Nuri Aydin

The use of screw at the fracture level in the treatment of thoracolumbar burst fractures.

Study Design In this prospective randomized study, the results of treating unstable thoracolumbar burst fractures by pedicle instrumentation with and without fracture level screw combination were given. Objective Our aim was to evaluate the efficacy of fracture level screw combination in achieving and maintaining correction in the treatment of unstable thoracolumbar burst fractures. Summary of Background Data Most authors reported that intraoperative correction of sagittal deformity is important for the maintenance of fracture reduction and is one of the most consistent predictor of satisfactory functional outcome. Methods Seventy-two patients with unstable thoracolumbar burst fractures were randomized into 4 groups with equal number of patients. In group 1, patients were treated by segmental posterior instrumentation with 2 levels above and 2 levels below the fracture level fixation, in group 2 they were treated as in group 1 with fracture level screw incorporation. In group 3, patients were treated by short-segment posterior instrumentation with 1 level above and 1 level below, in group 4 they were treated by short-segment posterior instrumentation with fracture level screw incorporation. Clinical and radiologic parameters were evaluated before surgery, after surgery, and at follow-up. Results The average follow-up was 50 months. Fracture level screw combination provided better intraoperative correction and maintenance in the treatment of unstable thoracolumbar burst fractures, which was more prevalent in short-segment fixation group. Conclusions Reinforcement with fracture level screw combination can help to provide better kyphosis correction and offers immediate spinal stability in patients with thoracolumbar burst fracture.

Single-row versus double-row arthroscopic rotator cuff repair in small- to medium-sized tears

HYPOTHESIS Double-row rotator cuff repair leads to superior cuff integrity and clinical results compared with single-row repair. MATERIALS AND METHODS The study enrolled 68 patients with a full-thickness rotator cuff tear who were divided into 2 groups of 34 patients according to repair technique. The patients were followed-up for at least 2 years. The results were evaluated by Constant score. DISCUSSION Despite the biomechanical studies and cadaver studies that proved the superiority of double-row fixation over single-row fixation, our clinical results show no difference in functional outcome between the two methods. It is evident that double-row repair is more technically demanding, expensive, and time-consuming than single-row repair, without providing a significant improvement in clinical results. RESULTS Comparison between groups did not show significant differences. At the final follow-up, the Constant score was 82.2 in the single-row group and 78.8 in the double-row group. Functional outcome was improved in both groups after surgery, but the difference between the 2 groups was not significant. CONCLUSIONS At long-term follow-up, arthroscopic rotator cuff repair with the double-row technique showed no significant difference in clinical outcome compared with single-row repair in small to medium tears.

The treatment of distal clavicle fractures with coracoclavicular ligament disruption: a report of 10 cases.

Objective: Fractures of the distal third of the clavicle with coracoclavicular ligament disruption have been associated with delayed union or nonunion. A combined surgical technique for the fracture fixation and ligament repair for acute fractures was developed. The technique includes K-wire fixation and suture anchor placement with Ethibond suture to the coracoid process. The results of this combined technique were evaluated. Design: Prospective, consecutive case series. Setting: Surgical treatment was performed at the Department of Orthopedics and Traumatology. Patients: Ten patients with acute fractures of the distal third of the clavicle were enrolled with a mean follow-up period of 24.1 (range, 12-36) months. Intervention: A single suture anchor was placed on the coracoid process in a vertical position. The Ethibond suture attached to the anchor was used to depress the elevated proximal part of the clavicle by pulling it down to the coracoid process where the anchor was placed. The suture was pulled over the proximal clavicle and tied. The distal fragment was fixed to the proximal clavicle by an intramedullary K-wire. The torn coracoclavicular ligaments were approximated using absorbable suture. Main Outcome Measurements: The patients were evaluated by the Constant scores and Modified Shoulder Rating Scale. Results: The mean Constant score was 96.6 points in the last follow-up. Nine patients had excellent results, and 1 patient had a good result, using the Modified Shoulder Rating Scale. Conclusions: This is a reliable technique with encouraging results for treating displaced distal third clavicle fractures with coracoclavicular ligament disruption.

Tuberculous spondylitis of the lumbosacral region: long-term follow-up of patients treated by chemotherapy, transpedicular drainage, posterior instrumentation, and fusion.

