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Long segment instrumentation of thoracolumbar burst fracture: fusion versus nonfusion.

OBJECTIVE The treatment of thoracolumbar burst fracture is a controversial issue. Although spinal fusion has been a touchstone of spinal fixation, nonfusion technique have become raising its popularity recently. Some studies suggested that nonfusion had several advantages over fusion. The aim of this prospective study was to compare long segment posterior instrumentation with fusion versus long-segment posterior instrumentation without fusion. METHODS For this purpose, 42 consecutive patients were assigned to two groups. Group 1 included 21 patients treated by long segment instrumentation with fusion (WF), whereas Group 2 included 21 patients treated by long segment instrumentation without fusion (WOF). Long segment instrumentation was hook fixation (claw hooks attached to second upper vertebra and infralaminar hooks attached to first upper vertebra) above and pedicle fixation (pedicle screws attached to first and second lower vertebrae) below the fractured vertebra. RESULTS Measurements of local kyphosis, sagittal index and anterior vertebral height compression showed that both group had similar outcome at final follow-up. Moreover, there was no difference between the two groups according to low back outcome score. Also, implant failure rate (4.7%) was quite low in both groups. However, WF group had prolonged operative time, increased blood loss and donor site morbidity. CONCLUSIONS Radiological and clinical parameters demonstrated that spinal fusion is not necessary in long segment posterior instrumentation for the management of thoracolumbar burst fractures.

Extracorporeal shock wave treatment for defective nonunion of the radius: a rabbit model.

Purpose. To investigate the effect of extracorporeal shock wave treatment (ESWT) on bony union using volume analysis of the callus mass by computed tomography and histology. Methods. Both radii of 13 rabbits were osteotomised and a defective bony nonunion created by placing a polyethylene pad between the osteotomy site for 40 days. Nonunion was confirmed by radiography using Lane-Sandhu criteria. ESWT (14 kW, 0.46 mJ/mm2, 1000 shock waves) was applied to the right radius of the rabbits. The left radius served as a control. Five rabbits were killed 4 weeks after ESWT (group 1) and 8 after 6 weeks (group 2). Volume analysis of the callus mass was performed using computed tomography and the bone healing process was assessed by histology. Results. In group 1, callus volume on the treated side was invariably greater than that on the control side; the difference being statistically significant (p=0.032). In group 2, the callus volume of the treated side was greater than that of the control side, except in rabbits 4 and 9. Only after excluding the findings from the latter did the difference attain statistical significance (p=0.020). Histology confirmed that the bone-healing process was faster in the treated side. Conclusion. ESWT enhanced the bone-healing process by increasing both volume and speed of callus formation.

School screening for scoliosis in Sivas, Turkey

OBJECTIVES We investigated the prevalence of scoliosis among primary school students in Sivas, Turkey. METHODS To determine the prevalence of scoliosis among primary school students in the age bracket of 10 to 15 years, 11 primary schools were selected with systematic sampling. A total of 3,175 students (1,538 girls, 1,637 boys) of grades 6 to 8 were selected from 16,103 students using a stratified sampling method. Examination for scoliosis was made by the forward bend test and palpation of the spine. RESULTS Fifteen children (0.47%) were found to have scoliosis, including 10 girls (66.7%) and five boys (33.3%). The prevalence of scoliosis was significantly higher in girls (0.65% vs. 0.31%; p<0.05). The mean lateral curvature of the spine was 6.9 degrees (range 5 degrees to 20 degrees ), being 7.9 + or - 4.6 degrees in girls, and 5.4 + or - 0.9 degrees in boys. The mean age was 13.5 + or - 1.2 years (range 12-15 years). The severity of the curvature showed no significant relationship with gender and age groups (p>0.05). The levels of involvement were lumbar vertebrae in 73.3% (n=11), thoracic vertebrae in 13.3% (n=2), and thoracolumbar vertebrae in 13.3% (n=2). Spinal curvature was to the right side in 12 cases (80%), and to the left in three cases (20%). Girls and boys did not differ significantly with respect to the severity and direction of the curvature (p>0.05). During a two-year follow-up of children with scoliosis, no progression of the curvature was observed, including one child who wore a Milwaukee brace. CONCLUSION School screenings may be performed as part of prevalence studies; however, routine school screening for scoliosis is debatable.

