Burak Akesen

Approach to supracondylar humerus fractures with neurovascular compromise in children

OBJECTIVE The aim of this study was to evaluate neurovascular compromise in childhood Gartland Type 3 supracondylar humerus fractures (SHFs), identify the factors correlated with increased need of open reduction and compare the clinical outcome of anterior open reduction with that of closed reduction. METHODS The study included 65 patients (46 male, 19 female; mean age: 7.03 years, range: 1 to 14 years) treated surgically for SCH fracture between January 2002 and June 2008. Fractures underwent closed reduction with percutaneous pinning when possible. Open reduction was performed when adequate reduction via the closed technique failed or vascular compromise were indications for open reduction. Patient demographics, physical examination findings, adequacy of reduction, functional and cosmetic outcomes were assessed. RESULTS During the antecubital approach, vascular pathology was noted in all patients with signs of vascular compromise at physical examination. Half of these patients underwent vascular intervention. Closed reduction failed in 93% of patients with concomitant edema, ecchymosis and dimple sign. Of these, the median nerve was trapped between the bone fragments in 4 patients with normal neurological examinations. Functional and cosmetic results of open reduction were similar to closed reduction (p>0.05). CONCLUSION Closed reduction should not be forced in cases with marked edema, ecchymosis, dimple sign, and absence of radial pulse. The anterior approach is the surgical approach of choice due to direct visualization of neurovascular bundle and availability of neurovascular intervention by extending the same approach.

The comparison of the negative effect of autoclaving and pasteurization on bone healing

OBJECTIVES The aim of this study was to compare the effects of autoclaving and pasteurization on bone healing. METHODS Twenty-five full-grown male rabbits were included in the study; all 25 had bone blocks resected and reimplanted. In group 1, bone blocks were autoclaved; in group 2, bone blocks were pasteurized; and in group 3 (controls), resected bone blocks were reimplanted without sterilization. RESULTS Heiple scores of the proximal parts of the fusion surfaces in group 1, group 2, and group 3 were 12.8±0.4, 6.8±1.2, and 10.2±1.9, respectively. Heiple scores of the distal parts of the fusion surfaces in group 1, group 2, and group 3 were 10.8±0.8, 6.0±1.1, and 9.8±1.5, respectively. Differences in radiologic scores were not statistically significant between the groups for proximal or distal fusion surfaces at 3 and 6 weeks. CONCLUSION In conclusion, pasteurization has a less negative effect on bone healing than autoclaving, and can be considered for bone sterilization in certain circumstances.

Traumatic Lumbosacral Spondyloptosis: A Case Report and Review of the Literature

Study Design Case report and review of the literature. Objective To report a case of traumatic L5–S1 spondyloptosis and review the literature. Method A 28-year-old man presented with severe low back pain, numbness at the soles of feet, and bowel and bladder dysfunction. Two days before admission, a tree trunk fell on his back while he was seated. A two-stage posterior-anterior procedure was performed. At the first stage, posterior decompression, reduction, and fusion with instrumentation were performed. At the second stage, which was performed 6 days after the first stage, the patient underwent anterior lumbar interbody fusion. The patient received physical therapy 1 week after the second stage. Results The patients numbness improved immediately after the first posterior surgery. His fecal and urinary incontinence improved 6 months after discharge. He has been pain-free for a year and has returned to work. Conclusion A PubMed search was performed using the following keywords: lumbosacral spondyloptosis, lumbosacral dislocation, and L5–S1 traumatic dislocation. The search returned only nine reported cases of traumatic spondyloptosis. Traumatic spondyloptosis at the lumbosacral junction is a rare ailment that should be suspected in cases of high, direct, and posterior impact on the low lumbar area, and surgical treatment should be the standard choice of care.

