Abstract Aim The aim of the study was to look for the effectiveness of percutaneous balloon kyphoplasty in the management of vertebral compression osteoporotic and pathological fracture. Methods A retrospective analysis of 112 patients with 198 symptomatic wedge vertebral compression fractures who were treated by percutaneous balloon kyphoplasty was done. Visual Analogue pain (VAP) scale, Oswestry Disability index (ODI) and Short Form (SF-36) were used to look for the outcome. Results Pre-operative median VAS score was (8.0, IQR 2.0) which decreased to (4.0, IQR 3.0) at 12 months. Pre-operative median ODI score was (66, IQR 22) which at 12 months follow up decreased to (28, IQR 31). Short-form 36 showed improvement in all quality of life sub-domains. The physical component summary (PCS) improved from 33.0 ± 5.0 to 37.4 ± 6.1. The Mental component summary (MCS) improved from 17.1 ± 8.6 to 23.5 ± 18.9. The results were statistically significant (p < 0.001). Conclusion Percutaneous balloon kyphoplasty alleviates pain and improves function, disability, and quality of life in osteoporotic and pathological fracture.

sagittal balance and predictive equations to determine lumbopelvic compensatory patterns (LPCP).These equations are used to guide surgical decision making and technique selection.Although other lumbopelvic compensation equations are available, these have not been compared with the SRS-Schwab equation. ObjectivesThe aim was to evaluate sagittal balance and LPCP in younger and older adults with scoliosis and to compare the two most commonly used LPCP predictive equations (SRS-Schwab and Legaye).Methods EOS radiographic data from 41 adults with scoliosis (coronal Cobb > 10°; 51 ± 19 years) stratified into younger (n = 20) and older (n = 21) groups above and below the mean age was retrospectively analysed.T-tests were used to compare group characteristics and Fisher's exact tests were used to evaluate differences in SVA (sagittal vertical axis), PT (pelvic tilt) and PI (pelvic incidence)-LL (lumbar lordosis) mismatch thresholds.Agreement between SRS-Schwab and Legaye classification was evaluated using Kappa tests and Bland Altman plots.Results and discussion 62% of the older group and 10% of the younger group exceeded the SVA threshold of 40 mm (p < .001).86% of the older group and 20% of the younger group exceeded the 20°pelvic retroversion threshold (p < 0.001).Normal PI-LL mismatch ranges were more prevalent in the younger group (70%) than the older group (28%) (p < .001)when analysed through the SRS-Schwab equation.Legaye equation analysis revealed no difference in the prevalence of normal PI-LL ranges between the younger (15%) and older group (10%) (P = .66).Lumbar hyperlordosis was more prevalent in the younger (25%) than older group (5%) (p < .001)when analysed through the SRS-Schwab equation but no difference was observed between the younger (10%) and older group (0%) (p > .05)when analysed through the Legaye equation.Lumbar hypolordosis was more prevalent in the older (67%) than the younger group (5%) (p < .001)but no difference was observed between the older (90%) and younger group (75%) when analysed through the Legaye predictive equation (P = .33).Agreement between the SRS-Schwab and Legaye equations was poor for the whole (κ = 0.148), older (κ = 0.277) and young groups (κ = 0.039). Conclusion and significanceThis study confirms that older patients more often exhibit higher SVA and pelvic retroversion than younger patients.Whilst analysis through SRS-Schwab classification reveals that younger patients more often exhibit lumbar hyperlordosis than older patients who more often exhibit lumbar hypolordosis, analysis through the Legaye equations revealed no differences.There is poor agreement between the SRS-Schwab and Legaye classification equations.Clinicians are cautioned to exercise clinical judgement when evaluating their patients with these equations until more research is done.

BACKGROUND CONTEXT: The Spinal Instability Neoplastic Score (SINS) categorises tumour-related spinal instability. The neurologic, oncologic, mechanical, and systemic (NOMS) framework incorporates sentinel qualitative decision points to guide the treatment of spinal metastases to determine treatment.

We present a case of osteolytic lesion in Gruen Zone 2, 3 in a six-month post-operative cemented THR initially diagnosed as early loosening-?Septic. Investigations and biopsy revealed metastatic renal cell carcinoma. A 79 year old gentleman had a Left cemented THR and was symptom free post-operative. Six months later he had pain in the left groin and thigh. Examination revealed painless hip movements. X-ray showed lytic area in zone 2 and 3. ESR -90 mm and CRP – 50 mg/dl. Hip aspiration excluded sepsis. Bone scan showed increased uptake of left femoral shaft, right scapula and L1 vertebra. Bone chemistry, renal & liver Assay and tumour markers were normal. Open biopsy showed erosion of lateral cortex, with friable soft tissue mass with profuse bleeding. Histopathological report showed classical clear cell renal cell carcinoma. CT abdomen and chest revealed multiple nodules in lung fields, multiple nodules in liver, mass in both kidneys consistent with Renal cell carcinoma, multiple skeletal lytic lesions. Patient was referred to oncologist for palliative treatment DISCUSSION: In case of osteolytic erosive lesions at cement bone interface, the possibility of metastatic lesions should be considered. In old age groups Biopsy is recommended to exclude malignancy after exclusion of septic and aseptic loosening and abdominal ultrasound to exclude primaries.

We reviewed 35 patients who underwent a medial unicondylar knee replacement, with an average follow up of 4 years (for functional assessment). All patents had a weight bearing AP and lateral X rays and were clinically assessed using Hospital for Special surgery score, Bristol Knee Score and SF 36 health assessment form. Five angles were measured on the x-rays to assess the alignment of the tibial and femoral alignment. There was a significant relation between the femoral component varus/valgus angle and three sub scores (fixed flexion contracture, maximum valgus/varus and range of movement) in Bristol Knee scores. The best functional out come correlated with femoral components of 4–8 degrees of valgus.

Twelve consecutive patients were reviewed after having Outerbridge-Kashiwagi procedure of the elbow to ascertain the effect of the site and number of loose bodies on the outcome. Patients were assessed using the Mayo Elbow Performance Score (MEPS) and the Derby Elbow Osteoarthritis Radiography Score (DEORS). Ten men and two women with a mean age of 47 years were followed up for a mean of 3.6 years. Seven patients had two or less loose bodies, and five had more than two loose bodies. Seven had anterior loose bodies alone and five had both anterior and posterior loose bodies. MEPS improved from a mean of 51 to 85 points. Visual analogue pain score improved from a mean of 7.4 to 2.6. DEORS improved from a preoperative mean of 6.5 to 5.3. Number of loose bodies had no significance on the functional outcome; neither had the site. We concluded that the number and site of loose bodies have no prognostic value in predicting the outcome.