Displacement Of Posterior Wall Research Articles

Does a simultaneous ventral/dorsal approach provide better reduction quality in treating acetabular fracture involving both columns with displaced posterior wall?

Various surgical techniques have been proposed to manage acetabular fractures involving both columns with posterior wall displacement. However, the optimal surgical approach to achieve satisfactory reduction quality remains controversial. This retrospective study evaluated 34 patients with fractures who were treated at a single medical institution. The patients were divided into two groups according to the ventral/dorsal surgical approach employed: simultaneous (SI) and sequential (SE). Perioperative parameters, as well as radiological and functional outcomes, were analyzed and compared between the two groups. The SI and SE groups comprised 9 and 23 out of the 34 patients, respectively. The SI group exhibited a significantly shorter surgical time and lower estimated blood loss than the SE group (p = 0.04 and 0.03, respectively). The quality of reductions of the anterior and posterior columns was similar between the two groups; however, superior reduction in the fracture gap of the posterior wall was observed in the SI group, as revealed by axial and coronal computed tomography scans. A simultaneous ventral and dorsal approach through the pararectus and the modified Gibson approach confer clinical advantages in reducing the fracture gap, surgical time, and intraoperative blood loss when managing acetabular fractures involving both columns and a displaced posterior wall. Therefore, these surgical approaches may be considered to be optimal for achieving satisfactory reduction quality in such fractures.

Radiological analysis of minimally invasive treatment of type A thoracolumbar fractures based on a series of 135 fractures

IntroductionAlthough the reduction of traumatic fractures of the thoracolumbar spine is of good quality during conventional so-called open procedures, the alternative minimally invasive approach also appears to confer good results. The aim of this study was to measure the radiological parameters before and after minimally invasive surgery, in order to assess the quality of the reduction of thoracolumbar compression fractures. Materials and methodsThis retrospective, monocentric study included 112 patients with a mean age of 48.9years, presenting with 135 type A thoracolumbar compression fractures treated by a posterior minimally invasive surgical approach comprising vertebral augmentation or posterior osteosynthesis or a mixed procedure. ResultsThe parameters analyzed were significantly lower whatever the procedure in the immediate postoperative period. Mean regional and local kyphosis, posterior wall displacement, and mean vertebral height were significantly lower (p<0.01). Fracture reduction was better when osteosynthesis was associated with vertebral augmentation. In the osteosynthesis subgroup with osteosynthesis hardware removal but without vertebral augmentation, we found a significant worsening of the regional kyphosis (p<0.05). ConclusionThe management of thoracolumbar compression fractures by a posterior minimally invasive approach allows excellent fracture reduction with a restoration of the spinal canal, vertebral height and kyphosis. Level of EvidenceIV.

Somatosensory evoked potentials in Hirayama disease: A Brazilian study.

Background: Hirayama’s disease (HD) is characterized by an insidious onset asymmetric weakness and atrophy of the forearm and hand. Taking as a premise, the etiopathogenesis of the disease is attributed to forward displacement of posterior wall of lower cervical dural canal in neck flexion causing marked compression and flattening of lower spinal cord. This may result in compression of the posterior column of the spinal cord and seems likely to result in somatosensory evoked potentials (SSEPs) abnormalities. In the present study, we studied the possible involvement of the lemniscal dorsal pathway in patients with HD.Methods: SSEPs in upper and lower extremities were prospectively performed in eight patients with HD. All the patients were recruited from the outpatient clinic of a neuromuscular disorder center from South Brazil. SSEPs were obtained by transcutaneous electrical stimulation of the median and posterior tibial nerves, on both sides. We collected the amplitude and the latency of the different components obtained in each channel. The interpretation was based on Brazilian study standards.Results: We evaluated seven men and one woman (mean age 27). The data obtained were compared to a control group consisting of eight patients with spondylotic cervical myelopathy, 6 men and 2 women with mean age of 59 years. The measurements of obtained by the SSEP were also compared between the groups and no significant difference was found for any of them.Conclusion: SSEP did not turn out to be an electrophysiological marker in our HD patients.

