Ali Öznur

Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure?

Study Design. A prospective, randomized study comparing two treatment methods for thoracolumbar burst fractures: short-segment instrumentation with transpedicular grafting and the same procedure without transpedicular grafting. Objective. To evaluate the efficacy of transpedicular grafting in preventing failure of short-segment fixation for the treatment of thoracolumbar burst fractures. Summary of Background Data. Short-segment pedicle instrumentation for thoracolumbar burst fractures is known to fail early because of the absence of anterior support. Additional transpedicular grafting has been offered as an alternative to prevent this failure. However, there is controversy about the results of transpedicular grafting. Methods. Twenty patients with thoracolumbar burst fractures were included in the study. The inclusion criterion was the presence of fractures through the T11–L3 vertebrae without neurologic compromise. The patients were randomized by a simple method into two groups. Group 1 patients were treated using short-segment instrumentation with transpedicular grafting (TPG) (n = 10), and Group 2 patients were treated by short-segment fixation alone (NTPG) (n = 10). Clinical (Likert’s questionnaire) and radiologic (sagittal index, percentage of anterior body height compression, and local kyphosis) outcomes were analyzed. Results. The two groups were similar in age, follow-up period, and severity of the deformity and fracture. The postoperative and follow-up sagittal index, percentage of anterior body height compression, and average correction loss in local kyphosis in both groups were not significantly different. The failure rate, defined as an increase of 10° or more in local kyphosis and/or screw breakage, was also not significantly different (TPG = 50%, NTPG = 40%, P = 0.99). Conclusions. Short-segment transpedicular instrumentation of thoracolumbar burst fractures is associated with a high rate of failure that cannot be decreased by additional transpedicular intracorporeal grafting.

Closure of central defects of the forefoot with external fixation: a case report

Excision of 1 or more central rays of the foot may complicate soft tissue coverage because large defects may result. The authors presents a technique in which an Ilizarov external fixator was used to narrow the forefoot after resection of the central rays in a patient with diabetes. After external fixator application for 8 weeks, the central defect healed uneventfully and has not shown any recurrence of ulceration after 4 years of follow-up.

Bilateral Peroneal Tubercle Osteochondroma of the Calcaneus: Case Report

A case of bilateral symmetric osteochondroma of the peroneal tubercle in a 24-year-old woman is presented. This lesion is discussed along with its etiology and related findings.

Minimum-Incision Ray Resection

Ray resection for localized necrosis, infection, and osteomyelitis is an accepted procedure allowing removal of the diseased toe and metatarsal. The traditional approach involves a rather lengthy incision and dissection that can compromise the vascular supply to the remaining forefoot. The use of minimum incision techniques to perform metatarsal ray resection as presented here represents a simple, reliable, and easily reproduced procedure that limits soft-tissue dissection and the associated wound healing-related complications inherent to the traditional approach. Following minimum incision metatarsal ray resection, the resultant defect from the toe amputation can be primarily closed, covered with a split-thickness skin graft, or closed in delayed primary fashion with the use of a mini-external fixation device. The authors present the proper indications and a step-by-step guide for performing minimum incision metatarsal ray resection with and without the supplemental use of mini-external fixation to close the soft-tissue defect about the toe amputation site.

A new surgical technique for anteromedial impingement of the talus

Anterior tibial spurs are a common source of ankle pain especially in those who forcefully dorsiflex their ankles such as football players, and runners. However, anteromedial bony impingement syndrome has not been described in the orthopaedic literature. We would like to present a case who had anteromedial impingement syndrome of the ankle. A new technique is also proposed for surgical treatment of anteromedial bony impingement of the ankle.