Plate Removal Research Articles

Врослий ніготь, оптимальна клініко-морфологічна класифікація: авторські погляди (моя модифікація) і дискусійні аспекти

Резюме. Операції з приводу патологічної інкарнації нігтьової пластини в епоніхеальний валик становлять значний відсоток хірургічних втручань, що здійснюються в амбулаторних хірургічних відділеннях; їх результати не завжди задовільні; за даними різних клінік, рецидиви спостерігаються у 3-35 % випадків. Вростання нігтя асоціюється з гіпертрофією епоніxeальних м'яких тканин, фокальними некрозами, гіпергрануляціями та іншими гнійними ускладненнями. Не існує консенсусу та не існує чіткої класифікації таких уражень. Потребують дискусії варіанти найпоширенішої форми дистального бокового вростання.Мета дослідження. Створити оптимальну клінічну класифікацію неускладненого та ускладненого вростання нігтів на основі аналізу літератури та власних даних.Матеріали та методи. Протягом п'яти років (2011-2016) було діагностовано 436 випадків вростання нігтів у пацієнтів віком 12-86 років (з них 325 випадків інкарнованого оніхомікозу), в 259 (59,4 %) чоловіків і 177 (40,6 %) жінок. У 182 (41,7 %) хворих були стверджені пізні рецидиви мікотичного асоціативного онйокриптозу після попередніх операцій в інших клініках.Результати та обговорення. Пізні рецидиви оніхокриптозу спостерігаються у 5-18 % (12,4 % – наша статистика), при оніхомікотичних інкарнаціях – 30-70 % (41,7 % – результати клінічного аналізу), що підтверджується нашими попередніми дослідженнями. Було також стверджено, що в 60-65 % випадках вростання нігтя з утворенням епоніхеальних гіпергрануляцій (60,3 % – наша статистика), спостерігається їх контамінація мікотичною флорою. У 82 випадках (18,8 % вибірки), захворювання перебігало на фоні облітеруючих захворювань артерій нижніх кінцівок атеросклерозу у 60 (13,76 %) та цукрового діабету у 22 пацієнтів (5,05 %). Клінічно оптимізовано і впроваджено нову авторську версію класифікації врослого нігтя "ENMK", з описом морфологічних характеристик нігтьового ложа; наявністю буквено-цифрового кодування, аналізом повного «спектру» та максимальним охопленням клінічних варіантів оніхокриптозу, включаючи випадки мікотичного вростання (за вираженістю усі морфологічні зміни парціально диференційовані на 5 субтипів): Е (епоніхеальна патологія), N (зміни краю нігтьової пластини), М (зміни матриксу та його деформації), К (наявність супутньої коморбідної патології). Основними, прийнятими в клінічній практиці методами хірургічного лікування інкарнацій є резекція нігтя і видалення нігтьової пластини з епоніхектомією та парціальною матриксектомією.Висновки. Чотирьохкомпонентна ENMK оптимізована клінічна класифікація повністю охоплює варіанти клінічного перебігу врослого нігтя та морфології ураження, клінічно значимі патологічні зміни, фонові та супутні захворювання. Резекція врослого нігтя або його видалення є клінічно ефективними, блокоподібна епоніхектомія та парціальна маргінальна матриксектомія (здійснюється механічним або хімічним шляхом) забезпечують санацію ділянки інкарнації, звужуючи ніготь і запобігаючи його повторному вростанню.

Arthroscopic fracture treatment of the shoulder joint

In recent years, the understanding of shoulder fractures has changed due to the progress of arthroscopy. In addition to the cosmetic result, the access morbidity, particularly the integrity of the subscapularis muscle in glenoid and scapular fractures, must be mentioned as an advantage of aminimally invasive approach. Furthermore, necessary secondary interventions, e. g. hook plate removal, can be prevented or minimized by modern implants and arthroscopic techniques.However, the available data and publications are almost exclusively limited to technical notes or small case series, so statements about faster recreation or potential reduction of infection risk cannot be made. Whether addressing concomitant injuries has an effect on the clinical and functional outcome is also unclear at the present time.

Optimal effective-site concentration of remifentanil for sedation during plate removal of maxilla.

