The C1 claw device: a new instrument for C1-C2 fusion.

A new fixation device for C1-C2 fusion is presented. It consists of a claw construct for the C1 arch that is rigidly attached to C1-C2 transarticular screws to form an instrument that combines anterior and posterior fixation in the same construct. The new device was successfully applied in a case with failed C1-C2 fusion that was initially stabilized with transarticular screws alone, where the usual posterior wiring was omitted due to a defect of the posterior C1 arch.

[The case of severe craniocervical dislocation due to rheumatoid arthritis].

Unlabelled: The authors describe a case of craniocervical dislocation secondary to rheumatoid arthritis producing important canal narrowing: ventrally by migrated odontoid and dorsally by posterior arch of C-1 with medullary compression. Symptoms of hyperreflexia, spasticity and left hemiparesis with Babinski sign were present.

Surgical Procedure: transoral odontoidectomy was performed followed by suboccipital approach, C-1 laminectomy and occipitocervical fixation (Olerud device and bone graft).

Limb lengthening by callus distraction. Complications in 53 cases operated 1980-1991.

We reviewed our first 53 lengthenings performed in 45 patients with an average age of 19 years at the time of lengthening. The shortening was congenital in 16 patients, post-traumatic in 15 and had various causes in the 14 remaining. 31 femurs and 22 tibias with an average shortening of 6 and 5 cm, respectively, were lengthened 6 (2-14) cm.