PubMed · 4572225
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L D Lutter. 1973. Post-traumatic hip redislocation.. https://pubmed.ncbi.nlm.nih.gov/4572225/
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STUDY DESIGN: In a prospective study of 90 patients undergoing lumbar pedicle screw instrumentation, 512 screws were tested intraoperatively using electrical stimulation. The accuracy of this technique was verified after surgery by computed tomography. OBJECTIVES: Computed tomographic scans taken after surgery were used to evaluate the efficacy of intraoperative screw stimulation and electromyographic monitoring of pedicle screw placement. SUMMARY OF BACKGROUND DATA: Previous cadaveric and clinical studies showed the risk of pedicle screw malposition and the inadequate reliability of intraoperative radiographs to identify misplaced screws. METHODS: Screws (total, 512) in 90 patients were stimulated intraoperatively, and stimulation threshold was recorded. Computed tomographic scans were taken after surgery to document pedicle screw position. Electromyographic thresholds and computed tomographic data were evaluated independently and compared to assess the accuracy of the electromyographic screw stimulation technique. RESULTS: Intraoperative screw stimulation was extremely accurate in confirming the adequacy of screw position. A stimulation threshold greater than 15 mA provided a 98% confidence that the screw was within the pedicle. In eight of 90 patients (9%), electromyographic monitoring detected a screw malposition that was not identified on lateral radiograph. CONCLUSIONS: Screw stimulation monitoring is a valuable and efficacious adjunct to lumbar pedicle screw instrumentation. A stimulation threshold greater than 15 mA reliably indicates adequate screw position. A stimulation threshold between 10 and 15 mA was generally associated with adequate screw position, although exploration of the pedicle is recommended. A stimulation threshold less than 10 mA was associated with a significant cortical perforation in most instances.
A case of an unusual lumbosacral fracture-subluxation associated with bilateral fractures of the first sacral pedicles is described. The authors are aware of only one reported case in the literature. A 58-year-old man was involved in an accident during which his trunk was severely twisted toward the left and flexed. He also demonstrated L5 and S1 radiculopathies. He was successfully treated with surgical decompression of the L5 and S1 nerve roots with bilateral foraminotomies, followed by posterolateral arthrodesis at the lumbosacral junction using a transpedicular screw system that extended fixation into the ilia.
Thirty-seven children with fresh, displaced (more than 2 mm in any direction) fractures of the lateral condyle of the humerus were treated by open reduction and internal fixation with a partially threaded 4.0-mm diameter AO lag screw. They were reviewed at a mean follow-up of 4.8 years. Painless, full-elbow movements were obtained in 36 cases. Delayed union, with loss of 10 degrees of elbow motion, was observed in one case (2.72%). Radiologically, less than 4 degrees of varus deviation, compared with the contralateral side, was found in four cases (10.8%). Mild fishtailing was observed in three cases (8.18%). Nonunion, avascular necrosis or clinically significant premature epiphysial fusion was not observed. Elbow function was excellent, irrespective of minor radiologic abnormalities.