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). Results Preoperatively, mean sagittal segmental alignment was 0.6° ± 2.0° and sagittal alignment of the cervical spine was 17.0° ± 4.9°. At last followup, the mean sagittal segmental alignment was 1.8° ± 4.1° and mean sagittal alignment of the cervical spine was 19.7° ± 6.6°. Adjacent-level degeneration was present in 60% of cases with postoperative sagittal segmental alignment of 0° or less and in 27% of cases with postoperative sagittal segmental alignment of more than 0°. Conclusions To prevent adjacent-level degeneration, we recommend proper lordotic sagittal segmental alignment when anterior interbody fusion of the cervical spine is indicated. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence....

Background Cervical 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 methods Fifty-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. Results Average 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%). Conclusions The 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.

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.

Objectives: The aim of this study is to retrospectively review the outcomes of patients with comminuted radial head fractures surgically treated with early radial head excision. Design: Retrospective follow-up study. Setting: University orthopaedic trauma center. Patients: Forty-two patients with unilateral, isolated, closed, displaced, or comminuted radial head fracture (Mason type 2-10, Type 3-32). Intervention: Early radial head excision. Main Outcome Measurements: Patients were clinically and radiographically evaluated at an average follow-up of 18 years. The uninjured contralateral limb was used as a comparison. Clinical evaluation was rated using the Broberg and Morrey system, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the visual analog scale (VAS) for pain. Results: At last follow-up, 36 patients had no complaints, whereas six admitted to occasional pain. The mean Broberg and Morrey score was 91.2 ± 6.3, and the mean Disabilities of the Arm, Shoulder and Hand score was 10.1 ± 8.8. Conclusion: Early radial head excision represents a viable option in case of displaced and comminuted fractures. According to the results of this study, it demonstrated a high rate of good results and patient satisfaction, a quick recovery after surgery, and a low rate of complications with durable results at long-term follow-up. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background Closed 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 methods One 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. Results Ninety-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. Conclusions We believe that nonoperative treatment is still appropriate in most cases, as it yields good results without incurring the potential complications of surgery.