P1820New parameters for the evaluation of mechanic and elastic properties of the aortic root in Marfan Syndrome

Abstract Background Elastic properties of the thoracic aorta in patients with Marfan Syndrome (MS) have already been evaluated with classic echocardiographic parameters. In the latest years the use of Speckle-Tracking (STE) ecocardiography has been widely extended. Our aim is to describe and provide new parameters of aortic deformation measured by STE in patients with MS. Methods 95 unoperated adult patients with MS and 32 healthy controls were prospectively enrolled. We measured classic parameters of the aortic root using 2D echocardiography. We calculated the posterior aortic wall systolic excursion at the sinuses of Valsalva and ascending aorta using M Mode in TDI colour; with ST 2D ecocardiography we measured the aortic strain at the sinuses of Valsalva (SV) and the anterior and posterior aortic wall displacement at the SV. Aortic distensibility was calculated using the formula: 1000 * (Ds − Dd)/Dd * 1/(Ps − Pd) in mmHg–1 (Ds: systolic and Dd: diastolic diameters, Ps systolic and Pd diastolic blood pressure). Aortic stiffness index was calculated as Ln((Ps/Pd)/(Ds-Dd)/Dd)). Results As shown in the table bellow, patients with MS had lower aortic strain, aortic anterior and posterior wall displacement and impaired aortic distensibility and stiffness index compared to healthy controls. We found a strong negative linear correlation between aortic root diameter at the SV and aortic root strain (r=−0.56, figure 1). Results of statistical analysis MS (n=95) Controls (n=32) p Age (years) 32.84±12.35 32.41±7.98 0.85 Aortic root diameter at the sinuses of Valsalva (mm) 38.82±5.35 30.92±3.65 &lt;0.001 Aortic root strain (%) 4.66±2.45 9.19±2.49 &lt;0.001 Anterior aortic wall displacement STE (mm) 10.39±3.64 13.10±2.26 &lt;0.001 Posterior aortic wall displacement STE (mm) 9.02±2.87 11.04±1.82 &lt;0.001 Aortic distensibility 0.98±0.46 1.37±0.72 0.01 Aortic stiffness index 3.74±0.43 3.47±0.51 0.01 MS = Marfan Syndrome; STE = Speckle Tracking Ecocardiography. Figure 1. Dispersion plot Conclusions Our results suggest that aortic deformation and displacement obtained by STE echocardiography is impaired in MS, showing a reduced distensibility and an increased stiffness of the aortic wall, with a strong negative correlation between aortic root dilation and aortic strain. All these parameters may be useful as additional tools for the diagnosis and follow-up of Marfan patients, and could be useful to to improve the echocardiographic evaluation of the aortic root.

Effectiveness of closed reduction and percutaneous fixation of isolated sacral fractures. Functional outcomes and sagittal alignment after 3.6 years in 20 patients

BackgroundDisplaced U- or H-shaped sacral fractures (Roy-Camille Grade II or III) are treated at our institution by early transcondylar traction and manual countertraction, hyperlordosis induced by a pad positioned under the lumbo-sacral junction, and percutaneous ilio-sacral screw fixation. The objective of this study was to evaluate the outcome of this technique used in a level 1 trauma centre.Hypothesis Our early reduction technique provides anatomical reduction of U- or H-shaped sacral fractures by correcting the sagittal malalignment due to the intra-sacral kyphosis, thereby obviating the need for decompression laminectomy and improving neurological outcomes. Material and methodsWe retrospectively evaluated 20 patients treated for U- or H-shaped sacral fractures using our original reduction technique followed by percutaneous fixation only. Mean follow-up was 42.4 months. Mean displacement of the S1 posterior wall was measured on computed tomography scans obtained before and after surgery. Pelvic incidence (PI) and measured lumbar lordosis (LLm) were evaluated on standard radiographs before surgery and on stereoradiographs after surgery. Expected lumbar lordosis (LLe) was computed as LLe=PI+9°. A 25% or greater difference between LLe and LLm defined lumbo-pelvic mismatch. At last follow-up, functional outcomes were assessed based on the Majeed score and the Iowa Pelvic Score (IPS), and a neurological examination was performed. ResultsMean S1 posterior wall displacement in the sagittal and axial planes was 64% and 64.8%, respectively, before surgery versus 5.6% and 15.2%, respectively, after surgery. At last follow-up, LLm was 63.5° and the LLe-LLm difference was 11.2%; only 3 (15%) patients had lumbo-pelvic mismatch at last follow-up. The mean Majeed score and IPS values were 86.6 and 79, respectively, and lumbo-pelvic mismatch correlated significantly with a worse functional outcome defined as a Majeed score below 75 (p=0.0087). At last follow-up, the neurological dysfunctions were improved in 90% of patients, and 70% of patients had achieved a full neurological recovery. Discussion/ConclusionGiven these encouraging findings, we advocate early reduction and percutaneous fixation of U- or H-shaped sacral fractures. Although technically demanding, this method restores the normal pelvic parameters and improves neurological function. Level of evidenceIV, retrospective observational study.

