Articles: joint-instability-etiology.
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Ulnar-sided injuries of the wrist have received more attention recently for their potential negative impact on the outcome of distal radius fractures. Radiographs and medical records were retrospectively reviewed for 166 distal radius fractures treated during a 1-year interval. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size and displacement. ⋯ The distribution of ulnar styloid fractures was not random; greater than one third involved the base. All distal radius fractures complicated by distal radioulnar joint instability were accompanied by an ulnar styloid fracture. A fracture at the ulnar styloid's base and significant displacement of an ulnar styloid fracture were found to increase the risk of distal radioulnar joint instability.
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Arch Orthop Trauma Surg · Feb 2002
Comparative StudyAdjacent segment degeneration after lumbar spinal posterolateral fusion with instrumentation in elderly patients.
This retrospective study investigated adjacent segments radiologically and clinically after posterolateral fusion of the lumbar spine with instrumentation. Thirty-two patients over 60 years old with a postoperative follow-up of at least 4 years were included. These patients all met the criteria of a postoperative symptom-free period of over 2 years, evident fusion mass seen on plain radiographs, and no implant breakage or loosening. ⋯ However, no statistically significant difference (p = 0.7878) was found according to the Fisher exact test. Comparing the effect of different types of instruments, there still was no statistically significant difference (p = 0.1161) between the VSP plate and Isola rod groups in inducing degeneration of adjacent segments after posterolateral fusion of the lumbar spine. After measuring the mobility of degenerated adjacent segments, relative hypermobility was more likely responsible for the accelerated degeneration rather than the absolute increase of mobility.
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This study is a retrospective review of 39 patients with previous instrumented lumbar fusion who underwent secondary spine surgery for lumbar adjacent instability. To the authors' knowledge, this is the largest study of surgical treatment of lumbar adjacent instability in the literature to date. ⋯ Autogenous posterolateral arthrodesis combined with pedicle screw fixation led to successful radiologic and clinical outcome in patients with lumbar adjacent instability. Adequate decompression of the adjacent stenosis requires medial facetectomy, thus preventing aggressive nerve root manipulation and reducing the incidence of dural tear.
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The reduction and stabilisation of high-grade dysplastic developmental spondylolisthesis by means of modern internal fixators can correct slip, but can leave the sagittal alignment unbalanced, causing instability, e.g. in the adjacent, non-fused lumbar segments. Through analysis of the modifications of imbalance in the spine and pelvic ring due to surgical correction, this study defines the unstable zone of high-grade dysplastic developmental spondylolisthesis and proposes a simple radiographic method to identify it.
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The aim of the present study was to outline a new surgical technique and describe how, in a clinical setting, computer-generated image-guidance can assist in the planning and accurate placement of transarticular C1/C2 screws inserted using a minimally invasive exposure. Forty-six patients with atlanto-axial instability due to rheumatoid arthritis underwent posterior stabilisation with transarticular screws. This was achieved with a minimal posterior exposure limited to C1 and C2 and percutaneous screw insertions via minor stab incisions. ⋯ This technique for placing transarticular screws is accurate and safe. It allows a minimally invasive approach to be followed. Image guidance is a useful adjunct for the surgeon undertaking complex spinal procedures.