BackgroundRemoval of the plate following Le Fort I osteotomy and BSSO (bilateral sagittal split osteotomy) is a common procedure. However, patients who undergo plate removal experience intense pain and discomfort. This study investigated the half-maximal effective concentration (Ce50) of remifentanil in the prevention of plate removal pain under sedation using dexmedetomidine.MethodsThe study evaluated 18 patients, between 18 and 35 years of age, scheduled for elective surgery. Remifentanil infusion was initiated after sedation using dexmedetomidine, and started at a dose of 1.5 ng/mL on the first patient via target-controlled infusion (TCI). Patients received a loading dose of 1.0 µg/kg dexmedetomidine over 10 min, followed by a maintenance dose of 0.7 µg/kg/h. When the surgeon removed the plate, the patient Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score was observed.ResultsThe Ce of remifentanil ranged from 0.9 to 2.1 ng/mL for the patients evaluated. The estimated effect-site concentrations of remifentanil associated with a 50% and 95% probability of reaching MOAA/S score of 3 were 1.28 and 2.51 ng/mL, respectively.ConclusionsPlate removal of maxilla can be successfully performed without any pain or adverse effects by using the optimal remifentanil effect-site concentration (Ce50, 1.28 ng/mL; Ce95, 2.51 ng/mL) combined with sedation using dexmedetomidine.

Ultrasonographic movement of the flexor pollicis longus tendon before and after removal of a volar plate for the distal radius fracture.

The purpose of this study was to compare the movement of the flexor pollicis longus (FPL) tendon on the distal radius during wrist and finger motions before and after removal of a volar plate in patients with distal radius fractures using transverse ultrasound and to evaluate the kinematic effects on the FPL by the removal. Twenty-five patients with distal radius fracture were evaluated quantitatively by transverse ultrasound using coordinates for the movement of the FPL on the distal radius during wrist and finger motions before and after the plate removal. At all wrist positions, during finger motion, the FPL moved significantly more palmarly away from the radius after plate removal compared to before. However, the FPL was still situated more dorsoulnarly compared with unaffected side. Moreover, the FPL moved significantly most dorsally both before and after removal at the wrist dorsal flexion position with finger flexion. These findings suggested that any adhesion between the FPL and the pronator quadratus (PQ) muscle was released by removing the plate and that the FPL would approach original tendon movement. Additionally, it is speculated that any remaining atrophy and fibrosis of the PQ may be the reason for more dorsoulnar location of the FPL in the affected side compared with the unaffected one. This ultrasound evaluation may be useful in further understanding the FPL kinematics on the distal radius, and in appropriate treatment of the distal radius fracture with plate fixation for preventing FPL rupture.

Acromioclavicular joint disruptions: A comparison of two surgical approaches 'hook' and 'rope'.

Acromioclavicular joint injuries are common shoulder girdle injuries most commonly resulting from a direct blow to the acromion with the arm adducted. Type-I or type-II acromioclavicular joint injuries can be managed with sling immobilization, early shoulder motion, and physiotherapy. The management of type-III injuries remains controversial and is individualized. Type IV and V injuries should be treated surgically. A myriad of surgical techniques for the management of acromioclavicular joint injuries have been reported. We present a comparative study of 76 patients treated with two most common modalities of treatment for AC joint disruption and that is Hook plate stabilisation (n=52) or arthroscopically assisted tight rope stabilisation (n=24). The primary objective was to establish whether hook plate stabilization was superior compared to arthroscopic tight rope fixation in reducing pain and increasing function in the short-term and long-term for patients with AC joint disruptions III-IV. We also wanted to assess how quickly patients returned to their work/job. It was a prospective study, we included all the patients operated between 2008 and 2015 for AC joint disruption by the two shoulder surgeons of our department. All patients followed a strict physiotherapy protocol and were assessed at 6 weeks, 3 months and 12 months. We used the Harm and cost criteria of assessment and the patient specific functional outcome scores. Both modalities of treatment have high patient satisfaction rate, return to work is faster in tight rope group but after a year both group of patients returned to their premorbid state. Removal of hook plate is not mandatory and lysis of acromion is rare (1% in our series). Despite the fact that both methods yielded similar results and have statistically similar number of complications, the type of postoperative complications was different between groups. The plate group had more postoperative pain and worse function but both aspects improved after plate removal. The rope group had more complex complications including deep infection and recurrence of deformity and fracture. These differences should be taken into consideration when consenting the patient regarding possible treatment.

