Surgery for patients with spinal metastases offers decreased pain and improved quality of life with low rates of surgical complications.

Acute traumatic pelvic ring instability causes severe pain and associated hemorrhage. Circumferential pelvic sheeting provides patient comfort and noninvasive, rapid, and temporary pelvic ring stability. A bed sheet is readily available, inexpensive, easily applied around the pelvis, and disposable.

The mechanism of Evans calcaneal lengthening involves adduction and plantarflexion of the midfoot relative to the hindfoot. The cuboid and navicular appear to move as a unit. The shape of the talar head, axis of the subtalar joint, degree of initial deformity, competence of plantar soft tissues, such as the long plantar ligament, and adequate length of the Achilles tendon are important. Knowing what qualitative three-dimensional changes take place allows a better understanding of the mechanics of the procedure and its possible applications.

Object The object of this study was to describe an unusual fracture subtype within C-1 injuries with a propensity to result in late deformity and pain. Most patients with C-1 injuries are nonsurgically treated using external immobilization unless there is an injury of the transverse atlantal ligament. The authors describe an unusual variant involving a unilateral sagittal split with a high tendency to late deformity and pain. They also review the literature and treatment of C-1 fractures. Methods A retrospective review of 12,671 CT scans from a Level I trauma center over a 6-year period yielded 54 patients with C-1 fractures. Among these patients, 6 had an unusual unilateral lateral mass sagittal split, which resulted in a late cock-robin deformity in all survivors and thus a surgical deformity correction with occipital-cervical instrumented fusions. Patient charts and radiographs were reviewed, this fracture subtype is described, and its treatment discussed. Results Radiographic studies in 6 patients with C-1 fractures demonstrated a unilateral sagittal split of the lateral mass but an intact transverse atlantal ligament. In the 3 surviving patients, a late cock-robin deformity, significant loss of neck rotation, and severe neck pain developed. Vertebral artery occlusion, as revealed on CT angiography, occurred in 1 patient. All patients were placed in traction and underwent successful occipital-cervical fusion and deformity correction. At the final follow-up, all patients had satisfactory pain relief and improved head alignment. Conclusions Patients with a unilateral sagittal split of the C-1 lateral mass have unstable injuries and must be carefully monitored, with a low threshold for surgical reconstruction or prolonged traction. Patients with late deformity can be successfully treated with occipital-cervical instrumented fusions.

Acute traumatic pelvic ring instability causes severe pain and associated hemorrhage. Circumferential pelvic sheeting provides patient comfort and noninvasive, rapid, and temporary pelvic ring stability. A bed sheet is readily available, inexpensive, easily applied around the pelvis, and disposable.

This study characterized and quantified the changes found in retrieved glenoid polyethylene components found at revision total shoulder arthroplasty (TSA). Twenty components obtained at revision TSA were evaluated, all from a system (Global, DePuy, Warsaw, IN) with a glenoid radius of curvature 3 mm greater than that of the humeral head. Laser surface scanning provided three-dimensional analysis of the surface of the glenoid component. Scans of unused components of similar sizes enabled determination of the changes occurring after implantation. Alterations in radius of curvature were noted in every glenoid. All showed loss of the balance stability angle (BSA, the maximal angle that the net humeral joint reaction force can make with the glenoid center line before the humeral head would dislocate) of at least 58 in one or more directions. Increase in BSA in one direction was seen in 11 of the components. In five of these, the increase was associated with a reduction of the local radius to match that of the humeral component. Glenoid surface morphology and stability can be changed by in vivo use. While correlation with clinical instability in the patients from whom the implants were obtained was not possible, many of the observed changes in surface morphology are of sufficient magnitude to compromise the contribution of the glenoid surface to shoulder stability. Three patterns of wear were identified: ''humeral'' that showed loss of the mismatch between the humeral and glenoid radii of curvature (5 of 20 components), ''diffuse'' that showed broad surface irregularity (18 of 20), and ''rim'' wear with loss of the polyethylene rim of the component (14 of 20). More than one type of wear was possible within a single glenoid. ß

Object Magnesium has been shown to have neuroprotective properties in short-term spinal cord injury (SCI) studies. The authors evaluated the efficacy of magnesium, methylprednisolone, and magnesium plus methylprednisolone in a rat SCI model. Methods A moderate-to-severe SCI was produced at T9–10 in rats, which then received saline, magnesium, methylprednisolone, or magnesium plus methylprednisolone within 10 minutes of injury. The Basso-Beattie-Bresnahan (BBB) motor score was evaluated weekly, beginning on postinjury Day 1. After 4 weeks, the rats' spinal cords were evaluated histologically to determine myelin index and gross white matter sparing. A second experiment was conducted to evaluate the effect of delayed administration (8, 12, or 24 hours postinjury) of magnesium on recovery. Results The mean BBB scores at 4 weeks showed that rats in which magnesium was administered (BBB Score 6.9 ± 3.9) recovered better than controls (4.2 ± 2.0, p < 0.01). Insufficient numbers of animals receiving methylprednisolone were available for analysis because of severe weight loss. The rats given magnesium within 8 hours of injury had better motor recovery at 4 weeks than control animals (13.8 ± 3.7 vs 8.6 ± 5.1, p < 0.01) or animals in which magnesium was administered at 12 or 24 hours after injury (p < 0.01). Steroids (30.2%), magnesium (32.3%), and a combination of these (42.3%) had a significant effect on white matter sparing (p < 0.05), but the effect was not synergistic (p > 0.8). Neither steroids nor magnesium had a significant effect on the myelin index (p > 0.1). Conclusions The rats receiving magnesium had significantly better BBB motor scores and white matter sparing 4 weeks after moderate-to-severe SCI than control animals. In addition, the groups given steroids only or magnesium and steroids had improved white matter sparing, although the limited numbers of animals reaching the study end point makes it difficult to draw firm conclusions about the utility of steroids in this model. The optimal timing of magnesium administration appears to be within 8 hours of injury.

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