Corrective Maneuvers Used in Different Scoliosis Deformities With the Experience of 72 Operated Patients.

PURPOSE: This study aimed to show the correction maneuvers used in scoliosis surgery and give hints and tips on achieving optimal correction with the help of visual content. MATERIALS AND METHODS: Seventy-two scoliosis patients with 96 major curves operated between 2011 and 2018 evaluated retrospectively. Seven different correction maneuvers (Ucar convex rod rotation technique, cantilever technique, convex double-rod rotation technique, convex double-rod translation technique, double-rod rotation with coronal bending, convex rod rotation with coronal bending, direct vertebral rotation) were used in these surgeries alone or together. Each method is explained with figures and videos. Type of scoliosis, follow-up time, age, preoperative and postoperative degree of curvature, amount of correction, surgical time, amount of transfusion, hemoglobin level, and hospital stay were evaluated. RESULTS: The mean follow-up was 42.5 (24-108) months, and the mean age was 15.8 (12-29) years. The mean preoperative scoliosis angle of the patients was 75.9 (50-139) degrees, and the final follow-up was 15.6 (5-40) degrees. The scoliotic deformity correction rate was 79.3%. The mean preoperative thoracic kyphosis of the patients was 58.7 (12-110) degrees, and the final follow-up was 41.2 (25-62) degrees. The mean surgical time was 293 (160-440) minutes. The mean hospitalization length was 5.8 (2-21) days. The blood delivered to patients during surgery and postoperative was 715 (300-1800) mL. There was a statistically significant difference between the preoperative and final follow-up scoliosis angle ( P =0.000). CONCLUSIONS: Providing an ideal correction without damaging the spinal cord depends on correctly applying the correction maneuvers. The use of correction maneuvers alone or in combination in the appropriate order will shorten the duration of the case, decrease the amount of bleeding, shorten the hospital stay, increase the amount of correction, and reduce complications.

Is It Difficult to Dominate the Coronal and Sagittal Planes in Convex Rod Rotation Technique? The Effect of the Ucar Convex Rod Rotation Technique.

STUDY DESIGN: Prospective multicenter study. OBJECTIVE: To analyze the effect of the Ucar convex rod rotation technique on coronal and sagittal correction in the treatment of Lenke type I adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Various common curve correction techniques were used in scoliosis. This report describes the efficacy of the global vertebral correction technique with convex rod rotation. MATERIALS AND METHODS: A total of 28 consecutive patients with Lenke type I adolescent idiopathic scoliosis managed with Ucar convex rod rotation technique between October 2012 and September 2015 were included. The average patient age was 14.8 years at the time of surgery. Measurements of curve magnitude and balance were made on standing anteroposterior, and lateral radiographs were taken before surgery, postoperatively, and at the last follow-up to assess deformity correction, spinal balance, and complications related to instrumentation. RESULTS: The average preoperative main thoracic angle was 64.8° and was decreased to 15.5° postoperatively. The average preoperative T4-T12 thoracic kyphosis was 19.6° and was improved to 24.8°. All patients had mildly imbalanced or balanced shoulders at the final follow-up. CONCLUSION: Correction rates in the coronal and sagittal planes were as acceptable as those achieved with conventional methods.

The Use of an "Internal Fixator Technique" to Stabilize Pathologic Fractures Developing Secondary to Osteomyelitis.

BACKGROUND: There is no consensus on the materials and the techniques to use in fixing pathologic fractures secondary to osteomyelitis. This study reports the results of the fixation of pathologic fractures secondary to osteomyelitis using the "internal fixator technique." METHODS: The internal fixator technique was performed on 11 children and adolescents with fractures secondary to osteomyelitis between 2003 and 2010. A retrospective chart review was conducted to record the following: age, sex, the anatomic region of infection, the time delay from symptom onset to fracture, the classification of chronic osteomyelitis, the Cierny-Mader classification, the causative organism, surgeries, the length of hospitalization, the location and the pattern of fracture, the duration of infection, the length of follow-up, and complications. RESULTS: The patients included 7 male and 4 female patients with a mean age of 8.7 (range, 6 to 13) years. Pathologic fractures were as follows: 7 femur and 4 tibia. Nine of them were in the metaphysis and 2 others were located in the diaphysis. The time delay from symptom onset to fracture was 3.36 (1 to 9) months. The anatomic region of infection was the diaphysis in 2 cases and the metaphysis in 9 cases. Fractures patterns were short oblique and transverse. The length of hospitalization was a mean of 7 days. The duration of infection ranged from 1 to 12 (mean, 4.38) months. The mean duration of follow-up was 57.09 (range, 36 to 73) months from the initial presentation. Only 2 patients developed shortening, for which no additional intervention was performed. CONCLUSIONS: This case series demonstrates that the "internal fixator technique" is an acceptable alternative to the management of pathologic fractures of the femur or the tibia in children and adolescents with unresolved acute and chronic osteomyelitis. Infections were resolved in all cases and fractures were sufficiently stabilized to allow union with a low complication rate. LEVEL OF EVIDENCE: Level IV-therapeutic.