Pelvic parameters as prognostic factors of radiographic progression in classical Ankylosing Spondylitis: A prospective follow-up data.

Radiographic progression in Ankylosing spondylitis (AS) is driven by mechanical strain. A well-balanced spine provides a favorable weight distribution across the entheses. Pelvic parameters are useful in assessing the shape of the spine. The present study aimed to prospectively investigate the predictive value of pelvic parameters for radiographic progression in AS. This non-interventional, observational, and prospective study enrolled AS patients fulfilling the modified New York criteria (mNY) currently under follow-up in the MARS (MARmara Spondyloarthritis) outpatient clinics. The primary objective was to investigate the relationship between the baseline pelvic parameters and radiographic progression in the spine. Two trained radiologists (EB, OB) independently assessed the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). An orthopedic surgeon (AHA) and a radiologist (EB) derived the pelvic parameters. Patients with no bridging or bamboo spine were included in the final analysis. Risk assessment for radiographic progression, defined as a two-unit increase in mSASSS or developing a new syndesmophyte every two years, was done using uni- and multivariate logistic regression analyses. Radiographs of 69 AS patients were analyzed. The median (IQR 25-75) prospective follow-up was 47.7 (34.6-52.8) months. Only 33.3% (23/69) had radiographic progression. The pelvic tilt (PT) was lower in patients with radiographic progression (p = 0.037) and each degree of decrease in PT provided a 9% increase in risk for radiographic progression. Male patients were 7.5 times more likely to progress. Pelvic parameters provide a prognostic insight into the radiographic progression in AS. Our observations may aid in selecting patient-specific interventions in addition to anti-inflammatory treatments.

Correlation of anterior chest wall anomalies and spinal deformities: a comprehensive descriptive study.

PURPOSE: To investigate the association and evaluate the characteristics between different types of anterior chest wall and spinal deformities. METHODS: A total of 548 patients with anterior chest wall deformities were included in this study. Clinical and radiological examinations were performed to determine spinal deformities. The type and severity of the spinal deformities were evaluated and their relationships with chest wall deformity subtypes were statistically analyzed. RESULTS: Spinal deformities were identified in 93 (16.97%) patients. The patients were subdivided into 71 (76.3%) male and 22 (23.7%) female patients. A spinal deformity was detected in 57 (13%) of 418 pectus excavatum (PE) patients, in 23 (19%) of 117 pectus carinatum (PC) patients, and in all patients with mixed pectus deformity (PE + PC), syndromic deformity and rib anomalies. In the PE group, scoliosis, and kyphosis were observed at 57.9 and 31.6%, respectively. In the PC group, these rates were 43.5 and 47.8%, respectively. Idiopathic scoliosis was observed in 42 (77.7%) and constituted the most common scoliosis subgroup. The main thoracic curvature was the most common curve pattern, which was observed in 15 (35.7%) patients with idiopathic scoliosis. CONCLUSIONS: Idiopathic scoliosis with main thoracic curvature is the most common deformity in patients with anterior chest wall deformity. Spinal deformities are more common in male patients with chest deformities. Kyphosis is found in a significant number of PE and PC patients. Patients with mixed PE and PC, rib anomalies, and syndromic disease are more likely to have spinal deformities.

Comparison of proximal junctional kyphosis rate according to fusion level.

INTRODUCTION: There are two main accepted reasons of Proximal junctional kyphosis (PJK) after Scheuermann's kyphosis treatment; overcorrection of initial curve and fusion that is too short proximally. The purpose of this study was to evaluate the incidence of PJK in patients who have been previously treated for Schuermann's kyphosis with a curve exceeding 70° and corrected under 40° according to proximal fusion level T2 or T3. METHODS: We retrospectively evaluated 30 patients treated for Schuermann's kyphosis with single stage posterior only procedure. We included patients that we achieved at least 50% correction of the initial curve. The surgeries were performed at the same institution by a single senior spinal surgeon. Patients were divided into two groups according to proximal fusion level T2 (16 patients) or T3 (14 patients) and evaluated for PJK, follow-ups ended three years after surgery. RESULTS: Mean age was 22.7 in T2 and 21.6 years in T3 group. Mean preoperative Cobb angle was 78° in T2 and 78.7° in T3 group. The mean postoperative Cobb angle was 33.2° in T2 and 35° in T3 group. None of the patients showed neurologic complications. Four patients had PJK in T3 group and one needed revision. CONCLUSIONS: Selecting T2 as the proximal fusion level in Schuermann's kyphosis may decrease the incidence of PKJ. Studies with a larger number of patients needed to verify our results.

