Addressing the challenges of complex type III odontoid fractures: Clinical and radiological outcomes of various treatment modalities.

Background: Unlike simple fractures, complex Type III odontoid fractures-characterized by intricate morphology and pathomechanics-pose significant management challenges. This study aims to evaluate the clinical and radiological outcomes of conservative and surgical treatment modalities for these complex fractures, with a focus on assessing factors influencing fracture union. Methods: Following approval of our institutional review board, this retrospective observational cohort study was conducted. All Patients with complex Type III odontoid fractures who were managed at our center from June 2016 to December 2022 were assessed for eligibility. The primary outcome was union status. Secondary outcomes included the ASIA impairment scale, neck disability index (NDI), and complications. Logistic regression analysis was conducted to identify risk factors for adverse union outcomes. Results: A total of 39 patients were included in the final analysis, with a mean age of 36.10 years. Nine patients were managed conservatively, 12 patients underwent anterior odontoid screw (AOS) fixation, and 18 patients received posterior fusion (PF). The rate of bony union varied significantly across the treatment groups, 100 % in the PF group, 58 % in the AOS group and 22 % in the conservative group (p = 0.0012). The NDI revealed superior functional outcomes in the PF group compared to the other groups (p = 0.0436). Failure of primary treatment was observed in seven patients (three from the conservative group and four from the AOS), necessitating secondary treatment with PF. Lateral mass gap >2 mm, coronal tilt >5°, and atlantoaxial instability >50 % were identified as significant risk factors for adverse union outcomes. Conclusions: Surgical treatment, particularly PF, offers superior outcomes in terms of union rates and functional recovery for complex Type III odontoid fractures. The identification of specific radiological measurements as significant risk factors for non-union underscores the need for detailed imaging and careful patient selection for conservative versus surgical management.

Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion for Adult Low-Grade Isthmic Spondylolisthesis: Analysis of Sagittal Radiographic Parameters - A Randomized Controlled Trial.

STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To compare the effect of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) on sagittal radiographic parameters in patients with low-grade isthmic spondylolisthesis. Additionally, to explore the correlation between changes in these parameters and clinical outcomes. METHODS: Forty-six consecutive patients with single-level low-grade isthmic spondylolisthesis were initially enrolled. They were randomly assigned to undergo either PLF or PLIF. Patients were followed up for at least 24 months. Radiographic outcomes included pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, sagittal vertical axis, T1 pelvic angle, slip angle, slip degree and disc height. Clinical outcomes were assessed by the Oswestry Disability Index (ODI) and visual analogue scale (VAS). RESULTS: Four participants were lost to follow-up. Of the remaining 42 patients, 29 were female. The mean age was 40.23 ± 10.25 years in the PLF group and 35.81 ± 10.58 years in the PLIF group. There was a statistically significant greater correction of all radiographic parameters in the PLIF group. The ODI and VAS improved significantly in both groups, with no significant differences between the two groups. Changes in the ODI and VAS were significantly correlated with changes in disc height, slip angle and lumbar lordosis. CONCLUSIONS: In patients with low-grade isthmic spondylolisthesis, PLIF demonstrates superior efficacy compared to PLF in correcting sagittal radiographic parameters. Nevertheless, this distinction does not seem to influence short-term clinical results. Restoring disc height, correcting the slip angle, and reestablishing normal lumbar lordosis are crucial steps in the surgical management of isthmic spondylolisthesis.

COVID-19. An update for orthopedic surgeons.

The COVID-19 pandemic has affected our world in a short period of time, and the orthopedic surgery practice was not an exclusion. Elective care was deferred in most health care facilities and emergency care was continued with strict precautions. With rapid progression of the pandemic, the response of the medical community is also rapidly changing in all aspects of delivering care. This led to a large number of publications with reports, guidelines, measures, ways to react to the crisis, and post-pandemic predictions and speculations. In this review we aimed at summarizing all the relevant information to the orthopedic surgery community. To do this, a comprehensive search was performed with all related terms on two scientific search engines, PubMed and SCOPUS, and the results were filtered by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The result was 72 articles that were further reduced to 33 articles after full text reading. The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. This review represents the most up to date information published in the literature that is a must-know to every orthopedic surgeon.