Analyzing neutron emission cross sections for 22.2 MeV proton-induced reactions on 58Ni and 52Cr.

Double differential cross-section calculations were performed for proton-induced reactions with 58Ni and 52Cr isotopes using Monte Carlo code PHITS 3.32 and TALYS 1.96. Comparative analyses with experimental data from the EXFOR library demonstrated the effectiveness of the CTFGM and BSFGM models in conjunction with the TALYS nuclear code program for (p,xn) reactions across all angular values. While the GSM model exhibited consistency regardless of the angle, FLUKA and PHITS showed some discrepancies depending on the angle, particularly at small angle values.

An optimization study for targeted alpha therapy: Ion behaviours and dose calculations within ICRU-compact bone tissue.

Targeted Alpha Therapy is a therapy method that can be applied to late-stage cancers, including bone metastases, and it is a hope for millions of people. This study is an optimization that includes the interactions of bone tissue with characteristic alpha particles of 223Ra, 225Ac (together with their decay product), which are frequently preferred in Targeted Alpha Therapy that aim to destroy metastatic tumour tissue in bone tissue. This optimization is designed to analyse some events such as ion spacing of alpha particles that can only infiltrate into bone tissue, stopping power of the target, dose calculations and atomic displacement. To ensure accuracy, calculations such as mass stopping power and ionizing dose obtained from CASP, SRIM and ASTAR programs were also compared among themselves. And then, tissue doses were calculated in IDAC-Dose 2.1, taking into account the half-lives of the radioisotopes, the administered activity and the integration time. Alpha particles of 213Po had the highest ion spacing, while alpha particles of 223Ra had the lowest ion range.

Relationship of Patellofemoral Angles and Tibiofemoral Rotational Angles With Jumper's Knee in Professional Dancers: An MRI Analysis.

BACKGROUND: Jumper's knee is a type of tendinopathy affecting the distal insertion of the quadriceps tendon (25% of cases) or the patellar tendon. It has been shown that frontal-plane measurements, such as genu valgum, genu varum, an increased quadriceps angle, a protuberant tibial tuberosity, patella alta, and short hamstring muscles, may be related to jumper's knee. PURPOSE: To investigate the effects of tibiofemoral rotational angles and patellofemoral (PF) angles on the development of jumper's knee in professional folk dancers. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We examined 26 dancers (16 male, 10 female) with knee pain using magnetic resonance imaging (MRI), for a total of 32 knees. Of the knees, 21 with quadriceps tendinopathy (QT) and 7 with patellar tendinopathy (PT) were detected. Using MRI scans, we measured PF angles (PF sulcus angle, lateral PF angle, patellar tilt angle, lateral trochlear inclination angle, lateral patellar tilt angle, and PF congruence angle) and tibiofemoral rotational angles (condylar twist angle, posterior condylar angle, femoral Insall angle, tibial Insall angle, posterior tibiofemoral angle, and angle between the Whiteside line and posterior femoral condylar line) and noted specifics such as patella alta, patella baja, and the Wiberg classification of the patellar shape between the patients with versus without QT and between patients with versus without PT to understand if there was any relationship with tendinopathy. RESULTS: No statistically significant difference was observed in age, sex, patella alta, or the Wiberg classification between the QT groups (with vs without) and between the PT groups (with vs without) (P > .05). Having QT was found to be significantly associated with the PF sulcus angle (P = .009), and having PT was found to be significantly associated with the femoral Insall angle (P = .029). CONCLUSION: Jumper's knee was found to be associated with anatomic variations of the PF sulcus angle and rotation of the patellar tendon in relation to the femur (femoral Insall angle) on axial MRI scans in professional dancers. Unlike those of other athletes, dancers' knees are exposed more to external rotation forces because of turnout, and this can be the cause of jumper's knee.

Traumatic knee injury patterns in Anatolian folk dancers: a case series and literature review.

