Kyphosis is a common sequel of inadequately managed thoracolumbar fractures. This study compares between pedicle subtraction osteotomy (PSO) and anterior corpectomy and plating (ACP) for correcting post-traumatic kyphosis. Forty-three patients with symptomatic post-traumatic kyphosis of the thoracolumbar spine were treated with PSO and prospectively followed for a minimum of 2 years. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess clinical improvement and radiographs were obtained at 2, 6, 12 and 24 months. The recorded clinical and radiological outcomes were compared to a control group of 37 patients, who were treated earlier by the same authors with ACP. The mean correction of the kyphotic angle was 29.8 for the PSO group and 22 for the ACP group (P = 0.001). PSO group showed significantly better improvement in the VAS score and the ODI. At final follow-up, patients reported very good satisfaction (93% in PSO vs. 81% in ACP) and good function (90% in PSO vs. 73% in ACP). Complications in the PSO group included pulling out of screws and recurrence of deformity requiring revision and longer fixation (1 patient), and transient lower limb paraesthesia (2 patients). Recorded complications in the ACP group included an aortic injury (1 patient) that was successfully repaired, pseudarthrosis (1 patient), persistent graft donor site morbidity (3 patients), and incisional hernia (1 patient). PSO and ACP are demanding procedures. PSO seems to be equally safe but more effective than ACP for correcting post-traumatic kyphosis.

Kyphosis is a common sequel of inadequately managed thoracolumbar fractures. This study compares between pedicle subtraction osteotomy (PSO) and anterior corpectomy and plating (ACP) for correcting post-traumatic kyphosis. Forty-three patients with symptomatic post-traumatic kyphosis of the thoracolumbar spine were treated with PSO and prospectively followed for a minimum of 2 years. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess clinical improvement and radiographs were obtained at 2, 6, 12 and 24 months. The recorded clinical and radiological outcomes were compared to a control group of 37 patients, who were treated earlier by the same authors with ACP. The mean correction of the kyphotic angle was 29.8 for the PSO group and 22 for the ACP group (P = 0.001). PSO group showed significantly better improvement in the VAS score and the ODI. At final follow-up, patients reported very good satisfaction (93% in PSO vs. 81% in ACP) and good function (90% in PSO vs. 73% in ACP). Complications in the PSO group included pulling out of screws and recurrence of deformity requiring revision and longer fixation (1 patient), and transient lower limb paraesthesia (2 patients). Recorded complications in the ACP group included an aortic injury (1 patient) that was successfully repaired, pseudarthrosis (1 patient), persistent graft donor site morbidity (3 patients), and incisional hernia (1 patient). PSO and ACP are demanding procedures. PSO seems to be equally safe but more effective than ACP for correcting post-traumatic kyphosis.

Purpose The purpose of this study was to present our experience in treating dorso-lumbar tuberculosis by one-stage posterior circumferential fusion and to compare this group with a historical group treated by anterior debridement followed by postero-lateral fusion and stabilization. Methods Between 2003 and 2008, 32 patients with active spinal tuberculosis were treated by one-stage posterior circumferential fusion and prospectively followed for a minimum of two years. Pain severity was measured using Visual Analogue Scale (VAS). Neurological assessment was done using the Frankel scale. The operative data, clinical, radiological, and functional outcomes were also compared to a similar group of 25 patients treated with anterior debridement and fusion, followed 10–14 days later by posterior stabilization and postero-lateral fusion. Results The mean operative time and duration of hospital stay were significantly longer in the two-stage group. The mean estimated blood loss was also larger, though insignificantly, in the two-stage group. The incidence of complications was significantly lower in the one-stage group. At final follow-up, all 34 patients with pre-operative neurological deficits showed at least one Frankel grade of neurological improvement, all 57 patients showed significant improvement of their VAS back pain score, the mean kyphotic angle has significantly improved, all patients achieved solid fusion and 43 (75.4%) patients returned to their pre-disease activity level or work. Conclusion Instrumented circumferential fusion, whether in one or two stages, is an effective treatment for dorso-lumbar tuberculosis. One-stage surgery, however, is advantageous because it has lower complication rate, shorter hospital stay, less operative time and blood loss.