Appropriate Pathways and Surgical Approaches in the Fractures of the Frontal Sinus

Fractures of the frontal sinus are part of the fractures of the border between the facial and the cranial regions. They cause both aesthetic and vital problems, but also functional, requiring rapid and global care in a multidisciplinary setting. The document provides a descriptive and cross sectional study with prospective data collection, conducted in the department of Maxillofacial and Aesthetic Surgery of the Mohammed 6 Teaching Hospital of Marrakech, describe describe 18case operated for frontal sinus fractures over a 2-year period. The ideal time of repair was beyond the 72nd hour, at best between the 8th and 15th days after the reduction of cerebral and facial edema and the exclusion of any lesions that require emergency intervention. Our indications were mainly influenced by aesthetic deformities, impaction and embarrure fracture of ethmoidal and orbital roofs with clinical expression, obliteration of the naso-frontal duct, posterior wall displacement predicting dura mater laceration, and by the time to management. The coronal approach was the most indicated with 83, 33% of the cases. We realized sinus exclusion in 72.22%, cranialization in 22.77%, and repair of dura mater injuries in 27.77%. The sequelae found in 27.77%, were essentially functional and aesthetic.

Evaluation of abdominal aortic elasticity by strain rate imaging in patients with type 2 diabetes mellitus.

To use strain rate imaging (SRI) to compare the abdominal aortic wall elasticity between patients with type 2 diabetes mellitus and controls. We measured the abdominal aorta intima-media thickness (IMT) with B-mode echography, and the anterior and posterior wall displacement (d), strain, and strain rate (SR) with SRI, in 90 patients with type 2 diabetes mellitus and 30 control subjects (group A). The patients were classified into group B (normal IMT), group C (thickened IMT), and group D (one single atheroma plaque). d, strain, and SR were significantly lower in group B, C, and D than in group A (p < .05). Systolic, early-diastolic, and late-diastolic SR were lower in patients with diabetes (especially in group D) than in controls. There were significant differences in systolic SR, early-diastolic SR, and late-diastolic SR between group A and group B (p < .05). SRI is a noninvasive method that can demonstrate a loss in aorta wall elasticity in patients with diabetes with normal IMT.

AB1053 Vertebral osteonecrosis: Clinical and radiological characteristics of a series of 18 cases

BackgroundThe vertebral osteonecrosis (VON) is much less known and less frequently diagnosed than peripheral osteonecrosis. VON is considered as result of delayed consolidation of a compression fracture due to ischemia,...

Incidence and pattern of technical complications in balloon-guided osteoplasty for depressed tibial plateau fractures: a pilot study in 20 consecutive patients.

