Kyphectomy and sliding growing rod technique in patients with congenital lumbar kyphosis deformity with myelomeningocele.

OBJECTIVE: Neural tube defects are the most common congenital disorders after cardiac anomalies. Lumbar kyphosis deformity is observed in 8-15% of these patients. This deformity severely limits the daily lives of these patients. In our study, we aimed to correct the kyphosis angle of the patients with lumbar kyphosis associated with myelomeningocele (MMC) and allow them to continue their growth without limiting their lung capacity by applying kyphectomy and sliding growing rod technique. PATIENTS AND METHODS: In this study, we retrospectively evaluated 24 patients with congenital lumbar kyphosis deformity associated with MMC, aged between 4 and 9 years, and who applied to Umraniye Training and Research Hospital between the dates of 2018 and 2021. We evaluated preoperative and postoperative kyphosis angles, correction rates, bleeding during operations, operation time, level of instrumentation, number of the resected vertebrae, initial levels of the posterior defects, duration of hospital stays, annual lengthening, and weight of the patients. RESULTS: Mean age was 5.04 (between 4 and 9). Mean preoperative and early postoperative kyphosis angles were 129.8° (87-175°) and 0.79° (- 20-24°), respectively. The kyphotic deformity correction rate was 99.1%. A difference was found regarding kyphosis measurements between preoperative and early period values (p < 0.05). The annual height lengthening of patients was calculated as 0.74 cm/year and 0.77 cm/year between T1-T12 and T1-S1, respectively. Mean preoperative level of hemoglobin (Hgb) was 11.95, postoperative Hgb value was 10.02, and the decrease was significant (p < 0.05). In terms of complications, 50% (12) had broken/loosen screws, 50% (12) had undergone debridement surgery, 37.5% (9) had vacuum-assisted closure therapy, and 33.3% (8) had to get all of their implants removed. CONCLUSION: We believe that our sliding growing rod technique is a new and updated surgical method that can be applied in these patient groups, facilitating the life, rehabilitation process, and daily care of MMC patients with lumbar kyphosis. This technique seems to be a safe and reliable method which preserves lung capacity and allows lengthening.

Comparison of the radiological and functional results of a plaster splint and dynamic stabilization splint for Boxer's fractures: A prospective randomized controlled study.

PURPOSE: This study compared the clinical and radiological results of fifth metacarpal neck fractures treated with a short-arm plaster splint (SAPS) versus a dynamic metacarpal stabilization splint (DMSS). MATERIALS AND METHODS: The 119 patients were referred to our institute between 2018 and 2019 and treated with SAPS or DMSS after appropriate initial closed reduction. Follow-up examinations were conducted at days 10 and 20, and at 1, 2, and 3 months after treatment. Alignment of the fracture, range of motion (ROM), and complications were evaluated during each visit. Grip strength was evaluated using a dynamometer. Self-care, usual daily activities, pain/discomfort, and anxiety/depression were evaluated using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) and a VAS. RESULTS: Of the 119 patients, 103 completed all follow up examinations. In total, 51 patients were treated with SAPS and 52 with DMSS. Skin lesions were detected in five patients in the DMSS group, but none in the SAPS group (p = 0.008). The grip strength of patients in the DMSS group was statistically better at the 1-, 2-month and 3-month follow-up visits (p < 0.001). ROM of the interphalangeal and metacarpophalangeal joints were statistically better in the DMSS group at the 1-month visit (p < 0.001) but similar at the 3-month visit (p = 0.27). Wrist ROM was statistically higher in the DMSS group at the 3-month visit (p < 0.05). Self-care, usual daily activities, pain/discomfort, and anxiety/depression were statistically better in the DMSS group at all follow-up visits (p < 0.05), as determined by the EQ-5D-5L. CONCLUSION: Dynamic stabilization of a stable boxer's fracture with DMSS is as effective as static stabilization with SAPS for maintaining the reduction and ensuring union. However, DMSS provides better early ROM, comfort, and muscle strength, as well as an earlier return to usual daily activities despite the occasional skin lesions happened.

Lumbopelvic Fixation with Bridged Distal Iliac Screws for Vertically Unstable Sacral Fractures.

