Minimally invasive surgical technique for unstable supracondylar humerus fractures in children (Gartland type III or IV).

Background: Achieving and maintaining anatomical reduction during the treatment of pediatric humerus fractures, classified as Gartland type III or IV, presents a clinical challenge. Herein, we present a minimally invasive surgical approach using a novel and simple K-wire push technique that aids in achieving and maintaining anatomical reduction. Methods: We reviewed data of children receiving treatment for supracondylar fractures of the humerus at our hospital between January 2016 and December 2020. Patients were divided into two groups based on the method of treatment: Group 1 was treated with the K-wire push technique, and Group 2 was treated with the standard technique as described by Rockwood and Wilkins. The medical records and radiographic images were reviewed. In total, 91 patients with Gartland types III and IV fractures were included, with 37 and 54 patients in Groups 1 and 2, respectively. Results: The postoperative reduction radiographic parameters and Flynn scores at final follow-up were not significantly different between the two groups. Conclusion: The minimally invasive K-wire push technique for unstable supracondylar fractures in children is a safe and effective alternative for improving reduction. Using this technique, complications can be minimized, and the requirement for open reduction can be reduced.

Outcome Prediction Model Following Proximal Femoral Osteotomy in Legg-Calvé-Perthes Disease Using Machine Learning Algorithms.

BACKGROUND: The purpose of the current study was (1) to analyze various factors that may be associated with the outcomes of Legg-Calvé-Perthes disease (LCPD), and (2) to develop and internally validate machine learning algorithms capable of providing patient-specific predictions of which patients with LCPD will achieve relevant improvement in radiologic outcomes after proximal femoral varus osteotomy (PFVO). We examined several variables, previously identified as factors, that may influence the outcome of LCPD and developed a machine learning algorithm based on them. METHODS: In this retrospective study, we analyzed patients aged older than  6 years at the time of LCPD diagnosis who underwent PFVO at our institution between 1979 and 2015. Univariate and multivariate logistic regression analyses were used to examine the effects of variables on the sphericity of the femoral head at skeletal maturity, including age at onset, sex, stage at operation, extent of epiphyseal involvement and collapse, presence of specific epiphyseal, metaphyseal, and acetabular changes, and postoperative neck shaft angle (NSA). Recursive feature selection was used to identify the combination of variables from an initial pool of 13 features that optimized the model performance. Five machine learning algorithms [extreme gradient boosting (XGBoost), multilayer perception, support vector machine, elastic-net penalized logistic regression, and random forest) were trained using 5-fold cross-validation 3 times and applied to an independent testing set of patients. RESULTS: Ninety patients with LCPD who underwent PFVO were included in this study. The mean age at diagnosis was 7.93 (range, 6.0 to 12.33) years. The average follow-up period was 10.11 (range, 5.25 to 22.92) years. A combination of 8 variables, optimized algorithm performance, and specific cutoffs were found to decrease the likelihood of achieving the 1 or 2 Stulberg classification: age at onset ≤ 8.06, lateral classification ≤ B, 12.40 < preoperative migration percentage (MP) ≤ 22.85, Catterall classification ≤ 2, 117.4 < postoperative NSA ≤ 122.90, -10.8 < postoperative MP ≤ 6.5, 139.65 < preoperative NSA ≤ 144.67, and operation at stage 1. The XGBoost model demonstrated the best performance (F1 score: 0.78; area under the curve: 0.84). CONCLUSIONS: The XGBoost machine learning algorithm achieved the best performance in predicting the postoperative radiologic outcomes in patients with LCPD who underwent PFVO. In our population, age at onset ≤ 8.06, lateral classification ≤ B, 12.40 < preoperative MP ≤ 22.85, Catterall classification ≤ 2, 117.4 < postoperative NSA ≤ 122.90, -10.8 < postoperative MP ≤ 6.5, 139.65 < preoperative NSA ≤ 144.67, and operation at an early stage had the likelihood of achieving the spherical femoral head for the patients with LCPD that underwent PFVO. After external validation, the online application of this model may enhance shared decision-making. LEVEL OF EVIDENCE: Level III-retrospective cohort study.