BackgroundInflation bone tamps are becoming increasingly popular as a reduction tool for depressed tibial plateau fractures. A number of recent publications have addressed the technical aspects of balloon inflation osteoplasty. However, no study has yet been published to describe the technical limitations, intraoperative complications, and surgical bailout strategies for this new technology.MethodsObservational retrospective study of all patients managed with inflatable bone tamps for depressed tibial plateau fractures between October 1, 2010 and December 1, 2012. The primary outcome parameter was the rate of complications, which were stratified into “minor” and “major” depending on the necessity for altering the surgical plan intraoperatively, and based on the risk for patient harm. This study was approved by the Institutional Review Board of the State of Colorado.ResultsA consecutive series of 20 patients were managed by balloon inflation osteoplasty for depressed tibial plateau fractures during the 15 months study period. The mean age was 42.8 years (range 20–79), with 9 females and 11 males. A total of 13 patients sustained an adverse intraoperative event (65%), with three patients sustaining multiple technical complications. Minor events (n = 8) included the burst of a balloon with extrusion of contrast dye, and the unintentional posterior wall displacement during balloon inflation. Major events (n = 5) included the intra-articular injection of calcium phosphate in the knee joint, and the inability to elevate the depressed articular fragment with the inflatable bone tamp.ConclusionThe observed intraoperative complication rate of 65% reflects a steep learning curve for the use of inflation bone tamps to reduce depressed tibial plateau fractures. Specific surgical bailout options are provided in this article, based on our early anecdotal experience in a pilot series of 20 consecutive cases. Patients should be advised on the benefits and risks of this new technology as part of the shared decision-making process during the informed consent.

Noncompaction Cardiomyopathy is Associated With Mechanical Dyssynchrony: A Potential Underlying Mechanism for Favorable Response to Cardiac Resynchronization Therapy

BackgroundThe aim of this study was to assess the presence of evidence of ventricular mechanical dyssynchrony in patients with isolated left ventricular noncompaction cardiomyopathy (IVNC) and the potential usefulness of cardiac resynchronization therapy (CRT) in those patients. Methods and ResultsWe studied 25 patients consecutively diagnosed with IVNC and a control group of 50 patients with dilated cardiomyopathy of different etiologies. Mechanical dyssynchrony was assessed by echocardiography by the presence of a septal flash, the time from peak septal to posterior wall displacement, and the time from septal to lateral wall peak systolic velocity. Among the patients with IVNC, 9 received CRT and were followed at 12 months. Overall, dyssynchrony parameters were significantly more frequent in IVNC, regardless of QRS duration. All 9 IVNC patients treated with CRT showed a septal flash, and a favorable response was observed in 8/9 patients (89%) regardless of QRS width. ConclusionsThe presence of mechanical dyssynchrony, amenable to correction with CRT, is common in patients with IVNC, independently from QRS width. This might be related to altered electrical endocardial activation associated with abnormal myocardium and could be the justification for the high response rate to CRT observed in these patients.

Spondylodiscite post-vertébroplastie. Cas clinique et revue de la littérature

We report the observation of a 76-year-old female who was treated with percutaneous vertebroplasty for an L3 osteoporotic compression fracture. Fifteen days after this procedure, a cauda equina syndrome occurred. The neuroimaging studies showed worsening of the compression fracture and the appearance of a posterior wall displacement. Blood test results showed a moderate inflammatory syndrome resembling lymphangitides complicating a venous arm perfusion. Therapeutic options consisted of a combined surgical approach associating an anterior approach with implantation of a corporeal prosthesis and a posterior osteosynthesis. At the postoperative period, the patient presented hyperthermia peaks and Staphylococcus aureus grew on three consecutive hemocultures. MRI evaluation demonstrated septic pseudarthrosis, the corporeal prosthesis was removed in a second combined approach, and it was replaced with an iliac crest graft, with posterior debridement. A three-month course of antibiotics was given. The follow-up was good with overall recovery of the deficit and disappearance of the fever. This case report emphasizes the importance of suspecting postprocedure spondylitis when in the follow-up neuroimaging of a vertebroplasty, an increasing compression fracture is noted even though the clinical picture of sepsis is not apparent.

