The relationship between intra-articular meniscal, chondral, and ACL lesions: finding from 1,774 knee arthroscopy patients and evaluation by gender.

Knowing the relationship between diagnoses is important in knee arthroscopy in terms of defining possible treatment modalities preoperatively. The purpose of our study was to define the diagnoses made intraoperatively through knee arthroscopy and the relationships between them. We evaluated the results of knee arthroscopies performed over a 10-year period. The sites and sizes of chondral lesions, the existence of anterior cruciate ligament (ACL) injury, and the sites of meniscal lesions were noted for a total of 1,774 patients. The relationships between these lesions were evaluated statistically. Chondral lesions and posterior medial meniscal tears were predominant in females, whereas complete ACL tears were predominant in males. ACL tears were commonly accompanied by medial and lateral meniscal bucket-handle tears. In cases with advanced chondral lesions, medial and lateral posterior meniscal and lateral anterior meniscal tears were more common. According to our results, posterior tears of the medial menisci, medial and lateral femoral condyles, lateral tibial plateau type 3 or 4 cartilage lesions, and the rate of diagnostic arthroscopy were higher in females, while middle substance and bucket-handle tears of medial menisci and total rupture of the ACL were more common in males. ACL injuries were seen to coexist with medial or lateral menisci bucket-handle tears, with no relationship between the site or size of the chondral lesions. A relationship between medial and lateral meniscal tears and the site of femoral and tibial chondral surface lesions was detected.

Monoplanar versus biplanar medial open-wedge proximal tibial osteotomy for varus gonarthrosis: a comparison of clinical and radiological outcomes.

PURPOSE: We compared clinical and radiological results of two proximal tibial osteotomy (PTO) techniques: monoplanar medial open-wedge osteotomy and biplanar retrotubercle medial open-wedge osteotomy, stabilised by a wedged plate. METHODS: We evaluated 88 knees in 78 patients. Monoplanar medial open-wedge PTO was performed on 56 knees in 50 patients with a mean age of 55 ± 9 years. Biplanar retrotubercle medial open-wedge PTO was performed on 32 knees in 28 patients with a mean age of 57 ± 7 years. Mean follow-up periods were 40.6 ± 7 months for the monoplanar PTO group and 38 ± 5 months for the biplanar retrotubercle PTO group. Clinical outcome was evaluated using the hospital for special surgery scoring system, and radiological outcome was evaluated by the measurements of femorotibial angle (FTA), patellar height and tibial slope changes. RESULTS: In both groups, post-operative HSS scores increased significantly. No significant difference was found between groups in FTA alteration, but the FTA decreased significantly in both groups. Patellar index ratios decreased significantly in the monoplanar PTO group (Insall-Salvati Index by 0.07, Blackburne-Peel Index by 0.07), but not in the biplanar retrotubercle PTO group. Tibial slopes were increased significantly in the monoplanar PTO group, but not in the retrotubercle PTO group. CONCLUSIONS: Biplanar retrotubercle medial open-wedge osteotomy and monoplanar medial open-wedge osteotomy are both clinically effective for the treatment for varus gonarthrosis. Retrotubercle osteotomy also prevents patella infera and tibial slope changes radiologically.

Minimally invasive reduction technique in split depression type tibial pilon fractures.

Tibial pilon fractures usually result from high energy trauma and present as a challenge to the orthopedic surgeon. Accurate reduction of the joint with meticulous care for the surrounding soft tissues is mandatory. We present a case report in which an anterior cruciate ligament targeting device is used with a minimally invasive technique under arthroscopic and fluoroscopic guidance for Orthopaedic Trauma Association 43-B2.3 type pilon fracture treatment.

Radiographical and clinical results of a new conservative treatment algorithm in Legg-Calvè-Perthes disease: A retrospective study.

