Objective : The Bernese periacetabular osteotomy (PAO) is a widely used technique for the treatment of non-arthritic, dysplastic, painful hips. It is considered a highly complex procedure with a steep learning curve. In an attempt to minimize complications, a double anterior-posterior approach has been described. We report on our experience while performing this technique on cadaveric hips followed by meticulous dissection to verify possible complications. Methods : We operated on 15 fresh cadaveric hips using a combined posterior Kocher-Langenbeck and an anterior Smith-Petersen approach, without fluoroscopic control. The PAO cuts were performed and the acetabular fragment was mobilized. A meticulous dissection was carried out to verify the precision of the cuts. Results : Complications were observed in seven specimens (46%). They included a posterior column fracture, and posterior and anterior articular fractures. The incidence of complications decreased over time, from 60% in the first five procedures to 20% in the last five procedures. Conclusions : We concluded that PAO using a combined anterior-posterior approach is a reproducible technique that allows all cuts to be done under direct visualization. The steep learning curve described in the classic single incision approach was also observed when using two approaches. Evidence Level: IV, Cadaveric Study.

OBJETIVO: Avaliar casos de espondilolistese traumática do áxis e descrevê-los com relação à epidemiologia, classificação, déficit neurológico, tempo de consolidação e tratamento. MÉTODO: Análise retrospectiva dos prontuários dos pacientes tratado de 2002 a 2010 no IOT-HCFMUSP. Critério de inclusão: fratura da pars interarticularis de C2. RESULTADOS: 68% dos pacientes do sexo masculino com idade média de 39,1 anos. Utilizamos a classificação de Effendi, modificada por Levine-Edwards. Observamos fratura do tipo I em cinco pacientes (31,2%) e tipo II em oito pacientes (50%). Apenas três pacientes (18%) apresentaram fratura do tipo IIa. Não houve casos do tipo III. Mecanismo: Oito acidentes automobilísticos e quatro quedas. Outros mecanismos: atropelamento e mergulho. Tratamento: tração com halo craniano em onze pacientes. Foram usados gesso minerva e halo-gesso. Tempo de consolidação: 3,6 meses. Tempo de seguimento: 9,6 meses. DISCUSSÃO: Nossos resultados confirmam que fratura do enforcado apresenta bom prognóstico. Não houve necessidade de cirurgia em nenhum caso. A incidência de déficit neurológico é baixa. Nenhum paciente apresentou fratura instável, tipo III. CONCLUSÃO: Este trabalho sugere que a espondilolistese traumática do áxis continua sendo uma lesão satisfatoriamente tratada de forma conservadora na maioria dos casos. Nível de Evidência IV, Série de casos.

OBJECTIVE: To evaluate cases of traumatic spondylolisthesis of the axis and describe them in relation to epidemiology, classification, neurological deficit, healing time and treatment method. METHOD: A retrospective analysis of the medical records of patients treated between 2002 and 2010 at IOT-FMUSP. Inclusion criteria: pars interarticularis fracture of C2. RESULTS: 68% were male patients, with a mean age of 39.1 years. We used the classification by Effendi, modified by Levine-Edwards. Type I fractures were observed in five patients (31.2%) and type II in eight patients (50%). Only three patients (18%) had type IIa fracture. There were no cases of type III. Mechanism: Eight car accidents and four falls. Other mechanisms: being run over, and diving accidents. Treatment with halo traction was used in eleven patients, using minerva cast and halo-cast. Healing time: 3.6 months. Follow-up time: 9.6 months. DISCUSSION: In general, hangman fracture has a good prognosis, which is confirmed by our results. There was no need for surgery in any of the cases. The incidence of neurological deficit is low. No patient had unstable fracture (type III). CONCLUSION: This paper suggests that traumatic spondylolisthesis of the axis continues to be an injury that is successfully treated by conservative treatment in most cases. Level of Evidence -IV, Case series.