Salter innominate osteotomy for treatment of developmental dysplasia of the hip

Purpose. To compare the results of Salter innominate osteotomy (SIO) for treatment of developmental dysplasia of the hip (DDH) in children. Methods. Between 1994 and 2002, 53 girls and 8 boys with DDH underwent open reduction and SIO; 21 were on the left side, 22 on the right side, 18 bilateral. They were divided into 2 groups: group 1 included 35 patients aged younger than 3 years (46 hips) and group 2 included 26 patients aged 3 years or older (33 hips). Clinical outcomes were assessed using the modified McKay criteria to measure pain symptoms, gait pattern, Trendelenburg sign status, and the range of hip joint movement. Radiographic outcomes were evaluated using the Severin method to measure the Sharp acetabular angle and the centre-edge angle. Results. Group-1 children achieved slightly better reduction and stabilisation of the hip joint empirically, but clinical and radiographic results and complication rates in the 2 groups were not significantly different. Conclusion. Open reduction and SIO without preoperative traction is effective for the management of DDH in children younger than 6 years.

Anterior versus modified combined instrumentation for burst fractures of the thoracolumbar spine: a biomechanical study in calves

Purpose. To compare stability after anterior instrumentation alone versus modified combined anterior and posterior instrumentation for burst fractures of the thoracolumbar spine in calves. Methods. Thoracolumbar spines of 10 calves were used. An axial compression force was applied on each specimen using a material-testing machine, until there was a burst fracture at T12 or L1. Five specimens were fixed with anterior instrumentation alone, using 2 rods connected by 2 screws above and 2 screws below the fractured vertebra plus one tranverse connector. Another 5 were fixed with our modified technique of combined anterior and posterior instrumentation. This entailed one rod connected with one screw above and one screw below the fractured vertebra anteriorly, and another rod connected with one transpedicular screw above and one transpedicular screw below the fractured vertebra posteriorly. After instrumentation, the experiment was conducted again on each specimen and the compressive stiffness and vertebral height loss between the 2 groups compared. Results. The mean compressive stiffness was significantly greater after modified combined anterior and posterior instrumentation than anterior instrumentation alone (5508 vs 2888 N, p=0.0256), whereas the respective vertebral height losses were 37 and 33 mm (p=0.3808). Conclusion. Our modified technique of combined anterior and posterior instrumentation provides greater stability than traditional anterior instrumentation alone.

Indirect spinal canal decompression of vertebral burst fracture in calf model

IntroductionAn experimental study of experimental burst fractures in bovine spinal specimens was conducted to analyze the effects of transpedicular short-segment posterior fixation followed by reduction on indirect spinal canal decompression.Materials and methodsFor this purpose, experimental burst fractures were created in 11 bovine specimens with a hydraulic materials-testing machine. The specimens were evaluated with plain radiographs and CT scans before reduction. Thereafter, they were instrumented with titanium transpedicular screws and rods (short-segment posterior fixation); and reduction was achieved which included distraction and kyphosis correction maneuvers.ResultsEach spinal specimen was evaluated with plain radiographs and CT scans after reduction by applying distraction and kyphosis correction maneuvers. Plain radiographic analysis showed that the kyphosis angle and segmental height values improved. Furthermore, CT scans revealed that the spinal canal diameter values improved compared with those before reduction. The differences between before and after reduction in kyphosis angle, segmental height, anterior body compression, and percentage of retropulsion were statistically significant.ConclusionShort-segment posterior fixation followed by indirect spinal canal decompression led to an improvement over spinal canal retropulsion in experimental burst fractures. Furthermore, the kyphosis angle and segmental height values improved following the reduction compared with those before reduction.