Comparison of Cefazolin/Metronidazole to Ampicillin/Sulbactam as Preoperative Antibiotics in Colorectal Surgery: A Retrospective, Single-Center Cohort Study.

AIM: The use of prophylactic antibiotics prior to colorectal surgery reduces surgical site infections. Cefazolin and metronidazole are used as a standard regimen. Ampicillin/sulbactam may be an alternative, but current data are limited. We compared the efficacy of ampicillin/sulbactam with cefazolin and metronidazole as prophylactic antibiotics. METHODS: Patients who underwent colorectal surgery at Inha University Hospital between 2010 and 2020 were treated prophylactically with cefazolin and metronidazole or ampicillin/sulbactam, and observed for 30 days following surgery. The primary outcome was surgical site infections. The secondary outcomes were deep/organ infections and the need for drainage. RESULTS: SSIs occurred in 2.6% (17/646) of the ampicillin/sulbactam group, whose rate was not inferior to the occurrence in the group receiving cefazolin and metronidazole (3.8%, 21/556). There was no significant difference between the two groups in the secondary outcomes. CONCLUSIONS: Compared to the cefazolin and metronidazole combination, ampicillin/sulbactam is not inferior as a preoperative prophylactic antibiotic regimen for colorectal surgery.

Treatment of bilateral congenital extensor tendon dislocation on multiple digits with only one sagittal band reconstruction: a case report.

Bilateral congenital dislocation of the extensor tendon in the metacarpophalangeal joint is an exceedingly rare disease and often involves multiple fingers. Surgical treatment of multiple congenital extensor tendon dislocations in both hands has been reported; however, no report has clearly stated whether all fingers should be surgically treated in patients with multiple finger involvement. We report a case in which we successfully treated bilateral congenital extensor tendon dislocation on multiple digits with only one single-loop reconstruction of the sagittal band instead of operating on all involved fingers.

Relationship between Slip Severity and BMI in Patients with Slipped Capital Femoral Epiphysis Treated with In Situ Screw Fixation.

Background: Slipped capital femoral epiphysis (SCFE) is a hip disorder that occurs in adolescence before epiphyseal plate closure, causing anatomical changes in the femoral head. Obesity is known to be the single most important risk factor for idiopathic slipped capital femoral epiphysis (SCFE), which is highly related to mechanical factors. Meanwhile, as increased slip angle increases major complications in patients with SCFE, slip severity is an important factor to evaluate prognosis. In obese patients with SCFE, higher shear stress is loaded on the joint, which increases the likelihood of slip. The study aim was to assess the patients with SCFE treated with in situ screw fixation according to the degree of the obesity and to find any factors affecting the severity of slip. Methods: Overall, 68 patients (74 hips) with SCFE who were treated with in situ fixation screw fixation were included (mean age 11.38, range: 6-16) years. There were 53 males (77.9%) and 15 females (22.1%). Patients were categorized underweight, normal weight, overweight, and obese depending on BMI percentile for age. We determined slip severity of patients using the Southwick angle. The slip severity was defined as mild if the angle difference was less than 30 degrees, moderate if the angle difference was between 30 and 50 degrees, and severe if the angle difference was greater than 50 degrees. To examine the effects of several variables on slip severity, we used a univariable and multivariate regression analysis. The following data were analyzed: age at surgery, sex, BMI, symptom duration before diagnosis (acute, chronic, and acute on chronic), stability, and ability to ambulate at the time of the hospital visit. Results: The mean BMI was 25.18 (range: 14.7-33.4) kg/m2. There were more patients with overweight and obese than those with normal weight in SCFE (81.1% vs. 18.9%). We did not find significant differences between overall slip severity and degree of obesity or in any subgroup analysis. Conclusions: We did not find a relationship between slip severity and degree of obesity. A prospective study related to the mechanical factors affecting the slip severity according to the degree of obesity is needed.

