Short Pedicle Research Articles

Treatment of thoracolumbar fractures by unilateral pedicle screw fixation plus short segment pedicle screw through para-vertebral muscles

A total of 33 non–neurological symptoms patients with thoracolumbar fractures underwent unilateral pedicle screw fixation plus short segment pedicle screw through para–vertebral muscles. Preoperative computed tomography (CT) scan showed one side pedicle was complete. The average follow–up period was 22 (12–40) months. There was no internal fixation failure. The posterior paraspinal approach for unstable thoracolumbar fractures, retaining posterior ligament complex and fixation by unilateral pedicle screw fixation through the pedicle of fractured vertebra, is both safe and effective for thoracolumbar fractures. Key words: Surgical procedures, operative; Spinal fractures

The Thin Gluteal Artery Perforator Free Flap to Resurface the Posterior Aspect of the Leg and Foot

The authors evaluated the clinical application of the gluteal artery perforator free flap harvested above the superficial fascia as a new approach to reconstruct soft-tissue defects of the posterior aspect of the lower limb. Between September of 2010 and August of 2013, 27 thin flaps were used to reconstruct lower extremity defects in 27 patients. All flaps were elevated on the superficial fascia plane and based on a single perforator from either the superior or inferior gluteal artery. With the exception of two flaps that healed secondarily after partial loss, all flaps survived completely. Average flap thickness was 8.5 mm (range, 5 to 11 mm). The average flap size was 125 cm (range, 9 × 4 cm to 25 × 12 cm). The average pedicle length was 5.5 cm (range, 3 to 8 cm.). The average artery diameter was 0.65 mm (range, 0.4 to 1.3 mm). During the average follow-up of 13 months (range, 2 to 35 months), all flaps showed good contour and did not require any secondary revisions. The gluteal artery perforator free flap provides a thin flap for ideal contour, minimizes the operative risks of changing the patient's position intraoperatively, and conceals the donor site with minimal morbidity. However, the pedicle can be short and supermicrosurgery skills may be needed to accommodate the short pedicle. Overall, this new approach of using a thin gluteal artery perforator free flap to reconstruct the posterior aspect of the leg and foot can be considered a feasible option. Therapeutic, IV.

Short segment pedicle screw instrumentation with an index level screw and cantilevered hyperlordotic reduction in the treatment of type-A fractures of the thoracolumbar spine

The purpose of this study was to evaluate and compare the effect of short segment pedicle screw instrumentation and an intermediate screw (SSPI+IS) on the radiological outcome of type A thoracolumbar fractures, as judged by the load-sharing classification, percentage canal area reduction and remodelling. We retrospectively evaluated 39 patients who had undergone hyperlordotic SSPI+IS for an AO-Magerl Type-A thoracolumbar fracture. Their mean age was 35.1 (16 to 60) and the mean follow-up was 22.9 months (12 to 36). There were 26 men and 13 women in the study group. In total, 18 patients had a load-sharing classification score of seven and 21 a score of six. All radiographs and CT scans were evaluated for sagittal index, anterior body height compression (%ABC), spinal canal area and encroachment. There were no significant differences between the low and high score groups with respect to age, duration of follow-up, pre-operative sagittal index or pre-operative anterior body height compression (p = 0.217, 0.104, 0.104, and 0.109 respectively). The mean pre-operative sagittal index was 19.6° (12° to 28°) which was corrected to -1.8° (-5° to 3°) post-operatively and 2.4° (0° to 8°) at final follow-up (p = 0.835 for sagittal deformity). No patient needed revision for loss of correction or failure of instrumentation. Hyperlordotic reduction and short segment pedicle screw instrumentation and an intermediate screw is a safe and effective method of treating burst fractures of the thoracolumbar spine. It gives excellent radiological results with a very low rate of failure regardless of whether the fractures have a high or low load-sharing classification score.