Purpose The purpose of this study was to present our experience in treating dorso-lumbar tuberculosis by one-stage posterior circumferential fusion and to compare this group with a historical group treated by anterior debridement followed by postero-lateral fusion and stabilization. Methods Between 2003 and 2008, 32 patients with active spinal tuberculosis were treated by one-stage posterior circumferential fusion and prospectively followed for a minimum of two years. Pain severity was measured using Visual Analogue Scale (VAS). Neurological assessment was done using the Frankel scale. The operative data, clinical, radiological, and functional outcomes were also compared to a similar group of 25 patients treated with anterior debridement and fusion, followed 10–14 days later by posterior stabilization and postero-lateral fusion. Results The mean operative time and duration of hospital stay were significantly longer in the two-stage group. The mean estimated blood loss was also larger, though insignificantly, in the two-stage group. The incidence of complications was significantly lower in the one-stage group. At final follow-up, all 34 patients with pre-operative neurological deficits showed at least one Frankel grade of neurological improvement, all 57 patients showed significant improvement of their VAS back pain score, the mean kyphotic angle has significantly improved, all patients achieved solid fusion and 43 (75.4%) patients returned to their pre-disease activity level or work. Conclusion Instrumented circumferential fusion, whether in one or two stages, is an effective treatment for dorso-lumbar tuberculosis. One-stage surgery, however, is advantageous because it has lower complication rate, shorter hospital stay, less operative time and blood loss.

Non-union occurs when bone healing ceases and does not continue without some type of intervention. Classification of non-union is traditionally based on the amount of callus or bone healing at the fracture site. Successful treatment of non-union often depends on appropriate reduction and realignment of the fracture, bone grafting if necessary, and stabilization. This may not be possible in some neglected and complicated non-unions. Under these circumstances, modification of the standard techniques or a limited surgical interference, that might not be anatomical, may succeed in improving function. We present four cases of non-anatomical salvage solutions for difficult long bone non-unions with satisfactory functional outcome.

Non-union occurs when bone healing ceases and does not continue without some type of intervention. Classification of non-union is traditionally based on the amount of callus or bone healing at the fracture site. Successful treatment of non-union often depends on appropriate reduction and realignment of the fracture, bone grafting if necessary, and stabilization. This may not be possible in some neglected and complicated non-unions. Under these circumstances, modification of the standard techniques or a limited surgical interference, that might not be anatomical, may succeed in improving function. We present four cases of non-anatomical salvage solutions for difficult long bone non-unions with satisfactory functional outcome.

Non-union occurs when bone healing ceases and does not continue without some type of intervention. Classification of non-union is traditionally based on the amount of callus or bone healing at the fracture site. Successful treatment of non-union often depends on appropriate reduction and realignment of the fracture, bone grafting if necessary, and stabilization. This may not be possible in some neglected and complicated non-unions. Under these circumstances, modification of the standard techniques or a limited surgical interference, that might not be anatomical, may succeed in improving function. We present four cases of non-anatomical salvage solutions for difficult long bone non-unions with satisfactory functional outcome.

Egypt had professional doctors as early as the old kingdom 5,000 years ago. There were also specialists in different branches of medicine. Homer (ca. 800 BC) remarked in the Odyssey: "In Egypt, the men are more skilled inmedicine than any of human kind". Hippocrates, Herophilos, Erasistratus and later Galen studied at the temple of Amenhotep, and acknowledged the contribution of ancient Egyptian medicine to Greek medicine [1].

Twenty-six patients with failed dynamic hip screw fixation of intertrochanteric fractures were included in this study. The mean age of the patients was 61 years (range, 38—84 years). Average limb shortening was 2.4 cm; 18 patients were treated with revision internal fixation and eight patients with prosthetic replacement. The decision depended on the physiological age of the patient, quality of bone, and condition of the femoral head and the acetabulum. The revision internal fixation group included DHS reinsertion in eight patients, valgus osteotomy and revision DHS fixation in six, while four patients were treated by valgus osteotomy and insertion of single-angled 1308 plate. The prosthetic replacement group included cemented Thompson endoprothesis in five patients and cemented total hip arthroplasty in three. The mean follow-up period was 31 months (range, 15—72 months). All patients of revision internal fixation group achieved fracture healing without bone grafting. Time to union averaged 17 weeks. Average gain in length was 2 cm Avascular necrosis of the femoral head occurred in one patient. Six patients of the prosthetic replacement group achieved good functional outcome and pain-free gait. The remaining two had unsatisfactory result.

Twenty-six patients with failed dynamic hip screw fixation of intertrochanteric fractures were included in this study. The mean age of the patients was 61 years (range, 38—84 years). Average limb shortening was 2.4 cm; 18 patients were treated with revision internal fixation and eight patients with prosthetic replacement. The decision depended on the physiological age of the patient, quality of bone, and condition of the femoral head and the acetabulum. The revision internal fixation group included DHS reinsertion in eight patients, valgus osteotomy and revision DHS fixation in six, while four patients were treated by valgus osteotomy and insertion of single-angled 1308 plate. The prosthetic replacement group included cemented Thompson endoprothesis in five patients and cemented total hip arthroplasty in three. The mean follow-up period was 31 months (range, 15—72 months). All patients of revision internal fixation group achieved fracture healing without bone grafting. Time to union averaged 17 weeks. Average gain in length was 2 cm Avascular necrosis of the femoral head occurred in one patient. Six patients of the prosthetic replacement group achieved good functional outcome and pain-free gait. The remaining two had unsatisfactory result.