Simultaneous versus staged surgeries for the treatment of bilateral developmental hip dysplasia in walking age: A comparison of complications and outcomes.

OBJECTIVES: This study aims to compare the radiological outcomes and rate of complication between single-stage and staged operation for the treatment of bilateral developmental dysplasia of the hip (DDH). PATIENTS AND METHODS: A total of 100 patients (13 males, 87 females; mean age: 18.1±2.1 months; range, 12 to 36 months) with bilateral DDH who were older than 15 months of age and treated with open reduction (OR) or Pemberton pericapsular osteotomy (PPO) were retrospectively analyzed. Of the patients, 48 were operated with OR and 52 were operated with PPO. Improvements in acetabular indices, presence of avascular necrosis, radiological results, and other complications were noted. RESULTS: There was no statistically significant difference in the preoperative acetabular indices, range of International Hip Dysplasia Institute (IHDI) classification, follow-up period, and age at the time of operation between the groups (p>0.05). There was no statistically significant difference in the acetabular indices, rate of avascular necrosis, and radiological results at the end of 24 months of follow-up between the groups (p>0.05). CONCLUSION: Our study results show no significant difference in the radiological outcomes and complications between simultaneous and staged surgeries for the treatment of bilateral DDH in children in the walking age.

Impact of presence of ossific nucleus on results of closed reduction in treatment of developmental dysplasia of the hip (302 hips).

Closed reduction is an effective treatment method for developmental dysplasia of the hip (DDH). Still, there are certain controversial issues regarding the timing of the treatment. In this study, we investigated the results of closed reduction and Outcomes of 302 hips of 218 patients treated with closed reduction have been analyzed retrospectively. One hundred fifty-two hips that had ossific nucleus [ossific nucleus (+)] during reduction have been compared with 150 hips that had no ossific nucleus [ossific nucleus (-)] during reduction. Also, the patients have been divided into two groups, the patients treated with closed reduction before the sixth month and the patients treated with closed reduction after the sixth month. Groups have been compared between themselves in terms of avascular necrosis (AVN) and redislocation. Seventy-seven of the 112 hips treated with closed reduction in the first six months were ossific nucleus (-), and AVN has been noted in 5 (6%) patients. However, although no AVN has been seen in any of the 35 ossific nucleus (+) hips, no statistically significant difference has been found between two groups. Seventy-three of the 190 hips treated with closed reduction after the sixth month were ossific nucleus (-), and AVN has been seen in 13 (17%) of these hips. AVN has been seen in 9 (7%) of the 117 ossific nucleus (+) hips. The AVN ratio was found significantly lower in the ossific nucleus (+) hips (P < 0.034). Although the presence of ossific nucleus does not provide extra protection against AVN in before the sixth month, the presence of ossific nucleus is protective against AVN after the sixth month.

Is it an asymptomatic tracheal injury or misdiagnosis in treatment of vertebral fracture: A case report.

INTRODUCTION: Pedicle screws are durable and safe instruments frequently used to treat vertebra injuries and deformities. There is also a possibility of medulla spinalis and visceral organ injury when the pedicle screws are delivered in unsuitable positions or dimensions. In this case, the authors want to draw attention to one of the visceral organ injuries during the thoracic pedicle screw placement. PRESENTATION OF CASE: A 31 years old man underwent posterior instrumentation and fusion for T4 vertebra fractures. The patient was not symptomatic in the postoperative period. Tracheal pressure was observed at the 3rd thoracic vertebra level on the second day after the operation. No complications were encountered in the 3-year follow-up of the patient, who did not accept a second surgery recommended for screw replacement. DISCUSSION: During surgery for thoracic vertebral fractures, the shoulder joint makes it difficult to imagine as the shoulder bones enter the field of view. Therefore, the number of misplaced screws increases. Moreover, it increases the risk of internal organ injury. CONCLUSION: The use of navigation systems or cannulated pedicle screws to treat thoracic vertebral fractures reduces internal organ injuries.

Comparison of the accuracy of the cannulated pedicle screw and the classical pedicle screw in the treatment of Scheuermann's kyphosis: A retrospective study.