Objective: Tuberculosis spondylitis of the lumbosacral region has rarely been documented in the literature. We present an 87-month follow-up study of 7 of 62 patients with tuberculous spondylitis of the lumbosacral region treated by chemotherapy, transpedicular drainage, posterior instrumentation, and fusion. The purpose was to prove the hypothesis that chemotherapy with transpedicular drainage and single-stage posterior instrumentation-fusion is enough for the prevention of lumbar kyphosis and sagittal offset in selected cases. Methods: There were four men and three women, with average age of 53 years. All patients underwent transpedicular debridement, posterior fusion, and instrumentation. We studied the following data for consideration in these patients: most involved vertebra, vertebral body loss, progress of kyphosis, and sagittal offset. Results: The fourth lumbar vertebra was the most commonly involved vertebral segment. The average preoperative kyphosis was 17.5° and decreased to 5.4° postoperatively. Mean preoperative and postoperative sagittal offset was 0.34 mm and −5 mm, respectively. The average postoperative sagittal offset was increased from −5 to −2 mm at the third month and henceforth remained unchanged. There was no recurrent infection. Conclusion: We consider that transpedicular drainage, posterior instrumentation, and fusion constitute a less demanding operative technique for lumbosacral tuberculous spondylitis for the prevention of lumbar kyphosis and sagittal offset in patients without neurologic deficit and major vertebral body loss. This is the only lumbosacral tuberculous spondylitis series in which the patients were operated on with single-stage posterior surgery and merits a brief report in the light of the larger series.

The effect of an intramedullary implant with a static magnetic field on the healing of the osteotomised rabbit femur.

Static magnetic fields are a type of electromagnetic fields used in clinical practice. To ascertain what effect a static magnetic intramedullary device implanted in the rabbit femur had on fracture healing, 20 male New Zealand white rabbits with magnetic/nonmagnetic intramedullary implants were examined histologically, radiologically and for bone mineral density. Three groups were constituted according to the poles of the magnets. During surgery the intramedullary device was driven into the medulla. A femoral osteotomy was created with a mini Gigli wire at the centre point of the rod. Radiographs were obtained at the second and fourth weeks. Histological examination and bone mineral density were evaluated at the fourth week. The results of this study verified that an intramedullary implant with a static magnetic field improves bone healing in the first two weeks radiologically and that the configuration difference in magnetic poles has an effect on bone quality. Static magnetic fields have minor effects on bone mineral density values.

Technique of Kirschner wire reduction and fixation of displaced two-part valgus angulated proximal humerus fractures at the surgical neck.

Summary: This article describes the technique of closed reduction with percutaneous fixation using Kirschner wires in helping the reduction of two-part valgus angulated and displaced proximal humerus fractures at the surgical neck. Traditional open reduction may lead to more accurate anatomic reduction; however, extensive tissue dissection increases the risk of avascular necrosis. Thus, closed reduction of unstable fracture mostly required forceful reduction maneuvers, which can harm the vascular supply and increase hematoma formation. Reduction of the fractured sides can easily be performed by engaging Kirschner -wires with a joystick method and fixation can be secured by using threaded pins. Thirty-six consecutive patients with displaced, two-part, valgus-angulated proximal humerus fractures at the surgical neck were treated by this method. The patients were followed for an average of 38 months. All fractures healed. According to the Constant scoring system, 21 patients (58%) had excellent, 9 patients (25%) had good, and 6 patients (17%) had fair results. The technique of closed reduction with a joystick method and percutaneous fixation is regarded as a reasonable treatment alternative in displaced two-part valgus angulated proximal humerus fracture.

Pseudomonas osteomyelitis of the proximal humerus after arthroscopic rotator cuff repair.

A 59-year-old male patient was operated arthroscopically due to a rotator cuff tear. An early postoperative Pseudomonas aeruginosa infection was treated with early arthroscopic debridement and antibiotic therapy. The patient was lost to follow-up and presented to our clinic with Pseudomonas aeruginosa osteomyelitis after two years. Debridement was again performed and antibiotic-impregnated cement beads were filled into the cavity and taken out 6 weeks postoperatively. No findings of infection were observed at the patients 2nd year follow-up. To our knowledge, this is the first case of Pseudomonas aeruginosa osteomyelitis of the shoulder after arthroscopic rotator cuff repair.

