Anterior instrumentation for the treatment of spinal tuberculosis.

BACKGROUND: Kyphosis and neurological impairment are the major residual problems of spinal tuberculosis after the microorganism has been eradicated with use of appropriate medications. Spinal instrumentation is needed to support anterior strut grafts in patients who have kyphosis that affects more than two levels. Most surgeons use posterior instrumentation. Anterior instrumentation, despite its advantages, has not been widely accepted, partly because of concerns about introducing foreign material into infected tissue. The purpose of the current study was to address those concerns. METHODS: Twenty-two patients who had tuberculosis of the spine with moderate-to-severe localized kyphosis and sixteen patients who had more than two involved levels had stabilization with anterior instrumentation. Antituberculous medication was used postoperatively according to a standardized regimen. The patients were followed to determine if there was any recurrence of the disease and if the correction had been maintained. RESULTS: The twenty-two patients who had involvement of one or two levels had an average correction of the deformity of 64 percent (range, 58 to 90 percent), and the sixteen patients who had more than two levels of involvement had an average correction of 81 percent (range, 75 to 97 percent). The correction was maintained in twenty-one patients, the maximum loss was 3 degrees in sixteen, and one patient died on the second postoperative day. There was no recurrence of the disease. CONCLUSIONS: We believe that anterior instrumentation is more effective than posterior instrumentation for reducing the deformity and stabilizing the vertebral column in patients who have kyphosis related to tuberculosis of the spine.

Effect on knee disarticulation on bone growth in immature rabbits.

This study was designed by the University of Ankara Experimental and Research Laboratory for animals in 1997. In the study an anteroposterior skin flap technique was used for 20 knee disarticulation amputations and also in 20 trans-femoral amputations on immature rabbits, in order to investigate their effects on the femoral epiphyseal growth plate. The femurs of the rabbits were observed radiographically for 8 weeks. It was observed that the femurs tended to grow at a slower rate compared to the normal contralateral femur. These studies showed that the disarticulated limb femurs grew 0.68 cm shorter on average compared to the contralateral femurs and the femurs in the trans-femoral amputated limbs 3.58 cm shorter on average compared to the contralateral ones. These results were found to be statistically significant.

Three dimensional measurements of pelvic tilt in trans-tibial amputations: the effects of pelvic tilt on trunk muscles strength and characteristics of gait.

The aim of this study was to determine the degree of pelvic tilt in the three dimensions, the trunk muscle strength and effects on gait in trans-tibial amputated patients. This study comprised of 22 unilateral trans-tibial amputated patients who were seen at the authors' Prosthetics and Orthotics Laboratory for the purpose of prosthetic provision. Measurements were made using plurimeter and caliper and gait observations were made by video camera. In the sagittal and horizontal planes respectively the pelvic tilt was measured to be 12 degrees and 5.73 degrees, and such measurements in relation to the trunk extensor and flexor muscles were shown to be statistically significant (p < 0.05). On the contrary, the same could not be said for frontal plane measurements. In addition, in 9 cases excessive knee flexion was noted during the stance phase having a direct influence on the pelvic tilt (p < 0.05).

The contribution of vitamin C to healing of experimental fractures.

The benefits of various minerals and vitamins on fracture healing have been demonstrated in animal models. Vitamin C is an essential substance in fracture healing but has not been studied previously on an experimental basis. Sixteen rats were grouped randomly into control and vitamin C-supplemented groups. The right tibias of all rats were fractured by digital manipulation. One group received single high dose of vitamin C intramuscularly. On the 5th, 10th, 15th, and 20th days, two rats from each group were killed and the tibias examined under light microscopy. It was seen that the vitamin C-supplemented group went through the stages of fracture healing faster compared with the control group.

Medial approach open reduction for congenital dislocation of the hip using the Ferguson procedure. A review of 31 hips.

Between January 1979 and October 1984, 31 congenitally dislocated hips in 19 patients were treated using open reduction via the medial approach, as described by Ferguson, at the Ankara University Faculty of Medicine. Patient age at operation ranged from 3 to 33 months (mean 12.1 months). The average follow-up was 94.7 months. All hips were evaluated both radiographically and clinically. Avascular necrosis of the femoral head was observed in 9.7% and slight, transient ischaemic radiographic changes of the femoral head in 22.6% of the hips; 25.8% of the hips have already undergone or are due to undergo subsequent surgery due to an insufficient radiographic result. The medial approach was found to be a reliable procedure for infants who have not had extensive previous conservative treatment and who are between 7 and 18 months of age.