Do Magnetically Controlled Growing Rods Stimulate Longitudinal Vertebral Growth in Early-Onset Scoliosis Patients?

OBJECTIVE: Distraction-based systems are the most common systems used in the treatment of early-onset scoliosis. In addition to its corrective and deformity progression preventive properties, its vertebral growth stimulation effect has been proved. Recently popularized magnetically controlled growing rods (MCGRs) showed superior results in terms of outcomes and decreased complication rate. Its vertebral growth stimulation effect has not been studied. The aim of the study is to evaluate the vertebral growth stimulation effect in patients treated with MCGR. METHODS: Patients with progressive scoliosis treated by dual MCGR, who had no obvious lumbar vertebral deformity and had a regular 3-month interval spinal lengthening for at least 30 months, were subdivided into 2 groups according to the inclusion of L3 vertebra within instrumentation segments. The L3 vertebral vertical and horizontal lengths were measured postoperatively and at the last follow-up, and their differences were analyzed statistically in both groups. RESULTS: Twenty-four patients were included; 18 of them had an L3 vertebra outside instrumentation segments, while the other 6 had spanned by MCGR. Uninstrumented L3 were followed up for an average of 36 months. The height difference between initial postoperative examination and the last follow-up was 3.55 mm ± 0.63 mm, and the width difference was 3.85 mm ± 0.75 mm. Conversely, patients with instrumented L3 were followed up for a mean of 38.9 months. Their initial postoperative examination and last follow-up differences in height and width were 6.91 mm ± 1.11 mm and 3.66 mm ± 0.92 mm, respectively. CONCLUSIONS: Frequent distractions stimulate longitudinal vertebral growth in vertebrae spanned by MCGR.

Mid-length Pedicle Screws in Posterior Instrumentation of Scoliosis.

Study Design: Prospective analysis of collected data. Purpose: We determine the need for the use of mid-length pedicle screws (screws with 2.5-mm long increments) during posterior spinal instrumentation. Overview of Literature: Many biomechanical studies have been performed showing that increasing the pedicle screw insertion depth provides an improved resistance to pullout, cyclic loading, and derotational forces, but no intermediate length screws were used. Methods: We prospectively evaluated 120 patients who received posterior segmental instrumentation for structural scoliosis. Preoperatively, 91.44-cm long cassette anteroposterior (AP), lateral, and AP bending radiographs and multiplanar computed tomography were performed in all patients routinely. We measured chord length to determine the maximum probable screw length of all vertebrae. All pedicle screws were attempted to be placed as long as possible. The main intention was at least to engage the subcortical bone of the anterior vertebral cortex. Especially in the apical region, the screws were attempted to be inserted bicortically. The length, level, region, and side of each screw were recorded. Screws with 5-mm increments were called standard length screws (SLS), and middle-sized screws with 2.5-mm increments were called mid-length screws (MLS). Results: Of 2,846 pedicle screws inserted, 1,575 (55.4%) were SLS and 1,271 (44.6%) were MLS, demonstrating a need for MLS in scoliosis surgery (p <0.05). The need for MLS increased significantly in the thoracic region, apical vertebrae, and convex side (p <0.05). Conclusions: If anterior cortex engagement or longer placement of pedicle screws is intended during scoliosis surgery, for safer placement, screws with 2.5-mm increments should be available in posterior instrumentation systems.

Comparison of the Pullout Strength of Different Pedicle Screw Designs and Augmentation Techniques in an Osteoporotic Bone Model.

