Mehmet Tukenmez

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.

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.

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.

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.