OBJECTIVE: This study aimed to establish a feasible conservative treatment algorithm for Legg-Calvè-Perthes Disease (LCPD), clarify its limitations, and evaluate the correlations between radiographical and clinical results. METHODS: Patients diagnosed with LCPD and treated conservatively were evaluated retrospectively; 39 hips from 35 patients were included. The treatment protocol consisted of intermittent manual traction, range of motion exercises, activity limitation, bed rest, NSAID (ibuprofen 100mg/5mL), and ASA (100mg/day) during attack periods. The treatment protocol was standardized, and an algorithm was established for all the patients. RESULTS: The mean follow-up was 13.7 (range = 8-22) years. According to the Stulberg classification, 26 (67%) hips were good, 6 (15,3%) were fair, and 7 (17%) were poor. No activity-limiting pain was detected in any patient. The mean Harris score was 90.5 ± 5.3 for Stulberg type 1, 2, and 3 hips, but 84.2 ± 8.8 for Stulberg type 4 and 5 hips. When the patients were evaluated in terms of pain, activity, and func- tion, it was seen that pain and activity were not different, especially in the Stulberg 1, 2, 3, and 4 patients during the mid-term follow-up. The function was the main factor correlating with the Stulberg classification. Twenty-nine (82.8%) families defined the applicability of the treatment protocol as "easy," 4 (10.3%) defined it as "moderate," and 2 (6.2%) defined it as "difficult." CONCLUSION: The present study demonstrated that the treatment protocol was successful and easily applicable to LCPD. Although lateral pillar classification was efficient to predict radiographic results, the Stulberg classification was not correlated with the clinical results for every subgroup. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Component alignment in simultaneous bilateral or unilateral total knee arthroplasty.

A bilateral total knee prosthesis procedure can be performed simultaneously in patients with bilateral gonarthrosis. The purpose of this study was to evaluate the differences in component alignment between the simultaneous bilateral TKA and unilateral TKA. A total of 20 patients out of 40 underwent simultaneous bilateral TKA, whereas 20 patients had unilateral TKA. The component alignments were compared radiographically. There was no statistically significant difference in the component alignment between the simultaneous bilateral TKA group and the unilateral TKA group. In conclusion, component alignment of the patients with simultaneous bilateral TKA is similar to that of unilateral TKA.

A legal overview of the use of messaging platforms in healthcare.

Medical interventions are becoming more complex day by day. Moreover, compared with the past, more healthcare professionals take part in the same intervention in the field of medicine. The use of technology in medical interventions has also increased. This change in the health sector brings together several legal discussions. In this study, the legal consequences that arise from the treatment processes carried out by the residents and resident educators (registerers / attending physicians), the exchange of information between them, and the usage of some messaging platforms, especially WhatsApp, in this process will be analyzed.

A patellar tendon length conservation method: Biplanar retrotubercle open-wedge proximal tibial osteotomy.

OBJECTIVE: The early-period results of our technique for performing a medial biplanar retrotubercle open-wedge proximal tibial osteotomy for the surgical treatment of varus gonarthrosis were evaluated and compared with those reported in the literature. METHODS: The clinical and radiological results of a medial biplanar retrotubercle open-wedge proximal tibial osteotomy performed on 23 knees in 22 patients with medial gonarthrosis with varus alignment were analyzed. RESULTS: Twenty patients were female and 2 were male. At the time of surgery, the mean age was 56.22 years (44-66 years), the mean body mass index was 31.95 kg/m2 (23.4-44.9 kg/m2), and the mean Hospital for Special Surgery (HSS) score was 68.7 (48-83). The mean preoperative femorotibial anatomical axis angle was 186.39° (173-194°), and the mean Insall-Salvati index value was 1.04 (0.94-1.171). The mean length of follow-up was 30.19 months (6-42 months). At the last follow-up examination, the mean HSS score was 86.48 (74-100), the mean femorotibial anatomical axis angle was 175° (168-171°), and the mean Insall-Salvati index value was 1.06 (0.857-1.32). Comparison of the final follow-up values with the preoperative values demonstrated significant improvement in the HSS score and femorotibial anatomical axis angle, but no significant difference in the Insall-Salvati index value. CONCLUSION: The results of this study indicated that frontal and sagittal plane deformities in patients with varus gonarthrosis can be treated with biplanar retrotubercle open-wedge proximal tibial osteotomy with good clinical results that achieve patellar tendon length stability and avoid patellofemoral problems.

Surgical treatment of displaced intraarticular calcaneus fractures using anatomical lateral frame plate.