Lower extremities, especially the knee region, are susceptible to traumatic injuries because of long-lasting hard landings and impacts. Most of the injuries described in the literature are associated with ballet. In this review study, the authors tried to present the traumatic knee injury patterns of the Anatolian folk dance. The Fire of Anatolia dance group consists of 82 dancers (37 males [45.1%] and 45 females [54.9%]) with the mean age of 27.96 (SD = 5.05) years (range: 18-38 years). The major folk dances of the region are Zeybek, Halay, Horon, Teke, Roman, Karsilama, Bar and Lezginka ("the Caucasian"). The dancers suffered from 9 orthopedic injuries requiring surgical treatment (3 meniscus tears, 4 anterior cruciate ligament tears, 1 posterior cruciate ligament tear, 1 patellar dislocation) during a 10-year period. The authors investigated solely the traumatic injuries of these folk dance styles and aimed at revealing the traumatic knee injury patterns in this case series and literature review. On the one hand, the Anatolian folk dancers experienced meniscus tears following frequent squats and twists on single leg stances, typical of Horon and Zeybek. On the other hand, anterior cruciate tears happened after jumps and landings in the Caucasian (Lezginka jump) dance. A posterior cruciate ligament tear was also seen after the Caucasian dance landing. The split figure in the Karsilama dance ended up with patellar dislocation. Certain dance figures seem to be related to specific types of injuries. Int J Occup Med Environ Health. 2019;32(5):585-93.

Relationship of Popliteus Sulcus Depth and Tibiofemoral Rotational Alignment with Popliteus Tendinitis in Professional Folk Dancers Exposed to Turnout Positions: An MRI Analysis.

AIMS: The popliteus musculotendinous unit plays the major role in range of motion, rotation and stabilization of the knee. Frequent repetition of the rotational strains such as turnout in dancers may be the cause of popliteus tendinitis. In addition, popliteus sulcus depth (PSD) and PSD/lateral condyle width (LCW) ratio are also highly related with popliteal tendinitis in professional folk dancers. In this study, we evaluated the association between clinically diagnosed popliteus tendinitis and PSD with analysis of the PSD/LCW ratio as measured on MRI and tibiofemoral rotational alignment in professional folk dancers. This study was intended to clarify any anatomical liability to popliteal tendinitis in professional folk dancers. Therefore, we looked for the anatomical variances affecting popliteal musculotendinous unit. METHODS: Thirty-two MRI scans from 32 members of a professional folk dance group (mean age 30.2±7.9 yrs, range 18-38) were analyzed retrospectively. Popliteal tendinitis was detected in 5 knees (5 dancers). The relationship of popliteal tendinitis to the tibiofemoral rotational angles (condilary twist angle, posterior codilary angle, posterior tibiofemoral angle), PSD, and PSD/LCW ratio were investigated. RESULTS: The popliteus tendinitis group had statistically significantly higher PSD and PSD/LCW ratio than the group without popliteal tendinitis (p=0.0001). There was no statistically significant difference between the two groups in the tibiofemoral rotational angles. CONCLUSION: In addition to long hours of practice and the turnout position, PSD and PSD/LCW ratio can place the professional folk dancer at increased risk for popliteus tendon injury.

The ANK nail treatment of lateral malleolar fractures with syndesmosis injury: Clinical outcomes at 10 years of follow-up.

BACKGROUND: Lateral malleolar fractures associated with syndesmotic injuries are common. Various surgical implants may be used for the management of syndesmosis injury. One of these is ANK nail. The aim of the present study was to assess the clinical and radiological outcomes of patients treated with ANK nail. METHODS: Forty-eight patients who were followed up for a minimum of 10 years were reviewed retrospectively using American Orthopedic Foot and Ankle Society (AOFAS) score, radiological evaluation, and development of posttraumatic arthritis. Final data were collected at the last follow-up. RESULTS: The mean age of the patients was 37.3 (17-69) years. The mean follow-up was 129.9 (123-150) months. Twenty-two patients had Weber type B fracture, and their mean AOFAS score was 93.36 points. The remaining 26 patients had Weber type C fracture, and their mean AOFAS score was 97.66 points. There was no relationship between the type of fracture and the clinical outcome. There was a significant correlation between shortening of the fibula and posttraumatic arthritis. CONCLUSION: The ANK nail used for the management of ankle fractures may provide both fracture and syndesmosis stabilities in selected cases and is also a cost effective method as cheap as a cortical screw and a Kirschner wire.

Criteria for Ending the Distal Fusion at the L3 Vertebra vs. L4 in Surgical Treatment of Adolescent Idiopathic Scoliosis Patients with Lenke Type 3C, 5C, and 6C Curves: Results After Ten Years of Follow-up.