Rotator Cuff Tear Arthropathy: Pathophysiology, Diagnosis and Treatment

The term rotator cuff tear arthropathy is a broad spectrum pathology but it involves common characteristic features as rotator cuff tear, leading to glenohumeral joint arthritis and superior migration of the humeral head. Although there are several factors described causing rotator cuff tear arthropathy, the exact mechanism is still unknown because the rotator cuff tear arthropathy develops in only a group of patients with chronic rotator cuff tear. The aim of this article is to review pathophysiology of rotator cuff tear arthropathy, to explain the diagnostic features and to discuss the management of the disease.

Comparison of distal and proximal centralising devices in hip arthroplasty.

Centralising devices were introduced to ensure that the prosthesis is implanted in a neutral position and that a cement mantle of optimal thickness is achieved proximally and distally. A distal centralising device (DCD) is compared with a proximal midshaft centralising device (PCD) to test which one provides a more neutral prosthetic alignment. Thirty consecutive patients undergoing hemiarthroplasties for femoral neck fractures were studied prospectively. Patients were blindly randomised to receive either a femoral component with proximal midshaft centraliser or distal centraliser. Both components were implanted following the manufacturer’s protocol. Postoperative true anteroposterior and lateral radiographs were made to assess the stem position. There was no statistically significant difference between the two groups in zones 1, 2, 3, 4, 5, 6 and 7 in both anteroposterior and lateral radiographic measurements. DCP and PCD both have similar centralisation and cement mantle. Future studies should be done to evaluate their long-term effect.RésuméObjectif: un matériel permettant de bien centrer la prothèse a été utilisé de façon à avoir une prothèse en position neutre avec un manteau de ciment dont l’épaisseur doit être optimale aussi bien pour la partie proximale que distale. Le centralisateur DCD est comparé avec le matériel permettant de centraliser la prothèse PCD. Matériel et méthode: 30 patients consécutifs ont bénéficié d’une arthroplastie, après une fracture du col du fémur. L’étude a été prospective. Les patients ont bénéficié d’une randomisation en double aveugle de façon à recevoir soit un composant fémoral fixé par le centralisateur médio diaphysaire, soit un centralisateur distal. Les composants fémoraux ont été implantés selon les recommandations du fabriquant. Des radiographies face profil ont été réalisées de façon à évaluer la position de la queue de la prothèse. Résultats: il n’y a pas de différence significative entre les deux groupes dans les zones 1, 2, 3, 4, 5, 6 et 7 que se soit sur les radios de face ou de profil. En conclusion, DCP et PCD ont, toutes les deux, une fonction de centralisation et d’organisation du manteau de ciment. Des études ultérieures seront nécessaires pour évaluer les effets à long terme de cette technique.

The comparison of arthroscopic acromioplasty with and without acromioclavicular coplaning

BACKGROUND Coplaning means the removal of medial acromial spurs and inferior aspect of the distal clavicle. The aim of the study was to evaluate the outcomes of arthroscopic acromioplasty with and without coplaning in patients without acromioclavicular (AC) joint arthritis. METHODS Because of impingement syndrome, arthroscopic subacromial decompression and acromioplasty was performed in Group 1 (9 males/31 female). In addition, coplaning was performed in Group 2 (8 males/21 females) by two different surgeons. The mean age was 48 in Group 1, 46 in Group 2. The mean follow-up was 50 months and 44 months, respectively. RESULTS Constant score, cross-body adduction test and AC joint tenderness was used for follow-up. The mean preoperative Constant scores were 45 points (range: 34-76 points) in Group 1, 39 points (range: 32-69 points) in Group 2. The mean Constant scores at the latest follow-up was 78 points (range: 68-100 points) for Group 1, 84 points (range: 72-100 points) for Group 2. There was no statistically difference between two groups at the latest follow-up (p<0.05). In two patients in Group 2, cross-body adduction test was positive but asymptomatic. CONCLUSION Excision of the inferior side of the lateral clavicle to the level of the acromion with minimal disruption of the joint capsule does not develop AC joint symptoms in long-term follow-up.