BACKGROUND: The present study evaluated the results obtained from the anatomical lateral frame plate treatment of displaced intraarticular calcaneus fractures. METHODS: Overall, 14 displaced intraarticular fractures of 13 patients (3 females, 10 males; Mean age, 37.5 years) were included in the present study. Surgery was performed using widened lateral approach and supported by auto grafts following joint line reduction in all patients. They were then fixated by anatomical lateral frame plate. All the joints were stabilized by casting after the operation. All patients were prescribed controlled and full weight bearing at 6-8th and 12th weeks, respectively. RESULTS: Mean follow-up of patients was 28 months. The fractures were classified according to Sanders system. Clinical scoring of the patients was performed according to American Orthopaedic Foot and Ankle Society, Creighton-Nebraska, and Maryland systems. According to these systems, the mean scores of the patients were 83.7, 75.7, and 88.5 respectively. CONCLUSION: In the present study, we have defined the results of anatomical lateral frame plate treatment in patients with displaced intraarticular calcaneus fractures. We have obtained clinically and radiologically satisfactory results with the anatomical compatibility of plate to the lateral surface of the calcaneus.

Ultrasonographic comparison of bilateral patellar tendon dimensions in patients treated via intramedullary tibial nailing using a transpatellar approach.

OBJECTIVE: One of the most common complications following intramedullary nailing of a tibial shaft fracture is anterior knee pain. The etiology of pain remains unclear. Patellar tendon entry point is the most suspected reason for anterior knee pain. This study, sonographically examined the patellar tendons of patients treated via intramedullary nailing. METHODS: Thirty-two patients with a tibial shaft fracture requiring intramedullary nailing via a transpatellar approach were included in the study. After all patients were grouped by reference to the presence of anterior knee pain, bilateral patellar tendon ultrasonography was performed. RESULTS: Thirty-two patients were included in the study. Patients were measured postop average in 38.3 months (10th months - 84th months). It was determined that 10 patients of total 32 (31.3%) had anterior knee pain. There were no statistically differences between study groups in the length of patellar tendon. In the painless group; patellar tendon was wider and thicker in the operated side than the non operated side. The mean differences in the thickness between operated side versus non - operated side of the painless group were 5.3 ± 1.8 in the operated side and 3.9 ± 1.4 in the non - operated side (p = 0.007 < 0.05). The corresponding values for width of the patellar tendon was 29.6 ± 3.3 in the operated side and 27.6 ± 3.8 in the non - operated side (p = 0.007 ˂ 0.05). As a result, there were no statistically significant differences between width and thickness of the patellar tendons in the painful group, on the contrary, in the painless group; patellar tendons were wider and thicker in the operated side than those in the non - operated side. Mean values for thickness of the operated and non-operated side were 5.9 ± 2.3 and 4.2 ± 2.0, respectively (p = 0.059 > 0.05). Mean values for width of the operated and non-operated side were 30.2 ± 4.5 and 28.5 ± 4.0, respectively (p = 0.103 > 0,05). CONCLUSION: Based on the ultrasonographic investigation of their patellar tendons after intramedullary nailing of a tibial shaft fracture, in the painless patients group; the patellar tendon was wider and thicker in the operated side than the non - operated side, however, in the painful patients there were no statistically significant differences between this parameters. Although the number of patients was not sufficient to conclude precise relation between patellar tendon entry point and anterior knee pain, we determined that thicker and wider tendon might be less related to anterior knee pain. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Effect of Repeated Sterilization by Different Methods on Strength of Carbon Fiber Rods Used in External Fixator Systems.

OBJECTIVES: We aimed to study the effects of repeated sterilization, using different methods, on the carbon fiber rods of external fixator systems. METHODS: We used a randomized set of 44 unused, unsterilized, and identical carbon fiber rods (11 × 200 mm), randomly assigned to 2 groups: unsterilized (4 rods) and sterilized (40 rods). The sterilized rods were divided into 2 groups, those sterilized in an autoclave and those sterilized using hydrogen peroxide. These were further divided into 5 subgroups based on the number of sterilization repetition to which the fibers were subjected (25, 50, 75, 100, and 200). A bending test was conducted to measure the maximum bending force, maximum deflection, flexural strength, maximum bending moment and bending rigidity. We also measured the surface roughness of the rods. RESULTS: An increase in the number of sterilization repetition led to a decrease in maximum bending force, maximum bending moment, flexural strength, and bending rigidity, but increased maximum deflection and surface roughness (P < 0.01). The effect of the number of sterilization repetition was more prominent in the hydrogen peroxide group. CONCLUSIONS: This study revealed that the sterilization method and number of sterilization repetition influence the strength of the carbon fiber rods. Increasing the number of sterilization repetition degrades the strength and roughness of the rods.