Increased Anterior Abdominal Aortic Wall Motion: Possible Role in Aneurysm Pathogenesis and Design of Endovascular Devices

To determine whether variations in aortic wall motion exist in mammalian species other than humans and to consider the potential implications of such variations. M-mode ultrasound was used to measure abdominal aortic wall motion in 4 animal species [mice (n=10), rats (n=8), rabbits (n=7), and pigs (n=5)], and humans (n=6). Anterior wall displacement, posterior wall displacement, and diastolic diameter were measured. The ratio of displacement to diameter and cyclic strain were calculated. Body mass varied from 24.1+/-2.4 g (mouse) to 61.8+/-13.4 kg (human); aortic diameter varied from 0.53+/-0.07 mm (mouse) to 1.2+/-1 mm (human). Anterior wall displacement was 2.5 to 4.0 times greater than posterior among the species studied. The ratios of wall displacement to diastolic diameter were similar for the anterior (range 9.40%-11.80%) and posterior (range 2.49%-3.91%) walls among species. The ratio of anterior to posterior displacement (range 2.47-4.03) and aortic wall circumferential cyclic strain (range 12.1%-15.7%) were also similar. An allometric scaling exponent was experimentally derived relating anterior wall (0.377+/-0.032, R2=0.94) and posterior wall (0.378+/-0.037, R2=0.93) displacement to body mass. Abdominal aortic wall dynamics are similar in animals and humans regardless of aortic size, wih more anterior than posterior wall motion. Wall displacement increases linearly with diameter, but allometrically with body mass. These data suggest increased dynamic strain of the anterior wall. Increased strain, corresponding to increased elastin fatigue, may help explain why human abdominal aortic aneurysms initially develop anteriorly. Aortic wall motion should be considered when developing endovascular devices, since asymmetric motion may affect device migration, fixation, and sealing.

Increased Anterior Abdominal Aortic Wall Motion: Possible Role in Aneurysm Pathogenesis and Design of Endovascular Devices

To determine whether variations in aortic wall motion exist in mammalian species other than humans and to consider the potential implications of such variations.M-mode ultrasound was used to measure abdominal aortic wall motion in 4 animal species [mice (n=10), rats (n=8), rabbits (n=7), and pigs (n=5)], and humans (n=6). Anterior wall displacement, posterior wall displacement, and diastolic diameter were measured. The ratio of displacement to diameter and cyclic strain were calculated.Body mass varied from 24.1+/-2.4 g (mouse) to 61.8+/-13.4 kg (human); aortic diameter varied from 0.53+/-0.07 mm (mouse) to 1.2+/-1 mm (human). Anterior wall displacement was 2.5 to 4.0 times greater than posterior among the species studied. The ratios of wall displacement to diastolic diameter were similar for the anterior (range 9.40%-11.80%) and posterior (range 2.49%-3.91%) walls among species. The ratio of anterior to posterior displacement (range 2.47-4.03) and aortic wall circumferential cyclic strain (range 12.1%-15.7%) were also similar. An allometric scaling exponent was experimentally derived relating anterior wall (0.377+/-0.032, R2=0.94) and posterior wall (0.378+/-0.037, R2=0.93) displacement to body mass.Abdominal aortic wall dynamics are similar in animals and humans regardless of aortic size, wih more anterior than posterior wall motion. Wall displacement increases linearly with diameter, but allometrically with body mass. These data suggest increased dynamic strain of the anterior wall. Increased strain, corresponding to increased elastin fatigue, may help explain why human abdominal aortic aneurysms initially develop anteriorly. Aortic wall motion should be considered when developing endovascular devices, since asymmetric motion may affect device migration, fixation, and sealing.

Acute Improvement in Global and Regional Left Ventricular Systolic Function After Percutaneous Heart Valve Implantation in Patients With Symptomatic Aortic Stenosis

The newly developed percutaneous heart valve (PHV) implantation technique decreases transaortic pressure gradient in patients with aortic stenosis. PHV replacement effects on left ventricular (LV) global and regional systolic function are currently unknown. Eight patients with severe aortic stenosis had 2D echocardiography at baseline and 24 hours after PHV implantation to evaluate changes in LV volume and LV ejection fraction. Regional function, ie, both peak systolic anterior and posterior wall tissue velocity, as well as strain and strain rate imaging, were measured by tissue Doppler imaging from a short-axis view. At 24 hours, a significant reduction in transaortic mean pressure gradient (from 46+/-15 to 8+/-3 mm Hg; P<0.0001) was accompanied by an increase in aortic valve area (from 0.59+/-0.11 to 1.69+/-0.11 cm2; P<0.0001). LV end-diastolic volume remained unchanged (102+/-36 to 101+/-12 mL; P=NS), whereas LV ejection fraction increased (48+/-18% to 57+/-12%; P<0.01). Improvement in posterior wall displacement (posterior wall tissue velocity increased from 2.2+/-0.5 to 4.4+/-1.0 cm/s(-1); P=0.0003) and deformation (strain rate imaging increased from 1.0+/-0.3 to 1.9+/-0.7 s(-1), P=0.009, and strain increased from 11+/-5% to 17+/-9%; P=0.02) were observed. Immediately after PHV replacement, improvement of LV global and regional systolic function was evidenced by tissue Doppler imaging.