STUDY DESIGN: Mechanical study. PURPOSE: To compare the pullout strength of different screw designs and augmentation techniques in an osteoporotic bone model. OVERVIEW OF LITERATURE: Adequate bone screw pullout strength is a common problem among osteoporotic patients. Various screw designs and augmentation techniques have been developed to improve the biomechanical characteristics of the bone-screw interface. METHODS: Polyurethane blocks were used to mimic human osteoporotic cancellous bone, and six different screw designs were tested. Five standard and expandable screws without augmentation, eight expandable screws with polymethylmethacrylate (PMMA) or calcium phosphate augmentation, and distal cannulated screws with PMMA and calcium phosphate augmentation were tested. Mechanical tests were performed on 10 unused new screws of each group. Screws with or without augmentation were inserted in a block that was held in a fixture frame, and a longitudinal extraction force was applied to the screw head at a loading rate of 5 mm/min. Maximum load was recorded in a load displacement curve. RESULTS: The peak pullout force of all tested screws with or without augmentation was significantly greater than that of the standard pedicle screw. The greatest pullout force was observed with 40-mm expandable pedicle screws with four fins and PMMA augmentation. Augmented distal cannulated screws did not have a greater peak pullout force than nonaugmented expandable screws. PMMA augmentation provided a greater peak pullout force than calcium phosphate augmentation. CONCLUSIONS: Expandable pedicle screws had greater peak pullout forces than standard pedicle screws and had the advantage of augmentation with either PMMA or calcium phosphate cement. Although calcium phosphate cement is biodegradable, osteoconductive, and nonexothermic, PMMA provided a significantly greater peak pullout force. PMMA-augmented expandable 40-mm four-fin pedicle screws had the greatest peak pullout force.

Short Segment Spinal Instrumentation in Early-onset Scoliosis Patients Treated With Magnetically Controlled Growing Rods: Surgical Technique and Mid - Short-term Outcomes.

STUDY DESIGN: A prospective, a single-institution, nonrandomized study. OBJECTIVE: The aim of this study was to evaluate the safety and effectivity of short-segment instrumentation in early-onset scoliosis (EOS) patients treated by magnetic-controlled growing rods (MCGRs). SUMMARY OF BACKGROUND DATA: Despite the common use of conventional growing rods and the recent popularity of MCGR in the treatment of progressive EOS, distal instrumented vertebra and number of the spanned levels are not standardized. METHODS: Patients with progressive EOS, characterized by the major thoracic curve and nonstructural compensatory curve, were a candidate to be treated by dual MCGR short segment spinal instrumentation spanning the major thoracic curve; such patients are followed up for a minimum period of 30 months. Radiological data were collected and analyzed in terms of Cobb angle of both primary and secondary curve, kyphosis angle, T1-T12, and T1-S1 distances, and T1-T12/T1-S1 ratio in preoperative, postoperative, and last follow-up. RESULTS: Sixteen patients with different diagnoses of EOS, mean age at the operation was 7 years and 10 months (5 years and 6 months-9 years and 10 months), and mean period of follow-up was 37 (30-54) months. The Cobb angle of both major and compensatory curve are corrected by the mean value of 62° (44-85), 35° (22-45) preoperatively to 29° (12-49), 14° (9-24) postoperatively, and maintained at 28° (10-47), 10° (2-20) in the last follow-up, respectively. The T1-T12/T1-S1 ratio was 0.58 preoperatively, 0.6 postoperatively, and 0.62 at the last follow-up. The average yearly T1-T12 and T1-S1 length increase were calculated as 7 and 9 mm/year, respectively. CONCLUSION: Selective fusion principals are applicable to EOS, in that short segment instrumentation with MGCR in thoracic curve EOS patients is an effective technique in correction of both structural and compensatory curve, and in maintaining the correction during subsequent nonsurgical spinal distraction. LEVEL OF EVIDENCE: 4.

Magnetic Controlled Growing Rods as a Treatment of Early Onset Scoliosis: Early Results With Two Patients.

STUDY DESIGN: Prospective unicentral nonrandomized study. OBJECTIVE: To evaluate the safety and effectivity profile of magnetic controlled growing rods (MCGR) in patients with early onset scoliosis (EOS). SUMMARY OF BACKGROUND DATA: Conventional growing rods are the most commonly used growth sparring devices in the treatment of EOS, as this technique requires repeated surgical operations for lengthening; it is associated with high rate of complications and increased costs. MCGR in treatment of EOS is effective in correcting deformity whereas allowing continuous spinal growth as reported by a few studies. METHODS: A total of 18 patients with progressive EOS were treated by MCGR, two of them had undergone final fusion operation. Patients were followed-up for a minimium time of 9 months from the time of initial surgery. Radiological data were analyzed in terms of Cobb angle, kyphosis angle, T1-T12, and T1-S1 distances in preoperative, postoperative, and last follow up. RESULTS: The mean preoperative Cobb and kyphosis angle were 68° (44-116°) and 43° (98-24°), it was corrected to 35° (67-12°) and 29° (47-21°) immediately after initial operation and maintained at 34.5° (52-10°) and 33° (52-20°) at last follow up, respectively.The mean preoperative T1-T12 and T1-S1 distance were 171 mm (202-130 mm) and 289 mm (229-370 mm), it was increased to 197 mm (158-245 mm) and 330 mm (258-406mm) immediately after initial operation and further increased to 215 mm (170-260 mm) and 357 mm (277-430 mm) at last follow up, respectively.Two patients had undergone final fusion, they had overall mean Cobb angle correction of 66° (62-70°), and kyphosis angle change of 53° (26-80°). Total height gain in T1-T12 and T1-S1 of 80.5 mm (67-94 mm) and 119 mm (105-133 ), respectively. CONCLUSION: MCGR is safe and effective technique in correction of EOS deformity and in maintaining the correction during nonsurgical distraction procedures. A further correction of the deformity and more spinal height gain can be achieved in the final fusion operation. LEVEL OF EVIDENCE: 3.