Introduction The selection of the most distal caudal vertebra in spinal fusion surgeries in adolescent idiopathic scoliosis patients with structural lumbar curvatures is still a matter of debate. The aim of this study was to determine the preoperative radiological criteria on the traction X-rays under general anesthesia (TrUGA) for selection between the L3 and L4 vertebrae and to assess the efficacy of these criteria via the long-term results of patients with Lenke Type 3C, 5C, and 6C curves. Methods Radiological data of 93 patients (84 females, 9 males) who met the inclusion criteria were retrospectively evaluated. The relationship between the L3 vertebra and the central sacral vertebral line, the portion of the L3 vertebra in the stable zone of Harrington, the parallelism of the L3 with the sacrum, and the tilt and rotation of the L3 on TrUGA radiographs were evaluated for the selection of the lowest instrumented vertebrae (LIV). Clinical results were analyzed using the Scoliosis Research Society-22 (SRS-22) questionnaire. Results The mean follow-up period of the study group was 149.3 months. According to the Lenke classification, 29 patients had Type 3C, 33 had Type 5C, and 31 had Type 6C curves. The preoperative analysis was based on standing anteroposterior (AP), supine traction, and bending X-rays, and the L3 vertebra was selected as the LIV in 37 patients (40%). These X-rays suggested L4 as the LIV in 56 patients (60%); however, based on our study criteria, the L3 vertebra was selected. No significant loss of correction was observed nor additional surgery due to decompensation was required in the follow-up period. Conclusion  The use of TrUGA radiographs with the identified criteria is an efficient alternative method in the selection of the LIV in patients with Lenke Type 3C, 5C, and 6C curves.

Minimally invasive plate osteosynthesis (MIPO) in diaphyseal humerus and proximal humerus fractures.

OBJECTIVE: Our aim was to evaluate the results of minimally invasive plate osteosynthesis (MIPO) using locking plates in diaphyseal humerus and proximal humerus fractures. METHODS: Nine patients who underwent open reduction and MIPO for the treatment of diaphyseal and proximal humerus fractures between June 2006 and October 2009 were included in this study. One S3(®) and 8 PHILOS(®) plates were used. Mean age was 75.2 (range: 32 to 86) years and all patients were females. Mean follow-up was 33.9 (range: 14.8 to 54.8) months. According to AO/ASIF classification, four patients had 12C1, two patients 12A1, one patient 12A2, and two patients 11A2 fractures. Axillary and radial nerves were explored and protected in all patients. Patients were evaluated radiographically for union and functionally using the Constant-Murley score. RESULTS: None of the patients had nonunion, avascular necrosis, axillary or radial nerve paralysis or implant failure. Mean Constant-Murley score was 86.8 ± 2.2 (range: 70 to 100). Mean union time was 3.2 (range: 2.5 to 5) months. CONCLUSION: MIPO of humerus diaphysis and proximal fractures allows for preservation of blood supply in fracture fragments, owing to less soft tissue and periosteal injury. When the procedure is performed with the lateral double incision, exposure and preservation of the axillary and radial nerves are necessary. Early return of function in the shoulder and elbow joints and favorable healing time are the major advantages of this method in this rare subset of humerus fractures.

Simultaneous repair of chronic full-thickness rotator cuff tears during fixation of proximal humerus fractures and clinical results.

OBJECTIVES: We investigated the incidence of chronic rotator cuff tears encountered during fixation of proximal humerus fractures with locking plate-screw systems, and evaluated the functional results of simultaneous surgical repair of these injuries. METHODS: A total of 111 patients underwent surgical treatment for proximal humerus fractures. Of these, nine patients (8 females, 1 male; mean age 73 years; range 56 to 84 years) who had concomitant chronic full-thickness rotator cuff tears were included in the study. According to the AO classification, the fractures were type 11A1 (12C1 also present) in one patient, 11A2 (12C2 also present) in one patient, 11B1 in two patients, 11B2 in three patients, and 11C2 in two patients. None of the patients underwent preoperative magnetic resonance imaging. Fracture fixation was made with the PHILOS plate in five patients, and with the S3 Proximal Humerus Plate in four patients. All full-thickness rotator cuff tears were detected during the operation. Following open reduction and internal fixation after a deltoid splitting incision, rotator cuff tears were repaired by primary suture in two patients, and with a suture anchor in seven patients. All the patients used a padded shoulder-arm sling for six weeks and received a standard rehabilitation program. All the patients were evaluated radiographically and functionally using the Constant-Murley shoulder score at postoperative 6 weeks, 6 months, and 12 months. The mean follow-up period was 17.3 months (range 8 to 30 months). RESULTS: The incidence of full-thickness rotator cuff tears was 8.1%. All the patients had supraspinatus tears, which were accompanied by infraspinatus tears in three patients. The sizes of the tears were classified as large (between 3-5 cm) in three patients, intermediate (between 1-3 cm) in five patients, and small (<1 cm) in one patient. One patient had L-shaped, two patients had U-shaped, and six patients had C-shaped tears. None of the patients had healing problems or avascular necrosis. The mean Constant-Murley shoulder score was 85.4 (range 67 to 100). All the patients were satisfied with the results of surgical treatment. CONCLUSION: The integrity of the rotator cuff must be checked after reduction and fixation of proximal humerus fractures and, when present, the tears should be repaired simultaneously either primarily or with suture anchors. Simultaneous repair of rotator cuff tears does not negatively affect functional outcomes.

