan University, Karachi, Pakistan.DesignCase series.Place and duration of studyThe Aga Khan University Hospital after a minimum of 2 years postoperatively.Patients and methodsA total of 20 patients with adolescent idiopathic scoliosis were recruited into the study and evaluated for radiological and functional outcome. The study period was from 2000 to 2005. Radiological outcome was assessed using Cobb angle measurement pre and postoperatively, hence assessing percentage correction. The lower instrumented vertebra was taken as the neutral vertebra and the level was recorded. Functional outcome was determined using the Scoliosis Research Society patient administered questionnaire. All patients were called to the clinic and asked to fill in the form. Those patients who were out of the city were mailed the forms and requested via telephone to complete and return.ResultsOf the 20 patients operated on, twelve were female and eight were male. The average age at operation was 12.7 years. The mean Cobb angle was 69° preoperatively and 20° postoperatively, representing a percentage correction of 71%. The average duration of follow-up was 3.6 years. There was one major complication involving neurological injury post-op and two minor complications involving wound infection. The average Scoliosis Research Society score (on a scale of 1–5, with 5 being best) for pain was 4.5, self-image was 4.2, functional status was 4.1, mental status was 3.8, and satisfaction was 4.4. There was no relationship between the percentage correction of scoliosis and the functional outcome. Those patients with a high preoperative Cobb angle tended to have a better outcome for functional and mental status postoperatively. There was no relation between the lower instrumented vertebra and functional outcome.ConclusionIn the correct indications, fourth-generation posterior instrumentation and fusion is a reliable and satisfactory technique to treat adolescent idiopathic scoliosis.

Surgical reconstruction of comminuted coronoid fracture in terrible triad injury of the elbow.

The terrible triad injury of the elbow is the combination of an elbow dislocation, a radial head fracture and a coronoid process fracture. In this study, we explored the outcome of a modified protocol for terrible triad injury of the elbow in a consecutive series of 14 patients, with a focus on reconstruction of comminuted coronoid fractures. Fourteen patients with terrible triad injuries of the elbow were retrospectively reviewed at a mean follow-up of 23months (range, 15-30months) and were clinically and radiographically evaluated. For comminuted coronoid fractures, autografting with resected radial head fragment or ilium fragment with cartilage surface and transosseous suture with non-absorbable suture were performed. Internal fixation of the radial head was performed in six cases and arthroplasty in five. The collateral ligaments were repaired. Mean flexion at last follow-up was 125°, ranging from 100° to 135°. Mean extension loss was 13°, ranging from 0° to 38°. Mean pronation was 70° and mean supination was 66°. No patient experienced dislocation of the radial head prosthesis. The mean Mayo Elbow Performance Score (MEPS) was 87 (range, 75-100), with six excellent cases and eight good cases. According to our intraoperative examination, no patient demonstrated unacceptable residual instability in extension following restoration of all of the osseous and ligamentous lesions. In conclusion, our protocol can achieve stable reconstruction of the coronoid process, which promotes the functional outcome of surgical treatment on terrible triad injuries of the elbow.

Functional outcome of surgical treatment for knee osteochondritis dissecans with Herbert screw

Summary Introduction Osteochondritis dissecans (OCD) can progress to loose body formation, resulting in a Grade IV defect. Several procedures for managing this problem have been established. Purpose The aim of this study is to determine whether the prognosis and patient satisfaction after Herbert screw insertion are satisfactory. Methods We collected eight cases that had been diagnosed to have OCD and had undergone Herbert screw insertion. The outcomes were determined via the preoperative, and postoperative magnetic resonance imaging and Knee injury and Osteoarthritis Outcome Scores (KOOS). The average follow-up period was 30.1 months. Results At an average of 30.1 months of follow-up (range, 14–68 months), all of the eight patients completed the KOOS. The KOOS subscale scores for pain (mean, 91.25; range, 80–97), other symptoms (mean, 89.88; range, 82–96), activities of daily living (mean, 92.88; range, 80–97), and function in sports and recreation (mean, 88.25; range, 75–96) were not significantly lower than in the published age-matched control group. Conclusion We believe that surgical intervention of unstable knee OCD with Herbert screw fixation is an effective procedure, and that unstable OCD should be treated as early as possible.