The authors report the results they obtained in a homogeneous series of fractures of the distal third of the femur treated by Grosse-Kempf nailing. Of the 67 fractures (58 closed, 9 exposed) treated with closed surgery (except for 1 case treated by nailing 35 days after trauma) non-union was never observed. The two cases of delay in consolidation (one related to an infection) did not require a change in method. Bone grafting was never necessary. Only in 3 cases (2 with multiple trauma, 1 treated by open reduction) was moderate reduction in range of movement of the knee observed.

Adolescent↗

PubMedDate not supplied

Failed back syndrome: a study on 95 patients submitted to reintervention after lumbar nerve root decompression for the treatment of spondylotic lesions.

The persistence of lumbar and nerve root pain after nerve root decompression surgery may be attributed to one of five causes; 1) progression of the spondylotic disease in the presence of peridural fibrosis; 2) recurrence of disc herniation or new hernia; 3) stenosis of the spinal or nerve root canal; 4) arachnoiditis; 5) vertebral instability. In most patients with peridural fibrosis and worsening of spondylotic lesions regression of nerve root symptoms was obtained after several months of conservative treatment, which continues to constitute essential treatment for most patients with recurrence of lumbar symptoms. The authors report the results obtained with the surgical treatment of 95 patients performed between 1981 and 1991 and divided into the categories listed above. Of these patients, 70 were submitted to further decompression surgery while 25 were submitted to posterolateral vertebral fusion. Reintervention obtained useful results in 83% of the cases where there had been recurrence of disc herniation; nerve root release obtained positive results in 100% of the cases where there was stenosis. Results obtained after wide decompression were poor in all of the cases with arachnoiditis; in these patients conservative treatment with T.E.N.S. can obtain a fair amount of control over pain. Positive results were obtained in 84% of the 25 patients submitted to posterolateral fusion for the treatment of vertebral instability, with fusion obtained in 96% of the cases. Surgical treatment is indicated for psychotic, neurotic patients or those with insurance-related motivations only when the organic cause of the symptoms is clearly evident.

Adolescent↗

PubMedDate not supplied

Caso quiz. Degenerative spondylolisthesis at L4.

Explore the source record for details and available documents.

Adult↗

PubMedDate not supplied

Differential diagnosis of low back pain.

Low back pain is a symptom common to many vertebral and extravertebral affections. The origin of low back pain mostly derives from a pathology localized in the spine, as in the case of degenerative lesions, neoplastic lesions, infections, fractures, metabolic diseases such as osteoporosis, or more rarely, rheumatological diseases. The causes of extravertebral low back pain may be renal, pancreatic, gastrointestinal, or of the female genital apparatus. The authors present a series of clinical aspects which must always be taken into consideration in order to avoid errors in the diagnosis and evaluation of a patient with low back pain.

Diagnosis, Differential↗

PubMedDate not supplied

Posterolateral spinal fusion: a study of 123 cases with a long-term follow-up.

A total of 123 patients submitted to posterolateral fusion according to the Wiltse method were followed-up after 2-10 years (mean 6 years and 2 months). The series included: isthmic spondylolisthesis: 80; degenerative spondylolisthesis: 18; failed back syndrome: 25. Good morphological fusion of the arthrodesis evaluated by conventional radiology and CT, was obtained in 87% of the entire series, while in 89% of the cases excellent or good clinical results were obtained according to the Friberg evaluation scale. Extent of the fusion to 1 or 2 intervertebral segments, or association of laminectomy did not influence the results. Clinical and radiographic results were maintained stable in time: in only 3 cases did we observe clinical deterioration due to degeneration of the segment located above the fusion 3-7 years after surgery. The only important complications observed were one cauda equina syndrome due to peridural hematoma after laminectomy-fusion, and one iliocaval venous thrombosis. The results of the series studied and the data reported in the literature show that posterolateral fusion is a method capable of providing a high percentage of good clinical and radiographic results, and it may be favorably compared with methods of interbody fusion and of pedicular fixation, compared to which it has the advantage of involving a minor number of complications. Anterior interbody fusion is however indicated for stabilization of the reduction of severe spondylolisthesis in the adolescent. Fusion with pedicular osteosynthesis is indicated for the treatment of macroscopic instability and in fusions which are extended to more than two intervertebral segments.

Adolescent↗

PubMedDate not supplied

Cyst of the medial meniscus: observation of two cases.

The authors report two cases of cyst of the medial meniscus. In both cases imaging diagnostics, CT scan, or MRI allowed us to reveal the characteristic horizontal meniscal lesion that would be the primary cause of cystic degeneration of the meniscus. The two cases were treated by selective resection of the meniscal lesion and arthroscopic decompression of the cyst.

Adult↗

PubMedDate not supplied

Reconstruction by Grosse-Kempf nailing in resections for bone tumor.

The authors report 38 reconstruction by Grosse-Kempf nailing for resection of bone tumor; there were: intercalar resections: 16; arthrodeses of the knee: 13; arthrodesis of the ankle joint: 5; gyroplasty: 4. Massive homoplastic bone graft was used in 26 cases, in 3 of which autoplastic grafting was associated; autoplastic grafts were used exclusively in 7 cases, and a cement spacer was used in 1. Twenty-nine patients (76%) obtained satisfactory final results, but in 10 cases secondary surgery was performed for a total of 14 operations, of which 7 major (1 nail substitution and 6 vascularized fibula operations). There were 7 failures: mechanical complications: 6; infection: 1. The highest number of non-unions were observed where massive homoplastic grafting was used: intercalar reconstruction: 11; arthrodesis of the knee: 7. The results were evidently better and the incidence of complications low in cases in which autoplastic grafting was used or where gyroplasty was performed. Absolute stiffness and best possible contact are difficult to obtain with blocked intramedullary nailing. On the contrary, when autoplastic grafts are used or when gyroplasty is performed micromovements allowed the instrumentation are compatible with good consolidation.

Adolescent↗

PubMedDate not supplied

Wear in carbon fiber-reinforced polyethylene (poly-two) knee prostheses.

The authors report a case of massive wear of carbon fiber-reinforced polyethylene used as an insert in a knee prosthesis. The finding, which was studied under a scanning electron microscope, in agreement with mechanical resistance and laboratory testing reported in the literature, confirms that this composite material (poly-two) is not more advantageous to use that ultra-high molecular weight polyethylene in terms of wear, despite favorable experimental premises.

Aged↗

PubMedDate not supplied

Two cases of hyperparathyroidism initially diagnosed as aneurysmal cyst.

The authors present two cases of primary hyper-parathyroidism initially diagnosed as aneurysmal cyst. The aspects of differential diagnosis are discussed, and the importance of evaluating all of the diagnostic elements in order to formulate a correct diagnosis is emphasized.

Adenoma↗