Purpose: The purpose of this study is to evaluate preliminary outcomes of vertically unstable sacral fractures treated by lumbopelvic fixation (LPF) augmented transiliac bridged screws. Methods: From April 2017 to December 2019, fifteen consecutive patients with vertically unstable sacral fractures who had undergone LPF augmented transiliac bridged screws were enrolled. The radiological assessment included standard lumbopelvic x-rays and pelvic computed tomography (CT) to evaluate the lumbosacral angle (LSA), sacral kyphosis angle (SKA), lumbar lordosis angles (LLA) and Matta's reduction criterias (MRC). Clinical and neurologic impairment outcomes were evaluated by the Majeed grading scale (MGS) and Gibbons criterias, respectively. Results: All patients were followed for an average of 18 months (range, 14-25). All sacral fractures eventually healed and implant failure did not occur in any patient, though there were two patients with a loss of reduction (< 5 mm) during the follow-up period. According to the MRC, the results were excellent on 14 sides, good on five sides, and fair on one side. The MGS mean score was 82 points (range, 49-98 points); the results were excellent in nine cases, good in four cases, and fair in two cases. There was no statistically significant difference in SKA and LLA in preoperative and postoperative final controls. The preoperative and postoperative LSA were 72 ± 13.9 and 44.1 ± 11.3, respectively, and a statistically significant improvement was observed (p = 0.01). Conclusion: In vertically unstable sacrum fractures, we believe that LPF augmented with transiliac bridging technique may expedite the reduction of vertical sacrum fracture and offers a reinforced fixation choice.

Extruded disc herniations are experienced earlier by inactive young people in the high-tech gaming era.

In this study, we would like to draw attention to the advanced disc diseases seen in young people. The objective is to investigate the reasons for the increasing trend of disc herniations in young people. A total of 33 young patients with extruded lumbar disc herniations managed by conservative or surgical approaches between 2017 and 2018 were included. The average patient age was 25 years. Smoking, familial predisposition, sporting activity, and the occupation of the patients were questioned and noted. A visual analog scale (VAS) was used to assess the efficacy of pain. Body mass index (BMI) was calculated. All patients were subjected to lumbar magnetic resonance imaging. Eighteen patients (8 females, 10 males) had disc extrusion at the L5-S1 level, whereas 12 patients (8 females, 4 males) had disc extrusion at the L4-L5 level. Three other patients had disc extrusion at the level of both L4-L5 and L5-S1 levels. Motor deficits were detected in four patients, and surgical treatment was required and performed. The other 29 patients were treated conservatively. Young non-sport-oriented patients may face severe disc herniations. Understanding how spine degeneration can affect the likelihood of developing a herniated disc can help people make small lifestyle changes to postpone any serious pain and deficits. While aging is unavoidable, simple lifestyle changes can help improve overall spine health and deter the risk of developing a degenerative spine condition.

Retrospective observational study of intramuscular oxygen-ozone therapy for the treatment of neck pain: cervical paravertebral injection.

Neck pain is one of the major pathologies responsible for loss of labor. Many conservative treatment methods for neck pain have been described. The purpose of this study was to obtain pain scores for patients undergoing paravertebral ozone-oxygen (O3/O2) injections for neck pain caused by cervical disc disease. Over the last 6 months of 2018, 72 patients who undergoing intramuscular O3/O2 injections to treat neck pain were examined retrospectively in this multicenter study. Patients were injected with 30 mL of 20 µg/mL O3/O2 gas (into the paravertebral space). Subjects were treated once a week for 6 weeks. The visual analog scale pain scores and Japanese Orthopedic Association scores were obtained before (pre-injection) and after treatment (i.e., at 2 and 6 months). Significant improvements were observed in visual analog scale and Japanese Orthopedic Association scores at both 2 and 6 months versus the pre-injection scores. There was no significant difference in the visual analog scale or Japanese Orthopedic Association scores between 2 and 6 months. Paravertebral O3/O2 injection is a reliable and effective treatment of neck pain caused by cervical disc disease. The study was approved by Umraniye Education and Research Hospital, University of Health Sciences, Turkey (Reference Number: 00102187854) on September 25, 2019.

