Spinal osteotomies: indications, limits and pitfalls.

The aims of spinal deformity surgery are to achieve balance, relieve pain and prevent recurrence or worsening of the deformity.The main types of osteotomies are the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO) and vertebral column resection (VCR), in order of increasing complexity.SPO is a posterior column osteotomy in which the posterior ligaments and the facet joints are removed and correction is performed through the disc space. A mobile anterior disc is essential. SPO is best in patients with +6-8 cm C7 plumbline. The amount of correction is 9.3° to 10.7°/level (1°/mm bone).PSO is a technique where the posterior elements and pedicles are removed. Then a triangular wedge through the pedicles is removed and the posterior spine is shortened using the anterior cortex as a hinge. The ideal candidates are patients with a severe sagittal imbalance. A single level osteotomy can produce 30° 40° of correction. A single level osteotomy may restore global sagittal balance by an average of 9 cm with an upper limit of 19 cm.BDBO is an osteotomy done above and below a disc level. A BDBO provides correction rates in the range of 35° to 60°. The main indications are deformities with the disc space as the apex and severe sagittal plane deformities.VCR is indicated for rigid multi-planar deformities, sharp angulated deformities, hemivertebra resections, resectable spinal tumours, post-traumatic deformities and spondyloptosis. The main indication for a VCR is fixed coronal plane deformity.The type of osteotomy must be chosen mainly according to the aetiology, type and apex of the deformity. One may start with SPOs and may gradually advance to complex osteotomies. Cite this article: EFORT Open Rev 2017;2:73-82. DOI: 10.1302/2058-5241.2.160069.

Can hyperbaric oxygen be used to prevent deep infections in neuro-muscular scoliosis surgery?

BACKGROUND: The prevalence of postoperative wound infection in patients with neuromuscular scoliosis surgery is significantly higher than that in patients with other spinal surgery. Hyperbaric oxygen has been used as a supplement to treat postsurgical infections. Our aim was to determine beneficiary effects of hyperbaric oxygen treatment in terms of prevention of postoperative deep infection in this specific group of patients in a retrospective study. METHODS: Forty two neuromuscular scoliosis cases, operated between 2006-2011 were retrospectively reviewed. Patients who had presence of scoliosis and/or kyphosis in addition to cerebral palsy or myelomeningocele, postoperative follow-up >1 year and posterior only surgery were the subjects of this study. Eighteen patients formed the Hyperbaric oxygen prophylaxis (P-HBO) group and 24, the control group. The P-HBO group received 30 sessions of HBO and standard antibiotic prophylaxis postoperative, and the control group (received standard antibiotic prophylaxis). RESULTS: In the P-HBO group of 18 patients, the etiology was cerebral palsy in 13 and myelomeningocele in 5 cases with a mean age of 16.7 (11-27 yrs). The average follow-up was 20.4 months (12-36mo). The etiology of patients in the control group was cerebral palsy in 17, and myelomeningocele in 7 cases. The average age was 15.3 years (8-32 yrs). The average follow-up was 38.7 months (18-66mo). The overall incidence of infection in the whole study group was 11.9% (5/42). The infection rate in the P-HBO and the control group were 5.5% (1/18), and 16.6% (4/24) respectively. The use of HBO was found to significantly decrease the incidence of postoperative infections in neuromuscular scoliosis patients. CONCLUSION: In this study we found that hyperbaric oxygen has a possibility to reduce the rate of post-surgical deep infections in complex spine deformity in high risk neuromuscular patients.

Protruded and nonprotruded subungual exostosis: Differences in surgical approach.

BACKGROUND: In subungual exostosis surgery, repair of the damaged nail bed and surgical excision of the mass without damaging the nail bed is important. The ideal method of surgery is still unclear. This study is done to qualify the effects of different surgical methods on outcome measures in different types of subungual exostosis. MATERIALS AND METHODS: Fifteen patients, operated with a diagnosis of subungual exostosis between January 2008 and June 2012, were evaluated. Protruded masses were excised with a dorsal surgical approach after the removal of the nail bed and nonprotruded masses were excised through a"fish-mouth" type of incision. RESULTS: The mean age of the patients in protruded subungual exostosis group was 17.3 years (range 13-22 years) and this group consisting of seven female and two male patients. The patients were followed up for a mean of 14.1 ± 4.8 months. The mean age of the patients in the nonprotruded subungual exostosis group was 14.6 years (range 13-16 years) and consisting of six female patients. The patients were followed up for a mean of 11.6 ± 2.9 months. The results were positively affected by changing the surgical approach depending on whether or not the exostosis is protruded from the nail bed. All patients had healthy toe nails in the postoperative period without any signs of recurrence. CONCLUSIONS: In patients with a protruded subungual exostosis, the mass should be removed by a dorsal approach with the removal of the nail and injury to the nail bed should be repaired. In patients with a nonprotruded subungual exostosis, the mass should be excised through a "fish-mouth" type incision at the toe tip without an iatrogenic damage.

