Emin Alici

A new method to measure vertebral rotation from CT scans

Abstract CT measurement methods have good reliability for idiopathic scoliosis transverse plane deformity evaluation. However, because of application difficulties and variations in how these methods are applied, more sensitive methods are needed. This paper presents a new method for measurement of vertebral rotation from tomographic scans. First, the method was subject to clinical, intra-observer and inter-observer analysis. Twenty-three patients with adolescent idiopathic scoliosis were studied to test the clinical reliability of this method. There were no statistical differences between the results of the new method and Ho’s method (P = 0.3380) in the clinical study. Intra-observer and inter-observer analysis showed that this method was reliable. An experimental study was then conducted to show the confidence limits of our new method, which were found to be ± 1.6°, and there was no significant difference between the mean rotation value obtained from CT scans using our new method and that obtained using the mechanical method. These results suggest that our new method is a simple, practical and reliable method for measurement of vertebral rotation from CT scans.

Treatment of cubitus varus using the Ilizarov technique of distraction osteogenesis

Seven children with a post-traumatic cubitus varus deformity were treated using the Ilizarov technique of distraction osteogenesis. The outcome was rated as excellent in each case and all were satisfied with the cosmetic appearance. No complications had been encountered by the latest follow-up at a mean of 66.7 months. This technique seems reliable for the treatment of such deformities, provided that it achieves full correction by gradual distraction. Nerve palsy and unsightly scars are avoided, and the range of movement of adjacent joints is preserved.

Thoracic duct variations may complicate the anterior spine procedures

The aim of this study is to localize and document the anatomic features of the thoracic duct and its tributaries with special emphasis on the spinal surgery point of view. The thoracic ducts were dissected from nine formaldehyde-preserved male cadavers. The drainage patterns, diameter of the thoracic duct in upper, middle and lower thoracic segments, localization of main tributaries and morphologic features of cisterna chyli were determined. The thoracic duct was detected in all cadavers. The main tributaries were concentrated at upper thoracic (between third and fifth thoracic vertebrae) and lower thoracic segments (below the level of ninth thoracic vertebra) at the right side. However, the main lymphatic tributaries were drained into the thoracic duct only in the lower thoracic area (below the level of the tenth thoracic vertebra) at the left side. Two major anatomic variations were detected in the thoracic duct. In the first case, there were two different lymphatic drainage systems. In the second case, the thoracic duct was found as bifid at two different levels. In formaldehyde preservation, the dimensions of the soft tissues may change. For that reason, the dimensions were not discussed and they may not be a guide in surgery. Additionally, our study group is quite small. Larger series may be needed to define the anatomic variations. As a conclusion, anatomic variations of the thoracic duct are numerous and must be considered to avoid complications when doing surgery.

Iliolumbar veins have a high frequency of variations.

The spectrum of individual anatomic variations of the vascular structures are broad, however, the exact incidence of variations of the lumbosacral vein is obscure. In the current study, 38 iliolumbar veins were dissected from 19 formaldehyde-preserved male cadavers. The drainage pattern of the iliolumbar vein was determined. The diameter and the length of the iliolumbar vein were measured, and the relationships of the iliolumbar vein with the lumbosacral trunk, obturator nerve, and iliolumbar artery were ascertained. Means and standard deviations were used as descriptive measures to define variations among the cases. The iliolumbar vein or veins were detected in both sides of all 19 cadavers. Five drainage patterns were seen between the iliolumbar vein and the lumbosacral major veins. In only five cadavers, symmetric drainage patterns were seen on the left and the right sides. In our study, two drainage patterns were seen that were not previously reported. Anatomic variations of the iliolumbar vein are numerous and should be considered to avoid complications when doing surgery.

A New Method for Detecting Pedicular Wall Perforation During Pedicle Screw Insertion

Study Design. Sensitivity, specificity, and predictive value analyses of a method that can be used to detect pedicular wall perforation during pedicle screw insertion were assessed. Objective. To determine the accuracy of observing the fatty material expelled during pedicle screw insertion for detecting pedicular wall perforations. Summary of Background Data. Although many methods for safe and accurate insertion of a pedicle screw are described, the rates of misplacement still are high, and complications may occur from improper placement of pedicle screws. Computer-assisted insertion techniques are reported to be very accurate, but these techniques are not yet commonly available. Methods. In this study, 74 pedicle screw insertions were observed for the material expelled after drilling for the pedicle screw. The outflows of blood and fatty particles were recorded separately. The position of the pedicle screws after surgery was verified by computed tomography. The specificity, sensitivity, positive and negative predictive values, and kappa statistics were assessed. Results. Visible fatty particles were observed during 51 pedicle screw insertions. The histologic analysis showed that the fatty particles were coming from the bone marrow of the corpus. For the observation of fatty particles in detecting perforations along the pedicle screw pathway, the specificity was 98%, the sensitivity 73%, the positive predictive value 84%, the negative predictive value 95%, and the kappa statistic 0.74. Conclusions. The observation of fatty particles in the blood that comes out after drilling for the pedicle screw may indicate that there is no perforation along the pedicle screw pathway. The observation is easy to perform and does not require any special instruments. Therefore, it can be used alone or in combination with other methods to improve the accuracy of pedicle screw insertion.