Characteristics of Giant Cell Tumor of the Bone in Pediatric Patients: Our 18-Year, Single-Center Experience.

A giant cell tumor (GCT) of the bone is characteristically found in skeletally mature patients. The tumor is rare in pediatric patients, and incidence reported in literature varies from 1.8% to 10.6%. We performed a retrospective study addressing symptoms, treatment, and outcome in pediatric patients who were diagnosed with GCT between March 1997 and January 2015 at our hospital. Fourteen (11.1%) of 126 surgically treated patients with histologically proven GCT were <19 years of age. We confirmed skeletal maturity using magnetic resonance imaging (MRI). Fourteen patients from 8 to 19 years old were identified. Sixteen lesions (76.2%) were found in long bones and 5 lesions (23.8%) in short bones. The most common site was around the knee in 8 patients (38%). GCTs mostly occur at the epi-metaphysis in 11 patients (52.3%). Regardless of the openness of epiphyseal plate, we observed GCT of bone in the epiphysis. Further study will be needed to prove the association between the presence of epiphyseal plate and location of tumor. Three patients (21.4%) had multicentric lesions, and four patients (28.5%) had local recurrence. Multicentric giant cell tumor and local recurrence occur more often in pediatric patients. The characteristics of GCT in pediatric patients do not differ from what is reported for GCT in adults.

Differences in Kinematic and Kinetic Patterns According to the Bone Tumor Location after Endoprosthetic Knee Replacement Following Bone Tumor Resection: A Comparative Gait Analysis between Distal Femur and Proximal Tibia.

Modular endoprostheses are frequently used to reconstruct skeletal and knee defects from bone tumor resection and preserve joint function in patients with bone tumors around the knee. Depending on the tumor location, the muscles and extent of the tumor can vary, which can affect gait function. This study aimed to analyze kinetic and kinematic characteristics according to tumor location in patients with endoprosthetic knee replacements after bone tumor resection. Gait analyses were performed in 16 patients who underwent knee endoprosthesis due to tumors around the knee. We divided the patients into distal femur (n = 7) and proximal tibia (n = 9) groups and conducted between-group comparisons and comparisons with healthy participants. Compared with the control group, the distal femur group showed a tendency for knee extension, and the proximal tibia group showed increased maximal dorsiflexion during stance. The proximal tibia group maintained a flexed hip during the entire gait cycle, compared with the distal femur group. In summary, our results suggest a difference in gait between the distal femur and proximal tibia groups. Patients who have undergone knee prosthesis after knee tumor resection may require different rehabilitation strategies according to the tumor location.

Multi-Level Seg-Unet Model with Global and Patch-Based X-ray Images for Knee Bone Tumor Detection.

Tumor classification and segmentation problems have attracted interest in recent years. In contrast to the abundance of studies examining brain, lung, and liver cancers, there has been a lack of studies using deep learning to classify and segment knee bone tumors. In this study, our objective is to assist physicians in radiographic interpretation to detect and classify knee bone regions in terms of whether they are normal, begin-tumor, or malignant-tumor regions. We proposed the Seg-Unet model with global and patched-based approaches to deal with challenges involving the small size, appearance variety, and uncommon nature of bone lesions. Our model contains classification, tumor segmentation, and high-risk region segmentation branches to learn mutual benefits among the global context on the whole image and the local texture at every pixel. The patch-based model improves our performance in malignant-tumor detection. We built the knee bone tumor dataset supported by the physicians of Chonnam National University Hospital (CNUH). Experiments on the dataset demonstrate that our method achieves better performance than other methods with an accuracy of 99.05% for the classification and an average Mean IoU of 84.84% for segmentation. Our results showed a significant contribution to help the physicians in knee bone tumor detection.

A Study on Focused Ion Beam (FIB) Milling Machining and Fabrication Technology of Nano-Scale Diamond Tool for Machining Fine-Patterns in a Free-Form Surfaces.