Isolated dorsal approach for the treatment of neglected volar metacarpophalangeal joint dislocations.

Here, we present the clinical and radiological results of three neglected volar metacarpophalangeal dislocations in 2 patients, which were treated with open reductions 10 and 24 mo after the dislocations. There was a mean of a 20° (range 10°-30°) limitation of extension and a 53.3° (range 30°-70°) limitation of flexion preoperatively. Postoperatively, there was no limitation of extension (at 8 and 12 mo) in any of the fingers. In terms of flexion, one finger had full function, one had a 10° and the last one had a 30° limitation of flexion. Two of the fingers presented anesthesia preoperatively, which improved to hypesthesia postoperatively. One finger had hypesthesia, which improved postoperatively. During surgery, a ruptured dorsal capsule was found to have interposed into the joint, making closed reduction impossible. Our experience with these two patients demonstrated that, even in neglected cases, open reduction using an isolated dorsal approach may result in satisfactory clinical and radiological outcomes.

The effects of diabetes on symptoms of carpal tunnel syndrome treated with mini-open surgery.

This study aimed to evaluate the influence of type II diabetes mellitus (DM) on the postoperative outcomes of mini-open carpal tunnel syndrome (CTS) surgery. A total of 99 hands in 74 patients were included in the study. Of these, 36 patients (54 hands) had type II DM (Group A), and 38 patients (45 hands) had idiopathic CTS (Group B). Mini-open carpal tunnel release surgery was performed on all the hands. The night pain, weakness, paraesthesia, numbness complaints were significantly improved in both groups after surgery. However, thenar atrophy was improved significantly only in group A. Night pain, weakness, paraesthesia, numbness, and pillar pain were significantly worse in Group A than in Group B on postoperative examination. Postoperatively, Tinnel and Phalen tests were positive in 32 hands in Group A and 6 hands in Group B. Persistence of symptoms in diabetic patients was found to be more prevalent compared to non-diabetic controls after mini-open carpal tunnel release.

Kyphectomy for congenital kyphosis due to meningomyelocele: a case treated with a modified approach to skin healing.

This study is a case report of a meningomyelocele patient with congenital kyphosis who was treated with kyphectomy and a special approach to soft tissue healing. The objective of this study is to show a step by step approach to surgical treatment and postoperative care of a meningomyelocele patient with congenital kyphosis. In meningomyelocele the incidence of kyphosis is around 12-20%. It may cause recurrent skin ulcerations, impaired sitting balance and respiratory compromise. Kyphectomy has first been described by Sharrard. This surgery is prone to complications including pseudoarthrosis, skin healing problems, recurrence of deformity and deep infections. A 15-year-old male presented with congenital kyphosis due to meningomyelocele. He had back pain, deformity and bedsores at the apex of the deformity. The wound cultures showed Staphylococcus epidermidis colonisation at the apex. He was given appropriate antibiotic prophylaxis. During surgery, the apex of the deformity was exposed through a spindle-shaped incision. After instrumentation and excision of the apex, correction was carried out by cantilever technique. Two screws were inserted to the bodies of L3 and T11. After the operation, the skin was closed in a reverse cross fashion. He was sent to hyperbaric oxygen treatment for prevention of a subsequent skin infection and for rapid healing of skin flaps post operation. The patient's deformity was corrected from a preoperative Cobb angle of 135°-15° postoperative. The skin healed without any problems. Preoperative culture and appropriate antibiotic prophylaxis, spindle-shaped incision, reverse cross-skin closure and postoperative hyperbaric oxygen treatment can be useful adjuncts to treatment in congenital kyphosis patients with myelomeningocele to prevent postoperative wound healing and infection problems. Reduction screws and intracorporeal compression screws help to reduce the amount of screws and aid in corection of the deformity.

The comparison of the effects of intraoperative bleeding control and postoperative drain clamping methods on the postoperative blood loss and the need for transfusion following total knee arthroplasty.