Complications encountered in proximal humerus fractures treated with locking plate fixation.

OBJECTIVES: We evaluated the complications encountered following locking plate fixation of proximal humerus fractures. METHODS: The study included 103 patients (70 females, 33 males; mean age 62 years; range 21 to 90 years) who were treated with open reduction and locking plate fixation for proximal humerus fractures between September 2005 and April 2009. Fixation was performed using the PHILOS locking plate in 93 patients, and S3 humerus plate in 10 patients. Postoperatively, a shoulder-arm sling was applied for six weeks and a standard rehabilitation program was used in all the patients. Intraoperative, acute postoperative, and late postoperative complications were assessed on radiographs. Varus inclination was defined as less than 120 degrees of the inclination angle on immediate postoperative radiographs, and varus displacement as postoperative increases in the varus angle. The mean follow-up period was 19 months (range 2 weeks to 43 months). RESULTS: Complications were seen in 10 patients (9.7%; mean age 67 years). The PHILOS plate was used in nine patients and S3 plate was used in one patient. Five patients (4.9%) had varus inclination with a mean inclination angle of 112.6 degrees (range 105 degrees to 118 degrees), four patients (3.9%) developed varus displacement with a mean inclination angle of 102.5 degrees (range 95 degrees to 110 degrees), and intra-articular screw penetration was seen in five patients (4.9%). The remaining complications were fixation failure (n=1, 1%), implant fracture (n=1), and deep infection (n=1). Screw penetration exceeded 3 mm in three patients, requiring revision surgery. The mean ages of patients with varus inclination, varus displacement, and screw penetration were 76.6, 74.4, and 71 years, respectively. Three patients with varus inclination (60%) developed varus displacement. Screw penetration was observed in three patients (60%) with varus inclination, and in all patients with varus displacement. The mean Constant-Murley shoulder score was 67.8 (range 50 to 90) in patients who developed a complication. CONCLUSION: Our findings show that locking plate and screw systems represent a significant treatment option in the treatment of comminuted and displaced humerus fractures, with low complication rates. Accurate indication, protection of the head's inclination angle through appropriate surgical approach and proper technique, and fine calculation of screw length are essential for successful functional results.

Microdecompressive laminatomy with a 5-year follow-up period for severe lumbar spinal stenosis.

STUDY DESIGN: The 2 groups of patients with severe lumbar spinal stenosis were prospectively compared as a case control study. OBJECTIVES: This prospective case control study sought to evaluate bilateral microdecompressive laminatomy (MDL) for treatment of severe lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: Total laminectomy is a general consensus on the therapy of severe spinal stenosis. The authors tried to investigate a new minimal invasive approach. METHODS: Patients were randomly divided into 2 groups. In first group, 34 patients underwent total laminectomy (TL) for severe lumbar spinal stenosis. In the second group, 37 patients with the same diagnosis underwent bilateral MDL. The groups were compared for disability, walking distance, degree of postoperative back and leg pain, perioperative complications, and postoperative instability. Radiographic analyses were performed at regular intervals to demonstrate satisfactory decompression. RESULTS: Mean follow-up was 5 years. Postoperative computerized tomography and magnetic resonance imaging demonstrated adequate decompressions in both groups. The walking distance, pain control, and disability scores were slightly higher among patients in the MDL group, although these results did not achieve statistical significance. Perioperative complications and postoperative instability were significantly higher in the TL group (P<0.05). CONCLUSIONS: Compared with classic approaches, bilateral MDL provides adequate and safe decompression in lumbar spinal stenosis. It significantly reduces clinical symptoms and disability. However, TL shows higher perioperative complications and postoperative instability. To the best of our knowledge, this is the first study to define a bilateral MDL approach to treat the stenotic lumbar spine without a herniated disc.