Radiological and clinical outcomes of medial approach open reduction by using two intervals in developmental dysplasia of the hip.

OBJECTIVE: To evaluate the midterm clinical and radiological outcomes of the medial approach using two intervals for developmental hip dysplasia (DDH). METHODS: The study involved 62 hips of 47 patients (41 girls, 6 boys) treated with medial approach for DDH from 1999 to 2010. The age of the patients at surgery was 18.7 ± 2.25 months. Follow up of the patients was 11.3 ± 3.07 years. The age of the patients at the last follow up was 12.6 ± 1.74 years. According to the Tönnis classification, 13 hips were grade II, 27 hips were grade III and 22 hips were grade IV. Patients were evaluated according to Omeroglu radiological criteria and modified McKay functional criteria. The presence of avascular necrosis (AVN) of the hip was questioned using the KalamchiMacEwen classification. RESULTS: Radiologically, forty eight (77%) hips were evaluated as "excellent", 8 (13%) hips as "good" and 5 (8%) hips as "fair plus" and 1 (%2) hip as "fair minus". Two (3%) patients had type 1 temporary AVN and one (1%) patient had type 4 AVN with coxa magna and overgrowth of the greater trochanter. According to McKay functional criteria, 56 (90%) hips had "excellent" and 6 (10%) had "good" results. Two (3.2%) hips of one patient had to be reoperated with Salter osteotomy and femoral shortening + derotation osteotomy. CONCLUSION: Medial approach using two separate intervals for tenotomy and capsulotomy does not jeopardize the medial circumflex or the femoral vessels and yields satisfactory midterm results for children 18 months old with dysplasia of the hip. LEVEL OF EVIDENCE: Level IV, therapeutic study.

A Scoring System to Demonstrate the Risk for Bone Injury in Patients with Clinically Suspected or Occult Scaphoid Fracture.

BACKGROUND: It is important to diagnose a scaphoid fracture accurately and start the correct treatment in the shortest time possible. However, the fracture of bone may not be visible on x-ray. In such cases, patients are clinically diagnosed with suspected or occult scaphoid fractures. The aim of this study was to define a scoring system based on physical examination to demonstrate the risk for bone injury in patients with clinically suspected and occult scaphoid fractures with negative radiographs and anatomical snuff box tenderness and to decrease the costs and workforce loss due to unnecessary treatment and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Patients were initially evaluated by the attendant orthopedic physician in the emergency service with X-ray of the wrist, and ten wrist physical examination techniques were used. The X-rays of patients were evaluated by three orthopedic surgeons. Finally sixty patients, who were diagnosed as having no fracture by all three orthopedic surgeon, were included in the study. The wrists of these patients were evaluated with MRI. RESULTS: There were 46 male (77%) and 14 female (23%) patients with a mean age of 21.5 years (range 7-61 years). About 3.3% had triquetrum fracture, 15% had bone edema in the scaphoid and radius, 18.3% had distal radius fracture, 31.6% had scaphoid fracture, and 31.8% had no bone injury. A scoring system was also proposed. It can be predicted that in the physical examination of the wrist if the total score is higher than 6.5, the probability of fracture is 2.87 (positive likelihood ratio) fold compared to scores below 6.5. CONCLUSIONS: Proposal of this new scoring system was thought to be useful for predicting the risk for bone injury in patients with clinically suspected scaphoid fractures and making decision regarding therapeutic options.

Biomechanical evaluation of different fixation plates in medial opening upper tibial osteotomy.

In this biomechanical study, 25 in vitro calf tibial models were used in order to compare the stability of the plates under axial compression loading. A 10-mm medial opening gap was stabilized in each of the five calf tibial models either with four or two-holed rectangular shaped plates with wedges, with four-holed reversed L-shaped plates with wedges, with the combination of these two types of plates, or with six-holed anatomical T-plates. The compression behavior of the model was tested by using a universal mechanical testing system. The specimens fixed with the combination of plates with the four-holed reversed L-shaped and with two-holed rectangular shaped; or with six-holed anatomical T-plates, showed significantly better stability than those of others. Four different kinds of failure (slippage of wedge, lateral cortex fracture, damage and/or loosening of screws, and bending of plates) were observed on the models. When the average value of force loading on the plates that were designed by the first author was considered, the plates were stable and the average force values at these points were higher than the loading force on a knee during the normal paced walking or running conditions.

