ORTHOPEDIC SURGERY Edited by Zaid Al-Aubaidi and Andreas Fette Orthopedic Surgery Edited by Zaid Al-Aubaidi and Andreas Fette Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Vedran Greblo Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Orthopedic Surgery, Edited by Zaid Al-Aubaidi and Andreas Fette p. cm. ISBN 978-953-51-0231-1 Contents Preface IX Part 1 Spine 1 Chapter 1 Microsurgical Management and Functional Restoration of Patients with Obsolete Spinal Cord Injury 3 Zhang Shaocheng Chapter 2 Unilateral Minimally Invasive Posterior Lumbar Interbody Fusion (Unilateral Micro-PLIF) for Degenerative Spondylolisthesis: Surgical Technique 27 Shigeru Kobayashi Part 2 Upper Extremity 43 Chapter 3 The Distal Forearm Region – Ultrasonographic Anatomy in Children and Adolescents 45 Johannes M. Mayr, Wolfgang Grechenig, Ursula Seebacher, Andreas Fette, Andreas H. Weiglein and Sergio Sesia Chapter 4 Limited Hand Surgery in Epidermolysis Bullosa 61 Bartlomiej Noszczyk and Joanna Jutkiewicz-Sypniewska Chapter 5 Special Aspects of Forearm Compartment Syndrome in Children 79 Andreas Martin Fette Part 3 Hip 99 Chapter 6 The Genotoxic Potential of Novel Materials Used in Modern Hip Replacements for Young Patients 101 Aikaterini Tsaousi Chapter 7 Total Hip Arthroplasty After Previous Acetabulum Fracture Surgery 127 Babak Siavashi VI Contents Part 4 Basic Science 139 Chapter 8 Bisphosphonates and Bone 141 Sirmahan Cakarer, Firat Selvi and Cengizhan Keskin Chapter 9 Biochemical Measurement of Injury and Inflammation in Musculoskeletal Surgeries 165 Dinesh Kumbhare, William Parkinson, R. Brett Dunlop and Anthony Adili Part 5 Anesthesia Considerations for Orthopaedic Trauma Surgery 183 Chapter 10 Anesthesia for Orthopedic Trauma 185 Jessica A. Lovich-Sapola and Charles E. Smith Preface Looking into the fascinating field of orthopedic surgery, pediatric hand surgery is surely one of our most challenging subspecialties. It is often difficult to quickly find the correct diagnosis and treatment in pediatrics, and surely the surgical anatomy of the growing hand is amazingly complex. In addition, some diagnoses are rare and less often mentioned in common surgical textbooks. I graduated from Baghdad University, school of medicine in 1993. At that time, the standard texts in basic and clinical medical science were available only in the form of hard copies, books. I can remember that these books were heavy, expensive, and not least hard to get. The access to journals was only available in hard copy forms. Registration and being a member was a prerequisite for that. Being a medical student with almost no income made this almost impossible. Since that time, I thought; this was wrong! I believed, and still do, that knowledge and science although invaluable, should be accessible for everyone. As we are dealing with medical science, the accessibility is even more important. This would mean a better knowledge for doctors and hence better treatment for patients. Through the last years, I had the chance to work in Africa for short periods. I have seen the willingness of the local doctors to give the right and best treatment for their patients. Beside the deficiency of postgraduate education and guidance, missing text books and essential medical journals are obstacles that make it very difficult for these doctors to accomplish their goal. To share our inspiration we would like to present the following chapters; Obsolete or chronic traumatic paraplegia is still a difficult medical problem at present time. So what factors then affect the recovery of the nerves functions? Through 17 anatomical studies and operative observations, and can nerve transplantation help in regaining some function? Chapter 1 will be able to answer these questions. Degenerative spondylolisthesis has long been recognized as a cause of chronic low back pain. The mechanism of pain in degenerative spondylolisthesis has been confirmed by demonstrating the disc lesion pre-operatively by X-rays and MR imaging usually treated with surgical interbody fusion. With advances in minimal X Preface access technology using operating microscope, PLIF can now be performed through a minimally invasive. In chapter 2 the authors present a novel surgical technique and clinical outcomes of the unilateral micro-PLIF for degenerative spondylolisthesis. The distal forearm and surrounding soft tissues are commonly affected by acute and chronic disorders. In children, the use of ultrasonography allows the chondral parts of the epiphyseal region to be better evaluated without exposure to radiation than using standard radiographic techniques. The aim of this study in chapter 3 is to demonstrate the normal ultrasonographic findings in the distal forearm region in children. Epidermolysis bullosa, form an entity of rare congenital diseases with an extraordinary susceptibility of the epithelium and skin to even minimal injury. This epidermal tears lead to blister formation and finally into serious wounds, leaving behind disabling scars and contractions, sometimes even leading to early death. The authors offer the reader of chapter 4 an exciting overview into the treatment of this disease Compartment Syndrome, is a serious condition of various etiology and clinical presentation. The diagnosis of Compartment Syndrome of the forearm usually needs emergency surgery to prevent disabling sequelae. A comprehensive overview about this pediatric hand surgical challenge will be given by Andreas Fette in chapter 5. Total hip replacement is the most common practiced and most effective surgical interventions introduced in the last 50 or so years in medicine. Bearing in mind that the use of artificial hips is more rigorous in younger patients and that life expectancy continues to increase, it is time that the question of possible adverse long term