BackgroundCervical degenerative pathology produces pain and disability, and if conservative treatment fails, surgery is indicated. The aim of this study was to determined whether anterior decompression and interbody fusion according to Cloward is effective for treating segmental cervical degenerative pathology and whether the results are durable after a 10-year-minimum follow-up.Materials and methodsFifty-one patients affected by single-level cervical degenerative pathology between C4 and C7 were surgically treated by the Cloward procedure. Clinical evaluation was rated using the Neck Disability Index (NDI) and the visual analog scale (VAS). At last follow-up, the outcomes were rated according to Odom’s criteria. On radiographs, the sagittal segmental alignment (SSA) of the affected level and the sagittal alignment of the cervical spine (SACS) were measured.ResultsAverage NDI was 34 preoperatively and 11 at last follow-up. Average VAS was 7 preoperatively and 1 at last follow-up. According to Odom’s criteria, the outcome was considered excellent in 18 cases, good in 22, and fair in 11. Average SSA was 0.5 ± 2.1 preoperatively, 1.8 ± 3.8 at 6 months, and 1.8 ± 5.7 at last follow-up. Average SACS was 16.5 ± 4.0 preoperatively, 20.9 ± 5.8 at 6 months, and 19.9 ± 6.4 at last follow-up. Degenerative changes at the adjacent levels were observed in 18 patients (35.3%).ConclusionsThe Cloward procedure proved to be a suitable and effective technique for treating segmental cervical degenerative pathology, allowing good clinical and radiographic outcomes even at a long-term follow-up.

Background The Cloward anterior interbody fusion is commonly performed for cervical disc herniation or spondylosis. In followup studies, various authors have noted clinically relevant adjacent-level degeneration. However, factors associated with adjacent-level degeneration are not well known. Questions/purposes We asked whether the postoperative sagittal segmental alignment of the fused vertebrae could be used as a predictor of adjacent-level degeneration. Methods We retrospectively studied 107 patients, aged 35 to 55 years, with one-level cervical disc disease between C4 and C7 operated on from 1985 to 1995 by discectomy and one-level anterior cervical fusion according to the Cloward procedure. In standard radiographs of the cervical spine in lateral view, the alignment of the involved intervertebral space (sagittal segmental alignment) and the sagittal alignment of the cervical spine were measured and the adjacent-level degeneration was assessed using the Kellgren and Lawrence criteria. The minimum followup was 10 years (mean, 16 years; range, 10-23 years).

BackgroundClosed displaced midshaft clavicle fractures used to be treated nonoperatively, and many studies have reported that nonoperative treatment gave good results. However, more recent studies have reported poorer results following nonoperative treatment, whereas the results of operative treatment have improved considerably. The aim of this paper was to report the results of treating closed displaced midshaft clavicle fractures nonoperatively.Materials and methodsOne hundred Edinburgh type 2B clavicle fractures (69 type 2B1 and 31 type 2B2) in 100 patients (78 males and 22 females) aged between 18 and 67 years (mean 32 years) were treated. All patients were treated using a figure-of-eight bandage. Clinical and radiographic assessment was performed at the time of trauma, 1, 2 and 3 months after the trauma, and then at an average follow-up of 3 years (range 1–5 years). The outcome was rated at the last follow-up using the DASH score.ResultsNinety-seven of the 100 fractures healed. Three nonunions were observed. Average healing time was 9 weeks (range 8–12 weeks). No statistically significant correlation between the type of fracture and the healing time was observed. The average DASH score was 24 (range 0–78) and, based on this score, 81 patients presented excellent results, 12 good, 5 fair, and 2 poor. No statistically significant correlation between the type of the fracture and the score was observed.ConclusionsWe believe that nonoperative treatment is still appropriate in most cases, as it yields good results without incurring the potential complications of surgery.