Effects of resveratrol on skeletal muscle in ischemia-reperfusion injury.

BACKGROUND: Resveratrol, a polyphenol found in grape and red wine, was previously shown to have free radical scavenging and antioxidant properties in various tissues. In this study, the effects of resveratrol were investigated in muscle tissue concerning the ischemia reperfusion (I/R) injury of rat hindlimb. METHODS: Arterial circulation of right hindlimbs of 24 Sprague-Dawley rats was ceased by a tourniquet applied for four hours (h). The tourniquet was released at the end of 4th hours and rats were divided into four groups of six rats. Then, extremity was reperfused for 4h in group I and for 8h in group II. Resveratrol in 0.5% ethyl alcohol was administered with a dose of 10 mg/kg in the treatment groups (group I and group II) intraperitoneally. Only 0.5% ethyl alcohol were administered in the control groups (group III and group IV) intraperitoneally. Gastrocnemius muscle was used for histological assessments and the anterior tibial muscle was used for measurement of malondialdehyde (MDA) levels. RESULTS: MN infiltration, edema, changes in diameters of muscle fibers and segmental necrosis were less prominent in rats treated with resveratrol compared with control groups (p<0.05). The MDA levels was significantly lower in treatment groups (p<0.05). CONCLUSION: The results suggest that resveratrol may protect the skeletal muscles against I/R injury with its potent antioxidant properties.

[Locked posterior dislocation of the hip: a case report]. / Kilitli posterior travmatik kalça çikigi: Olgu sunumu.

Impaction fractures of the femoral head occurring after anterior or posterior hip dislocations are well described. However, locked posterior hip dislocation resulting in sinking of the posterior acetabular rim into the femoral head has hitherto been undescribed. A 26-year-old male patient presented with complaints of severe pain in the left thigh and marked limitation in the movements of the left hip two weeks after an in-car crash. He could only walk with crutches. Shortly after the accident, he was examined at another center with physical examination and plain radiographies and was given bed rest and medications for pain relief. Computed tomography demonstrated the locked posterior hip by the impact of the posterior acetabular rim against the femoral head. At surgery, the posterior acetabular rim was embedded in the anteromedial surface of the femoral head resulting in an osteochondral impaction fracture with a penetration depth of 12 mm. Due to wide destruction to the cartilage surface, an uncemented bipolar hemiarthroplasty was performed. After 28 months of follow-up, he had no complaints and hip movements were painless with full range of motion.

[The effect of human placental suspension on rat sciatic nerve healing]. / Siçan siyatik sinir iyilesmesinde insan plasenta süspansiyonunun etkisi.

OBJECTIVES: We investigated the effect of human placental suspension (HPS) on rat sciatic nerve regeneration. METHODS: Eight adult female Sprague-Dawley rats weighing between 250 and 300 g were randomly divided into control and study groups equal in number. Both sciatic nerves were explored under anesthesia, transsected and then immediately repaired. At the end of the operation, and on the second and fifth days, HPS and saline were administered to the operation zone in the test and control groups, respectively. For functional examination, electromyographic activity was measured in posterior extremities of all rats preoperatively and at the end of eight weeks. The rats were then sacrificed to obtain transections from the repaired area and its distal region for histologic examination and the number of myelin-sheathed axons was estimated in both regions. RESULTS: Electromyographic study showed delayed latency and decreased amplitude following operation in both groups, being less severe in the study group without reaching a significant difference from the control group (p>0.05). The most notable histopathologic finding was increased endoneural collagen in the control group and regenerative axonal growth in the HPS group. The number of axons was greater in the distal region in both groups. In both regions, the number of myelin-sheathed axons was greater in the HPS group, but this difference was significant only for the number of axons in the repair zone (p=0.001). CONCLUSION: Our data suggest that HPS may exert a favorable effect on peripheral nerve regeneration.

Arthroscopic Technique for Treatment of Schatzker Type III Tibia Plateau Fractures Without Fluoroscopy.