Recently, the technology of the industry has been increasing for diffractive optical elements, holograms, optical components, and next-generation display components. The advanced high value-added industry is designing fine patterns on ultra-precision optical components and applying them to various industries. In the case of the ultra-fine pattern, a contact-type machining technique is required because it requires a precise pattern in nano-scale units. In this paper, the fabrication technology of ultra-precision diamond which is essential in the ultra-precision processing technology was suggested. The material used in the experiment was a single-crystal diamond tool (SCD), and the equipment for machining the SCD used a focused ion beam (FEI COMPANY, system Nova 600) equipment. The back fire method was applied without metal coating in order to carry out the process study and the focused beam of 30 keV Ga+ ions were carried out processing for various fabrication of diamond cutting tools. As a result of applying the backfire method through the process experiment, the cutting edge width of the ultra-precision diamond tool was verified 275 nm.

Does the Duration of Each Waldenström Stage Affect the Final Outcome of Legg-Calvé-Perthes Disease Onset before 6 Years of Age?

The purpose of this study was to evaluate the outcomes of patients with Legg-Calvé-Perthes disease (LCPD) with disease onset before 6 years of age who were treated with conservative methods and to identify prognostic factors. Moreover, we evaluated the duration of the Waldenström stage and its correlation with the disease outcome. Disease severity was assessed using the lateral pillar classification, and the final outcome was evaluated using the Stulberg classification. We divided patients with LCPD into two groups according to the age at onset: group 1 (<4 years) and group 2 (4-6 years). The final outcomes of the two groups were compared. We also assessed the duration of each Waldenström stage. LCPD was noted in 49 hips of 49 patients. The lateral pillar class was A in one patient, B in 29 patients, and B/C or C in 19 patients. The Stulberg class was I or II (good) in 30 patients, III (fair) in 13 patients, and IV or V (poor) in six patients. The lateral pillar class significantly correlated with the final outcome. Groups 1 and 2 comprised 25 and 24 patients, respectively. The prevalence of good outcomes did not significantly differ between the groups (p = 0.162). The duration of the initial stage was 4.1 months in the good outcome group and 6.2 months in the fair or poor outcome group. The duration of the fragmentation stage of the femoral head was 5.9 months in the good outcome group and 11.9 months in the fair or poor outcome group. The durations of initial and fragmentation stages significantly differed between good outcome group and fair or poor outcome group (p = 0.009 and p < 0.001, respectively). The prognosis of patients with disease onset before the age of 6 years was favorable. The disease severity and duration of each Waldenström stage can be predictors of the outcome. Patients with prolonged initial and fragmentation stages showed worse outcomes and often required more active treatment to shorten the durations of the initial and fragmentation stages.

Characteristics of hip impingement syndrome in patients with multiple hereditary exostoses.

BACKGROUNDS: This study aimed to investigate the characteristic deformities of the hip in multiple hereditary exostoses patients (MHE) and its association with the hip impingement syndrome. MATERIALS AND METHODS: Between 2001 and 2019, total 51 patients (102 hips) were evaluated in this study. Patients with MHE were classified to femoro-acetabular impingement (FAI) symptom group, ischio-femoral impingement (IFI) symptom group and non-impingement symptom group by comparing the symptoms, clinical signs and imaging studies. To assess the morphometry of the hip in patients with MHE, the femoral neck-shaft angle, Sharp's acetabular angle and center-edge (CE) angle were evaluated. Alpha angle was further evaluated to investigate the FAI using radiographs, and the minimum ischio-femoral distance was further measured to investigate the IFI using computed-tomographic (CT) study. RESULTS: On hip impingement symptom analysis, FAI symptom and IFI symptom were confirmed in 14 hip joints and 18 hip joints, respectively. Unlike general population, the number of the hip with IFI-symptom was higher than those with FAI symptom in this study. In morphometric evaluation of MHE hips, coxa valga was most prominent deformity with occasional tendency of mild acetabular dysplasia. In a comparison of morphometric study between the impingement symptom group and non-symptom group, the FAI symptom showed significant differences of morphometric measure values than those of the non-symptom group (FAI symptom group vs. Non-FAI symptom group; Femoral neck-shaft angle (153.9 vs 142.6), Sharp's angle (45.0 vs 41.5), CE angle (21.1 vs 28.8) and alpha angle (76.7 vs 57.9)). Similarly, the IFI symptom group also showed significant differences of morphometric measure values than those of the non-symptom group (IFI-symptom vs. Non-IFI symptom; Femoral neck-shaft angle (150.9 vs 142.7), Sharp's angle (44.7 vs 41.4), CE angle (21.1 vs 29.3) and alpha angle (73.3 vs 56.8)). In addition, the minimum ischio-femoral distance measured using CT was significantly decreased in the IFI symptom group (IFI symptom group: 6.6, Non-IFI symptom group: 16.4). CONCLUSION: The results suggest that the characteristic deformities represented by coxa valga in the MHE hip act as an offset for FAI symptoms, on the contrary, act as a trigger for IFI symptoms. LEVEL OF EVIDENCE: Level III.