OBJECTIVES: This study aims to investigate if use of cannulated pedicle screw (CPS) in the dysplastic pedicles in Scheuermann's kyphosis (SK) increases the accuracy rate of the screw and reduces screw-related complications. PATIENTS AND METHODS: This retrospective study included 21 patients (11 males, 10 females; mean age 19.1 years; range, 13 to 22 years) (550 screws) who received correction with pedicle screws due to SK deformity between May 2015 and January 2019. Between 2017 and 2018, classical pedicle screws were used in addition to CPSs in the upper thoracic region (T2, T3, T4) and thin pedicles (group 1). However, during the years 2015 to 2016, only classical pedicle screws were used for the patients who underwent posterior instrumentation for SK (group 2). Computed tomography scanning was used to investigate the accuracy of the screws. RESULTS: There were 12 patients (316 screws) in group 1 and nine patients (234 screws) in group 2. Seventy-four (13.4%) of all screws were inserted incorrectly. Incorrect screw rate in group 1 was significantly lower than group 2; 21 (6.6%) and 53 (22.6%), respectively (p<0.001). There were no complications related to the use of CPSs after a mean follow-up of two-and-a-half years. CONCLUSION: The use of CPS in the surgical treatment of SK does not increase the complication rate; instead it increases the accuracy of the screw. For this reason, we believe that CPS may be an effective and reliable option in the treatment of SK.

Comparison of total cost and outcomes between single-stage open reduction and Pemberton periacetabular osteotomy operation and two separate consecutive operations in treatment of bilateral developmental hip dysplasia in children at walking age.

Open reduction and Pemberton periacetabular osteotomy (PPO) is one of the most preferred techniques for the treatment of developmental hip dyslaplasia (DDH) after the walking age. Performing the surgery as a one-stage operation or two separate consecutive operations is a controversial issue. In this study, we aimed to compare the outcomes, length of hospitalization and total cost between the patients whom had single-stage open reduction and PPO or two consecutive operations due to bilateral DDH in the walking age children. One hundred thirty patients with bilateral DDH had undergone open reduction and PPO for both hips. Seventy-five patients had one-stage open reduction and PPO for both of the hips, whereas 55 patients have two separate consecutive operations. Total time of exposure to anesthetics, blood loss and duration of operation were noted. Hospitalization period and total treatment costs were also noted for each patient. There was no statistically significant difference between the groups regarding the preoperative and postoperative AIs (P > 0.05). Comparing the total cost, length of hospitalization, exposure to anesthetics, perioperative blood loss, there was statistically significant difference between the groups (P < 0.005). Single-stage surgery had favorable outcomes. Major benefits of single-stage surgery for treatment of bilateral DDH are the reduced costs, anesthesia duration, intraoperative blood loss and hospitalization period. Also it can be presumed that prolonged immobilization can lead to loss of bone strength and resulting in fragility fractures. So single-stage open reduction and PPO for bilateral DDH can be preferred in experienced clinics.

Comparison of Open Reduction Alone and Open Reduction Plus Pemberton Osteotomy Techniques in the Treatment of Developmental Hip Dysplasia at Walking Age.

OBJECTIVE: Open reduction (OR) alone and OR plus Pemberton periacetabular osteotomy (PPO) techniques are commonly used in the treatment of developmental dysplasia of the hip at walking age. However, discussions on the timing of acetabular osteotomy are still ongoing. The aim of the present study was to compare the results of patients who underwent Ferguson OR (FOR group) and OR plus PPO group. MATERIALS AND METHODS: Between 2008 and 2017, we performed surgery on the hips, which we thought were used for closed reduction but could not be reduced as closed, or that the reduction was not stable. Patient follow-up was ≥12 months. The study included 75 hips of 57 patients of which 20 (26.7%) patients with FOR and 55 (73.3%) patients with PPO. Preoperative and postoperative acetabular indices (AIs), additional surgical intervention rates, and avascular necrosis (AVN) rates were compared. The Kalamchi-McEwen classification system was used to evaluate AVN. RESULTS: The average age of the patients was 12.38 (9-14) months. The mean follow-up period was 38.95 (12-140) months. AVN developed in 21 (24%) hips (6 (8%) type 1, 13 (17.3%) type 2, and 2 (2.7%) type 3). AVN developed in 7 (35%) hips in the FOR group and 14 (25.5%) hips in the PPO group. No statistically significant difference was found between the two groups (p=0.416). Revision surgery was performed in 2 (3.7%) cases of the PPO group and 6 (31.5%) cases of the FOR group. Statistically, the PPO group had less revision surgery (p=0.004). The PPO group had an AI of 13.33° (5°-27°) that was significantly lower (p<0.001) than that of 27.98° (18.39°) of the FOR group. CONCLUSION: Ferguson and Pemberton techniques are current and effective in the treatment of patients with developmental hip dysplasia at walking age. There was no significant difference between the two groups when examined from the point of view of AVN, but the results of PPO surgery were found to be better with respect to AI and revision surgery.