Comparison of hemiarthroplasty and total hip arthroplasty in elderly patients with displaced femoral neck fractures

Objective This study was performed to compare the clinical and radiological outcomes of displaced femoral neck fractures (FNFs) treated with either hemiarthroplasty or total hip arthroplasty (THA) in elderly patients. Morbidity and mortality were also evaluated. Methods Twenty-two patients who underwent hemiarthroplasty and 16 patients who underwent THA for treatment of Garden type 3–4 FNFs from 2012 to 2015 were enrolled in this study. All patients were >65 years of age. Cox regression analysis was performed for mortality evaluation. Results The postoperative blood loss volume, decrease in the hemoglobin level, and transfusion rate were significantly higher in the THA group. The univariate mortality risk was higher in patients with a Charlson comorbidity score of >4, American Society of Anesthesiologists score of >2, Singh index of <3, and postoperative hospitalization of >1 week. Conclusion This study revealed no significant difference in the short-term clinical and radiological results between cementless hemiarthroplasty and THA in elderly patients with displaced FNFs. However, morbidity and mortality were associated with the presence of additional systemic diseases. THA is the preferred surgical technique in patients with displaced FNFs and low comorbidities.

The comparison of the results after spinal fusion with or without iliac screw insertion in the treatment of neuromuscular scoliosis

Introduction Neuromuscular scoliosis leads to a wide range of spinal disorders which disturb the musculoskeletal system. The aim of this study is to compare the clinical and radiological results of posterior spinal fusion with and without extending the instrumentation to iliac bones in treatment of neuromuscular scoliosis. Methods Medical records and radiographies of 36 patients with neuromuscular scoliosis who underwent posterior instrumentation between 2011 and 2015 were reviewed. Age and body mass index at time of surgery, underlying diagnosis, gender, postoperative infection rates, perioperative and postoperative blood transfusion, duration of surgery, complication rates were identified for each patient retrospectively. SF-36 physical questionnaire was applied to all patients. Surgery was performed in each patient and included posterior spinal fusion with pedicle screws from the proximal thoracic spine (T2 or T3) to S1 (Group A) or extension of distal instrumentation to pelvis by bilateral iliac screws (Group B). Results A total of 23 patients in group A were compared with 13 patients in group B. Median age was 14 (9–38) years for group A and 16 (12–25) years for group B. Median follow-up period was 20 (12–66) months. Preoperative median Cobb angles were 66° and 60° and postoperative Cobb values were 33° and 31° in group A and B respectively. Median Cobb angle reduction was 40° and 34° for group A and B. We are able to see in this study that the usage of illiac screws do not increase implant failure and help achieve better functional results. Conclusion This study shows that the extention of instrumentation to the pelvis with illiac screws can be beneficial in terms of functional and complicational incidences. Level of evidence: Level III, therapeutic study.

Evaluation of the Shoulder Imbalance Angular Parameters and the Usage of Midtrapezial Angle Clinically and Radiologically in Adolescent Idiopathic Scoliosis (AIS) Cases

Introduction Evaluating AIS patients with shoulder imbalance, radiologic angular parameters generally used are: radiographically costoclavicular intersection angle (CCA), angle of the line connecting the coracoids (Corac), the angle of line connecting the upper limit of the first costal angle (FRA), and the tilt angle of the first thoracic vertebra line (T1T). The angles shown on digital photographs are axillary folds line (ax), deltoids peak line (d) and midtrapezial line angle (tra) between the horizontal line. Material and Methods A total of 29 cases with AIS are separated into two groups, having distance of horizontal lines drawn from coraciods with 2cm shoulder height differences (SHD) and others. Statistics; paired-samples t-test or wilcoxon tests are used depending on normalization of variables. For each variable ROC analysis is performed. Pearsons correlation analyses used with the changes of shd valvues for each parameter. Results Sensitivity of ax is the highest value with 90% than to tra and cca of 80%. Tra and cca angles has highest spesifity valvues with 63.16% than to ax of 57,89%. All radiologic parameters changes found strongly correlated with the changes of shoulder height differences. Conclusion The mid trapezial and axillary fold angles over 2,8 and 2,9 degrees respectively is found in shoulder imbalance by cosmetic parameters. The costoclavicular intersection angle over 4 degree is found to be the radiologic shoulder imbalance parameter for ais. These cut off valvues can be usefull for determining the the shoulder imbalance for selection of upper enstrumantation levels in AIS. Midtrapezial angle can be used as a parameter of clinical cosmetic shoulder imbalance in adolescent idiopathic scoliosis. Axillary fold angles and costoclavicular intersection angle can also helpfull for defining shoulder imbalance in adolescent idiopathic scoliosis.