Refracture after removal of triple plate for proximal tibial fracture―A case of refracture caused by screw holes―

Refracture after removal of triple plate for proximal tibial fracture―A case of refracture caused by screw holes―

Surgical fixation of Rookwood Type III–V acromioclavicular joint dislocation with acromioclavicular: Hook plate

Context: Acromioclavicular (AC) joint dislocation is one of the common shoulder problems accounting for 9% of all shoulder injuries and occurs five times more frequently in men than in women. Aims: In the present study, we aim to assess the functional outcome of hook plate fixation for the treatment of acute Rockwood Type III–V AC joint dislocation and to know the complications associated with the implant. Settings and Design: This was a prospective study. Subjects and Methods: Twenty patients, both male and female, with a mean age of 42 years who had acute dislocation of the AC joint were included for the study. Nine patients had Type III, four patients had Type IV, and 7 patients had Type V dislocation according to Rockwood classification. Patients were followed up till 6 months and were evaluated using Constant–Murley score. Statistical Analysis used: For the statistical analysis, descriptive statistics were calculated with the objective of summarizing the set of data analyzed. Results: The mean Constant–Murley score was 82.5 at 6-month follow-up. Four patients had complications of which one had superficial infection, two had subacromial erosion, and one had osteoarthritis of AC joint. Conclusions: Radiographic outcome based on the maintenance of reduction indicates that hook plate fixation is a better treatment option and is an effective method for the treatment of AC joint dislocation. Osteoarthritis and osteolysis are two common complications, which are associated with impairment of shoulder function. Shoulder function will be improved after the removal of hook plate.

Краниотомия в лечебной практике носителей археологических культур: случай прижизненной трепанации в эпоху поздней бронзы на юге Сибири

Complete trepanation with the removal of the inner bone plate was studied on a cranium of a male aged ca 35 from a Late Bronze Age burial at Anzhevka in the Krasnoyarsk-Kansk forest-steppe, dating to 1000–700 BC. Certain burials including that with a trephined cranium reveal traces of post-funerary rituals. The individual displays the Paleosiberian (Baikal) combination of craniometric and dental characteristics. Results of the macroand microscopic analysis of the affected area, along with multislice computed tomography (MSCT), suggest that the trepanation was performed to treat osteomyelitis of the parietal bone with an epidural abscess (empyema), caused by an open depressed fracture of the left parietal bone, infl icted with a tool having a small contact area. In modern forensic practice, such perforations are attributed to hammer blows. This would explain the absence of linear fractures of the parietal bone around the trepanation zone. Craniotomy with the removal of the osteomyeliti с focus and the emptying of the epidural abscess led to a prolonged preservation of the patient’s life. Results of a traceological analysis suggest that the aperture was made by scraping, and a thin tetrahedral tool was used to remove the bone fragment. Possibly the use of bronze instruments, known to have antiseptic properties, helped the ancient healer to cope with an advanced infectious process.

Gold nanodots self-assembled polyelectrolyte film as reusable catalyst for reduction of nitroaromatics

Separation of homogeneous catalyst from the reaction mixture is a crucial and difficult process in any catalytic process. To address this issue, a new class of multifunctional catalyst in the form of film was developed using a facile approach to enjoy the advantages of homogeneous catalyst with the versatility of heterogeneous catalyst. To achieve the same, methionine-capped gold nanodots (AuNDs) were self-assembled on a cationic polyelectrolyte modified glass plate for the catalytic reduction of nitro functional groups in the presence of olefinic double bond at mild conditions. Separation of this reusable catalytic film from the reaction mixture is very simple and advantageous when compared to the currently available and conventional catalytic systems. Kinetics of nitro reduction was monitored using absorption spectroscopy and the product formation was confirmed by $$^{1}\hbox {H}$$ and $$^{13}\hbox {C}\,\hbox {NMR}$$ analyses. Prepared AuNDs catalyst was characterized using UV-Vis spectroscopy, X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), high-resolution transmission electron microscopy (HRTEM), cyclic voltammetry and atomic force microscopy (AFM) techniques. SYNOPSIS Colloidal gold nanoparticles are efficient catalysts for organic reactions. But the removal of homogeneous gold colloids from the reaction mixture is very difficult. To address this issue, gold nanodots were synthesized and self-assembled over polyelectrolyte film to form catalytic plates. Removal of these reusable catalytic plates from the reaction mixture is facile.