Diagnosis and Management of Hip Dislocation in Patients with Kabuki Syndrome.

BACKGROUND: Kabuki syndrome is a rare genetic disorder characterized by distinct dysmorphic facial features, growth deficiency, intellectual disabilities, unusual dermatoglyphic patterns, and skeletal abnormalities. The incidence of hip dislocation in Kabuki syndrome ranges from 18% to 62%. We reviewed the outcomes of management of hip dislocations in patients with Kabuki syndrome with special attention to the diagnostic processes for hip dislocation and Kabuki syndrome. METHODS: Among 30 patients with mutation-confirmed Kabuki syndrome, we selected six patients who had hip dislocations and reviewed their medical records and plain radiographs. The modes of presentation and diagnostic processes for both hip dislocations and Kabuki syndrome were investigated. The management and treatment outcomes of hip dislocations in patients with Kabuki syndrome were evaluated. RESULTS: The average age of patients at the time of diagnosis of hip dislocation was 7.7 months (range, 1 week to 22 months). None of the patients were diagnosed as having Kabuki syndrome at that time. Two patients were treated with a Pavlik harness; one, with closed reduction; two, with open reduction and later pelvic and/or femoral osteotomies; and one, with open reduction combined with pelvic osteotomy. The patients were followed up for 5.8 years on average (range, 2.0 to 10.5 years). The radiologic outcome was graded as Severin IA or IB for three patients who were older than 6 years at the latest follow-up (mean age, 9.9 years; range, 7.8 to 12.4 years). In the remaining three patients younger than 6 years (mean age, 3.8 years; range, 2.7 to 5.3 years), the lateral center edge angle was more than 15°. The clinical diagnosis of Kabuki syndrome was made during follow-up after hip dislocation treatment and confirmed by mutational analysis at a mean age of 4.7 years. The mean interval between the diagnosis of hip dislocation and Kabuki syndrome was 4.0 years. CONCLUSIONS: The management of hip dislocation by conservative or surgical method showed successful results. Awareness of Kabuki syndrome could lead to an early diagnosis of this rare disease in patients with hip dislocation and allow for early detection of other underlying conditions and multidisciplinary management.

Clinical analysis of patients with skeletal metastasis of lung cancer.