Comparison of the accuracy of cannulated pedicle screw versus conventional pedicle screw in the treatment of adolescent idiopathic scoliosis: A randomized retrospective study.

BACKGROUND: Pedicle screws are commonly used to treat adolescent idiopathic scoliosis (AIS). Many studies have discussed the rates and effects of pedicle screw misplacement. In this study, to increase the accuracy rate, cannulated pedicle screws were inserted into the periapical vertebrae, highly rotated vertebrae, and vertebrae with very thin pedicles in a single patient group. We compared these results with those of a patient group who underwent conventional pedicle screw placement. METHODS: Twenty-eight AIS patients treated surgically between 2015 and 2017 with cannulated pedicle screws or conventional pedicle screws were included. Group 1 (n = 15) received cannulated pedicle screws, whereas group 2 (n = 13) received conventional pedicle screws. Postoperative computed tomography scans were used to evaluate pedicle screw position. Pedicle perforation was assessed using the classification by Rao et al: grade 0, no perforation; grade 1, only the threads outside the pedicle (less than 2 mm); grade 2, core screw diameter outside the pedicle (2-4 mm); and grade 3, screw entirely outside the pedicle. Medial screw malposition was measured between the medial pedicle wall and the medial margin of the screw. Lateral screw malposition was measured between the lateral corpus wall and lateral screw margin. RESULTS: Placement accuracy of 703 screws (group 1, 376; group 2, 327) was evaluated. A total of 142 (20.1%) pedicle screw perforations occurred: 63 (17.1%) in group 1 and 79 (25%) in group 2 (P < .05). There was no statistically significant intergroup difference in medial perforation (group 1, 34 [9%] vs group 2, 31 [10%]). Lateral perforation was significantly less common in group 1 (n = 29; 7.7%) than in group 2 (n = 4; 14.7%) (P = .0002). CONCLUSIONS: The use of cannulated screws to treat AIS decreases perforation and complication rates. Although it did not significantly lower the medial perforation rate, it dramatically reduced the lateral perforation rate. The use of cannulated screws enables intraoperative confirmation of placement accuracy. Our data suggest that cannulated pedicle screw use to treat AIS is safer and more efficient.

Successful Surgical Therapy of Gross Thoracolumbar Kyphosis in Boy with Achondroplasia.

We present a case of successful treatment of severe spinal deformity in a 4-year-old boy with achondroplasia. Using posterior segmental instrumentation with a sliding growing rod system, we were able to achieve reduction of thoracolumbal kyphosis from 45 to 11.3 degrees. Post surgery, the patient's spinal hump was completely corrected.

Does It Make a Difference to Stop Fusion at L3 Versus L4 in Terms of Disc and Facet Joint Degeneration: An MRI Study With Minimum 5 Years Follow-up.

OBJECTIVES: To compare the functional outcomes of patients with idiopathic scoliosis who had surgical correction and fusion with all pedicle screw construct down to L3 or L4 and to evaluate whether saving a mobile lumbar motion segment distally would demonstrate any difference in terms of disc degeneration (DD) and facet joint degeneration (FJD) after minimum 5 years follow-up. SUMMARY OF BACKGROUND DATA: Selection of lowest instrumented vertebra (LIV) is often difficult when lumbar curve was included into the fusion (L3 vs L4). Saving L4 is believed to be beneficial for preserving motion and preventing degeneration of unfused lumbar spine. METHODS: The L3 group included 21 patients (mean age of 21.4) and L4 group included 16 patients (mean age 22.9). Control group included 30 healthy individuals with no spinal deformities (mean age of 23.8). Follow-up lumbar magnetic resonance images (MRIs) were evaluated for each patient in terms of DD and FJD. Clinical evaluation was done by using the Scoliosis Research Society-22r, Oswestry Disability Index, and Numeric Rating Scale. RESULTS: Mean follow-up period was 7.4 (5-10) years in the L3 group and 9 (5-17) years in L4 group. Average correction rates for lumbar curve magnitudes were 78% in the L3 group and 79% in the L4 group, with no significant correction loss at the final follow-up. There was no statistical difference for DD in all groups (p > .05). FJD was significantly greater in both L3 and L4 groups compared to the control group (p < .001). Clinical outcome scores were similar among all three groups (p > .05). CONCLUSION: Spinal balance and corrections remained stable, without showing any decompensation over time. This midterm MRI study demonstrated similar disc and facet degeneration rates for L3 and L4 groups. FJD at the upper two levels adjacent to the LIV was significant for both surgically treated groups. Clinical outcome scores were similar for all groups at minimum 5 years follow-up.