Total hip arthroplasty without femoral osteotomy in patients who had high and low dislocation due to developmental dysplasia of the hip.

BACKGROUND: Various surgical techniques and outcome results have been reported after primary total hip arthroplasty for the treatment of patients dysplastic hips. Low failure and complication rates have been reported when the acetabular component has been placed in the true acetabulum. The current study reports the results of primary total hip arthroplasty in patients with high and low dislocation for whom the acetabular component was placed in the true acetabulum without femoral or trochanteric osteotomy. METHODS: 26 primary total hip replacements were performed on 22 patients. The mean duration of follow-up was 8.9 years.There were 4 men and 18 women. 17 hips were classified as type B (low dislocation) and 9 as type C (high dislocation), according to the classification system of Hartofilakidis et al. Acetabular components were placed in the true acetabulum without osteotomy for all patients. RESULTS: At the time of final follow-up (mean 8.9 years) the average Harris Hip Score was 85 points. Femoral head autograft was used in 9 hips to supplement acetabular coverage. In 8 patient linear calcar fracture. 7 fixed with Dall-Mile cable and 1 fixed with a side plate. On radiologic evaluation, 2 incidents of asymptomatic osteolysis, 1 of acetabular loosening, 1 graft resorption, and 1 impingement (correlated with physical examination) were identified. 2 patients had neuropraxia and were treated medically. There were no early or late infections. Only 1 patient with acetabular loosening required revision surgery. CONCLUSIONS: Although it is surgically difficult to place the acetabular component in the true acetabulum without femoral or trochanteric osteotomy, at the final follow-up we report favourable results. Long-term follow-up is needed to verify our results.

Comparison of straight median sternotomy and interlocking sternotomy with respect to biomechanical stability.

AIM: To increase the stability of sternotomy and so decrease the complications because of instability. METHODS: Tests were performed on 20 fresh sheep sterna which were isolated from the sterno-costal joints of the ribs. Median straight and interlocking sternotomies were performed on 10 sterna each, set as groups 1 and 2, respectively. Both sternotomies were performed with an oscillating saw and closed at three points with a No. 5 straight stainless-steel wiring. Fatigue testing was performed in cranio-caudal, anterio-posterior (AP) and lateral directions by a computerized materials-testing machine cycling between loads of 0 to 400 N per 5 s (0.2 Hz). The amount of displacement in AP, lateral and cranio-caudal directions were measured and also the opposing bone surface at the osteotomy areas were calculated at the two halves of sternum. RESULTS: The mean displacement in cranio-caudal direction was 9.66 ± 3.34 mm for median sternotomy and was 1.26 ± 0.97 mm for interlocking sternotomy, P < 0.001. The mean displacement in AP direction was 9.12 ± 2.74 mm for median sternotomy and was 1.20 ± 0.55 mm for interlocking sternotomy, P < 0.001. The mean displacement in lateral direction was 8.95 ± 3.86 mm for median sternotomy and was 7.24 ± 2.43 mm for interlocking sternotomy, P > 0.001. The mean surface area was 10.40 ± 0.49 cm² for median sternotomy and was 16.8 ± 0.78 cm² for interlocking sternotomy, P < 0.001. The displacement in AP and cranio-caudal directions is less in group 2 and it is statistically significant. Displacement in lateral direction in group 2 is less but it is statistically not significant. Surface area in group 2 is significantly wider than group 1. CONCLUSION: Our test results demonstrated improved primary stability and wider opposing bone surfaces in interlocking sternotomy compared to median sternotomy. This method may provide better healing and less complication rates in clinical setting, further studies are necessary for its clinical implications.

