Materials and methods: We reviewed four patients with neurofibromatosis with severe PT spinal deformity. Case 1, a 16-year-old male presented with severe PT kyphoscoliosis (scoliosis: 89°, kyphosis: 124°) and thoracic myelopathy. Case 2 was a 14-year-old, skeletally immature male who presented with a PT lordoscoliosis (scoliosis: 85°). Case 3, a 13-year-old male, presented with severe PT kyphoscoliosis (scoliosis: 100°, kyphosis: 95°). Case 4, a 35-year-old gentleman, presented with severe PT kyphoscoliosis (scoliosis: 113°, kyphosis: 103°) and thoracic myelopathy. All patients underwent pre-operative halo-pelvic traction. After a period of traction, all patients underwent posterior spinal fusion (PSF) with autologous bone grafts (local and fibula bone grafts) and recombinant human bone morphogenetic protein-2 (rhBMP-2).
Results: Both patients with thoracic myelopathy regained near normal neurological status after halo-pelvic traction. Following traction, the scoliosis correction rate (CR) ranged from 18.0% to 38.9%, while the kyphosis CR ranged from 14.6% to 37.1%. Following PSF, the scoliosis CR ranged from 24.0% to 58.8%, while the kyphosis CR ranged from 29.1% to 47.4%. The total distraction ranged from 50-70mm. Duration of distraction ranged from 26-95 days. The most common complication encountered during halo-pelvic traction was pin-related e.g. pin tract infection, pin loosening and migration, osteomyelitis, and halo-pelvic strut breakage. No patients had cranial nerve palsies or neurological worsening.
Conclusion: Pre-operative correction of severe PT spinal deformities could be performed safely and effectively with the halo-pelvic device prior to definitive surgery.
METHODS: We conducted a retrospective study in the Hand and Microsurgery Unit of Hospital Selayang, Batu Caves, Malaysia, which included all patients who sustained non-pathological DRFs over 24 months, from 01 January 2022 to 31 December 2023. Medical records were analyzed in terms of detailed demographic data, fracture characteristics, and mode of treatment.
RESULTS: Over the two-year study period, we identified 446 patients with DRF, totaling 450 DRFs (four patients had bilateral injuries). Male patients outnumbered female patients 114 (64%) to 63 (36%) in 2022 and 145 (54%) to 124 (46%) in 2023. The mean age of patients was significantly higher in 2023 compared to 2022 (54.51 ± 22.20 vs. 45.25 ± 23.64 years, respectively; p < 0.0001). The most common fracture type was type A, based on the Orthopaedic Trauma Association(OTA) classification, accounting for 83.6% of cases in 2022 and 87.4% of cases in 2023. In terms of treatment, most DRFs were treated conservatively as opposed to operatively (77.4% vs. 71.3%), with plate fixation being the most common operative intervention, accounting for 57.5% of cases in 2022 and 73.3% of cases in 2023.
CONCLUSION: The incidence of DRF was higher among male patients than among female patients in our study population, with an increasing annual trend. Most cases were the result of low-impact trauma and were closed fractures that were conservatively managed.