Clinical and radiological results of kyphectomy and sliding growing rod surgery technique performed in children with myelomeningocele.

BACKGROUND: The aim of this study was to present clinical and radiological results of myelomeningocele (MMC) patients treated with the sliding growing rod (SGR) technique after kyphectomy. METHODS: Between 2016 and 2019, 30 patients (21 males and nine females) who underwent the SGR technique with kyphectomy and posterior instrumentation due to MMC were retrospectively reviewed. Patients' pre- and postoperative kyphosis, scoliosis, correction rates, bleeding during surgery, blood supply during and after surgery, operation time, instrumentation levels, number of vertebrae removed, MMC onset levels, hospital stay, annual lengthening amounts, and complications were evaluated. RESULTS: The mean patient age was 6.9 (4-10) years. Mean preoperative kyphosis was 115° (87-166°), mean early postoperative kyphosis was 3.9° (20-10°), and final follow-up postoperative kyphosis was 5.1° (22-8°). In nine patients presenting with scoliosis, scoliosis was evaluated as 60.2° (115-35°) preoperative, as 12.9° (32-0°) early postoperative, and 15.7° (34-0°) in the final measurement. The kyphotic deformity correction rate was 96.5%, and the scoliotic deformity correction rate was 74.9%. A statistically significant difference was seen between pre- and early postoperative values in kyphosis and scoliosis measurements (p < 0.05). The annual prolongation of the patients was calculated as averages of 0.72 and 0.77 cm/year between T1-T12 and T1-S1, respectively. CONCLUSION: Kyphectomy performed during the early MMC period patients appears to be an excellent method for facilitating rehabilitation and daily care of these patients. It appears that the SGR technique, which provides lung volume protection and lengthening with kyphectomy, is a safe and reliable method in patients. LEVEL OF EVIDENCE: Level 4.

A new approach for spinal deformity patients with meningomyelocele: reverse Y incision.

We report a new surgical incision for spinal deformity in patients who had undergone meningomyelocele closure surgery. Six patients underwent kifectomy using an inverse Y incision. They all had multiple prior operations in the lumbar region due to dural meningomyeloceles. Four of the patients were girls. The primary indication for the reverse Y incision was a T12 and above posterior fusion defect and a large lumbar posterior fusion defect. These patients included four with kyphoscoliosis, one with lordoscoliosis, and one with lumbar kyphosis. The median age of the patients was 5.52 at the time of operation. The median follow up time was 17.3 months. Under appropriate indication, the reverse Y approach offers a reliable and successful solution for surgery.

Transforaminal Lumbar Interbody Fusion For Lumbar Degenerative Disease: Patient Selection And Perspectives.

Most adults will experience low back pain during their lifetime, with most of these instances resolving or improving without sequelae in a few weeks. For the small number of patients with severe, recalcitrant pain, lumbar fusion may be required, particularly when concomitant leg pain or deformity is present. Lumbar interbody fusion surgery is the usual treatment for degenerative lumbar disease, but it requires a long recovery period. Many surgical techniques have been described in the literature for spondylolisthesis. The main objective is to create interbody fusion, decompression of normal structures and a stable vertebrae. TLIF surgical techniques has a long learning curve. Comorbidities of the patient may make surgery more difficult. Methods such as transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion, anterior lumbar interbody fusion and lateral lumbar interbody fusion are also available for interbody fusion in the literatüre. The aim of this review is to show which patients are more suitable for TLIF surgery and to discuss the advantages and disadvantages of TLIF surgery over other techniques.

The Effect of Paravertebral Ozone Injection in the Treatment of Low Back Pain.

