PubMed · 4870232
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H J Hommel. 1967. [Bones as osteosynthesis material].. https://pubmed.ncbi.nlm.nih.gov/4870232/
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Different methods are recommended for the surgical reconstruction of the resected mandible. The advantages for implant stabilised prostheses in restoring the occlusion are recognised but few papers provide adequate data to identify the successful outcome of treatment. The literature is reviewed and the advantages of imaging together with the use of digitised data is highlighted by a case requiring rehabilitation with enhanced planning methods.
STUDY DESIGN: The case report of a 60-year-old man with late onset back pain after lumbar spine fusion is presented. OBJECTIVE: To report the rare complication of bilateral pedicle stress fractures after instrumented posterolateral lumbar fusion. SUMMARY OF BACKGROUND DATA: A 56-year-old man underwent revision spinal surgery for ongoing back pain secondary to pseudoarthroses. A posterolateral L4-S1 instrumented fusion using pedicle screws was performed. Autologous bone graft was applied to the decorticated lateral masses. The internal fixation was removed 2 years later, at which time plain radiographs showed that the fusion mass was solid. At the age of 60 years, the man presented with worsening back pain. Plain radiographs and computed tomographic scans demonstrated bilateral L4 pedicle stress fractures. A bone scan indicated that these were recent in origin. METHOD: The clinical assessment was undertaken by the senior author and surgeon. Investigations included plain radiography, computer tomography, and scintographic imaging. A systematic literature review of the relevant publications was performed. RESULTS: In the reported patient, bilateral pedicle stress fractures developed 2 years after pedicle screw removal from an L4-S1 instrumented posterolateral lumbar spine fusion. This occurred at the uppermost level of the fusion mass. CONCLUSIONS: The pedicle is the weakest point in the neural arch after posterolateral fusion. Although movement continues at the level of the disc space anteriorly, the pedicle is susceptible to fracture. Pedicle fracture is a rare late complication of posterolateral lumbar spine fusion.
The goal of every hip revision is to restore as much function as possible. Frequent problems are defects of the load-carrying bony substance and functional deficits due to trochanteric avulsions, abductor insufficiencies, and lesions of the superior gluteal nerve. Disturbed functions of these important structures may lead to unsatisfactory results with high dislocation rates and limping. Various femoral defect classifications differ in their description of the lesion as well as in their proposed therapeutic approach. Significant differences exist in the field of allograft use. Among others, the AAOS, SO.F.C.O.T, and Paprosky's classifications are described. Our own easy to use alternative classification is introduced which takes into consideration the fixation principle of the new stem. It thus helps to select the type of implant and offers a guideline for technical modalities. A Type 1 defect allows a revision with a component suitable for a primary case. Type 2 defects can be treated with a short revision stem exceeding the length of the revised stem. Type 3 defects are treated with a "load-sharing" concept where an optimized metaphyseal fill and a cylindrical shape distally share the axial and torsion loads. Type 4 defects are reconstructed with a combination of a revision stem and an allograft.