Intramedullary nailing of adult isolated diaphyseal radius fractures.

BACKGROUND: The aim of the present study was to evaluate functional and cosmetic outcomes of adult patients who underwent intramedullary nailing with newly designed intramedullary radius nails for isolated radius diaphyseal fractures. METHODS: Seventeen adult patients who had undergone intramedullary nailing for radius diaphyseal fractures were retrospectively evaluated. Patients with isolated radius diaphyseal closed fractures were included. Closed reduction was achieved in all patients. Wrist and elbow ranges of movement were calculated at final follow-up. Grip strength was calculated using a hydraulic hand dynamometer. Maximum radial bowing (MRB) and maximum radial bowing localization (MRBL) were calculated for treated and uninjured arms. Functional evaluation was performed using Grace-Eversman evaluation criteria and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score. RESULTS: Of the 17 patients with isolated radius diaphyseal fractures evaluated, 11 (64.7%) were male and 6 (35.3%) were female, with a mean age of 35.76 years (range: 23-61 years). Fractures were right-sided in 11 (64.7%) and left-sided in 6 (35.3%) patients. Mean time to bone union was 10.2 weeks (range: 8-20 weeks). Mean supination was 75.35º (range: 67º-80º), pronation was 85.18º (range: 74º-90º). According to Grace-Eversman evaluation criteria, results were excellent in 16 (94%) and good in 1 (6%) patient. Mean DASH score was 12.58 (3.3-32.5). CONCLUSION: The gold-standard treatment of adult isolated radius diaphyseal fractures is plate and screw osteosynthesis. However, intramedullary nailing of isolated radius fractures is a good alternative treatment method, with excellent functional results and union rates similar to those of plate and screw osteosynthesis.

Does pedicle screw fixation under age 5 cause spinal canal narrowing? A CT study with minimum 5 years follow-up.

PURPOSE: The aim of this retrospective study was to evaluate the changes in the vertebral body and spinal canal area in a group of patients who had pedicle screw fixation under age 5 for the treatment of congenital spinal deformity at least 5 year follow-up. METHODS: 11 patients who had been operated due to spinal deformity under age 5 with who had a CT examination at least 5 years after the initial operation were included in the study. All patients underwent hemivertebrectomy and transpedicular fixation procedures at an average age of 3.18 years (range 2-5 years). All had preoperative CT to evaluate the congenital deformities. Measurements were done at the instrumented vertebrae as well as the un-instrumented ones above and below them to evaluate; vertebral body parameters, pedicle parameters and spinal canal area of upper instrumented vertebra (UIV), lower instrumented vertebra (LIV), upper adjacent un-instrumented vertebra and lower adjacent un-instrumented vertebra. RESULTS: The average follow-up was 7.2 (range 5-12) years. Six of the patients were over age 10 during the final CT examination while 5 were at age 7. Female-to male ratio was 8-3. Measurement of all the parameters in 22 instrumented and 22 non-instrumented segments showed a proportional increase rather than a decrease at each segment. The percentage of canal area growth at UIV and LIV was 21 and 17.5 %, respectively. CONCLUSION: Pedicle screw instrumentation has no adverse effect on further spinal body, pedicle and canal growth and does not result in iatrogenic spinal canal stenosis.

Surgical treatment of cervical unilateral locked facet in a 9-year-old boy: A case report.