Delayed Removal of Clavicular Hook Plates; The Effect on Complications and Functional Outcome

Delayed Removal of Clavicular Hook Plates; The Effect on Complications and Functional Outcome

Anesthetic Management of a Pediatric Patient with Hypokalemic Periodic Paralysis - A Case Report

We report on the anesthetic management of an 11-yearold girl with hypokalemic periodic paralysis who underwent left radius plate removal surgery. This patient’s course was complicated early in the postoperative period by an episode of bilateral lower limb paralysis. She presented with hypokalemia after general anesthesia; however, she recovered well after taking a potassium supplement. Patients with this disorder, who are apparently normal, can develop sudden paralysis when they are exposed to predisposing factors peri-operatively. Complications related to this rare genetic disorder, the factors that can precipitate these, and preventive measures are discussed.

Bioabsorbable plates versus metal miniplate systems for use in endoscope-assisted open reduction and internal fixation of mandibular subcondylar fractures

PurposeTo compare bioabsorbable plates with metal miniplate systems for use in endoscope-assisted open reduction and internal fixation (EAORIF) of mandibular subcondylar fractures. Materials and methodsThis retrospective cohort study included patients with mandibular subcondylar fractures treated with EAORIF using bioabsorbable unsintered hydroxyapatite/poly l-lactide composite plates or titanium miniplate systems. The outcome variables included preoperative fracture conditions, postoperative stability during fracture healing, and complications during the follow-up period. Other variables included clinical characteristics (age, sex, fracture site, and total follow-up duration) and intra- and postoperative data (surgical duration, duration of intermaxillary fixation/elastic band guidance). Variables were evaluated using descriptive statistics and compared between groups using the Mann–Whitney test and the chi-square test or Fisher's exact test, as appropriate. ResultsIn total, 28 patients were analyzed, including 13 who underwent EAORIF using bioabsorbable plates and 15 who underwent EAORIF using titanium miniplates. With the exception of second surgery for plate removal, none of the assessed variables showed significant differences between the two groups (p < 0.05). ConclusionsOur results suggest that EAORIF using biodegradable plates is a stable and reliable method for the management of mandibular subcondylar fractures and eliminates the need for secondary surgery for plate removal.

УСКЛАДНЕНИЙ ОНІХОМІКОЗ ТА ВРОСТАННЯ НІГТЯ: КОМПЛЕКСНЕ ЛІКУВАННЯ (АНАЛІЗ КЛІНІЧНИХ СПОСТЕРЕЖЕНЬ)

The aim of research is optimal sequence of surgical treatment, local and system therapy after moving away of the staggered nails at destructive onychomycosis, complicated by the secondary ingrown nail for some patients with the complicated mycotic defeat of nails. Materials and methods. Over a fi ve-year period 325 cases of incarnated onychomycosis, 182 cases late relapses of onychocryptosis (after previous surgeries at other clinics) were performed. Patients with such combined pathology got fi ve-day system «pulses» of 400 mg/day itraconazole therapy at a simultaneous use of hepatoprotectors and correction of comorbid pathology. Results. Three variants of dermatophytoma are differentiated: front center – with up to 25% eroded nail – 65 cases, subtotal – from 25 to 70% (without capturing the growth plate) – 138 cases, total – from 70 to 90% (with affected growth plate of the nail) – other cases. Surgical treatment provided in addition to standard decompression stage (complete removal of the nail plate), cutting pathologic eponychial tissues, hypergranulations and dermatophytoma, contained antirecurrent component (partial marginal matrixectomy in the ingrowth area) to prevent from repeated ingrowth. Conclusions. In all cases of mycotic onychocryptosis (secondary ingrown toenail) underwent a comprehensive treatment of comorbid pathology, system therapy of itraconazole to operative treatment (basic onychial defeats sanation) and in a postoperative period, sanation of other nails for prevention of mycotic reinfection was carried out by ciclopirox & amorolfi ne nail lacquer.

Biological Response Following Inlay Arthroplasty of the Knee: Cartilage Flow Over the Implant.