Accurate reduction and maintenance of the stability with correct implant positioning is critical for surgical treatment of tibial plateau fractures. Our technique includes an arthroscopic reduction and fixation of Schatzker type III tibial plateau fractures with a bulls-eye screw placement without fluoroscopy control. With the arthroscopic guidance, an anterior cruciate ligament drill guide is placed and a K-wire sent to the midpoint of the depressed fragment through the guide at a 40° angle to the coronal axis of the tibia. A tunnel is created with the drill over the K-wire. The depressed fragment is further augmented with gentle impacts over the K-wire. After arthroscopic reduction control, an appropriate-sized iliac graft is pushed until it is below the depressed fragment. The targeting device is adjusted at 130° so that it is parallel to the joint line and a K-wire sent through the device so that it would pass just below the graft. The graft is then supported with cannulated screws sent over the K-wire. This technique provides an arthroscopic reduction of the chondral surface and precise placement of the rafting screws without fluoroscopy.

[Assessment of the vulnerability of the proximal tibiofibular joint to injury during osteotomies]. / Osteotomilerde proksimal tibiofibular eklemin yaralanma riskinin degerlendirilmesi.

OBJECTIVES: We evaluated the dimensions and anatomic localization of the proximal tibiofibular joint (PTFJ) in human cadaver and amputated knees. In addition, we assessed the relation between the osteotomy line and the PTFJ and its vulnerability to injury on radiographs of patients after proximal tibial medial open wedge osteotomy (PT-MOWO). METHODS: In the first phase, dimensions of the tibial part of the PTFJ lying between the lateral tibial condyle and the fibular head were measured by digital calipers in six human cadaver and six fresh amputed tibiae (4 females, 8 males; mean age 57 years) to evaluate the relation between the tibial surface of the PTFJ and the posterior part of the lateral tibial plateau. In the second phase, anteroposterior, lateral, and medial oblique radiographs were assessed with respect to the relation of the osteotomies with the PTFJ following PT-MOWO in 46 knees of 44 consecutive patients (38 females, 6 males; mean age 51 years). RESULTS: On cadaver and fresh amputation materials, the mean long and short axis dimensions of the ellipsoidal articular surface of the PTFJ in the posterolateral aspect of the tibial plateau measured 18.8 mm (range 13 mm to 20 mm) and 14.9 mm (13 mm-17 mm), respectively. The upper articular border lied at a mean of 6.3 mm (2 mm to 11 mm) distal to the posterior border of the articular surface of the lateral tibial plateau. Medial oblique radiographs showed that the osteotomy line extended to the PTFJ in cases in which it was proximally located, particularly in three cases (6.5%) where lateral cortex continuity was interrupted. CONCLUSION: The osteotomy line may encroach upon the PTFJ unless preoperative oblique radiographs are evaluated and a parallel course to the tibial slope of the lateral tibial plateau is followed. In addition, insufficient evaluation of PT-MOWO candidates may result in damage to the lateral cortex, which increases the risk for injury to the PTFJ.

[Comparison of the pull-out strengths of three different screws in pedicular screw revisions: a biomechanical study]. / Pediküler vida revizyonlarinda üç farkli tip vidanin siyirma kuvvetlerinin karsilastirilmasi: Biyomekanik çalisma.

OBJECTIVES: We investigated the possible effects of three pedicular screws on axial pull-out strength in pedicular revision surgery. METHODS: Two study groups were formed from calf lumbar vertebrae. Initially, Alici pedicular screws with an outer diameter of 6.5 mm were applied (with or without tapping) to all the pedicles. All the pedicles were subjected to axial pull-out testing to induce pedicular insufficiency. Then, Alici pedicular screws with an outer diameter of 7 mm were applied to the left pedicles. The right pedicles in the two study groups were assigned to receive two different types of pedicular screws with an expandable (enlargeable) end, respectively. Axial pull-out testing was repeated in both groups and the results were compared with the initial pull-out strength values. RESULTS: In the first group, 65% and 64% of the initial pull-out strengths were obtained with 7-mm Alici pedicular screws and with expandable pedicular screws, for the left and right pedicles, respectively. The corresponding pull-out strengths in the other study group were 70% and 68.5% of the initial values, respectively. Tapping of the screw hole entrance resulted in a mean decrease of 13% in the pull-out strength compared to screw applications without tapping. CONCLUSION: Pedicular screw revisions using a 0.5 mm greater screw in diameter did not provide adequate screw-bone inter-face strength and pedicle filling. Similarly, expandable pedicular screws did not contribute to screw stability.