OBJECTIVE: We aimed to determine and compare the effects of intraoperative bleeding control and two hours postoperative drain clamping method on postoperative wound drainage and the need for donor blood transfusion following total knee arthroplasty (TKA). METHODS: Seventy-one patients who underwent TKA were randomly assigned into two groups. Fourty-four knees of 32 patients comprised Group A and 51 knees of 39 patients comprised Group B. In Group A, no bleeding control was done and postoperatively, the drain was clamped for 2 hours. Then it was unclamped to begin aspiration after the 2nd hour. In Group B, the bleeding was controlled intraoperatively, and the drain was not clamped after the surgery. Drains were removed 48 hours after the surgery in both groups. Bilateral and unilateral arthroplasty patients were evaluated separately. The groups were compared for their preoperative and postoperative 3-day haemoglobin (Hb) levels, total drainage amount and total number of blood transfusions. RESULTS: The haemoglobin levels were similar in both groups preoperatively and at the 1st, 2nd and 3rd postoperative days. In Group A, the wound drainage was 696.1±235.4 ml in unilateral TKA patients and was 1010.8±535.5 ml in bilateral arthroplasty patients. In Group B, the wound drainage was 710.1±380.1 ml in unilateral TKA patients and was 878.3±489.6 ml in bilateral arthroplasty patients. The mean number of transfusions was 1.41 units with no significant differences between the groups. CONCLUSION: The two hour drain clamping method without intraoperative bleeding control does not seem to affect the amount of blood loss and the need for transfusion when compared to intraoperative bleeding control in total knee arthroplasty patients. Hovewer, it is a simple and feasible method and can be used to decrease the operation time.

[Healing of osteochondral defects in canine knee with avocado/soybean unsaponifiables: a morphometric comparative analysis]. / Avokado/soya fasülyesinin sabunlasmayan ekstresi verilen köpeklerin dizlerinde osteokondral defekt iyilesmesi: Bir karsilastirmali morfometrik analiz.

OBJECTIVES: This study aims to determine the effects of avocado/soybean unsaponifiables (ASU) on healing in a canine osteochondral defect model. MATERIALS AND METHODS: Fourteen dogs were included in the study and randomly divided into two groups. Two osteochondral defects were produced in the lateral aspect of the trochlear groove of the knee joint. The treatment group (group 1; n=7) was given 300 mg ASU capsules every three days whereas the control group (group 2; n=7) was given a normal diet. Animals were then allowed to ambulate normally until euthanasia at 15 weeks. The knees were dissected and the trochlear grooves with defects were removed for pathological examination. The amount of regenerated tissue was determined quantitatively using image analysis and the tissue content was evaluated semi-quantitatively using Safranin-O and Masson trichrome histochemical stains. Transforming growth factor beta (TGF-beta) increase was evaluated semi-quantitatively with immunohistochemical staining methods. RESULTS: Morphometric analysis revealed a significantly more immature repair tissue in group 1 (p<0.002). Both collagen and chondral tissue content of the regenerated tissue were significantly increased in group 1 (p<0.002). Compared to that in group 2, cartilage tissue in group 1 showed a much more marked immunostaining reaction of TGF-beta. CONCLUSION: Avocado/soybean unsaponifiables treatment stimulates the healing of the osteochondral defects in canine knee possibly by increasing TGF-beta in the tissues.

Talonavicular joint approach to the talar body: a cadaver study.

BACKGROUND: Lesions of the talar dome or tumors within the talar body may require an open approach with medial or lateral malleolar osteotomies. The aim of this study was to evaluate the possibility and feasibility of a new minimally invasive approach without osteotomy, using the talonavicular joint (TJ) as the entry portal for lesions of the talar body. MATERIALS AND METHODS: Nine cadaveric feet were used for this study. Using the TJ and a 5-mm skin incision we aimed to reach the superolateral, superomedial, inferolateral and inferomedial corners of the talar body under fluoroscopy. A 2-mm Kirshner wire and a 4-mm cannulated drill bit were used to reach the desired target area and an angled curette was used for curettage after reaching the target. The proximity of vascular structures to the entry portal was noted. The talar and navicular joint surfaces were checked for any damage. The articular areas of the talar heads and the defect areas were measured. RESULTS: All 4 targets and even the posterior talus could be reached by this approach. The nearest neurovascular structures were the saphenous vein and the saphenous nerve. The navicular cartilage was not damaged in any specimen. The talar defect area corresponded to only 3.3% of the talar head cartilaginous area. CONCLUSION: The TJ approach can be used to reach lesions in all regions of the talar body without the need for an osteotomy. A mini-incision may be used to retract the saphenous nerve and vein. Damage to the talar head cartilage is minimal with this approach which requires no special equipments. CLINICAL RELEVANCE: This study shows that talar dome lesions can be reached with a minimally invasive method.

