Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains unclear whether additional fixation of more segments could improve clinical and radiological outcomes. This meta-analysis was performed to evaluate the effectiveness of fixation levels with pedicle screw fixation for thoracolumbar burst fractures. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Springer, and Google Scholar were searched for relevant randomized and quasirandomized controlled trials that compared the clinical and radiological efficacy of short versus long segment for thoracolumbar burst fractures managed by posterior pedicle screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. Based on predefined inclusion criteria, Nine eligible trials with a total of 365 patients were included in this meta-analysis. Results were expressed as risk difference for dichotomous outcomes and standard mean difference for continuous outcomes with 95% confidence interval. Baseline characteristics were similar between the short and long segment fixation groups. No significant difference was identified between the two groups regarding radiological outcome, functional outcome, neurologic improvement, and implant failure rate. The results of this meta-analysis suggested that extension of fixation was not necessary when thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with high quality are still needed in the future.

/pdf/short-segment-versus-long-segment-pedicle-screws-fixation-in-1majpj5ns5.pdf

Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis.

Background
Currently, Posterior Short Segment Pedicle Screw Fixation is a popular procedure for treating unstable thoracolumbar/lumbar burst fracture. But progressive kyphosis and a high rate of hardware failure because of lack of the anterior column support remains a concern. The efficacy of different methods remains debatable and each technique has its advantages and disadvantages.

/pdf/posterior-short-segment-pedicle-screw-fixation-and-tlif-for-3y7qm6fmgn.pdf

Posterior short segment pedicle screw fixation and TLIF for the treatment of unstable thoracolumbar/lumbar fracture

Two different techniques of short-segment instrumentation, with and without a pedicle screw at the fracture level, were compared in thoracolumbar burst fractures in neurologically intact (ASIA-E) patients. The sagittal index, kyphosis angle (Cobb), canal compromise ratio, and compression ratio of the anterior vertebral height were analyzed. Seventy patients who underwent short-segment stabilization for thoracolumbar (T11-L2) burst fractures in our clinic between 2008 and 2012 were included in this retrospective study. In 35 patients (group 1), a pedicle screw was placed only one level down and one level up from the fracture level. In another 35 patients (group 2), a screw was placed at the fracture level in addition to the short segment. Only neurologically intact patients with burst fractures according to the Denis classification were included. The patients were evaluated according to their age/gender, trauma etiology, and fracture level. Their preoperative and most recent postoperative follow-up radiographs and CTs were evaluated in terms of the sagittal index, kyphosis angle (Cobb), ratio of canal compromise, and anterior vertebral height. The two groups were similar in their ages, follow-up periods, and severity of the deformity and fracture. When the pedicle screw was placed at the fracture level in addition to short-segment stabilization, statistically significant improvements in the sagittal index (p < 0.001), local kyphosis (Cobb) angle (p = 0.006), and compression ratio of the anterior vertebral height (p = 0.002) were observed. Concerning the ratio of canal compromise according to the CT findings (p = 0.189), moderate differences were found. Short-segment stabilization in thoracolumbar burst fractures with additional screws at the level of the fracture results in an improved kyphosis correction, sagittal index, and compression ratio of the anterior vertebral height. However, long-term follow-up is needed to determine the clinical significance of these findings.

Results of treatment of unstable thoracolumbar burst fractures using pedicle instrumentation with and without fracture-level screws

Full article available online at ORTHOSuperSite.com. Search: 20110627-08 Posterior short-segmental fi xation is reliable for the management of thoracolumbar fractures; however, it is associated with recurrence of kyphosis and failure of fi This study compared the short-term results of short-segmental ficombined with intermediate screws with those of conventional intersegmental fi xation in the treat- ment of monosegmental thoracolumbar fractures. The records of 62 consecutive pa- tients with thoracolumbar monosegmental fractures who underwent conventional 4- screw intersegmental fi xation (35 patients) or short-segmental ficombined with intermediate screws (27 patients) were reviewed. The study population included 43 men and 19 women (mean age, 44.113.6 years). The majority of fractures were L1 (28 (45.1%)) and T12 (21 (33.9%)) fractures. There were no signifi cant differences be- tween the 2 groups with respect to the preoperative relative height of the fractured ver- tebra or the segmental kyphotic angle. There was a signifi cant difference in the restora- tion rate between the conventional and short-segmental fi xation groups (62.638.7% vs 100.425.4%, respectively; P.001). However, a statistically signifi cant decrease in postoperative segmental kyphotic angle was noted in both groups (P.001). The mean change of segmental kyphotic angle in the short-segmental fi xation group was greater than in the conventional fi xation group (14.46.8 vs 8.37.9, respectively; P.002). Patients in the short-segmental fi xation group ambulated an average of 10 days earlier than those in the conventional fi xation group. These fi ndings indicate that compared to conventional intersegmental fi xation, short-segmental fi xation combined with intermediate screws more effectively restores fractured vertebral height, is associ- ated with a decrease in the segmental kyphotic angle, and allows earlier ambulation.

http://m3.wyanokecdn.com/e82ea55db5d1c731f54d372ba645df2d.pdf

Posterior short-segmental fixation combined with intermediate screws vs conventional intersegmental fixation for monosegmental thoracolumbar fractures.