effects following implantation needs to be addressed. In chapter 6 the proposed links between hip replacements and carcinogenesis to date would be discussed. Fractures of the acetabulum are increasing in the same speed of the increasing in motor vehicle accidents. The importance of the acetabulum is clear as being the weight bearing surface of the hip joint. If anatomical reduction and stable internal fixation not done, it can end with painful hip joint due to early osteoarthritis. In chapter 7 the author will present the indications and techniques to perform total hip arthroplasty in this group of patients. After the discovery of biological effects of bisphosphonates more than 30 years ago, they have now become indispensable in medicine for the treatment of skeletal complications of malignancy, Paget’s disease, osteoporosis, multiple myeloma, hypercalcemia and fibrous dysplasia. Chapter number 8 will review history, classification, pharmacokinetics, clinical relevance, the mechanism of action and adverse effects. Tissue trauma produces a temporary rise in circulating concentrations of various tissue proteins as well as acute phase inflammation related analytes. Measurement of biomarkers in orthopaedic surgeries has been undertaken to evaluate the impact of the [...]... illuminate the importance of these markers in orthopaedic surgery Musculoskeletal injuries are the most frequent indication for operative management in most centers Trauma management of the poly-traumatized patient includes, besides resuscitation, early stabilization of long-bones and pelvic fractures Chapter number 10, will discuss the following; orthopedic trauma anesthesia issues: Pre-operative evaluation,... spinal cords had no severe damages During the operation, any impediments to functional recovery of the spinal cord such as bone compression or unstable canales spinalis stenosis were eliminated 4 Orthopedic Surgery Patients with chronic high-level complete spinal cord injury suffer from spastic paralysis as well as bowel and bladder dysfunctions, which cannot be improved by drug treatment or physical... sac is the main obstacle to nerve function recovery, a condition which could not be relieved by the body itself This microsurgical technique did promote functional nerve recovery in our patients 6 Orthopedic Surgery Fig 3 Intra-op view showing mini incisions on the dura 2.2 Intra-dural microlysis of the spinal cord and nerve roots Similar to the procedure described in section 2.1, in some patients with... microsurgically denuded of their epineuriums and perineuriums, making them resemble cauda equina-like tissues, they were aligned longitudinally with severed strips implanted into the spinal cord incisions 8 Orthopedic Surgery Fig 5 Harvested autogenous sural-nerve segments Finally, the endorachis and spinal canal were covered by a sacrospinal muscle pedicle flap All patients showed recovery of sensory, motor,... covered with artificial dura mater or sacrospinal muscle flap All patients who underwent this procedure showed recovery or improved partial sensory and motor functions of 1-2 nerve root segments 10 Orthopedic Surgery 3.2 Function restoration of chronic complete spinal cord injury by peripheral nerve rerouting and nerve insert grafting Various nerve-rerouting surgeries are described below: 3.2.1 C2~4 Injuries:... accessory nerve and cervical plexus were cut off distally, then transferred to the supraclavicular level and “grafted” into the internal root or proximal segment of the median nerve (Figure 8) 12 Orthopedic Surgery Acss Nerve & Cervical N Medial nerve Fig 8 Intra-op view of connections of accessory, cervical plexus and Median nerves in the supraclavicular region 3.2.4 C8 Injury: Connecting pronator... iliac artery and vein or femoral artery and vein Then the deep or superficial branches of ulnar nerve are connected to the femoral nerve, and the dorsal branch stitched to the ilioinguinal nerve 14 Orthopedic Surgery Med bund of brachial plexus Ulnar n Thoracodorsal a Superior ulnar collateral a Superior ulnar collateral a Flexor carpi ulnaris branch of ulnar n Anterior interosseous n Subcostal n Superficial... nerve roots to reconstruct iliopsoas function (grafting technique) Indications: Spastic paralysis of both lower extremities Surgical purposes: To reconstruct iliopsoas function（mobile with brace） 16 Orthopedic Surgery Anatomy: iliopsoas, quadriceps and vastus medialis are controlled by nerve fibers from L2~4 nerve roots Patients with improved iliopsoas function could achieve hip flexing, and train quadriceps... the perineum Surgical procedure: 0ne incision about 12cm long laterally on the chest wall along the 8th or 9th rib Expose the underlying tissues and take the vascularized intercostals nerve Make 18 Orthopedic Surgery another incision about 8cm long laterally in the costo-iliac region of the abdominal wall; explore and identify the ilio-inguinal nerve Make a subcutaneous tunnel connecting the two incisions... where these two nerves go out of pelvis are very close to each other And the muscular branches of superior/ inferior gluteal nerves are long enough to be connected with pudendal nerve directly 20 Orthopedic Surgery Surgical procedure: In the incision in the hip, isolate superior/inferior gluteal nerve near piriformis muscle and find the pudendal nerve by the outer edge of the sacrum Cut off one of the . ORTHOPEDIC SURGERY Edited by Zaid Al-Aubaidi and Andreas Fette Orthopedic Surgery Edited by Zaid Al-Aubaidi and Andreas. Surgery 183 Chapter 10 Anesthesia for Orthopedic Trauma 185 Jessica A. Lovich-Sapola and Charles E. Smith Preface Looking into the fascinating field of orthopedic surgery, . www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Orthopedic Surgery, Edited by Zaid Al-Aubaidi and Andreas Fette p. cm. ISBN 978-953-51-0231-1