Mini-open versus all-arthroscopic rotator cuff repair: comparison of the operative costs and the clinical outcomes.

INTRODUCTION: Rotator cuff injury is one of the most frequently encountered problems of the shoulder in the daily practice of orthopaedic surgeons. This study compared all-arthroscopic cuff repair (ARCR) and mini-open rotator cuff repair (MORCR) methods in regard to clinical outcomes and costs. METHODS: Fifty patient charts and operative repairs were analysed (25 ARCR and 25 MORCR). Pre-and postoperative Constant-Murley and UCLA scores along with factors such as tear size, tear type, pre-operative physical therapy, motion and satisfaction levels were compared for the two procedures. Cost-benefit analysis was also performed for comparison between procedures. The duration of follow-up was 31.20 and 21.56 months for MORCR and ARCR groups, respectively. RESULTS: Tear sizes (P=0.68), pre-and postoperative Constant-Murley and UCLA scores (P=0.254) and satisfaction levels were not significantly different between groups. However, the differences between pre-and postoperative Constant-Murley and UCLA scores were statistically significant within both groups (P<0.01). The MORCR group stayed 1 day longer in hospital than the ARCR group, which was statistically significant (P=0.036). The differences regarding mean pain scores, abductions, internal and external rotations in Constant-Murley scores and forward flexion scores in UCLA scores were not significant. The ARCR group cost more, leaving less profit. CONCLUSION: Results suggest that ARCR yields similar clinical results but at a higher cost compared with MORCR.

[The prevalence of low back pain and risk factors among adult population in Afyon region, Turkey]. / Afyonkarahisar ilinde eriskinlerde bel agrisi sikligi ve etkileyen faktörler.

OBJECTIVES: This study was designed to determine the prevalence of and risk factors for low back pain (LBP) in a sample of Turkish population among adults living in the Afyon region, Turkey. METHODS: A field screening investigation was performed in a total of 75 areas including the city center, 18 districts, and 57 associated small municipalities. Adequate sample size was determined as 1,990 and a total of 2,035 individuals (1,194 females, 841 males) were enrolled. Participants were inquired about age, occupation, sex, height, weight, history of LBP, hypertension, diabetes, and smoking. Depression symptoms were evaluated using the Symptom Checklist-90-Revised. RESULTS: The prevalence of lifetime LBP was 51%, and the prevalence of chronic LBP was 13.1%. Overall, 63.2% of women and 33.8% of men had LBP at least once in their lives (p=0.001). With regard to occupation, the highest incidence of LBP was seen in housewives (64.2%; p=0.0001), whose age and body mass index (BMI) were also higher compared to employed women. Depression (p=0.016) and increased BMI (p=0.000) were found to increase the risk for LBP, whereas smoking, hypertension, or diabetes were not correlated with the prevalence of LBP. Poverty was found to be the leading cause (39.7%) for not presenting to a physician. CONCLUSION: Among risk factors reported for LBP, many are also effective in Turkish population. Special attention should be given to the education of housewives in terms of low back protection, healthy nutrition, and family planning. Poverty seems to be a significant barrier to patient presentation to physicians, requiring extended social security coverage.

[Hip rotation degrees, intoeing problem, and sitting habits in nursery school children: an analysis of 1,134 cases]. / Anaokulu çocuklarinda kalça rotasyon dereceleri, içe dönük yürüme sorunu ve oturma aliskanliklari: 1134 olgunun analizi.