[Surgical treatment of elbow dislocations accompanied by coronoid fractures]. / Koronoid kiriklarinin eslik ettigi dirsek çikiklarinda cerrahi yaklasim.

OBJECTIVES: We evaluated the results of surgical treatment for elbow dislocations accompanied by Regan-Morrey type 2-3 coronoid fractures. METHODS: Eight patients (6 males, 2 females; mean age 44 years; range 23 to 76 years) underwent surgical treatment for elbow dislocations accompanied by a coronoid fracture. Three patients had Regan-Morrey type 2, five patients had type 3 coronoid fractures. Accompanying injuries were Mason-Johnston type 4 radial head fractures (n=6), olecranon fractures (n=4), lateral humeral condyle fracture (n=1), and lateral (n=5) or medial (n=2) collateral ligament ruptures. Coronoid fractures were fixed with a plate, screw, or a cerclage wire in all the patients except for one patient who underwent coronoid excision. For radial head fractures, plate or screw and K-wire fixation was performed in two patients and radial head prosthesis was used in four patients. Olecranon fractures were fixed with a plate or AO tension band. Functional results were assessed using the Mayo elbow performance score. The mean follow-up period was 22.6 months (range 1 to 65.5 months). RESULTS: Union was achieved in all the patients. At the latest assessments, the mean Mayo elbow performance score was 84.3 (range 50 to 100). All the patients expressed satisfaction with surgical treatment except for one patient who underwent coronoid excision. All the fixation materials used for olecranon fractures were removed after union due to implant-associated pain. Ulnar nerve transposition was required in two patients with fractures involving the anteromedial facet of the coronoid process. Two patients developed heterotopic ossification that did not affect the range of motion of the elbow. CONCLUSION: Surgical treatment of elbow dislocations associated with Regan-Morrey type 2-3 coronoid fractures enables a concentric reduction of the elbow, stability, and early motion.

[Early results of autologous mononuclear bone marrow cell implantation in nontraumatic avascular necrosis of the femoral head]. / Travmaya bagli olmayan femur basi osteonekrozunda otolog konsantre mononükleer kemik iligi hücre naklinin erken dönem sonuçlari.

OBJECTIVES: We evaluated early clinical and radiologic results of core decompression combined with autologous mononuclear bone marrow cell implantation for early stage nontraumatic avascular necrosis of the femoral head. METHODS: The study included nine patients (1 female, 8 males, mean age 46.5 years; range 33 to 59 years) with stage I-II nontraumatic avascular necrosis of the femoral head, according to the Steinberg classification. Bone marrow-derived CD34 cells were injected through a core decompression channel into the femoral head. Clinical assessment included a visual analog scale (VAS), Harris hip score, and the WOMAC Osteoarthritis Index. Radiologically, femoral head collapse, narrowing of the coxofemoral joint space, and the size of the osteonecrotic area were assessed. The mean follow-up was 27.2 months (range 24 to 38 months). RESULTS: Pre- and postoperative (24th month) evaluations showed that the mean VAS score and the WOMAC Osteoarthritis Index decreased from 3.4+/-0.4 to 1.2+/-0.6, and from 33+/-3 to 11+/-6, respectively, with an increase in the Harris hip score (from 54 to 92). Preoperatively, two patients were Steinberg I-B, four were I-C, and three were II-A. Finally, all the patients were stage 0 except for one patient who regressed to I-A. None of the patients exhibited femoral head collapse or narrowing of the coxofemoral joint space. CONCLUSION: Autologous mononuclear bone marrow cell implantation relieves articular pain, prevents the progression of osteonecrosis, and hence subchondral fractures. Therefore, it may be treatment of choice particularly in stage I-II avascular necrosis of the femoral head.

[The results of internal fixation of proximal humeral fractures with the PHILOS locking plate]. / Proksimal humerus kiriklarinda kilitli plak PHILOS ile internal tespit sonuçlari.