Most of the cervical spine injuries in the pediatric population are typically seen in the upper cervical region. Unilateral cervical facet dislocation (UFD) in subaxial region is a rare injury in pediatric population. In this paper, a rare case of delayed locked UFD in a 9-year-old boy with rare injury mechanism treated surgically is reported. Clinical and radiological findings were described. The patient with C6-7 UFD without neurologic deficit was underwent open reduction and internal fixation via anterior and posterior combined approaches. Significant improvement of pain and free motion in cervical spine was obtained. There was no complication during the follow up. Only three case reports presented about the lower cervical spine injury with UFD under the age of 10 were found in the literature.

Selective Thoracic Fusion Provides Similar Health-Related Quality of Life but Can Cause More Lumbar Disc and Facet Joint Degeneration: A Comparison of Adolescent Idiopathic Scoliosis Patients With Normal Population 10 Years After Surgery.

OBJECTIVES: To evaluate the long-term behavior of the lumbar curve in patients with adolescent idiopathic scoliosis treated with selective thoracic fusion and to assess the clinical and radiologic outcomes in this fusion group compared with an age- and gender-matched group. SUMMARY OF BACKGROUND DATA: Selective thoracic fusion for the treatment of adolescent idiopathic scoliosis (AIS) preserves lumbar motion segments but leaves a residual deformity. By avoiding fusion of the lumbar spine, a greater mobility may be preserved, which may be an advantage in long-term follow-up in terms of degenerative changes in unfused segments. METHODS: Group A included 25 AIS patients with mean a age of 23.8 years and a mean 11.4 years of follow-up. Group B included 30 age- and gender-matched subjects without any deformity. Preoperative, postoperative, and follow-up radiographs were reviewed. All patients had MRIs taken at the final follow-up in order to evaluate disc degeneration (DD) and facet joint degeneration (FJD) at the unfused lumbar spine. Clinical evaluation was done by using Scoliosis Research Society-22R, Oswestry Disability Index, and numerical rating scale. RESULTS: Sagittal and coronal balance and lowest instrumented vertebra disc angulation were stable over time. Mean grading of lumbar DD was 2.16 (2-4) in Group A and 1.86 (1-3) in Group B. Lumbar FJDs were 2.05 (1-4) in Group A and 1.60 (1-3) in Group B. There was significant difference between the two groups for DD except for the L4-L5 level (p = .26). FJD was significantly higher in the L1-L2 and L2-L3 levels (L1-L2, p = .002, L2-L3, p = .002) but not for the other levels. Outcome scores were similar without significant differences between the two groups (p > .05). CONCLUSION: Selective thoracic fusion provides satisfactory outcomes at more than 10 years of follow-up. Our study demonstrated a moderate increase in the rate of disc degeneration in the unfused segments. Facet joint degeneration was significant at the upper two levels adjacent to the lowest instrumented vertebra.

Early and late-term results of arthroscopic surgery on patients with gonarthrosis.

OBJECTIVE: To provide guidance in the selection of the appropriate patient for arthroscopic debridement. MATERIALS AND METHODS: Ninety patients who were diagnosed with gonarthrosis according to modified American College of Rheumatology (ACR) criteria and who underwent arthroscopic debridement and meniscectomy were evaluated. Functional assessment of patients was made based on preoperative as well as 1 month and 1 year postoperative results of the Lysholm Knee Score and the Visual Analog Scale (VAS). One year postoperatively, the Tapper-Hoover Scoring System was used to calculate long-term results. Analyses were conducted using SPSS 18 software. For this study ethics committee approval was received from the ethics committee of Ataturk University Medical Studies Department Head on 08.10.2010 at the 6th meeting with regards to the document written on 16.06.2010 with number 998. RESULTS: Differences between preoperative and 1-month and 1-year postoperative values in the Western Otorino and McMaster Universities Osteoarthrosis (WOMAC) Index, Lysholm and VAS were found to be statistically significant (p<0.001) (Table 1). According to Tapper-Hoover results, 82.8% of patients benefited from arthroscopic debridement in the long term (Table 2). Among body mass index (BMI) groups, the WOMAC, Lysholm and VAS values of obese patients were worse than those of normal weight and underweight patients, and the difference was statistically significant (p<0.005). Late-term results of patients younger than 55 were superior to those over 55. CONCLUSION: In the treatment of patients with gonarthrosis, arthroscopic debridement is a good option. Patients who have a low BMI and are younger than 55 years old experience more benefit from arthroscopic debridement.