Effect of the pedicle and posterior arch on vertebral body strength predictions in finite element modeling.

A finite element study to predict the contribution of the pedicles and the posterior arch to vertebral body strength. To determine the effect of the pedicle and posterior arch on strain distributions occurring within the vertebral body under axial compressive loading. Posterior vertebral body fracture can arise from high-impact or normal loading in bones compromised by osteoporosis or neoplasm and can result in spinal canal encroachment. Anatomically, the pedicles and posterior arch have a potential role as a structural buttress to the posterior vertebral body wall. However, most finite element models used to investigate vertebral body strength have neglected these structures. Three 3-dimensional finite element models were developed of L1, incorporating anatomic curvature, with varying degrees of posterior element inclusion (no pedicle, pedicle, and pedicle and posterior arch). Three cases were analyzed with each model: 25% dehydrated disc, normal healthy disc, and uniform pressure loading. Outcome variables were the maximum von Mises strains and the displacement of the posterior wall into the spinal canal. Inclusion of the posterior arch resulted in substantial decreases in maximum strain and posterior wall displacement under all loading configurations using transversely isotropic trabecular bone properties. No changes in maximum strains or displacements were recorded in the pedicle model, compared with that observed in the no-pedicle baseline case. The pedicle functions as a structural buttress, providing support to the posterior wall of the vertebral body when constrained through the posterior arch. To yield more accurate vertebral body strength predictions from finite element modeling, the posterior arch should be included.

Cardiac dose response relationship for intravenously infused glucagon in normal intact dogs and men

The mechanism of glucagon's cardiac effects is not well understood. As the cardiac dose response to glucagon in intact animals has not been elucidated, this was determined in normal men and dogs. In man, heart rate, blood pressure, systolic time intervals and echocardiographic indices of ventricular wall motion were determined. Plasma glucagon levels (PGL) were measured by radioimmunoassay. Men received 3 glucagon infusions of 10 −10 to 10 −8 moles/minute followed by a bolus of 0.5 mg. or 1.0 mg. Small but significant changes were observed in ejection fraction and left ventricular posterior wall displacement at the 10 −9 moles/minute infusion rate (mean PGL 1.9 ng./ml.), a PGL close to that of some pathophysiologic states such as burns, ketoacidosis, and acute myocardial infarction, while cardiac output, heart rate, and other indices of cardiac performance were significantly changed only at the 10 −8 moles/minute and bolus injections. Some indices, notably stroke volume, were unchanged. In dogs, left ventricular (LV) pressure, LV pressure derivative (LV dP dt ), and aortic flow were measured with implanted LV solid state pressure transducers and electromagnetic flow probes. Dogs received six infusions from 2.7 × 10 −11 to 2.7 × 10 −8 moles/minute followed by a bolus of 2 mg. In dogs, significant changes occurred in LV dP dt at 2.7 × 10 −9 moles/minute (mean PGL 31.5 ng./ml.) and in heart rate at 2.7 × 10 −8 moles/minute only. It appears that substantial hemodynamic effects do not appear in man or dogs until PGL 10 to 100 times those seen in pathophysiologic states are achieved. Thus, it seems unlikely that glucagon contributes substantially to the hyperdynamic circulatory conditions observed in these states. Significant hemodynamic response to glucagon was noted in normal men, however, at a PGL less than that achieved by usual pharmacologic doses of glucagon and this lower PGL was not associated with the gastrointestinal symptoms commonly observed clinically.