OBJECTIVES: We investigated hip rotation degrees, frequency of intoeing problems, and sitting habits in nursery school children and the relationship between these parameters. METHODS: The study included 1,134 children (612 boys, 522 girls), aged between three to six years, attending 26 nursery schools in the central area of Afyon. First, informed consent was obtained from the parents and a questionnaire was administered about demographic data and sitting habits of the children. Then, the children were examined in lower underwear. Foot progression angles were determined and progression to midline during walking was evaluated as intoeing. Internal and external rotation degrees of the hips were measured using a goniometer in prone and supine positions. RESULTS: In girls, internal rotation of the hip was nearly 13 degrees greater in the prone position, and 9 degrees greater in the supine position compared to those of the boys. Intoeing was detected in 67 children (5.9%), 76.1% being bilateral. The girl-to-boy ratio was 2.4/1. Intoeing problem originated from the femur in 74.6%, and from the tibia in 25.4%. Compared to normal children, intoeing was associated with a greater internal rotation and a smaller external rotation of the hip. Overall, 36.7% had a crossed-leg sitting habit, and 63.3% had a television sitting habit. The latter was more frequent in intoeing children (p=0.001). CONCLUSION: Although hip rotation degrees in our study were similar to those reported in the literature, higher hip internal rotation degrees were found especially in girls. Television sitting which is a frequently preferred position among nursery school children was significantly prevalent in intoeing children.

The healing potential in cauda equina syndrome secondary to traumatic posterior L5-S1 dislocation. A case report with 16 years follow-up.

Cauda equina syndrome is the result of any lesion that compresses or paralyzes cauda equina roots which are both motor and sensory. It is an uncommon syndrome, which features low back pain, sciatica, variable lower extremity motor and sensory loss with possible bladder and bowel dysfunction. It is an emergency situation as it may cause significant morbidity such as permanent paralysis, impaired bladder and/or bowel control or loss of sexual sensation. We present the case of a patient who was admitted to the emergency department with a traumatic posterior L5-S1 dislocation, low back pain and bladder dysfunction 8 days following an initial trauma. Open L5-S1 reduction and posterior stabilization was performed and the dural sac was decompressed. Most of the patient's neurological deficits resolved over several years, following the initial surgery.

Use of a splint following open carpal tunnel release: a comparative study.

This study was undertaken to compare the clinical effectiveness and costs of postoperative splintage and late rehabilitation with a bulky bandage dressing versus early rehabilitation after carpal tunnel release. In this comparative study, 46 patients were randomly divided into 2 groups. In each group, 3 patients were excluded because of improper follow-up, leaving a total of 40 patients. Group 1 used a splint (exercises given 3 wk postoperatively) and group 2 was given a bulky bandage (exercises provided immediately) after open release. Patients were assessed preoperatively and at the first and third postoperative months with the Questionnaire of Levine for Clinical Assessment of Carpal Tunnel Syndrome. The 2 groups were similar in terms of preoperative functional status scores and in controls at the first and third months (P=.549, P=.326, P=.190). When both groups were compared, no statistical significance was found regarding symptom severity scale scores preoperatively and at the first postoperative month (P=.632 vs P=.353). At the third month, scores were lower in favor of group 2 (P=.023). Additionally, 16 of 20 patients (80%) in group 1 reported a heavy feeling and discomfort caused by the splint. This problem was not reported by the patients in group 2. The cheapest splint on the market was 9 times more expensive than a bulky dressing. The investigators concluded that postoperative immobilization with a splint has no detectable benefits. Use of bulky dressings and abandonment of the use of postoperative splints may prevent unnecessary expenditures without sacrificing patient comfort or compromising the course of healing in carpal tunnel surgery.

Treatment with unsaponifiable extracts of avocado and soybean increases TGF-beta1 and TGF-beta2 levels in canine joint fluid.

Avocado and soya unsaponifiables (ASU) are plant extracts used as a slow-acting antiarthritic agent. ASU stimulate the synthesis of matrix components by chondrocytes, probably by increasing the production of transforming growth factor-beta (TGF-beta). TGF-beta is expressed by chondrocytes and osteoblasts and is present in cartilage matrix. This study investigates the effect of ASU treatment on the levels of two isoforms of TGFbeta, TGF-beta1 and TGF-beta2, in the knee joint fluid using a canine model. Twenty-four outbred dogs were divided into three groups. The control animals were given a normal diet, while the treated animals were given 300 mg ASU every three days or every day. Joint fluid samples were obtained prior to treatment, and at the end of every month (up to three months). TGF-beta1 and TGF-beta2 levels were measured using a quantitative sandwich enzyme immunoassay technique. ASU treatment caused an increase in TGF-beta1 and TGF-beta2 levels in the joint fluid when compared to controls. The different doses did not cause a significant difference in joint fluid TGF levels. TGF-beta1 levels in the treated animals reached maximum values at the end of the second month and then decreased after the third month, while TGF-beta2 levels showed a marginal increase during the first two months, followed by a marked increase at the end of the third month. In conclusion, ASU increased both TGF-beta1 and TGF-beta2 levels in knee joint fluid.