OBJECTIVES: Proximal and diaphyseal humeral fractures are common especially in the elderly, presenting as a challenging problem due to their high complication rates following surgical treatment. In this prospective study, we evaluated the results of patients treated with the PHILOS (Proximal Humeral Internal Locking System) locking plate, a new technique recently developed by the AO/ASIF. METHODS: Forty-one patients who were treated with the PHILOS plate for proximal humeral fractures were evaluated in two age groups. Group A included 24 patients (12 males, 12 females; mean age 47 years; range 24 to 64 years) younger than 65 years, and group B involved 17 patients (4 males, 13 females; mean age 78 years; range 67 to 90 years) at or above 65 years. Radiographically, all fractures were classified according to the AO/ASIF system. Surgery was performed with the deltopectoral approach in 10 and two patients, and with a deltoid split in 14 and 15 patients in group A and B, respectively. Functional and radiographic results were evaluated after a mean follow-up of 15 months (range 6 to 28 months). RESULTS: The mean Constant scores were 95.0 (range 74 to 100) and 92.8 (range 72 to 100) in group A and B, respectively (p>0.05). After six months of surgery, Constant scores and functional outcomes were similar in patients operated on with the deltopectoral approach or deltoid split. There was neither nonunion nor implant failure. Complications included intra-articular screw penetration (n=1), displacement of the greater tuberculum (n=1) with oblique placement of the plate (n=1), insufficient reduction (n=4), and varus displacement of the humeral head (n=3). No avascular necrosis was seen. CONCLUSION: Locking plate system is superior over other means of fixation methods, particularly in osteoporotic fractures, because it allows early rehabilitation and does not result in implant failure.

Magnetic resonance imaging finding in severe head injury patients with normal computerized tomography.

AIM: Computerized tomography (CT) has been the primary diagnostic instrument of neurosurgical centers for head injury until now. However, there is a subgroup of patients who have persisting neurological deficits without visible pathology on CT. MATERIAL AND METHODS: Between 2000 and 2002, 3000 patients were enrolled in this prospective study in emergency unit. There was a total of 124 patients (4.1%) who had persisting severe neurological deficits with normal findings on repeated CT scans. These patients underwent 1.5 Tesla cranial MRI study between posttraumatic days 2 and 10 (5.2+/-4.5). Data on epidemiological, clinical, radiological factors and final outcome were collected. RESULTS: 76 (61.2%) of the patients were male and 48 (38.7%) were female. 113 (91.1%) of the 124 patients showed significant primary pathology on MRI study. The most common pathology was shear injuries in 75 (60.4%) followed by cortical contusion in 45 (36.2%) cases. 27 (21.7%) patients showed primary brain stem lesions and 8 (0.6%) patients showed subcortical gray matter lesions. 32 patients showed mixed lesions. There was one traumatic aneurysm detected. CONCLUSION: The MRI examination in head injury is informative in detecting subtle lesions when the neurological condition cannot be explained by CT.

Complete cranium bifidum without scalp abnormality. Case report.

Cranium bifidum is an unusual lesion in newborns. The majority of previously reported cases have described enlarged parietal foramina with some scalp and other congenital abnormalities. In this report the authors present the first case of complete cranium bifidum without any other anomaly. The cranial defect persisted for 3 years during the follow-up period. No hereditary or familial transition has been observed. The authors conclude that such an extremely rare occurrence of complete cranium bifidum may be a result of a coincidental mutation.

Lumbar facet joint angle and its importance on joint violation in lumbar microdiscectomy.

OBJECTIVE: We investigated facet joint angle at the level of the nucleus pulposus in herniated disks and documented the importance of this angle in preserving articulation and surgical view in patients undergoing lumbar microdiscectomy. METHODS: In this prospective study using pre- and postoperative magnetic resonance imaging scans, two blinded radiologists measured and inspected the facet joint angles in 168 patients. Patients were treated with single-level, unilateral, lumbar microdiscectomy. Postoperatively, patients were divided into two groups according to whether or not any portion of the facet joint had been violated during surgery. Using the magnetic resonance imaging scans, the angles of the facet joints were measured and then correlated with whether or not the facet joint was preserved. RESULTS: The follow-up period for this study was 6 months. Postoperative radicular and back pain during the follow-up period and the need for opioids in the early postsurgery period (48 h) were higher in the nonpreserved group, but these differences were not statistically significant (P > 0.05). If the facet joint angle at the disc was lower than 35 degrees in the horizontal plane, articulation cannot be preserved. However, if this angle is greater than 35 degrees, articulation may be preserved and the surgical view is satisfactory for lumbar microdiscectomy. CONCLUSION: The angle of the lumbar facet joint is important to protect articulation during lumbar microdiscectomy, and violating the facet joint may affect early postoperative pain. A facet angle of less than 35 degrees does not allow for a safe surgical corridor in which to use instruments, nor does it provide a satisfactory view for the surgeon.