BACKGROUND: Many factors influence bone metastases of lung cancer, and several studies report about survival of skeletal metastasis. However, few studies have focused on identifying the prognostic factors for skeletal metastasis of lung cancer, especially following orthopedic surgery. We conducted a retrospective analysis of the clinical characteristics of skeletal metastasis from lung cancer and discuss the prognostic factors. METHODS: We performed a medical record review of 202 patients who were diagnosed with skeletal metastasis from lung cancer. Adenocarcinoma was found in 116 patients (57.4%), squamous cell carcinoma in 29 (14.4%), small-cell lung cancer (SCLC) in 37 (18.7%), and large-cell carcinoma and other types of cancer in 20 patients (9.9%). Orthopedic surgery for skeletal metastasis was performed in 41 patients (20.3%). RESULTS: Lung cancer survival was 12.1 months. After diagnosis of lung cancer, skeletal metastasis was found at a mean of 2.5 months, and skeletal metastasis survival was 9.8 months. Lung cancer survival in patients younger than 60 years was 13.8 months, and lung cancer survival in patients 60 years or older was 10.8 months (p = 0.009). Skeletal metastasis survival in patients younger than 60 years was 11.0 months, and skeletal metastasis survival in patients 60 years or older was 8.8 months (p = 0.002). Mean skeletal metastasis survival with surgery was 12.6 months and without surgery was 9.1 months (p < 0.000). In the multivariate analysis of lung cancer survival, age under 60 years [HR (95% CI) 1.549 (1.122-2.139), p = 0.008], non-small cell lung cancer pathology type [HR (95% CI) 1.711 (1.157-2.532), p = 0.008], chemotherapy for skeletal metastasis [HR (95% CI) 8.064 (3.981-16.332), p < 0.000], and radiation therapy for skeletal metastasis [HR (95% CI) 1.791 (1.170-2.742), p = 0.007] were significant, independent, good prognostic factors. In the multivariate analysis of skeletal metastasis survival, age under 60 years [HR (95% CI) 1.549 (1.124-2.134), p = 0.007], non-small cell lung cancer pathology type [HR (95% CI) 2.045 (1.373-3.047), p < 0.000], chemotherapy for skeletal metastasis [HR (95% CI) 7.121 (3.542-14.317), p < 0.000], and orthopedic surgical treatment for skeletal metastasis [HR (95% CI) 1.710 (1.148-2.547), p = 0.008] were significant, independent, good prognostic factors. CONCLUSIONS: Patients who survived longer were less than 60 years old, received chemotherapy as treatment for skeletal metastasis, had NSCLC rather than SCLC, and underwent orthopedic surgery for skeletal metastasis.

The role of fractures on pathologic bone in healing of proximal humerus unicameral bone cysts.

PURPOSE: To evaluate the role of fractures on pathologic bone in healing of proximal humerus unicameral bone cysts (UBCs) and investigate the clinical factors that affect healing of UBCs after fractures on pathologic bone. METHODS: This prospective study was carried out between 2002 and 2014. We evaluated 56 patients with a UBC accompanying fractures on pathologic bone in the proximal humerus. Clinical data were collected from the patients' medical records. Age, gender, degree of fracture displacement, location of cyst, and cyst size were investigated, and we assessed how these factors affected cyst healing. RESULTS: The overall healing rate of UBCs 1 year after fracture was 66% (37 of 56 cases). The healing rate was significantly lower in pubescent patients (10-14 years old; 45%) than in those who were 9 years old (76%) or 15 years old (80%). The rate of healing of fractures in the metaphysis (53%) was lower than that of breaks in the diaphysis (85%). The mean cyst ratio was 1.31 in the 37 patients who experienced cyst healing within 1 year and 1.79 in the 19 patients who needed surgical treatment within 1 year. CONCLUSION: In latent lesions and in patients who are older (after puberty), UBCs of the humerus after fracture have better clinical results than do active lesions and those in younger patients (before puberty). Fractures on pathologic bone in proximal humerus UBCs often dramatically decrease cyst size, and patients with such fractures have excellent clinical results in terms of healing rate.

Prognostic implications of polycomb proteins ezh2, suz12, and eed1 and histone modification by H3K27me3 in sarcoma.