Posterior interosseous artery perforator-free flap: Treating intermediate-size hand and foot defects

Ambiguous defects on the hand and foot, especially on the fingers and toes, are still challenging to treat despite achievements in reconstruction. The purpose of this study was to evaluate the use of the posterior interosseous artery perforator flap for resurfacing intermediate-sized defects and provide adequate coverage over tendons and bones. Between October 2008 and March 2013, a total of 19 patients with soft-tissue defects on the hand or foot were treated. Flap elevation, anatomy, and clinical progress were evaluated. All flaps survived and covered the defects, which ranged in area from 12 to 45 cm(2). The freestyle approach was used to harvest the flaps. The average length of the pedicle was 2.5 cm, and the pedicle was harvested without affecting the source vessel. The average diameter of the artery was 0.8 mm, and the average thickness of the flap was 3.5 mm. Anastomosis was performed either end-to-end on the perforator, or end-to-side on deep vessels. No subsequent thinning or surgical flap correction was necessary. Ambulation was allowed at 3 days postsurgery. The donor site was closed primarily to leave an acceptable donor site. A posterior interosseous artery perforator-free flap is a suitable choice for intermediate-size defects that are too large to cover using a local flap or too small for a first-line perforator flap. Up to 45 cm(2) of adequate coverage can be provided using a thin posterior interosseous artery perforator-free flap that does not require additional debulking. The disadvantages of a short pedicle can be overcome using perforator-to-perforator supermicrosurgery.

Posterior short segment pedicle screw fixation and TLIF for the treatment of unstable thoracolumbar/lumbar fracture

BackgroundCurrently, Posterior Short Segment Pedicle Screw Fixation is a popular procedure for treating unstable thoracolumbar/lumbar burst fracture. But progressive kyphosis and a high rate of hardware failure because of lack of the anterior column support remains a concern. The efficacy of different methods remains debatable and each technique has its advantages and disadvantages.MethodsA consecutive series of 20 patients with isolated thoracolumbar/lumbar burst fractures were treated by posterior short segment pedicle screw fixation and transforaminal thoracolumbar/lumbar interbody fusion (TLIF) between January 2005 and December 2007. All patients were followed up for a minimum of 2 years. Demographic data, neurologic status, anterior vertebral body heights, segmental Cobb angle and treatment-related complications were evaluated.ResultsThe mean operative time was 167 minutes (range, 150–220). Blood loss was 450 ~ 1200 ml, an average of 820 ml. All patients recovered with solid fusion of the intervertebral bone graft, without main complications like misplacement of the pedicle screw, nerve or vessel lesion or hard ware failure. The post-operative radiographs demonstrated a good fracture reduction and it was well maintained until the bone graft fusion. Neurological recovery of one to three Frankel grade was seen in 14 patients with partial neurological deficit, three grades of improvement was seen in one patient, two grades of improvement was observed in 6 patients and one grade of improvement was found in 6 patients. All the 6 patients with no paraplegia on admission remained neurological intact, and in one patient with Frankel D on admission no improvement was observed.ConclusionPosterior short-segment pedicle fixation in conjunction with TLIF seems to be a feasible option in the management of selected thoracolumbar/lumbar burst fractures, thereby addressing all the three columns through a single approach with less trauma and good results.

The Early Pleistocene water buffalo associated with Gigantopithecus from Chongzuo in southern China

Water buffalo materials were unearthed from the cave deposits paleomagnetically dated at 1 Ma during the excavation of Gigantopithecus in Queque Cave in Chongzuo, Guangxi, southern China. The morphological comparison and phylogenetic analyses show that the materials represent a new subspecies, Bubalus brevicornis chowi subsp. nov. It is a water buffalo with relatively short and stout horn core, the proximal and middle core cross sections are nearly equilateral triangular; a short neck or pedicle is present between the frontal and core. The materials represent the earliest record of fossil water buffalo. A consequent review of all fossil water buffaloes from China suggests integrating the previously reported ten species into a proposed six species.

Biomechanical impact of C2 pedicle screw length in an atlantoaxial fusion construct.