Biomechanical properties of ciprofloxacin loaded bone cement

OBJECTIVE The purpose of this study was to investigate the biomechanical properties of bone cement used in joint replacement surgery after the addition of ciprofloxacin. METHODS The first group received bone cement only and served as a control for the 4 groups where 500 mg, 1000 mg, 1500 mg and 2000 mg of ciprofloxacin were added to yield 40 g of bone cement. Axial compression tests were conducted using a 50,000 Newton capacity tension-compression testing device. RESULTS While axial compression strength at failure was 80.2±4.3 MPa in the control group, values in the ciprofloxacin-treated groups decreased with rising concentration of ciprofloxacin to 74.5±5.4 MPa, 70.6±4.8 MPa, 70.5±4.7 MPa, and 69.3±3.4 MPa. CONCLUSION Bone cement with addition of 500 to 1500 mg ciprofloxacin maintained mechanical axial strength values above 70.0 MPa recommended by American Society for Testing and Materials and can be safely used in joint replacement surgery.

One-stage combined surgery with or without preoperative traction for developmental dislocation of the hip in older children.

Purpose. To compare one-stage combined surgery with and without preoperative traction, in older children with developmental dislocation of the hip (DDH). Methods. Records of 9 children who underwent combined surgery for DDH with preoperative traction in 12 hips (group 1) and 12 undergoing the same procedure without preoperative traction in 16 hips (group 2) were retrospectively reviewed. The surgery consisted of open reduction, Salters innominate osteotomy and femoral shortening with derotation varus osteotomy. The mean age of the patients at the time of operation was 5.8 years. The mean follow-up period was 5.9 years. Results. At final follow-up, clinical outcome in group 1 was worse than that in group 2, though radiographic assessment demonstrated no significant difference between the groups. Conclusion. One-stage combined surgery without preoperative traction is effective in the treatment of DDH in older children, and has a lower complication rate, but radiographically the groups did not differ.

Investigation of mechanical strength of teicoplanin and ciprofloxacin impregnated bone cement on Day 1 and Day 15

OBJECTIVE The aim of this study was to compare the mechanical effects of different concentrations of teicoplanin and ciprofloxacin addition in bone cement. METHODS In an experimental design, 3 different doses of teicoplanin and ciprofloxacin (800, 1600 and 3200 mg) were added to bone cement. Mechanical tests using compression and four-point bending tests were performed on Day 1 and after antibiotic leaching in water at 37°C on Day 15. Specimens that contained no antibiotics served as controls. Mechanical strength for each antibiotic concentration on Day 1 and Day 15 were evaluated. RESULTS Both teicoplanin and ciprofloxacin significantly decreased the mean strength values in compression and four-point bending tests at Days 1 and 15 (p<0.05). While teicoplanin significantly decreased the mean strength values at high doses in both tests at Days 1 and 15 (p<0.05), ciprofloxacin did not significantly change these values. When the effects of two drugs compared, there were significant differences at the 3200 mg dose at Day 1 and at 1600 and 3200 mg doses at Day 15 in the compression testing and at 3200 mg at Day 15 in the four-point bending test. CONCLUSION Teicoplanin and ciprofloxacin addition may adversely affect the biomechanical strength of bone cement. Ciprofloxacin addition seems to have less of a negative effect on strength than teicoplanin.

Aseptic necrosis of the hamate: a case report.

The case of a 25-year-old man with osteonecrosis of the hamate is reported. He had pain and swelling in his right wrist. The diagnosis was accomplished with plain radiographs as well as with MRI. The case was treated surgically that included resection of the necrotic bone. The occured cavity was filled with autogenous cancellous bone graft. In addition, capito-hamate arthrodesis was performed. Histopathological examination following the operation demonstrated avascular necrosis of the hamate. The arthrodesis was obtained four months after the operation.