BACKGROUND: Polycomb repressive complex 2 (PRC2; formed by EZH2, SUZ12, and EED protein subunits) and PRC1 (BMI1 protein) induce gene silencing through histone modification by H3K27me3. In the present study, we characterized the PRC expression pattern and its clinical implication in sarcoma. METHODS: Using immunohistochemistry, we analyzed PRC expression in 105 sarcoma patients with 5 subtypes: synovial sarcoma (n = 18), rhabdomyosarcoma (n = 28), Ewing sarcoma (n = 15), osteosarcoma (n = 30), and others (n = 14). RESULTS: The median age at diagnosis in the patient cohort was 26.8 years (range: 1-78 years) and the male-to-female ratio was 1:4. Initial disease presentation was locoregional disease in 83% of patients and initial metastatic disease in the remaining 17%. PRC expression was not significantly different according to histologic subtype (P = 0.400). Overall survival (OS) was significantly poor for SUZ12 high (P = 0.001), EED1 high (P = 0.279), and H3K27me3 high (P = 0.009). Ultimately, patients with PRC2high had significantly inferior OS than the no expression group (P = 0.009). In the Cox proportional hazard model adjusted for stage, histologic grade, surgery, margin and initial metastasis, SUZ12 expression (P = 0.020, HR 29.069, 95% CI 1.690-500.007), H3K27me3 (P = 0.010, HR 3.743, 95% CI 1.370-10.228) expression was significantly associated with shorter OS. CONCLUSION: We detected PRC expression in various sarcomas and demonstrated its independent negative prognostic role, suggesting the PRC axis as promising therapeutic target for treating sarcoma.

Developmental pattern of the hip in patients with hereditary multiple exostoses.

BACKGROUND: Coxa valga is a common clinical feature of hereditary multiple exostoses (HME). The current study aimed to determine the unique developmental pattern of the hip in patients with HME and evaluate the factors that influence its progression. METHODS: Thirty patients (57 hips) with HME were divided into two groups according to the Hilgenreiner epiphyseal angle (HEA). Twenty-two patients (44 hips) including 13 men and 9 women were assigned to group 1 (HEA <25°), and 8 patients (13 hips) including 3 men and 5 women were assigned to group 2 (HEA ≥25°). The mean age at the initial presentation was 6.0 (4-12) years with 6.8 (4-11) years of follow-up in group 1, and 10.4 (8-13) years with 5.4 (2-9) years of follow-up in group 2. We measured the HEA, neck-shaft angle (NSA), acetabular index (AI), center-edge angle (CEA), and migration percentage (MP) for radiographic evaluation. RESULTS: Among the hips, 50 (87.7%) hips had coxa valga and 27 (47.4%) hips had abnormal MP (42.1% were borderline and 5.3% were subluxated). There was a significant difference in the HEA and NSA between the groups (p < 0.001 and p < 0.05, respectively). The HEA significantly correlated with the development of the NSA and no correlation was found between the HEA and AI, CEA, and MP. CONCLUSIONS: There was a significant relationship between the HEA at the initial presentation and the NSA at skeletal maturity. We should consider guided growth for patients with lower HEA to prevent significant coxa valga deformity with close follow-up.

Clinical adjacent-segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10-year follow-up.