Background:Posterior, atlantoaxial (AA) fusions of the cervical spine may include either standard (26 mm) or short (16 mm) C2 pedicle screws. This manuscript focused on an in vitro biomechanical comparison of standard versus short C2 pedicle screws to perform posterior C1-C2 AA fusions.Methods:Twelve human cadaveric spines underwent C1 lateral mass screw and standard C2 pedicle screw (n = 6) versus short C2 pedicle screw (n = 6) fixation. Six additional controls were not instrumented. The peak torque, peak rotational interval, and peak stiffness of the constructs were analyzed to failure levels.Results:The peak torque to construct failure was not statistically significantly different among the control spine (12.2 Nm), short pedicle fixation (15.5 Nm), or the standard pedicle fixation (11.6 Nm), P = 0.79. While the angle at the peak rotation statistically significantly differed between the control specimens (47.7° of relative motion) and the overall instrumented specimens (P < 0.001), the 20.7° of relative rotation in the short C2 pedicle screw specimens was not statistically significantly higher than the 13.7° of relative rotation in the standard C2 pedicle screw specimens (P = 0.39). Similarly, although the average stiffness was statistically significantly lower in control group (0.026 Nm/degree) versus the overall instrumented specimens (P = 0.001), the standard C2 pedicle screws (2.54 Nm/degree) did not differ from the short C2 pedicle screwsConclusions:Both standard and short C2 pedicle screws allow for equally rigid fixation of C1 lateral mass-C2 AA fusions. Usage of a short C2 pedicle screw may be an acceptable method of stabilization in carefully selected patient populations.

The use of the free vascularised bone graft for nonunion of the scaphoid: a systematic review

BackgroundFractures of the scaphoid are well known to be problematic especially when complicated by avascular necrosis, nonunion and carpal collapse. Fixation techniques have involved nonvascularised bone grafting; however, in the presence of avascular necrosis, generally poor union rates (47%) occur as identified by a meta-analysis performed by Merrell et al. The introduction of pedicled vascularised bone grafts showed further improvement; however, in the presence of carpal collapse, union rates as low as 50% have been reported by Chang et al. amongst others using the 1,2-intercompartmental supraretinacular artery pedicled graft. The difficulty lies in having a short pedicle with limited manoeuvrability to correct a humpback deformity and insert into the scaphoid cavity. Prior trauma to the soft tissues or distal radius may prohibit the use of pedicled grafts. The aim of this systematic review is to examine the published evidence for the use of free vascularised bone grafts in cases of scaphoid nonunion.MethodsA systematic review was performed with the following defined search strategy on MEDLINE and Google Scholar: ((scaphoid nonunion) OR scaphoid pseudarthrosis) AND bone graft. Articles were reviewed and data compiled into tables for analysis. Statistical analysis was performed with determination of descriptive statistics, and differences between the groups were calculated using categorical variables and chi-square test. A p value of 0.05 or less was considered to be statistically significant.ResultsTwo hundred and sixty-three articles were identified with a total of 12 articles meeting the inclusion criteria. Two hundred and forty-five cases of scaphoid nonunion were identified through the articles included in this systematic review. Fifty-six patients underwent free vascularised bone grafts from the medial femoral condyle with a 100% union rate and correction of humpback deformity, and 188 patients underwent free vascularised bone grafting from the iliac crest with an 87.7% union rate. The difference between the two similar groups was statistically significant (p = 0.006).ConclusionsThe promising data suggests that the medial femoral condylar free graft based on the descending genicular vessels can be considered in cases of proximal pole avascular necrosis and humpback deformity or in situations where other flaps are precluded or deemed unlikely to cause union.

Predictive factors for a kyphosis recurrence following short-segment pedicle screw fixation including fractured vertebral body in unstable thoracolumbar burst fractures.

ObjectiveThe technique of short segment pedicle screw fixation (SSPSF) has been widely used for stabilization in thoracolumbar burst fractures (TLBFs), but some studies reported high rate of kyphosis recurrence or hardware failure. This study was to evaluate the results of SSPSF including fractured level and to find the risk factors concerned with the kyphosis recurrence in TLBFs.MethodsThis study included 42 patients, including 25 males and 17 females, who underwent SSPSF for stabilization of TLBFs between January 2003 and December 2010. For radiologic assessments, Cobb angle (CA), vertebral wedge angle (VWA), vertebral body compression ratio (VBCR), and difference between VWA and Cobb angle (DbVC) were measured. The relationships between kyphosis recurrence and radiologic parameters or demographic features were investigated. Frankel classification and low back outcome score (LBOS) were used for assessment of clinical outcomes.ResultsThe mean follow-up period was 38.6 months. CA, VWA, and VBCR were improved after SSPSF, and these parameters were well maintained at the final follow-up with minimal degree of correction loss. Kyphosis recurrence showed a significant increase in patients with Denis burst type A, load-sharing classification (LSC) score >6 or DbVC >6 (p<0.05). There were no patients who worsened to clinical outcome, and there was no significant correlation between kyphosis recurrence and clinical outcome in this series.ConclusionSSPSF including the fractured vertebra is an effective surgical method for restoration and maintenance of vertebral column stability in TLBFs. However, kyphosis recurrence was significantly associated with Denis burst type A fracture, LSC score >6, or DbVC >6.