Bilateral trochanteric fractures of the femur in a patient with chronic renal failure.

Abstract We report a spontaneous intertrochanteric fracture with bilateral avulsion of the greater trochanter in a patient with chronic renal failure.Résumé Nous rapportons une cas de fracture intertrochantérienne spontanée avec avulsion bilatérale du grand trochanter chez un malade insuffisant rénal chronique.

Reliability of the Radiographic Union Score for Tibial Fractures

OBJECTIVE The aim of this study was to investigate the correlation between the recently developed Radiographic Union Score for Tibial Fractures (RUST) scoring system and clinical outcomes in tibial fractures. METHODS The study included 41 patients with tibia shaft fractures who underwent intramedullary nailing between 2005 and 2010. Mean follow-up period was 26.32 (range: 12 to 48) months. Clinical outcomes were measured using the Karlström-Olerud physical function scale, VAS score and SF-36 physical function and pain scores during follow-up. RUST scores were noted after radiological evaluation. RESULTS RUST scores accurately reflected healing and union of the bone (p<0.05). RUST scoring also showed significant correlation with widely used physical and pain scoring systems (SF-36, VAS and Karlström-Olerud). CONCLUSION The RUST scoring system appears to be a reliable tool for the evaluation of clinical outcomes in management of tibial fracture.

Task-based learning programme for clinical years of medical education.

CONTEXT Task-based learning (TBL) is an educational strategy recommended for the later years of the medical education programme. The TBL programme was adopted for clinical years in the 2000-2001 academic year in Dokuz Eylul University School of Medicine (DEUSM). OBJECTIVE The aim of this paper is to describe the TBL programme of DEUSM. METHODS DEUSM outlined 50 clinical tasks for fourth-year students and 37 for fifth-year students. The tasks were grouped into four and five blocks. Interdisciplinary practicals, lectures and patient visits were organised in each tasks schedule. The tasks were the focus of learning and each discipline contributed its own learning opportunities to the attached tasks. Formative and summative methods were used to evaluate the programme. CONCLUSION Based on the experience and feedback provided by the students and trainers, the authors considered TBL an applicable and advisable approach for the clinical years of medical education.

Treatment of displaced, proximal, humeral, epiphyseal fractures with a two-prong splint

To evaluate the use of a two-prong splint for displaced, proximal, humerus, epiphyseal fractures, seven children with Neer-Horwitz Classification Type 3–4 fractures of the proximal humerus were retrospectively investigated. After closed reduction, fracture stabilization was accomplished with the use of a two-prong splint, and at an average follow-up of 54 months (range 48–62 months), all children were evaluated radiographically and functionally. There were no complications, and all patients had full painless range of shoulder and elbow motion, without malunion, joint incongruity, nonunion, avascular necrosis, and limb-length discrepancy. The results did not change over time. Treatment of displaced, proximal, humeral, epiphyseal fractures with a two-prong splint gives satisfactory results while allowing immediate motion and gradual reduction of the fragments without anesthesia, and it may be the treatment of choice for such injuries in children.

Apical instrumentation alters the rotational correction in adolescent idiopathic scoliosis.

Abstract. The aim of this study was to retrospectively evaluate the effect of apical vertebral instrumentation in the axial plane in the surgical treatment of idiopathic scoliosis. Seventy-six consecutive patients with King type II idiopathic scoliosis, treated with posterior spinal instrumentation, were included in the study. The mean age of the patients was 14.5 years (range 10–18 years), and the mean follow-up was 49 (range 28–74) months. Preoperative radiological evaluation was performed with postero-anterior, lateral, traction and side-bending radiographs. Vertebral rotation was measured with a Perdriolle torsion meter. Patients were retrospectively divided into two groups according to the presence of apical vertebra instrumentation. Group 1 consisted of 43 patients in whom the upper and lower neutral and intermediate vertebrae of thoracic curves had been instrumented on the concave side. Group 2 consisted of 33 patients who had received instrumentation of the apical vertebra on the concave side in addition to the instrumentation configuration of group 1. Posterior fusion was added in all patients. Cobb and Perdriolle measurements were compared between the two groups preoperatively and at the last follow-up. Preoperative age and gender distribution, Cobb angle and rotational measurements, and correction ratios on side-bending films were similar in the two groups. Although the differences between the two groups in preoperative mean values of both Cobb angle and apical rotation were not statistically significant (P>0.05), mean values of apical rotation were significantly different postoperatively (P<0.05). At the same time, apical derotation ratios differed significantly between the two groups (P=0.000). We conclude that instrumentation of the apical vertebra provides better derotation at the apex.