AIM: Paravertebral ozone injection is a new treatment method described in the literature for low back pain. The aim of this study was to compare the pre- and post-treatment pain scores of patients undergoing paravertebral ozone/oxygen (O3 /O2 ) injections for low back pain. METHODS: From September 2018 to December 2018, 122 patients who underwent paravertebral ozone injections due to low back pain were examined retrospectively; 62 patients who met the study criteria were included. The patients were injected with 15 µg/mL (50 mL) O3 /O2 gas in the paravertebral space. The subjects were treated every 7 days for 6 total session. The VAS and Oswestry Disability Index (ODI) scores were assessed before treatment and after treatment (first and third months). The patients' body mass indexes (BMIs) were measured before the injections. RESULTS: There were 12 male patients and 50 female patients. The mean age was 51.9 (range 25 to 71) years. The mean duration of pain was 9.1 (3 to 24) months. Significant improvements were observed in the statistical comparison of VAS and ODI scores between the pre-injection and first month controls (P < 0.000). There was no significant difference in the statistical comparison of VAS and ODI scores between the first and third months (P < 0.05). There was no statistically significant difference between BMI and pain scores (P > 0.213). CONCLUSION: Paravertebral O3 /O2 gas is a reliable and effective treatment for the treatment of lumbar disc herniation, radicular pain, and mechanical back pain due to low back pain.

What every spine surgeon should know about transforaminal lumbar interbody fusion surgery for herniated discs.

PURPOSE: The aim of this study is to report our experiences on managing large lumbar disc herniations with several symptoms by surgery with transforaminal lumbar interbody fusion (TLIF) and to shed light for spine surgeons about TLIF surgery. METHODS: We retrospectively evaluated our database of patients with various lumbar spine pathologies who underwent TLIF surgery from 2014 to 2017. We separated 18 patients who had been operated on for extruded disc herniation, which causes severe pain and radicular symptoms. The pain was quantified by visual analog scores (VAS). The disability status were pre-operatively and post-operatively evaluated by the Oswestry Disability Index (ODI). We evaluated the patients for at least two years. Interbody fusion was detected by routine radiographs at six, 12, and 24 months after surgery. RESULTS: An ODI outcomes analysis demonstrated a statistically significant improvement in the six and 24-month mean scores compared with the pre-operative scores on the same scales. Patients' mobility improved significantly after surgery, as indicated by the decrease in the Oswestry Disability Index from 72 to 23 over two years (p < 0.001). Pain rapidly decreased in all patients and continued to decrease at the time of the latest follow-up. The mean pre-operative VAS scores for pain was 8.8; it had improved to 2.4 after surgery (p < 0.05). Within the follow-up period of two years, the ascertained mean VAS declined from 8.8 to 1.4 (p < 0.001). The average disc space height at the herniated levels was fairly well maintained. No patient had evidence of implant failure. Interbody fusion was graded as definitely solid in 100% of cases two years post-operatively. One patient displayed a superficial wound infection. Following appropriate debridement and antibiotics, the wound healed without sequelae. No major complications were observed, including permanent neurological deficit, pulmonary embolism, peri-operative cardiac event, or death. CONCLUSIONS: The findings of our study and those in the literature showed that primary herniated disc patients with radicular and chronic low back pain, degenerative changes, bi-radicular symptoms, and instability are required to have fusion after a discectomy. Being a heavy-duty worker is also a criterion for fusion surgery. TLIF is performed by a unilateral approach preserving the interlaminar surface on the contralateral side, which can be used as a site for additional fusion. As an effective results TLIF procedure should be chosen for fusion surgery.

Surgical treatment of patients with myelomeningocele-related spine deformities: study of 26 cases.