Posterior reduction and short pedicle screw fixation at fracture level for treatment of single level compress thoracolumbar fractures

Objective To assess the efficacy and safety of posterior reduction and short pedicle screw fixation at fracture level(method A)for treatment of single level compress thoracolumbar fractures.Methods The clinical data of 87patients with single level compress thoracolumbar fractures,who were surgically treated between January 2010and January 2012in our hospital,were retrospectively analyzed.treated by posterior.The patients were divided into two groups according to surgical methods.Group A:Patients were treated with method A;Group B:Patients were treated by conventional posterior decompression,redultion of fracture and short segment fusion and internal fixation.The operation time and intraoperative blood loss were recorded and the postoperative pain was evaluated.The adjacent vertebral Cobb angle and the anterior height of the injured vertebra on the lateral radiographs were measured before surgery,immediately after surgery,and 1year after surgery,and the vertebral compression ratio was calculated.Results Among the 73patients who were finally included in the study,38were in group A and 35in group B.There were no significant differences in patient age,compression ratio,Cobb angle before or after surgery between the two groups.The operation time in group A was signficantly longer than that in group B(121min vs 92min,P0.05);the compression ratios immediately and 1year after surgery in group A were significantly higher than those in group B([immediately after surgery:91.3%(82%-93%)vs 77.2%(73%-86%),P0.05;1year after sugtery:87.2%(79%-93%)vs 73.1%(68%-80%),P0.05]).The Cobb angle at 1year after operation in group A was significantly smaller than that in group B(7.8°[0°-15°]vs 11°[2°-17°],P0.05).There was no significant differences in blood loss or scores of low back painbetween the two groups.Conclusion Posterior reduction and short pedicle screw fixation can safely and effectively reconstruct the vertebral body height and correct kyphosis in patients with single level compress thoracolumbar fractures.

Ten-year experience of superior gluteal artery perforator flap for reconstruction of sacral defects in Tri-Service General Hospital

Background: Despite advances in reconstruction techniques, sacral sores continue to present a challenge to the plastic surgeon. The superior gluteal artery perforator (SGAP) flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. However, the dissection of the perforator is tedious and carries a risk of compromising the perforator vessels. Patients and Methods: During the period between April 2003 and March 2013, 30 patients presented to our section with sacral wounds causing by pressure sores or infected pilonidal cysts. Of a total of 30 patients, 13 were female and 17 were male. Their ages ranged from 22 to 92 years old (mean 79.8 years old). Surgical intervention was performed electively with immediate or delayed reconstruction using a SGAP flap. The characteristics of patients' age, and sex, and cause of sacral defect, co-morbidities, wound culture, flap size, perforator number, hospital stay, and outcome were reviewed. Results: For all operations, the length of the pedicle dissection will not exceed 1 cm because of the vascular anatomy of the SGAP, which lies adjacent to the sacral region. Due to short pedicle dissection, all SGAP flap were elevated around an hour. All flaps survived except two, which had partial flap necrosis and were finally treated by contralateral V-Y advancement flaps coverage. The mean follow-up period was 14.8 months (range 3-24). No flap surgery-related mortality was found. Conclusion: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Our study shows that deep pedicle dissection is unnecessary when the surgery involves an accurate indicating perforator, adequate flap size design, and correct selection of flap utilization between tunnel and rotation. The advantages of this modification include a faster operation, less bleeding, and less trauma of the pedicle, which make the SGAP flaps an alternative choice for sacral sores coverage.

