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Lumbar interspinous devices are intended to unload the facet joints, restore foraminal height, lower intradisk pressure, and provide motion-preserving stabilization. They are an alternative treatment for patients with spinal degeneration and have increased in popularity in recent years. To the authors' knowledge, heterotopic ossification has not been previously reported around an interspinous device, and this is the first reported case of interspinous fusion after interspinous device placement.A 66-year-old man presented with a 3-year history of low back pain and a 4-month history of radiating pain down his left leg. A diagnosis was made of lumbar spinal stenosis and left disk herniation at L4-L5 after physical and imaging examinations. A dynamic interspinous device was implanted after the decompressive surgery. The patient's symptoms were relieved postoperatively. Thirty-two months later, he returned with back pain after being in a traffic accident. Lumbar radiographs showed a massive bony formation around the implant. Radiographs and a computed tomography scan 4.5 years later revealed that the implanted device segments were fused. No implant motion was seen on dynamic radiographs. Because the patient was symptom free, no interventions were performed.Heterotopic bone formation around a dynamic interspinous device may hamper motion preservation, and heterotopic ossification is a potential mid- and long-term complication.

The objective of this study was to prospectively compare intraoperative fluoroscopy time and clinical and radiological results in pediatric femoral shaft fractures treated with titanium elastic nailing (TEN) using a small-incision, blind-hand reduction vs closed reduction. From February 2008 to December 2009, sixty-eight children were enrolled in the study. Patients were divided into 2 groups: group A comprised 34 patients treated with a small-incision, blind-hand reduction technique and group B comprised 34 patients treated with a closed reduction technique. Operative time, intraoperative fluoroscopy time, fracture union time, and complications were recorded in both groups. Clinical and radiological results were assessed using the TEN scoring system. Mean operative time was 30.5±8.5 in group A and 53.0±15.0 minutes in group B, and mean fluoroscopy time was 28.4±18.5 seconds in group A and 65.0±28.5 seconds in group B. Operative time and fluoroscopy time were significantly longer in group B (P<.001). According to the TEN scoring system, the results were excellent in 31 patients and good in 3 patients in group A and excellent in 29 patients and good in 5 patients in group B. There was no significant difference between the 2 groups in terms of clinical and radiological results. There was also no significant difference in terms of fracture healing time, weight-bearing time, and complications. The small-incision, blind-hand reduction technique provided similar clinical results as closed reduction. This technique could be an alternative to closed reduction because it significantly reduced intraoperative radiation exposure and operative time.

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