The effect of expansive open-door laminoplasty on spinal canal diameter: an experimental study on rabbits.

OBJECTIVE: The aim of this experimental study was to evaluate the effect of expansive open-door laminoplasty with simple suture fixation on spinal canal diameter in a rabbit model. METHODS: Twenty white New Zealand rabbits were operated on with C4-C7 Hirabayashi open-door laminoplasty. The spinal canal diameter was evaluated radiologically on preoperative day 1 and postoperative days 1 and 42. RESULTS: The mean spinal canal diameter was 6.42 mm preoperatively, 8.04 mm on postoperative day 1 and 8.02 mm at day 42. There was a significant difference between the mean preoperative and postoperative day 1 spinal canal diameter (p<0.001). There was no significant difference between the mean spinal canal diameter at postoperative day 1 and 42 (p>0.05). CONCLUSION: Our results suggest that the open-door laminoplasty with simple suture fixation is an effective method to expand the spinal canal diameter. No recurrent narrowing is expected in short term.

The results of Grice Green subtalar arthrodesis of valgus foot in spina bifida.

BACKGROUND: Valgus foot is a common foot deformity in spina bifida. The most popular operation for the valgus deformity has been the Grice talocalcaneal blocking. It has not been studied primarily in children with spina bifida. We report a prospective series, we present the results of hind foot valgus deformity of children with spina bifida, using Grice talocalcaneal arthrodesis with a tricortical iliac bone graft. MATERIALS AND METHODS: Between May 2000 and December 2003, 21 patients with bilateral (42 feet) valgus deformity of feet underwent surgery. There were 7 males and 14 females. The mean age of patients was 67.7 months (range 50-108 months). RESULTS: The total number of feet that had nonunion was 11, in 7 of them the grafts were completely reabsorbed and the outcome of all these feet was unsatisfactory. Four feet had partial union of which three had unsatisfactory and one had satisfactory outcome. Sixteen feet had residual valgus deformity at the last followup visit, 10 patients had nonunion, and 6 had inadequate correction. Mean preoperative talocalcaneal and calcaneal pitch angles were 48.5° and 31.9°, respectively, which decreased to 38.5° and 29.1°, respectively, postoperatively. The decrease in talocalcaneal angle and calcaneal pitch was significant between preoperative and postoperative measurements (P<0.05). CONCLUSION: Grice subtalar arthrodesis technique is still a valuable option for valgus foot in patients with spina bifida. In this study, we found more encouraging results in older patients.

Bicortical versus unicortical pedicle screws in direct vertebral rotation: an in vitro experimental study.

STUDY DESIGN: In vitro experimental study. OBJECTIVE: This study aimed to evaluate the biomechanical properties of bicortically placed and laterally oriented screws, which may represent an alternative approach for challenging sites during direct vertebral rotation (DVR). SUMMARY OF BACKGROUND DATA: DVR corrects the transverse plane deformity and the thoracic hump in idiopathic scoliosis. However, instrumentation of the convex side of the scoliosis apex may pose a challenge, not allowing the placement of suitable sized screws in adequate direction. METHODS: Forty-eight calf vertebrae were used and each vertebral body was instrumented with 1 pedicle screw as follows: unicortical group (n=16), a short screw was unicortically placed and directed laterally; bicortical group (n=16), a short screw was bicortically placed again in lateral direction; control group (n=16), a screw with ideal length and direction was placed. Vertebral bodies were rigidly anchored in a custom device. Each screw was rotated using a constant length lever arm while collecting "force to failure" data. RESULTS: Significantly better results were obtained with bicortical screwing when compared with unicortical screwing (335.4±45.6 vs. 239.5±58.50 N, P<0.001). However, mean "force to failure" was significantly higher in the controls than in the bicortical group (415.8±49.2 vs. 335.4±45.6 N, P<0.001). CONCLUSIONS: Bicortical screw placement may provide a biomechanically superior construct than unicortical screw placement for resisting DVR maneuver during scoliosis correction. This technique may represent an effective and safe approach, particularly for the convex side of the scoliosis apex, with increased resistance to derotational forces and decreased risk of bone failure. Further clinical studies are warranted for firmer conclusions.

Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head.