BACKGROUND CONTEXT: Anterior cervical discectomy and fusion using cervical plates has been seen as effective at relieving cervical radiculopathy and myelopathy symptoms. Although it is commonly used, subsequent disc degeneration at levels adjacent to the fusion remains an important problem. However, data on the frequency, impact, and predisposing factors for this pathology are still rare. PURPOSE: To evaluate the incidence, predisposing factors, and impact of radiographic and clinical adjacent-segment pathologies after anterior cervical discectomy and fusion using cervical plates and to analyze the efficacy of this surgical method over the long term, after a minimum follow-up period of 10 years. STUDY DESIGN: Retrospective clinical study. PATIENT SAMPLE: Our study was a retrospective analysis of 177 patients who underwent anterior cervical discectomy and fusion using cervical plates, with follow-up periods of at least 10 years (mean 16.2 years). OUTCOME MEASURES: Radiographic adjacent-segment pathology using plain radiographs and clinical adjacent-segment pathology after anterior cervical discectomy and fusion using cervical plates. METHODS: We defined a new grading system of plain radiographic evidence of degenerative changes in adjacent discs after anterior cervical discectomy and fusion using cervical plates; Grade 0 is considered normal, and Grade V consists the presence of posterior osteophytes and a decrease in disc height to less than 50% of normal. The incidence, predisposing factors, and impact of radiographic and clinical adjacent-segment pathologies were analyzed according to etiologies, number of fused segments, and plate-to-disc distance. RESULTS: Radiographic and clinical adjacent-segment pathologies were found in 92.1% and 19.2%, respectively, of patients. By etiology, clinical adjacent-segment pathology was observed in 13.5% of patients who had sustained trauma, 12.7% of those with disc herniation, and 33.3% of those with spondylosis. By number of fused segments, clinical adjacent-segment pathology was found in 13.2% of patients who underwent single-level fusion and in 32.1% of those who underwent multilevel fusion surgeries. Patients with a plate-to-disc distance of less than 5 mm, who had spondylosis, or who underwent multilevel fusion had a higher incidence of clinical adjacent-segment pathology after anterior cervical discectomy and fusion using cervical plates than other groups did (p<.05). Of all patients, only 6.8% needed follow-up surgery. CONCLUSIONS: We found that over the long term, at a minimum follow-up point of 10 years, a plate-to-disc distance of less than 5 mm, having spondylosis, and undergoing multilevel fusion were predisposing factors for the occurrence of clinical adjacent-segment pathology. Nevertheless, the incidence of clinical findings of adjacent-segment pathology was much lower than the incidence of radiographic findings. Also, the rate of follow-up surgery was low. Therefore, anterior cervical discectomy and fusion using cervical plates can be considered a safe and effective procedure.

New posterior column reconstruction using titanium lamina mesh after total en bloc spondylectomy of spinal tumour.

PURPOSE: To investigate the usefulness of titanium lamina mesh for posterior column reconstruction after total en bloc spondylectomy in patients with spinal tumour and evaluate the radiographic outcomes of this method. METHOD: Eight patients who underwent total en bloc spondylectomy with posterior column reconstruction using titanium lamina mesh and bone graft to treat a spinal tumour were included in this study. The mean age at the time of surgery was 50.6 years (range, 16.5-70.9 years) and the mean follow-up duration was 50.2 months (range, 28.1-68.7 months). The pathological lesions were located from the T2 to L1 vertebrae. There were four patients in each primary and metastatic tumour group. For the posterior column reconstruction, titanium lamina mesh was used and bone graft was applied over the lamina mesh. Radiographic evaluation was used to investigate the displacement of lamina mesh and union of the grafted bone above lamina mesh. RESULTS: At the postoperative six month follow-up, a bony bridge on the titanium mesh between upper and lower adjacent lamina was observed in all cases, except for one with infection. On the last follow-up, there was no collapse or displacement of titanium lamina mesh, and there was no instability or malalignment of the spinal column. CONCLUSIONS: Posterior column reconstruction using titanium lamina mesh during total en bloc spondylectomy for spinal tumour was a useful surgical option that provided new lamina reconstruction for stability of spinal column and protection of the neural elements.

Multicentric giant cell tumor in adolescents: three case reports.

The presentation of multicentric giant cell tumor in adolescents with an open physis is very rare. We report three cases of a multicentric giant cell tumor of the bone in adolescents, and a review of the literature is also presented.

Extraskeletal mesenchymal chondrosarcoma in the axillary region: reports of two cases.

Extraskeletal mesenchymal chondrosarcomas (EMCs) are relatively uncommon, and a location in the upper extremity, especially in the shoulder or axillary region, is rare. Furthermore, the radiographic findings of EMCs do not show any features that distinguish them from other neoplasms, and therefore, definitive diagnoses are made based on histological features. EMC is an aggressive tumor with a poor prognosis, and requires wide surgical excision. However, its treatment may involve peculiarities such as a difficulty in obtaining a proper surgical margin in the axillary region or shoulder. In this report, the authors present two rare cases of EMCs in the axillary region.