Large, uncontained, lumbar disc herniations can be sufficiently removed using MED which is an effective alternative to open discectomy procedures with remarkable long-term outcome. Although the neurological outcome of the two procedures is the same, the morbidity of MED is significantly less than open discectomy. Maximum benefit can be gained if we adhere to strict selection criteria. The optimum indication is single- or multi-level radiculopathy secondary to a single-level, large, uncontained, lumbar disc herniation.

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Fracture Surgery Internal fixationLocked plate a b s t r a c t Background: The ideal surgical fixation for displaced distal clavicle fractures should not

Background: Total knee arthroplasty is a successful surgical procedure with a survivorship greater than 90% after 15 years. Preoperative range of motion is believed to have a large influence in the postoperative results. The mobility of the polyethylene insert permits rotation and gliding. Aims of study is to present the results of a prospective, long-term clinical follow-up of 86 patients were managed with simultaneous bilateral mobile-bearing total knee arthroplasty, and to evaluate their outcome. Patients and Methods: Patients were followed up for 92 months (range 72-102 months), 32 men and 54 women with average age 63 years. Radiographic evaluation was carried out preoperatively and postoperatively. All procedures were performed by using a standard technique, including the necessary soft-tissue release required to obtain adequate balance. Rehabilitation started on the first postoperative day assisted by a physical therapist with full weight bearing. Results: Clinical and radiographic evaluations were done on regular bases. Outcomes were measured using the American Knee Society Score and the Oxford Knee Score. The mean improvement in the postoperative arc of flexion was 30°. The average length of physiotherapy before going back to near the normal activities was 23 days. Before surgery, the average Knee Society knee score was 49.7 points and at final follow-up was 86 points. The Oxford knee score was 42 points before surgery and at final followup was 24 points. Both scores show significant improvements. Radiologically, the averaged varus was 16° and at final follow up was 6° of valgus. No significant complications were recorded. Conclusions: not all patients are candidates for mobile-bearing TKA, it has lower the loosening rate, and it has the ability to self-align, moreover that, the surgical technique is of paramount importance during the implantation of a mobile-bearing prosthesis.