Iso-C navigation increases accuracy, and reduces surgical time and radiation in thoracic deformity correction surgeries.

3.

No abstract

Humeral shaft fractures respond well to conservative treatment and unite without much problem. Since it is uncommon, there is not much discussion regarding the management of nonunion in the literature, and hence this is a challenge to the treating orthopaedic surgeon. Osteoporosis of the fractured bone and stiffness of the surrounding joints compounds the situation further. The Ilizarov fixator, locking compression plate, and vascularised fibular graft are viable options in this scenario but are technically demanding. We used a fibular strut graft for bridging the fracture site in order to enhance the pull-out strength of the screws of the dynamic compression plate. Six patients in the study had successful uneventful union of the fracture at the last follow-up. The fibula is easy to harvest and produces less graft site morbidity. None of the study patients needed additional iliac crest bone grafting. This is the largest reported series of patients with osteoporotic atrophic nonunion of humerus successfully treated solely using the combination of an intramedullary fibular strut graft and dynamic compression plate.

No abstract

Direct pedicle screw fixation of the C2 is rarely performed in trauma owing to the risk of damage to the neurovascular structures. Computed tomography-based navigation has the problem of change in intersegmental anatomy after positioning for surgery. Iso-C-based computer navigation acquires the intraoperative real-time images after patient positioning and thus avoids registration errors and improves accuracy. A Hangman fracture treated by posterior direct pedicle screw fixation using Iso-C computer navigation guidance is reported. Postoperative computed tomographic images confirmed the accurate placement of pedicular screws. Intraoperative fluoroscopy-based computer navigation is advantageous especially in an unstable upper cervical spine injury where the likelihood of change in the intersegmental relationship is maximal before and after positioning for surgery. The Iso-C navigation has the advantages of clarity and accuracy, making safe pedicle fixation of C1 and C2 possible despite fractured posterior elements. To our knowledge, this is the first reported case of displaced Hangman fracture treated successfully using Iso-C fluoroscopic navigation assisted direct pedicle screw osteosynthesis in the literature. Intraoperative acquisition of fluoroscopic images avoids registration-related problems. Three-dimensional fluoroscopic navigation gives excellent accuracy and safety in screw instrumentation of Hangman fracture.

No abstract

We treated 21 consecutive patients between 1998 and 2002 with complex tibial pilon fractures, eight type B and 13 type C, using percutaneous reduction and fixation with the small diameter Ilizarov apparatus. The average patient age was 34+/-5.6 years (range 28-52 years). Nine of the patients had open fractures (two type I, four type II, and three type IIIA). The patients were followed up regularly at 6-month intervals for 2 years. All fractures united. The fixator was removed at an average of 26.6+/-4.2 weeks (range 20-34 weeks). The average American Orthopaedic Foot and Ankle Society ankle-hind foot score was excellent in 11 patients, good in five, fair in four, and poor in one. Thirteen patients were able to squat and climb stairs.