OBJECTIVE: Osteonecrosis of the femoral head, a disease primarily affecting young adults, is often associated with the collapse of the articular surface and subsequent arthrosis. Some authors have reported good results with the use of vascularized and non-vascularized fibular grafts to treat osteonecrotic lesions of the femoral head. The aim of this study was to compare the results of vascularized fibular grafting with that of non-vascularized fibular grafting in the treatment of femoral head osteonecrosis. METHODS: Between January 1999 and June 2008, 11 osteonecrotic hips of 8 patients who underwent vascularized fibular grafting and 15 osteonecrotic hips of 13 patients who underwent nonvascularized fibular grafting were compared according to etiology, stage, age, sex, preoperative and postoperative first year Harris hip and VAS scores. RESULTS: Steroid use was the most common etiologic factor, found in 26 hips of 21 patients in the entire patient population. There was no significant difference between the two groups according to their age, sex and preoperative Harris hip scores (p>0.05). According to the Ficat staging system for radiological evaluation, 4 hips were Grade 2A, 4 hips were Grade 2B, and 3 hips were Grade 3 in the vascularized group and 8 hips were Grade 2A, 3 hips Grade 2B, 3 hips Grade 3 and one hip was identified as Grade 4 in the non-vascularized group. When the Harris hip and VAS scores of both groups were evaluated, the group treated by vascularized fibular grafting had significantly higher scores than the ones treated by non-vascularized fibular grafting in the other group (p<0.05). Furthermore, when the Harris hip and VAS scores of preoperative and postoperative first year of vascularized fibular grafting patients were compared, there were significantly higher scores after the surgery. CONCLUSION: Although there was no significant radiological difference in the early results of both surgical techniques, the clinical results of vascularized fibular grafting treatment were significantly better than the results of non-vascularized fibular grafting treatment in the osteonecrosis of the femoral head. Vascularized fibular grafting improves the clinical status at an early period and prevents subchondral collapse.

The effect of an intramedullary implant with a static magnetic field on the healing of the osteotomised rabbit femur.

Static magnetic fields are a type of electromagnetic fields used in clinical practice. To ascertain what effect a static magnetic intramedullary device implanted in the rabbit femur had on fracture healing, 20 male New Zealand white rabbits with magnetic/nonmagnetic intramedullary implants were examined histologically, radiologically and for bone mineral density. Three groups were constituted according to the poles of the magnets. During surgery the intramedullary device was driven into the medulla. A femoral osteotomy was created with a mini Gigli wire at the centre point of the rod. Radiographs were obtained at the second and fourth weeks. Histological examination and bone mineral density were evaluated at the fourth week. The results of this study verified that an intramedullary implant with a static magnetic field improves bone healing in the first two weeks radiologically and that the configuration difference in magnetic poles has an effect on bone quality. Static magnetic fields have minor effects on bone mineral density values.

The use of screw at the fracture level in the treatment of thoracolumbar burst fractures.

STUDY DESIGN: In this prospective randomized study, the results of treating unstable thoracolumbar burst fractures by pedicle instrumentation with and without fracture level screw combination were given. OBJECTIVE: Our aim was to evaluate the efficacy of fracture level screw combination in achieving and maintaining correction in the treatment of unstable thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA: Most authors reported that intraoperative correction of sagittal deformity is important for the maintenance of fracture reduction and is one of the most consistent predictor of satisfactory functional outcome. METHODS: Seventy-two patients with unstable thoracolumbar burst fractures were randomized into 4 groups with equal number of patients. In group 1, patients were treated by segmental posterior instrumentation with 2 levels above and 2 levels below the fracture level fixation, in group 2 they were treated as in group 1 with fracture level screw incorporation. In group 3, patients were treated by short-segment posterior instrumentation with 1 level above and 1 level below, in group 4 they were treated by short-segment posterior instrumentation with fracture level screw incorporation. Clinical and radiologic parameters were evaluated before surgery, after surgery, and at follow-up. RESULTS: The average follow-up was 50 months. Fracture level screw combination provided better intraoperative correction and maintenance in the treatment of unstable thoracolumbar burst fractures, which was more prevalent in short-segment fixation group. CONCLUSIONS: Reinforcement with fracture level screw combination can help to provide better kyphosis correction and offers immediate spinal stability in patients with thoracolumbar burst fracture.

[Unusual migration of K-wire following fixation of clavicle fracture: a case report]. / Klavikula kirigi internal fiksasyonu sonrasinda K-telinin atipik migrasyonu: Olgu sunumu.