INTRODUCTION: Scoliosis, kyphosis, and sacral agenesis (SA) are common spine deformities in myelomeningocele (MMC) patients. Surgery of spine deformities in MMC patients is associated with various difficulties as infection, pathological skin breakage, instrumentation failure, and neurological deterioration. The purposes of this study are to share our clinical experience and discuss different surgical techniques which are defined in the literature. PATIENTS AND METHOD: We retrospectively evaluated our database of patients with MMC who underwent surgical procedures for spine deformities from 2014 to 2016. Demographic and clinical data, surgical parameters, surgical techniques and levels, pre- and postoperative deformity angles, level of posterior fusion defect, spinal malformations, neurological evaluation of lower extremities and complications were collated. We divided the cases into three groups according to the type of deformities. The groups were lumbar kyphosis (Group 1), congenital scoliosis (Group 2), and paralytic scoliosis (Group 3). RESULTS: There were 26 patients in the study. Fifteen patients were male and 11 patients were female. The median age of the patients was 8.03 (range = 3-17 years) at the time of operation. There were 10 patients in Group 1, 7 patients in Group 2, and 9 patients in Group 3. In Group 1, preoperative kyphosis angle varied between 51° and 160°, with an average of 95.7°. In Group 2, preoperative Cobb angle varied between 57° and 150°, with an average of 106.6°. Kyphosis was present in 4 patients. Preoperative kyphosis angle varied between 74° and 140°, with an average of 93°. In Group 3, preoperative Cobb angle varied between 45° and 145°, with an average of 72.5°. CONCLUSION: Spinal deformity in children with MMC has been considered to cause severe disability. Surgical treatment is a challenging procedure with a wide spectrum of complications, but can provide good correction of spinal deformity and pelvic obliquity, and improve the quality of life. Self-growing systems which are a new alternative to traditional growing rod systems, must be considered to preserve growing potential of spine.

Hemimetameric shift in spina bifida: three case reports.

PURPOSE: Hemivertebrae is the most frequent reason of congenital scoliosis, and hemimetameric shift is a finding, which is characterized by two hemivertebraes located contralateral, with at least one normal vertebra between them. Embryologically, hemivertebrae is caused by delay in somite movements and as a result, a total vertebral shift occurs because of mismatches in the following segments. Hemimetameric shift accompanying spina bifida is described as extremely rare. There are only two case series of hemimetameric shift in literature but no spina bifida patient was reported in these series. METHODS: We report three cases of hemimetameric shift with spina bifida with their detailed clinical and radiological evaluations. RESULTS: Case 1 is a 3-year-old congenital scoliosis patient with tethered cord. She has mild scoliosis with a very demonstrative hemimetameric shift. Case 3 is an infant with multiple-level hemivertebrae anomalies and hemimetameric shift who had myelomeningocele closure and ventriculoperitoneal shunt installation neonatally. Case 3 is a 9-year-old male who had operated for myelomeningocele in the neonatal period. He had evident scoliosis with cervicothoracic hemimetameric shift and he is the only patient we operated for prominent scoliosis. CONCLUSIONS: The present classification of hemimetameric shift was described by Kawakami et al. in 2009. It is based on development of anterior and posterior hemivertebrae segments but we think it is not suitable for patients with posterior fusion defects such as spina bifida patients. Spina bifida patients with scoliosis and hemimetameric shift are a rare but important patient group to evaluate in terms of understanding scoliosis patients with neural tube defects.

A new corrective technique for adolescent idiopathic scoliosis (Ucar's convex rod rotation).

STUDY DESIGN: Prospective single-center study. OBJECTIVE: To analyze the efficacy and safety of a new technique of global vertebral correction with convex rod rotation performed on the patients with adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Surgical goal is to obtain an optimal curve correction in scoliosis surgery. There are various correction techniques. This report describes a new technique of global vertebral correction with convex rod rotation. MATERIALS AND METHODS: A total of 12 consecutive patients with Lenke type I adolescent idiopathic scoliosis and managed by convex rod rotation technique between years 2012 and 2013 having more than 1 year follow-up were included. Mean age was 14.5 (range = 13-17 years) years at the time of operation. The hospital charts were reviewed for demographic data. Measurements of curve magnitude and balance were made on 36-inch standing anteroposterior and lateral radiographs taken before surgery and at most recent follow up to assess deformity correction, spinal balance, and complications related to the instrumentation. RESULTS: Preoperative coronal plane major curve of 62° (range = 50°-72°) with flexibility of less than 30% was corrected to 11.5°(range = 10°-14°) showing a 81% scoliosis correction at the final follow-up. Coronal imbalance was improved 72% at the most recent follow-up assessment. No complications were found. CONCLUSION: The new technique of global vertebral correction with Ucar's convex rod rotation is an effective technique. This method is a vertebral rotation procedure from convex side and it allows to put screws easily to the concave side.

The effect of hyperbaric oxygen therapy on fracture healing in nicotinized rats.