Objective Inlay arthroplasty (IA) has seen growing interest as a new primary arthroplasty intervention for patients that need to transition from biology to joint replacement. The purpose of this study was to investigate the biological response to this procedure. Design Patients presenting with symptomatic mono- or bicompartmental arthrosis and varus malalignment underwent IA and concurrent medial open wedge high tibial osteotomy (HTO). A subset of patients required hardware removal and consented to second-look arthroscopy without biopsy allowing for assessment of IA components and compartment-specific findings related to implant fixation, cartilage flow, propagation of lesions, and opposing tibial surfaces. Results In a series of 41 knees (35 patients) treated with combined IA and HTO (mean varus >7°), 26 knees (23 patients, 18 male, 5 female) with a mean age of 52 years (range = 43-67) required HTO plate removal. Concurrent second look arthroscopy was performed at a mean of 14 months (range = 12-19) following the index procedure. On probing, all arthroplasty components showed solid fixation without gap formation. On the medial femoral condyle, 15 mm implants ( n = 14) showed a peripheral cartilage flow of 12% (range = 5% to 25%), 20 mm implants ( n = 12) of 9% (range 5% to 15%), and trochlear implants ( n = 12) of 20% (range 10% to 40%). No progressive deterioration of the index defects or progression of tibial and retropatellar grades were seen. Conclusion Joint surface reconstruction using IA showed stable fixation with peripheral cartilage coverage ranging from 9% to 20% and no further chondral damage on opposing surfaces. Future clinical effectiveness studies are required to support the positive biological integration.

Outcomes of the Ulnar Shortening Osteotomy Using a Dynamic Compression Plate on the Ulnar Surface of the Ulna.

Background The purpose of this study is to evaluate the results of patients with ulnar impaction syndrome treated with diaphyseal osteotomy using freehand technique and fixation with ulnar osteotomy compression plate placed on the ulnar surface of the ulna. Materials and Methods A retrospective chart review of patients with ulnar impaction syndrome between 2010 and 2014 identified 38 patients. The following clinical data were observed: patient age, sex, range of motion, grip strength, visual analog scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiological assessment, and complications. The mean follow-up period is 30 months. Eleven patients were excluded from the study. Results Compared with the contralateral side, the 27 patients included in this study attained 93 to 96% of wrist and forearm motion and 81% of the grip strength. The average DASH score was 18 in a mean follow-up period of 30 months. Three patients required plate removal and one case showed nonunion and a further operation was needed. Two patients reported persistent ulnar-sided wrist pain. Conclusion We concluded that placing the ulnar osteotomy plate on the ulnar surface of the ulna is a quicker procedure, with less soft tissue dissection and irritation, and very high union rate. Level of Evidence Level IV.

Outcome and complications after treatment of facial fractures at different times in polytrauma patients

Finding the correct point of time for operative treatment of facial fractures in multiply injured people remains one of the most important challenges in modern emergency medicine. Findings relating to pathophysiological mechanisms after severe trauma argue against the early operative treatment of non-life-threatening injuries. Our retrospective analysis investigated the effects on complications and outcome of different time points for operative treatment of maxillofacial fractures in multiply injured patients.Over a period of 10 years (2003–2012) we could identify 1543 patients, of whom 553 had fractures of the facial skull. 168 of the facial fracture patients were operated on their fractures, 97 at a time later than 72 h. Despite the delayed time of operation, the patients showed fewer complications (21.6% vs 25.4%). This resulted in fewer additional stays in hospital (9.3% vs 11.3%), and also in fewer plate removals (23.7% vs 33.8%). We conclude that delayed operative fracture treatment does not lead to more complications. The optimal time for operative treatment has to be determined individually as the earliest point at which no adverse effects from comorbidities are expected.

A Newly Designed Intramedullary Nail for the Treatment of Diaphyseal Forearm Fractures in Adults.