The majority of compressive vertebral fractures in osteoporotic bone occur at the level of the thoracolumbar junction. Immediate decompression is often required in order to reduce the extent of neurological damage. This study evaluated four fixation methods for decompression in patients with thoracolumbar burst fractures, and presented the most suitable method for osteoporotic patients. A finite element model of a T7-L5 spinal segment was created and subjected to an L1 corpectomy to simulate a serious burst fracture. Five models were tested: a) intact spine; 2) two segment fixation (TSF), 3) up-three segment fixation (UTSF), below-three segment fixation (BTSF), and four segment fixation (FSF). The ROM, stiffness and compression ratio of the fractured vertebra were recorded under various loading conditions. The results of this study showed that the ROM of the FSF model was the lowest, and the ROMs of UTSF and BTSF models were similar but still greater than the TSF model. Decreasing the BMD to simulate osteoporotic bone resulted in a ROM for the four instrumented models that was higher than the normal bone model. Of all models, the FSF model had the highest stiffness at T12-L2 in extension and lateral bending. Similarly, the compression ratio of the FSF model at L1 was also higher than the other instrumented models. In conclusion, FSF fixation is suggested for patients with osteoporotic thoracolumbar burst fractures. For patients with normal bone quality, both UTSF and BTSF fixation provide an acceptable stiffness in extension and lateral bending, as well as a favorable compression ratio at L1.

/pdf/the-stability-of-long-segment-and-short-segment-fixation-for-uya981m6so.pdf

The stability of long-segment and short-segment fixation for treating severe burst fractures at the thoracolumbar junction in osteoporotic bone: A finite element analysis.

Correction of rotational malalignments caused by fractures is essential as it may cause pain and gait disturbances. This study evaluated the intraoperative use of a smartphone application (SP app) to measure the extent of corrective rotation in patients treated using minimally invasive derotational osteotomy. Intraoperatively, two parallel 5 mm Schanz pins were placed above and below the fractured/injured site, and derotation was performed manually after percutaneous osteotomy. A protractor SP app was used intraoperatively to measure the angle between the two Schanz pins (angle-SP). Intramedullary nailing or minimally invasive plate osteosynthesis was performed after derotation, and computerized tomography (CT) scans were used to assess the angle of correction postoperatively (angle-CT). The accuracy of rotational correction was assessed by comparing angle-SP and angle-CT. The mean preoperative rotational difference observed was 22.1°, while the mean angle-SP and angle-CT were 21.6° and 21.3°, respectively. A significant positive correlation between angle-SP and angle-CT was observed, and 18 out of 19 patients exhibited complete healing within 17.7 weeks (1 patient exhibited nonunion). These findings suggest that using an SP app during minimally invasive derotational osteotomy can result in accurate correction of malrotation of long bones in a reproducible manner. Therefore, SP technology with integrated gyroscope function represents a suitable alternative for determination of the magnitude of rotational correction when performing corrective osteotomy.

/pdf/minimally-invasive-derotational-osteotomy-of-long-bones-e3tws2y0.pdf

Minimally Invasive Derotational Osteotomy of Long Bones: Smartphone Application Used to Improve the Accuracy of Correction

Purpose: Although closed reduction and extension block pinning have been widely used for acute mallet finger fracture, the problem of reduction remains a concern. We describe a tip for the reduction technique using a towel clamp, which provides a longitudinal traction force to the distal phalanx, and report the results of the technique.Methods: The medical records of 14 consecutive cases from 12 patients with acute mallet fractures were retrospectively reviewed. Reduction was achieved using the towel clamp reduction technique. The radiologic results were evaluated by simple radiographs, the functional results were analyzed in terms of range of motion, and remaining pain was assessed using Crawford criteria.Results: The mean follow-up period was 8.4 months. The mean union duration was 6 weeks. The mean range of motion was 73°. Eight cases had excellent outcomes, one had good outcomes, four had fair outcomes, and one had poor outcomes. One case of superficial infection and one case of skin necrosis developed, and three cases showed arthritic changes in the distal interphalangeal joint. Conclusion: The towel clamp technique can provide good reduction during surgery, with favorable radiologic and clinical results.

/pdf/extension-block-pinning-combined-with-traction-using-towel-29yo1a3h.pdf

Extension block pinning combined with traction using towel clamps for effective reduction of mallet fracture: a technical tip

Treatment of unstable thoracolumbar fractures is controversial regarding short or long segment pedicle screw fixation Although long level fixation is better, it can decrease one motion segment distally, thus increasing load to lower discs We retrospectively analyzed 31 unstable thoracolumbar fractures with partial or intact neurology All patients were operated with posterior approach using pedicle screws fixed two levels above and one level below the fracture vertebra No laminectomy, discectomy or decompression procedure was done Posterior fusion was achieved in all Post operative and at final follow-up radiological evaluation was done by measuring the correction and maintenance of kyphotic angle at thoracolumbar junction Complications were also reported including implant failure Average follow-up was 34 months All patients had full recovery at final follow-up Average kyphosis was improved from 267° to 41° postoperatively and to 63° at final follow-up And mean pain scale was improved from 75 to 39 postoperatively and to 16 at final follow-up, All patients resumed their activity within six months Only 4 (12%) complications were noted including only one hardware failure Two levels above and one level below pedicle screw fixation in unstable thoracolumbar burst fracture is useful to prevent progressive kyphosis and preserves one motion segment distally

/pdf/two-levels-above-and-one-level-below-pedicle-screw-fixation-4dtaub9zj6.pdf

Two levels above and one level below pedicle screw fixation for the treatment of unstable thoracolumbar fracture with partial or intact neurology

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Minimally Invasive Derotational Osteotomy of Long Bones: Smartphone Application Used to Improve the Accuracy of Correction

Extension block pinning combined with traction using towel clamps for effective reduction of mallet fracture: a technical tip

Two levels above and one level below pedicle screw fixation for the treatment of unstable thoracolumbar fracture with partial or intact neurology