Modification of the superior gluteal artery perforator flap for reconstruction of sacral sores

Despite advances in reconstruction techniques, the treatment of sacral sores remains challenging to plastic surgeons. The superior gluteal artery perforator (SGAP) flap is reliable and preserves the entire contralateral side as a future donor site. The ipsilateral gluteal muscle is preserved, and the inferior gluteal artery flaps are viable. However, dissection of the perforator is tedious and may compromise the perforator vessels. Between April 2003 and March 2013, we performed two modified flap-harvesting techniques: a rotational and a tunnel method, with only a short pedicle dissection to cover 30 sacral defects. Patient characteristics including sex, age, cause of sacral defect, flap size, perforator number, use and postoperative complications were recorded. All flaps survived except two, which developed partial flap necrosis and were finally treated by contralateral V-Y advancement flap coverage. The mean follow-up period was 14.8 months (range, 3-24 months). No flap surgery-related mortality or recurrence of sacral pressure sores or infected pilonidal cysts were noted. Perforator-based flaps have become popular in modern reconstructive surgery because of low donor-site morbidity and good preservation of muscle. The advantages of our modification procedure include shorter operative time, lesser bleeding and lesser pedicle trauma, which make the SGAP flaps an excellent choice for sacral sore coverage.

Short segmental pedicle instrumentation via the paraspinal approach for the treatment of thoracolumbar fractures complicated with posterior ligamentous complex injury

Objective To study the efficacy and safety of short segmental pedicle instrumentation via the paraspinal approach for the management of neurologically intact patients with thoracolumbar burst fracture and posterior ligamentous complex injury.Methods From October 2008 to June 2010,70 such patients were treated in our department.They were 44 males and 26 females,with an average age of 33.4 years (range,from 19 to 55 years).They were divided into 2 groups according to 2 different operative methods.In group A,35 patients were treated via the paraspinal approach while 35 patients in group B were treated via the traditional open approach.The 2 approaches were compared in terms of operation time,intraoperative bleeding,postoperative ambulant time,hospital stay,changes in local kyphosis angle (LKA) and vertebral body height (VBH) at preoperation,postoperation and the last follow-up,postoperative complications and accuracy of screw insertion.Results The time for follow-up ranged from 24 to 36 months (mean,29.3 months).The operation time,intraoperative bleeding,postoperative ambulant time and hospital stay in group B were significantly more than in group A(P ＜ 0.05).No implant failure occurred in either group.There was no significant difference in pedicle screw cut-out between the 2 groups [7 (5.0％) versus 6 (4.3％)] (P ＞0.05).The LKA and VBH increased significantly at postoperation and the last follow-up compared with the preoperation in both groups (P ＜ 0.05),but there was no significant difference between the postoperation and the last follow-up (P ＞ 0.05).There were no significant differences between the 2 groups regarding LKA and VBH at preoperation,postoperation and the last follow-up (P ＞ 0.05).Conclusion The paraspinal approach may result in a good and safe clinical outcome in the treatment of thoracolumbar burst fractures with posterior ligamentous complex injury,because it can maintain the fracture reduction effectively and minimize the iatrogenic injury to soft tissues. Key words: Thoracic vertebrae; Lumbar vertebrae; Fracture; Surgical procedures, minimally invasive

Pathophysiology, clinical presentation, natural history, and review of the SPORT trials

Lumbar spinal stenosis is a combination of intervertebral disk degeneration (leading to loss of normal disk height), facet joint hypertrophy, ligamentum flavum hypertrophy/infolding, and osteophyte formation that results in narrowing of the spinal canal and compression of the lumbo-sacral nerve roots. This mechanical compression presents in patients as neurogenic claudication and resultant back and leg pain. Spinal stenosis is most commonly seen in the elderly population secondary to the normal aging of the lumbar spine. However, some patients may be predisposed to its effects due to congenitally narrowed canal secondary to short pedicles. The literature describes a variable natural history with a general worsening over time. Recently, more has been learned about the natural history of lumbar spinal stenosis with the addition of the Spine Patient Outcomes Research Trial (SPORT) to the literature.