Percutaneous resection of a patellar osteoid osteoma using a cannulated skin punch biopsy needle.

Patella is a very rare localization for osteoid osteoma. Non-specific knee complaints and difficulty to distinguish nidus in direct radiographs may cause a delay in diagnosis and make the definite diagnosis troublesome. The most effective and non-invasive method in treatment of osteoma is CT guided excision of the nidus. We present a case of patellar osteoid osteoma diagnosed by MRI scans. After being marked under CT guidance, the lesion was completely excised with a skin punch. We propose that, this method is both minimal invasive and effective in the management of patellar osteoid osteoma.

Percutaneous release of the trigger thumb: is it safe, cheap and effective?

Percutaneous release of the trigger finger and trigger thumb has recently gained popularity. The aim of this study was to determine the clinical results and safety of percutaneous release in trigger thumbs. Twenty-five thumbs of 21 patients were released percutaneously in the polyclinic under local anaesthesia. Steroid injection was performed following the release procedure using the same needle. The thumb function was evaluated by a patient questionnaire, and functional thumb scores (VAS) were calculated in the preoperative and postoperative periods. At the 1 week follow-up, four patients had signs of discomfort and triggering because of incomplete release. These patients underwent open A1 pulley release. Three superficial tendon lacerations were seen during these open procedures. There were no wound complications or signs of digital nerve or artery injury in any of the patients. The preoperative mean VAS was 26.62 (18-36). This decreased to 2.57 (0-5) at the first postoperative month (P<0.001) and to 2.19 (0-3; P<0.001) at the sixth month. When the VAS scores at the first and sixth months were compared, the difference was statistically significant. We concluded that percutaneous release of trigger thumbs is a cheap, safe and effective procedure with a low rate of complications.

Functional results of vertebral augmentation techniques in pathological vertebral fractures of myelomatous patients.

INTRODUCTION: This is a retrospective study to determine the effects of vertebroplasty and kyphoplasty on quality of life in multiple myeloma patients with spinal compression fractures. MATERIAL AND METHODS: Thirty-four patients with primary multiple myeloma were treated for symptomatic compression fractures between June 2003 and June 2005. Kyphoplasty was applied to 22 levels in 18 and vertebroplasty to 28 levels in 16 patients. The pain-related disability was evaluated for every single daily living activity using visual analog scale (VAS) over 10 points. (pain at rest, walking, sitting-standing, taking a shower and wearing clothes). (This evaluation is performed to every patient with degenerative disorders of the spine upon admission to our clinic.) Overall VAS scores were evaluated over 50 points (0 minimum, 50 maximum) preoperatively, at postoperative six weeks, six months and at one year prior to taking analgesics. The amount of analgesic use was recorded. Data was analyzed statistically using variance analysis, Friedman's multiple comparison test and Student's t test. RESULTS: The mean overall pain score in the kyphoplasty group decreased from a preoperative value of 36 to 12.13 at the sixth postoperative week, to 8.63 at the sixth month and to 9.72 at one year. (p<0.001). The mean overall pain score in the vertebroplasty group decreased from a preoperative value of 37.83 to 15.33 at the sixth postoperative week, to 12.17 at sixth months and to 13.47 at one year. (p<0.001). Student's t test was used to analyze the percentage of differences in overall pain score. Difference between groups was not statistically significant at the sixth week (p=0.106) but was statistically significant both at the sixth month (p=0.024) and at one year (p=0.027) in favor of kyphoplasty group. No secondary collapse was observed in adjacent levels in both groups. There were no intrapostoperative neurologic/pulmonary complications in both groups. Analgesics usage significantly decreased in both groups. CONCLUSION: In multiple myeloma, when pathological spinal compression fractures cause intractable pain and are unresponsive to conservative treatment, both vertebroplasty and kyphoplasty are effective in increasing quality of life and decreasing pain.

Radiographic artifact mimicking epiphysis of the femoral head in a seven-month-old girl.

Conventional x-ray is still the most important diagnostic and follow-up tool in developmental dysplasia of the hip joint, where hip joint ultrasonography cannot be performed. Artifacts that are seen because of technical errors can cause difficulties in diagnosis and and even can lead to wrong diagnoses and treatments. Herein, we report a diagnostic problem caused by an x-ray artifact in a child who is followed up with developmental dysplasia of the hip joint.