The migration of various internal fixation devices, especially Kirshner (K) wires, is well established. The wires usually follow a retrograde path, protruding near the entry point. When they migrate in the other direction, serious problems may occur. Migration of K-wires to the lung, heart, spleen, subclavian artery, pulmonary artery and aorta have been reported in a few cases. A 26-year-old male with chest pain was seen in our clinic. The patient had been operated for left distal clavicle fracture two years before. No abnormality was noted on the physical examination. Radiographs showed migration of the wire outside the clavicle across the sternum to the opposite hemithorax. The pin was removed through the incision over the sternum under direct vision with thoracoscope. The pin was extrapleurally located. There was no additional morbidity attributed to thoracoscopy or chest tube. In conclusion, K-wires can easily migrate, resulting in serious complications. Close follow-up should be done after internal fixation.

Quantification of acromioclavicular reduction parameters after the Weaver-Dunn procedure.

BACKGROUND: The combination of the reconstruction of the coracoclavicular ligaments with the resection arthroplasty of the distal end of the clavicle is a commonly used technique in acromioclavicular separations. HYPOTHESIS: The purpose of the current study was to quantify the reduction parameters using 3-D CT and to analyze their effects on clinical outcomes. STUDY DESIGN: Case series. METHODS: The patients with chronic symptoms after acromioclavicular dislocation (type III) were treated with reconstruction of the coracoclavicular ligaments. The average follow-up was 69.5 months. The patient group consisted of 21 men and 8 women. The initial treatment at the time of injury was nonoperative in 26 of 29 patients. CT was used to document anteroposterior (APD), craniocaudal (CCD) and mediolateral (MLD) acromioclavicular reduction parameters. Constant Shoulder scoring system was used. RESULTS: The mean preoperative Constant score was 56.62 +/- 18.63 points while the postoperative score was 89.93 +/- 10.79 points. The mean APD was 9.2 mm, the mean CCD was 1.1 mm and the mean MLD was 8.4 mm. There was no correlation between the APD, MLD and the Constant Scores. However, an inverse correlation between the CCD and the postoperative Constant Scores was found. CONCLUSIONS: CCD plays an important role on the postoperative function. If the CCD is larger, the Constant score is lower. CLINICAL RELEVANCE: The reduction loss is a distinctive parameter of the functional outcome, even when the reconstructed coracoclavicular ligament is intact. Secure fixation may be achieved with techniques preserving CCD.

[Treatment strategy in tuberculous spondylitis: long-term follow-up results of 55 patients]. / Tüberküloz spondilitinde tedavi stratejisi: 55 hastanin uzun dönem takip sonuçlari.

OBJECTIVES: We evaluated our treatment algorithm used in adult patients with tuberculous spondylitis together with long-term treatment results. METHODS: The study included 55 adult patients (26 males, 29 females; mean age 50 years; range 23 to 71 years) with tuberculous spondylitis. The patients underwent four different treatment methods including non-operative treatment (NO, 6 patients), posterior debridement, fusion and instrumentation (PDFI, 21 patients), anterior debridement, instrumentation and fusion (ADIF, 21 patients), and finally, urgent radical debridement (RD, 11 patients) due to financial limitations of the patients. All the patients received antituberculous therapy for 12 months. On presentation, 17 patients (30.9%) had neurologic deficits (ADIF, 6 patients; RD, 11 patients). Neurologic assessment was made according to the Frankel grading system. The results were evaluated with respect to kyphosis, sagittal balance, neurologic recovery, and patient satisfaction. The mean follow-up period was 95.3 months (range 66 to 114 months). RESULTS: Radiographically, successful bone fusion was achieved in all the patients. Following treatment, all surgically treated groups exhibited decreases in the kyphotic angle. The mean correction was significantly greater in ADIF (17.5 degrees ) and PDFI (12.1 degrees ) groups compared to the RD group (4.9 degrees ) (p<0.05). Final increases in the kyphotic angle were 0.7 degrees , 1.2 degrees , 1.4 degrees , and 1.6 degrees in NO, PDFI, ADIF, and RD groups, respectively. The mean sagittal deviations in the first postoperative month were +2 mm, +11 mm, +12 mm, and +14 mm in NO, PDFI, ADIF, and RD groups, respectively, which remained unchanged till the end of follow-up. Complete neurologic recovery was obtained in all but one patient. All the patients expressed satisfaction with the treatment. No recurrences or reactivation of disease were observed. CONCLUSION: This study showed that, with appropriate patient selection, the results of NO, PDFI, and ADIF were satisfactory and comparable.