Less invasive reduction and fusion of fresh A2 and A3 traumatic L1–L4 fractures with a novel vertebral body augmentation implant and short pedicle screw fixation and fusion

The aim of this clinical study was to report on the efficacy in reduction and safety in PMMA leakage of a novel vertebral augmentation technique with PEEK and PMMA, together with pedicle screws in the treatment of fresh vertebral fractures in young adults. Twenty consecutive young adults aged 45±11years with fresh burst A3/AO or severely compressed A2/AO fractures underwent via a less invasive posterior approach one-staged reduction with a novel augmentation implant and PMMA plus 3-vertebrae pedicle screw fixation and fusion. Radiologic parameters as segmental kyphosis (SKA), anterior (AVBHr) and posterior vertebral body height ratio (PVBHr), spinal canal encroachment (SCE), cement leakage and functional parameters as VAS, SF-36 were measured pre- and post-operatively. Hybrid construct restored AVBHr (P<0.000), PVBHr (P=0.02), SKA (P=0.015), SCE (P=0.002) without loss of correction at an average follow-up of 17months. PMMA leakage occurred in 3 patients (3 vertebrae) either anteriorly to the fractured vertebral body or to the adjacent disc, but in no case to the spinal canal. Two pedicle screws were malpositioned (one medially, one laterally to the pedicle at the fracture level) without neurologic sequelae. Solid posterolateral spinal fusion occurred 8-10months post-operatively. Pre-operative VAS and SF-36 scores improved post-operatively significantly. This study showed that this novel vertebral augmentation technique using PEEK implant and PMMA reduces and stabilizes via less invasive technique A2 and A3 vertebral fractures without loss of correction and leakage to the spinal canal.

Pure percutaneous pedicle screw fixation without arthrodesis of 32 thoraco-lumbar fractures: clinical and radiological outcome with 36-month follow-up

To evaluate the outcome of pure percutaneous fixation of unstable single level fractures at the thoraco-lumbar junction (A1 to B2 Magerl/AO Spine). Neurological intact patients were included in a 2-year prospective study (follow-up 36 months). Two groups were considered: the group in which additional short bilateral screws in the fractured vertebra were placed was called lordorizing screw group (LSG), the other was called non lordorizing screw group (nLSG). Clinical outcome was evaluated using the SF-36, the Oswestry disability index and the recovery time needed to go back work. The following radiological parameters were also evaluated on the follow-up exams: the Mid-Sagittal Index, the Cobb's angle and the Sagittal Index. In the LSG, the correction values of MSI, Cobb's angle and SI were statistically significantly higher than in nLSG. When feasible we recommend a pure percutaneous short segment pedicle screw fixation adding a lordorizing screw.

Anatomic radiological variations in developmental lumbar spinal stenosis: a prospective, control-matched comparative analysis

Background contextDevelopmental lumbar spinal stenosis is a maldevelopment of the dorsal spinal elements involving short pedicles and a trefoil bony spinal canal that increases the likelihood of neural compression at an earlier age. PurposeTo identify radiographically the anatomic variations caused by the maldevelopment of the infrequently characterized dorsal spinal elements. Study designA prospective, control-matched comparative analysis. MethodsMagnetic resonance imaging (MRI) and anteroposterior (AP) plain radiographs of 66 patients (mean age, 40.7 years) selected and randomized prospectively and compared with images of 45, age- and gender-matched control subjects. Variables assessed included spinal canal cross-sectional area (CSA), thecal sac AP and transverse canal diameters (CSA), and interpedicular distance. All were expressed in ratios with vertebral body diameter (VBD), interlaminar angle, stenosis grade, and MRI evidence of disc degeneration. ResultsIn the stenosis cohort, global pathology and multilevel involvement with L3, L4, and L5 segments were involved more commonly and severely. Severe stenosis, at L1, L2, and S1 occurs infrequently. Multivariate analysis demonstrated a statistically significant reduction in spinal canal CSA-to-vertebral body CSA ratio, AP spinal canal diameter-to-VBD ratio on axial and sagittal magnetic resonance images, and plain radiograph interpedicular distance-to-VBD ratio at all levels. Interlaminar angle and the transverse spinal canal diameter-to-VBD ratio were reduced significantly in the stenosed cohort at all levels, except L1. No statistically significant difference regarding the incidence of disc degeneration on MRI between the two cohorts, as well as thecal sac CSA-to-spinal canal CSA ratios across all levels were observed, except for L3 and S1 (p<.05). ConclusionsThree spinal canal morphologies were identified: (1) “flattened” canal with predominantly reduced spinal canal AP diameter, (2) spinal canal with predominantly reduced interlaminar angle, and (3) global reduction of all canal parameters. Early age at presentation and subtle spondylosis, although typical, should not be considered the identifying, differentiating factors.

