Posterior Stabilization for Management of Neglected Odontoid Fractures

Background: Odontoid fractures are specific types of cervical fractures that show many challenges in their management. There are several types of Odontoid fractures with different modes of stability. There is no definite widely accepted way of management of Type II fractures among spine surgeons. There is a high rate of delayed or non-union of Odontoid fracture cases that are managed conservatively which may lead to dangerous complications. If non-union occurs, the patient should undergo surgical intervention as early as possible to avoid neurological deterioration. Objective: To demonstrate the value of intra-operative reduction and posterior stabilization of atlanto-axial junction in cases of non-union old Odontoid fractures and their outcome. The study was also to check for criteria associated with a favorable outcome and if posterior decompression will be associated with a better outcome. Patients and Methods: 12 patients of old neglected Odontoid fractures following conservative management and complicated by non-union were operated through intra-operative reduction with posterior stabilization and fixation of atlanto-axial junction at Al-Azhar University Hospitals during the period starting from June 2016 till the end of December 2019 using Screws and Rods. Intra-operative reduction under C-Arm X-ray and firm stabilization were aimed in all cases. Posterior cord decompression was an option in selected 4 patients with severe cord compression. Both intra-operative, post-operative radiological and clinical outcomes were assessed. Results: Good intra-operative reduction and alignment of fractured Odontoid process were obtained in all cases with use of 4 screws and 2 rods (2 screws and 1 rod on each side) in 11 cases and with using 2 screws and 1 rod (unilateral fixation) in one case. Good clinical outcome was obtained in all patients with improvement of pre-operative condition except in 3 patients where there were persistent pre-operative neurological deficits and without deterioration of pre-operative condition. Additional posterior cord decompression was associated with a better clinical outcome in 2 of 4 selected cases with severe cord compression. Conclusion: Good intra-operative reduction under C-Arm X-ray with posterior stabilization through atlanto-axial fixation using screws and rods is a reliable way of management of neglected type II Odontoid fractures complicated with non-union. Better results were obtained with less pre-operative neurological deficits and with absence of myelomalacia in MRI images. Additional posterior decompression may improve clinical outcome in cases of severe cord compression.

Effect of posterior condylar offset on clinical results after posterior-stabilized total knee arthroplasty

Purpose： To determine the effect of the posterior condylar offset （PCO） on clinical results after total knee arthroplasty （TKA） using a high-flex posterior-stabilized （PS） fixed-bearing prosthesis. Methods： We prospectively studied the clinical and radiographic materials of 89 consecutive female patients （89 knees）, who had undergone primary TKAs for end-stage osteoarthritis. All operations were performed by a single senior surgeon or under his supervision using the same operative technique. Based on the corrected PCO change, we divided all cases into two groups： group A （corrected PCO change _〉0 mm, 58 knees） and group B （corrected PCO change 〈0 ram, 31 knees）. One-year postoperatively, clinical and radiographic variables from the two groups were compared by independent t-test. The as- sociations between the corrected PCO changes and the improvements of clinical variables in all patients were analyzed by Pearson linear correlation. Results： One-year postoperatively, the Knee Society Scores, the Western Ontario and McMaster Uni- versities Osteoarthritis Index, non-weight-bearing active and passive range of knee flexion, flexion contracture, extensor lag, and their improvements had no statistical differences between the two groups （all p 〉 0.05）. The corrected PCO change was not significantly correlated with the improvement of any clinical variable （all p 〉 0.05）. Group A demonstrated greater flexion than group B during active weight bearing （p 〈 0.05）. Conclusions： Restoration of PCO plays an important role in the optimization of active knee flexion during weight-bearing conditions after posterior-stabilized TKA, while it has no benefit to non-weight-bearing knee flexion or any other clinical result.

Advances and disputes of posterior malleolus fracture

Objective The objective of this article is to summarize the development of evaluation and treatment of posterior malleolus fracture （PMF）. Data sources Data used in this Study selection Articles were review were mainly from English literature of PubMed data base. ncluded in this review if they were related to the PMF or trimalleolar fracture.