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.

Autofusion in growing rod surgery for early onset scoliosis; what do we know so far?

The evolving landscape of early onset scoliosis management has shifted from the traditional paradigm of early definitive spinal fusion towards modern growth-friendly implants, particularly Growing Rods (GR). Despite the initial classification of GR treatment as a fusionless procedure, the phenomenon of autofusion has emerged as a critical consideration in understanding its outcomes. Studies have demonstrated the presence of autofusion since the early 1980s. The consequences of autofusion are extensive, impacting curve correction, diminishing trunk growth rate, and contributing to the "law of diminishing returns" in growing rod surgery. The literature suggests that autofusion may complicate definitive fusion surgery, leading to prolonged and intricate procedures involving multiple osteotomies. Additionally, it poses challenges in identifying anatomical landmarks during surgery, potentially increasing the risk of complications and revisions. While autofusion poses challenges to achieving optimal outcomes in growing rod treatment, it cannot be considered a standalone replacement for definitive fusion. Recent advances aim to limit autofusion and enhance treatment outcomes. In this review, we will delve into the existing literature on autofusion, examining studies that have documented its presence, probable causes, pathophysiology, potential implications for long-term patient outcomes, and possible new implants and techniques that decrease its incidence.

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.