Does shaving the incision site increase the infection rate after spinal surgery?

STUDY DESIGN: A prospective randomized clinical study. OBJECTIVE: To determine whether shaving the incision site before spinal surgery causes postsurgical infection. SUMMARY OF BACKGROUND DATA: Spine surgeons usually shave the skin of the incision site immediately before surgery is performed. However, evidence from some surgical series suggests that presurgical shaving may increase the postsurgical infection rate. To our knowledge, no previously published studies have addressed this issue. METHODS: A total of 789 patients scheduled to undergo spinal surgery were randomly allocated into 2 groups: those in whom the site of operation was shaved immediately before surgery (shaved group; 371 patients) and the patients in whom presurgical shaving was not performed (unshaved group; 418 patients). The mean duration of anesthesia and the infection rates in both groups were recorded and compared. RESULTS: The duration of anesthesia did not differ in the 2 groups (P > 0.05). A postoperative infection developed in 4 patients in the shaved group and in 1 patient in the nonshaved group (P < 0.01). CONCLUSIONS: The shaving of the incision site immediately before spinal surgery may increase the rate of postoperative infection.

Skin traction in hip spica casting for femoral fractures in children.

BACKGROUND: The purpose of this study was to evaluate the skin traction in hip spica casting when applied as the standard treatment for children with femoral shaft fractures. METHODS: A total of 207 patients with femoral fractures were treated with this method. The average age was 4.7 years. After the application of skin traction, the fracture of the femur was reduced and was placed in a hip spica cast. Traction was continued in the cast. RESULTS: All fractures united within 4-8 weeks. No significant residual angular deformities were seen in any of the children. The only complication was refracture in two children who fell after removal of the cast. None of the children required external shoe lifts, epiphysiodesis, antibiotics, irrigation, or débridement. CONCLUSIONS: Skin traction and a well-molded hip spica cast is a safe, reliable treatment option for isolated, closed femoral fractures in children 2-7 years of age.

A comparison of changes over time in cervical foraminal height after tricortical iliac graft or polyetheretherketone cage placement following anterior discectomy.

OBJECT: The authors prospectively evaluated cervical foraminal height changes after anterior cervical discectomy and fusion. To their knowledge, this prospective study is the first in which foraminal height changes over time are compared following the placement of a tricortical graft or a polyetheretherketone (PEEK) cage. METHODS: The patients were randomly divided in two groups. In one group, 30 patients underwent anterior cervical microdiscectomy and free bone graft (FBG) insertion at 46 levels via the Smith-Robinson technique. The FBG was harvested from the right iliac crest. Another 35 patients underwent the same operation, but fusion was provided by the insertion of PEEK intervertebral cages at 41 levels. Fusion status and the C2-7 Cobb angle, interspace height, and foraminal height changes were observed on anterior, lateral, and oblique radiographs obtained at the 18-month follow-up examination. There were no differences between the groups with regard to clinical recovery, fusion status, and Cobb angle. A significant interspace height reduction was observed in the FBG group during the 1st postoperative month. In the FBG group, the mean heights (+/- standard deviation) of the foramina were 8.2 +/- 2.7 mm preoperatively, 10.8 +/- 2.6 mm on postoperative Day 2, and 8.1 +/- 1.5 mm after 18 months of follow up. In the PEEK cage group, the mean heights were 8.4 +/- 2.8 mm preoperatively, 10.3 +/- 1.1 mm on postoperative Day 2, and 9.6 +/- 1.2 mm after 18 months of follow up. The increase in foraminal height was significantly preserved at the 6th, 12th, and 18th months in the cage group. CONCLUSIONS: In both groups the foraminal height increased sufficiently and the nerve root was decompressed postoperatively. The PEEK cages may provide sufficient preservation of foraminal height even 1.5 years after the operation.