PurposeTo assess the clinical and radiographic outcomes of coronoid process fractures surgically managed with buttress plate fixation via a medial approach.MethodsA retrospective review of all coronoid fractures surgically fixed in our institution using a buttress plate technique via a medial approach between June 2012 and April 2015 by the senior author was performed. These fractures were all sizeable fractures contributing to persistent elbow instability in terrible triad or varus posteromedial rotatory instability injury patterns. A prospective telephone questionnaire was conducted to assess patient outcomes using the disabilities of the arm, shoulder and hand (DASH) score and Mayo hlbow performance score (MEPS).ResultsTwelve patients were included in the study, comprising 10 males and 2 females with an average age of 39 years (range, 19–72 years). Mean follow-up was 16 months (range, 4–18 months). The average time to radiographic union was 4 months (range, 3–7 months). Range of motion measurements at final follow-up were obtained in 11 out of 12 patients, with one patient defaulting follow-up. All 11 patients displayed a functional elbow range of motion of at least 30°-130°, with an average arc of motion of 130° (range, 110° −140°), mean elbow flexion of 134° (range, 110° −140°) and mean flexion contracture of 3° (range, 0° −20°). The mean DASH score was 16 (range, 2.5–43.8) and the mean MEPS was 75 (range, 65–100). Complications observed included one patient with a superficial wound infection which resolved with a course of oral antibiotics and one patient with radiographic evidence of heterotopic ossification which was conservatively managed. No residual elbow instability was observed and no reoperations were performed.ConclusionButtress plate fixation via a medial approach of coronoid process fractures that contribute to persistent elbow instability represents a reliable method of treatment that produces satisfactory and predictable outcomes.

We conclude that raised compartment pressures are frequently seen in patients with tibial shaft fractures; but in most cases, it does not equate to the presence of compartment syndrome. Diagnosis of compartment syndrome based on intracompartmental pressure measurements alone may result in unnecessary fasciotomies in a sizeable number of patients. Compartment syndrome remains a clinical diagnosis, and one which always needs to be considered when managing tibial fractures.

Instrumented fusion with rods and pedicle screws is often performed for the surgical treatment of adult spinal deformity (ASD). One of the complications of such long construct fusions is that of pseudoarthrosis, which can present with implant loosening, failure, and rod breakage. However, migration and spontaneous extrusion of the rod is relatively rare and has yet to be reported in the literature. We report a gentleman with previous long construct instrumented fusion done six years ago for ASD, who presented with gluteal pain. Radiographs revealed rod breakage and caudal migration towards the left gluteal region. He subsequently reported spontaneous extrusion of the broken rod through the gluteal skin, without the need for surgical removal. This case is reported for its rarity and to raise awareness about the rare occurrence of rod migration after breakage that can lead to potential complications if left unattended.

Revision anterior cervical spine surgery has a higher risk of recurrent laryngeal nerve palsy (RLNP). We describe a unique case of an isolated RLNP contralateral to the side of the surgical approach in a patient who underwent revision anterior cervical discectomy and fusion (ACDF) for cervical myelopathy, and in whom pre-operative laryngoscopic evaluation had excluded a pre-existing occult RLNP. Scarring around the recurrent laryngeal nerve at the previous surgical site may have rendered it less mobile, resulting in it being more susceptible to compression from an inflated endotracheal tube (ETT) cuff or traction from surgical retractors. This case illustrates that acute RLNP can rarely occur contralateral to the side of surgical approach in the setting of revision surgery. Surgeons performing revision ACDF can consider approaching from the same side as the index surgery or a posterior approach to reduce the risk of developing bilateral RLNP.

Introduction The trauma patient has an increased susceptibility to postoperative surgical site infection (SSI). There is a lack of studies in the literature investigating the rates of SSI in minimally invasive spine (MIS) surgery for trauma patients with associated injuries, who also require surgical intervention for thoracolumbar fractures. We aim to investigate if MIS surgery for trauma patients reduces the incidence of SSI through a less invasive approach and smaller surgical incision. Methods A case series of 30 trauma patients who underwent MIS surgery for thoracolumbar spine fractures at our center were followed up for a year. The primary outcome measured was the presence of a postoperative SSI. Subgroup analysis was performed to determine if there were specific factors that increase the risk of developing a SSI. Results In total, 4 (13%) patients developed postoperative SSI out of which 1 was a deep infection (3%). Subgroup analysis of both patient and surgical factors did not demonstrate statistically significant results to suggest risk factors for SSI post-MIS surgery in our patient group. Conclusion Our series of patients did not reflect a lower incidence of SSI with MIS surgery compared to incidences in the literature. This may suggest that the increased rates of SSI in the trauma patient may not be best addressed by a minimally invasive approach alone. A multidisciplinary approach that addresses other factors – such as prolonged recumbence and a compromised immunological state may yield improved results.