Modified Superficial Circumflex Iliac Artery Perforator Flap and Supermicrosurgery Technique for Lower Extremity Reconstruction

The superficial circumflex iliac artery perforator (SCIP) flap is an evolved form of groin flap. It overcomes the inherent disadvantages of the groin flap by preserving the deep fascia but still requires challenging skills because of short pedicles and small caliber of vessels. The use of SCIP flap was evaluated for lower extremity use.From June of 2009 to August of 2011, a total of 79 cases were performed (age range, 4-80 years) on the lower extremity using supermicrosurgical approach. All flaps were harvested above the deep fat and the pedicles were taken above or just below the deep fascia to reconstruct the defects throughout the lower extremity.Supermicrosurgery technique was used in 71 cases. A total of 75 cases were performed successfully; 1 case underwent revision but failed and 2 cases were lost within 2 days of surgery. Average size of the flap was 75.5 cm, thickness 7 mm, average length of pedicle was 5 cm, and the average caliber of artery was 0.7 mm. Donor sites were all closed primarily but complications were noted with 1 dehiscence and prolong drainage of lymphatics. Flaps provided good functional coverage and appearance. The average follow-up was 12 months.With the modification of elevating the flap on the superficial fascia, we can harvest a thin flap without additional debulking and avoid complications such as lymphorrhea. Furthermore, with the perforator to perforator or perforator to small distal vessel approach, we can apply this flap on all regions of the lower extremity overcoming the difficulties with short pedicle and small vessel caliber. In our hands, the modified SCIP flap is the flap of choice for small to moderate size defects in the lower extremity.

Osteological evidence of short-limbed dwarfism in a nineteenth century Dutch family: Achondroplasia or hypochondroplasia

An opportunity to explore osteological features of a form of disproportionate dwarfism is presented by a recent archaeological discovery. Excavation of a predominately nineteenth century Dutch cemetery from the rural, agricultural village of Middenbeemster revealed an older adult female with skeletal changes consistent with achondroplasia. The most marked features are a rhizomelic pattern of shortened and thickened upper and lower limbs, frontal bossing and a moderately depressed nasal bridge, small lumbar neural canals with short pedicles, bowing of the femora and tibiae, and short stature (130.0±5cm). However, some common features of achondroplasia like cranial base reduction and shortened fingers and toes are absent. The alternative diagnosis of a more mild form of short-limbed dwarfism, hypochondroplasia, is explored and aided by archival identification of the individual and her offspring. Five offspring, including three perinates, a 10-year-old daughter, and a 21-year-old son, are analysed for evidence of an inherited skeletal dysplasia. The unique addition of family history to the paleopathological diagnostic process supports a differential outcome of hypochondroplasia. This combination of osteological and archival data creates a unique opportunity to track the inheritance and manifestation of a rare disease in a past population.

A minimally invasive surgery combining temporary percutaneous pedicle screw fixation without fusion and vertebroplasty with transpedicular intracorporeal hydroxyapatite blocks grafting for fresh thoracolumbar burst fractures: prospective study

The conventional surgical treatment for thoracolumbar burst fractures is physically invasive for the patient and also causes problems such as the sacrifice of healthy mobile segments to stabilize the fracture site. We performed a procedure for the treatment of fresh thoracolumbar burst fractures by combining percutaneous short pedicle screw fixation and vertebroplasty with transpedicular intracorporeal hydroxyapatite blocks grafting. Patients with type A3 fresh thoracolumbar burst fractures with no or mild neurological symptoms were treated using temporary posterior fixation without fusion. Consecutive 21 patients were studied, with a mean age of 45.4years (range 23-73) and a mean follow-up period of 21.9months (range 15-25). We evaluated operative time, estimated blood loss, low back pain on a visual analogue scale, change in the kyphotic angle, correction loss, bone union, and complications. The average operative time was 95.7min (range 69-143), and the average blood loss was 38.6mL (range 10-130). The average correction angle was 9.6°. There were slight correction losses of height of the vertebral bodies. Bone union was obtained in all patients, with no instrumentation failures. Our procedure resulted in no surgery-related complications. For the treatment of type A3 fresh thoracolumbar burst fractures, this method is less invasive and can preserve the adjacent healthy mobile segment. Our treatment is an optional therapeutic strategy for patients with thoracolumbar burst fractures and is a good option particularly for young adult patients.