BACKGROUND: The aim of the present study was to investigate the effect of hyperbaric oxygen therapy on fracture healing in nicotinized rats. METHODS: Thirty-two rats were divided as follows: nicotinized group (1), hyperbaric oxygen group (2), nicotinized + hyperbaric oxygen group (3), and control group (4). For 28 days, nicotine was administered in Groups 1 and 3. Then, a standard shaft fracture was induced in the left femur of rats. Groups 2 and 3 underwent hyperbaric oxygen therapy for 21 days. At the end of the experiment, fracture site, left femur and whole body bone mineral content and density were measured. RESULTS: The radiological and histopathological scores of Group 1 were statistically significantly lower compared to Groups 2, 3 and 4, and there was no statistically significant difference between the Groups 2, 3 and 4. In a comparison between the groups, no statistically significant difference was found in terms of bone mineral content and density values measured at the fracture site, left femur and whole body. CONCLUSION: The negative effects of nicotine on fracture healing are eliminated with hyperbaric oxygen therapy, but hyperbaric oxygen alone does not cause significant changes in healing (radiologically and histopathologically).

Salter pelvic osteotomy in the treatment of Legg-Calve-Perthes disease: the medium-term results.

In this study, clinical and radiological results were evaluated in patients with Legg-Calve-Perthes disease treated with Salter pelvic osteotomy. Between 2004 and 2008, 16 patients underwent a Salter osteotomy as treatment for Legg-Calve-Perthes disease (15 male, 1 female; 10 right hip, 6 left hip). The mean age at the time of surgery was 8.1 +/- 1.4 (range: 6 to 10) years. Surgical indications were : age between 6-10 years at the onset of the disease; Herring classification type B, B/C, or C; and at least one risk sign. 6-8 year old patients were classified as group I and 9-10 year olds were classified as group II. We investigated the effects of age and Herring classification on radiological outcomes. The final radiographic evaluation according to the Stulberg classification showed nine hips (56.25%) classified as good (Stulberg I/II), five (31.25%) as fair (Stulberg III); and two (12.5%) as poor (Stulberg IV). In group I, 7 patients (70%) had good results, while only 2 (33.3%) in group II. The results in group I were statistically better than group II (p < 0.05). Based on the Herring lateral pillar type, of the 12 patients classified as B or B/C, at final follow-up, 8 (66.6%) had a good outcome (Stulberg I/II), whereas in the four patients classified as type C, only one (25%) had a good outcome. The Salter pelvic osteotomy is an effective method of surgical treatment for Legg-Cave-Perthes in patients between 6-8 years of age.

Anterior Glenohumeral Instability: Classification of Pathologies of Anteroinferior Labroligamentous Structures Using MR Arthrography.

We examined labroligamentous structures in unstable anteroinferior glenohumeral joints using MR arthrography (MRA) to demonstrate that not all instabilities are Bankart lesions. We aimed to show that other surgical protocols besides classic Bankart repair are appropriate for labroligamentous lesions. The study included 35 patients (33 males and 2 females; mean age: 30.2; range: 18 to 57 years). MRA was performed in all patients. The lesions underlying patients' instability such as Bankart, anterior labral periosteal sleeve avulsion (ALPSA), and Perthes lesions were diagnosed by two radiologists. MRA yielded 16 diagnoses of Bankart lesions, 5 of ALPSA lesions, and 14 of Perthes lesions. Albeit invasive, MRA seems to be a more reliable and accurate diagnostic imaging modality for the classification and treatment of instabilities compared to standard MRI.

Titanium elastic intramedullary nailing: closed or mini-open reduction?

The authors retrospectively studied 43 children with femoral fractures, treated with titanium elastic nailing (TEN). Twenty-two underwent closed fluoroscopic reduction ( Group I), whereas the other 21 underwent mini-open reduction (Group II). The operation time averaged 71 minutes in group I, and 48 minutes in group II (p < 0.001). The mean fluoroscopy time was 793 seconds in group I, and 35.5 seconds in group II (p <0.001). However, blood loss and hospital stay were significantly higher in group II (p < 0.001 and p = 0.001 respectively). Time to full weight bearing, time to radiographic union and TEN outcome score did not differ significantly. Overall, no one technique was really superior. From a practical viewpoint, a mini-open reduction may be decided intra-operatively if closed reduction proves to be problematic. This decreases intra-operative radiation and length of the surgical procedure.