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Indications and techniques of locked plate fixation for the treatment of challenging fractures continue to evolve. As design variant of classic locked plates, the polyaxial locked plate has the ability to alter the screw angle and thereby, enhance fracture fixation. The aim of this observational study was to evaluate clinical and radiographic results in 89 patients with 90 fractures of the distal femur treated, between June 2006 and November 2011, with such a polyaxial locked plating system (Polyax™ Locked Plating System, DePuy, Warsaw, IN, USA). Seventy-seven fractures formed the report of this study. These cases were followed up until complete fracture healing or for a mean time of 77 weeks. At the time of last follow-up, 58 of 77 fractures (75.3 %) progressed to union without complication and radiographic healing occurred at a mean time of 16.3 weeks. Complications occurred in ten fractures that did not affect the healing and in nine fractures that showed delayed or non-union. The mean American Knee Society Score at the time of final follow-up was 83 for the Knee Score and 71.1 for the Functional Score. In conclusion, there is a high union rate for complex distal femoral fractures associated with a good clinical outcome in this series.

Acetabular and femoral abnormalities make total hip arthroplasty in developmental hip dysplasia a challenging procedure. We present details of long-term follow-up of a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using a cementless tapered stem. Thirty-five hips in 20 patients (18 women and 2 men) aged between 44 and 60 years (mean 51 years) were observed. Clinical evaluation was conducted using the Harris Hip Score (HHS). Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowe's classification, 25 hips had grade 2 and 10 hips grade 3 dysplasia. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis™). After surgery the patients were clinically and radiographically evaluated at 1, 2, 3, 6 and 12 months and annually thereafter. The average follow-up was 12 years (range 10-14 years). The average HHS was 57±7 (range 45-66) preoperatively, 90±7 (range 81-100) 12 months after surgery and 90±6 (range 83-100) at last follow-up. Radiographic evaluation demonstrated excellent osseointegration of the implants in most cases. Signs of bone resorption were present in 5 hips, but no evidence of loosening was observed and none of the implants have been revised. The tapered stem achieved adequate stability and orientation, and may be a suitable option for total hip arthroplasty for arthritis following developmental hip dysplasia.

Complex tibial plateau fractures are a challenge in trauma surgery. In these fractures it is necessary to anatomically reduce the articular part of the fracture and to obtain stable fixation. The aim of this study is to review the results of a surgical technique consisting of fluoroscopic closed reduction and combined percutaneous internal and external fixation. Thirty-two complex tibial plateau fractures in 32 patients were included. Twenty-one fractures were closed, 4 were open Gustilo grade I, 3 were Gustilo grade II and 4 were Gustilo grade III. The mean age was 37.8 years (range 21-64 years). Surgery was performed with patients in transcalcaneal traction and the knee flexed at 30°was used. Through a 1-cm incision centred over the tibial metaphysis of the tibia, a 3.2-mm hole was drilled in the antero-medial tibial aspect. The tibial plateau fracture fragments were elevated using either 1 or 2 curved Kirschner wires under fluoroscopy to control the reduction. Then the fragments were fixed with 2 cannulated AO screws inserted through small incisions into the medial aspect of the tibial plateau. Knee rehabilitation started postoperatively. Weight bearing started after 8-12 weeks depending upon the radiographic appearance. All external fixators were removed in outpatient facilities. All patients were clinically and radiographically evaluated at a mean follow-up of 48 months (range 38-57 months). Clinical results were evaluated according to the Knee Society clinical score. Average healing time was 24 weeks (range 18-29 weeks). In 1 patient a non-union occurred. This patient was treated with open reduction and plate fixation. In 2 patients a varus knee deformity occurred and a surgical correction was performed. There were no surgical complications. Mean knee range of motion was 105°(range 75-125°) and mean Knee Society clinical score was 89. Twenty-five results were scored as excellent, 4 good, 2 fair and 1 poor. Using this technique there is limited soft tissue damage and virtually no periosteum damage to the fracture fragments. However anatomical reconstruction of the joint can be obtained. Furthermore knee rehabilitation can be started immediately after surgery. We think that these factors were responsible for the optimal clinical long-term results.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.