Background:The treatment of diaphyseal forearm fractures using open reduction and plate fixation is generally accepted as the best choice in many studies. However, periosteal stripping, haematoma evacuation may result in delayed union, nonunion and infection. Refracture after plate removal is another concern. To overcome these problems intramedullary nails (IM) with different designs have been used with various outcomes. However previous IM nails have some shortcomings such is rotational instability and interlocking difficulties. We evaluated the results of newly designed IM nail in the treatment of diaphyseal forearm fractures in adults.Materials and Methods:32 patients who had been treated with the interlocking IM nail for forearm fractures between 2011 and 2014 were included in this study. There were 23 males and 9 females with mean age of 36 years (range 18-68 years). 22 patients (68.8%) had both bone fractures. Nine patients (28.1%) had open fractures. The remaining ten patients (31.2%) had radius or ulna fractures. Grace and Eversmann rating system was used to assess functional evaluation. Patient reported outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores.Results:Union was achieved in all patients. The mean followup was 17 months (range 13 – 28 months). According to the Grace-Eversmann criteria, 27 patients (87.5%) had excellent or good results. The mean DASH score was 14 (range 5-36). Overall complication rate was 12.5%. Superficial infection was encountered in two patients. One patient had delayed union, however fracture healed without any additional surgical procedure. One patient who had open grade 3A, comminuted proximal third radius fracture developed radioulnar synostosis.Conclusions:The new design IM interlocking forearm nail provides satisfactory functional and radiological outcomes in the treatment of adult diaphyseal forearm fractures.

A Dorsal Approach for Ulnar Shortening Osteotomy.

Aim This study aims to evaluate the long-term complications, results, and patient satisfaction rates of a dorsally approached ulnar shortening osteotomy for ulnar impaction syndrome. Methods A retrospective chart review of 20 patients was performed. Primary outcomes of interest were subjective, measured using the Patient-Rated Wrist Evaluation (PRWE) score, Disability of the Arm, Shoulder, and Hand (DASH) score, and the third questionnaire about patient satisfaction, composed by the authors. Secondary outcomes included hardware removal due to irritation and other complications. Results Mean postoperative functional score of PRWE was 28 (standard deviation [SD], 30) and DASH 20 (SD, 26), respectively. Fifteen patients were satisfied with the operation. Removal of hardware was noted in six patients. In one patient plate breakage occurred. Conclusion Similar postoperative functional scores and complications were seen in patients undergoing an ulnar shortening osteotomy with a dorsally placed plate for ulnar impaction syndrome, compared with other plate placement localizations. The incidence of plate removal is also comparable to previously described results. As the dorsally placed plate and freehand technique, are relatively easy, we feel that it has a place in the treatment of ulnar impaction syndrome. Level of Evidence Level IV, retrospective cohort study.

Smoking and obesity influence the risk of nonunion in lateral opening wedge, closing wedge and torsional distal femoral osteotomies.

Lateral distal femoral osteotomies (DFO) have recently been performed more frequently. In addition to realignment for varus and valgus deformity, the indication was extended with the introduction of torsional osteotomies in patellofemoral instability. The purpose of this study was to assess the general and technical risk factors for nonunion in lateral opening, closing and torsional DFO. A total of 150 lateral DFO [98 opening wedge (LOWDFO) and 52 closing wedge (LCWDFO)] were analyzed in regard to potential risk factors for nonunion until plate removal. Nonunion was defined as failure of osseous consolidation according to clinical and radiological evaluation. In LOWDFO, the nonunion rate was 2%, in LCWDFO the rate was higher with 9.6%. Nicotine abuse (p = 0.009) and a higher body mass index (p = 0.003) were significant risk factors. Patient's age and gender, the wedge height, hinge fractures, monoplanar versus biplanar osteotomy as well as additional torsional osteotomies were not significant in regard of nonunion. Lateral DFO have a low rate of complications and nonunion. Smoking and obesity were significantly associated with the risk of nonunion. Hinge fractures, monoplanar technique or complete bone cuts of the opposite hinge in torsional osteotomies did not negatively influence the nonunion rate in DFO. Level IV.

Fracture of fusion mass following anterior cervical plate removal: Case report

We present the case of a delayed pseudoarthrosis resulting from a fracture at the site of a radiographically confirmed anterior cervical fusion following plate removal. In this case, an anterior cervical plate was removed to allow for further surgery at a supra-adjacent level. A modicum of literature exists describing delayed fractures following hardware removal in thoracolumbar fusion constructs. The development of a fracture/pseudoarthrosis following hardware removal at the site of a radiographically confirmed anterior cervical fusion has not been previously reported. We describe the clinical presentation and operative management in the case of this rare and unexpected complication.