Open reduction and Kirschner wire fixation with triceps lengthening for neglected elbow dislocations.

PURPOSE. To evaluate outcome of open reduction and Kirschner wire fixation with triceps lengthening for neglected elbow dislocations. METHODS. Records of 6 women and 14 men aged 7 to 60 (mean, 20) years who underwent open reduction and Kirschner wire fixation with triceps lengthening for neglected elbow dislocations were reviewed. The dislocations were posterolateral (n=11), posterior (n=4), and posteromedial (n=5). No patient had a neurologic deficit. Elbow stiffness was the main indication for surgery. The duration of dislocation was 25 to 45 days in 11 patients and >45 days in 9; the mean was 47 days. The Mayo Elbow Performance Index (MEPI) was used to assess outcome at the final follow-up. The maximum score was 100. Scores of 90 to 100 were considered excellent, 75 to 89 good, 60 to 74 fair, and <60 poor. RESULTS. The mean follow-up period was 39.1 months. At the final follow-up, the mean MEPI score was 79.3; outcome was excellent in 6 patients, good in 8, fair in 4, and poor in 2. The mean MEPI was 86.4 and 70.6 for patients with ≤45 or less and >45 days of dislocation, respectively. The mean range of movement improved from 20 to 84.5 degrees (p<0.001). The 2 groups were significantly different in terms of MEPI (p=0.005) and range of movement (p=0.001). The MEPI correlated negatively with the duration of dislocation (r= -0.562, p=0.01). The range of movement correlated negatively with patient age (r= -0.649, p=0.002). CONCLUSION. Open reduction and Kirschner wire fixation with triceps lengthening, together with active postoperative elbow movements achieved favourable results for neglected elbow dislocations, especially in younger patients and those in whom the duration of dislocation was <45 days.

Nonunion of the medial cuneiform: a rare case.

Isolated medial cuneiform fractures are quite rare. Conservative treatment is adequate in most cases, while deplaced or unstable fractures are treated surgically. Nonunion is seen extremely rarely after medial cuneiform fractures. There is only one case report in the literature. This case presented here is a 62-year-old male patient who had an isolated medial cuneiform fracture resulting from the impact of a falling metal object. Conservative treatment was performed initially. The patient was diagnosed as nonunion after physical and radiological examinations nine months after he presented to the outpatient clinic. Internal fixation with a mini plate and one staple after reduction was performed surgically. Defective region was filled with a 2 mL of autograft, and the operation was terminated.

Effectiveness of locking versus dynamic compression plates for diaphyseal forearm fractures.

This study compares the results of the locking compression plate (LCP) and the dynamic compression plate (DCP) in the treatment of diaphyseal forearm fractures in adults and defines the indications for the use of the LCP. Forty-two patients with diaphyseal forearm fractures were retrospectively analyzed. Of those, 22 had been treated with the LCP (LCP group) and 20 had been treated with the DCP (DCP group). The AO/ASIF classification was used to classify the fractures. Patients were assessed using the Grace-Eversmann criteria and the Disabilities of the Arm and Shoulder and Hand questionnaire during the final follow-up. Mean follow-up was 21 months (range, 20-24 months) in the LCP group and 23 months (range, 19-26 months) in the DCP group. Union was achieved in all patients. Mean time to union was 15 weeks (range, 12-25 weeks) in the LCP group and 17 weeks (range, 13-24 weeks) in the DCP group. In each group, 1 patient experienced delayed union, which required no additional surgical intervention. No significant difference was found regarding the time to union between the groups (P>.05). No significant difference existed between the 2 groups in terms of Grace-Eversmann criteria and Disabilities of the Arm and Shoulder and Hand scores (both P>.05). The results of these different fixation methods for forearm fractures in adults are similar. As such, the correct selection and application of surgical technique is more important than the type of plate used.