Onur Basci

The effect of laminae lesion on thoraco-lumbar fracture reduction

INTRODUCTION The treatment of fractures involving the lumbar spine has been controversial. Laminae lesion may be complete or of the greenstick type (incomplete). Dural tears and nerve root entrapment may accompany these laminae fractures. The aim of this study is twofold, to assess the effect of different types of laminae fractures on the anteriorvertebral height restoration in upper lumbar burst fractures and to determine the incidences of the intraoperatively detected dural tear and neural entrapment in complete and incomplete laminae fractures to choose the optimal treatment. MATERIALS AND METHODS A retrospective review was conducted on 112 patients with 114 lumbar burst fractures treated operatively, age ranged from 17 to 55 years (mean age 32). Male to female ratio was (93%/7%), 8 females. Patients were divided into three groups, group 1 patients without lamina fracture, group 2 patients with complete type lamina fracture and group 3 patients with (percutaneous) incomplete type lamina fractures. All clinical charts and radiologic data of these groups were analyzed for their association with dural tears, neural entrapment and the impact of lamina fracture (complete and incomplete types) on the efficacy of anterior vertebral height restoration. The severity of injury was determined using the ASIA (Modified Frankel scale). RESULTS Out of 114 upper lumbar burst fractures, lamina fracture occurred in 34 patients (29.8%), complete lamina fracture occurred in 21 patients (61.7%), whereas incomplete lamina fracture occurred in 13 patients (38.3%). Dural tear was detected in 16 patients (47%) and was predominantly higher in complete type lamina fracture 12 patients (57%) when compared to 4 dural tears (30%) in incomplete lamina fractures. Analysis of the data revealed no significant difference in the preoperative anterior vertebral height loss and local kyphotic angle between the three groups. However the anterior vertebral height and local kyhpotic angle restoration were found to be affected by the presence of complete lamina fracture when compared to other groups with incomplete lamina fracture and without lamina fracture (P=0.001). CONCLUSION In upper lumbar burst fractures, complete lamina fracture is an indicator of injury severity. When detected preoperatively on CT or MRI scanning, it should be operated by open book laminectomy even if the patient is neurologically intact since it carries a high risk of neural entrapment, and its presence affects the intraoperative postural and instrumental trials for anterior vertebral height restoration.

Iatrogenic lateral meniscus anterior horn injury in different tibial tunnel placement techniques in ACL reconstruction surgery – A cadaveric study

Objectives The aim of this study was to analyze the effect of tibial tunnel positioning in single bundle and double bundle ACL reconstructions on lateral meniscus anterior root. Materials Twelve single knee cadavers were used, 6 for a single bundle ACL reconstruction, which were reamed gradually starting from 8 mm, 9 mm and ended with a 10 mm reamers, while the other 6 were prepared for a double bundle ACL reconstruction in which 7 mm reamer for the AM tunnel and 6 mm reamer for the PL tunnel were used. After drilling, changes of lengths and thicknesses of anterior horns of the lateral menisci were recorded. Results Before drilling, the groups were homogenous for the lateral menisci dimensions. After drilling, no statistically significant difference was noticed between the two groups. However, in single bundle group, 2 anterior horns width injury (1.44 mm and 2.13 mm) with the 9 mm reamer and 3 anterior horns width injury (2.51 mm, 3.55 mm and 4.28 mm) with the 10 mm reamer were recorded. However in double bundle group a single anterior horn width injury (2.82 mm) was recorded. Conclusion Using a greater size reamer in single bundle reconstruction, causes a relatively higher risk of lateral meniscal anterior root injury. Lateral meniscus stability should be examined arthroscopically after reaming with large reamers.

The primary factor for suture configuration at rotator cuff repair: Width of mattress or distance from tear edge

Objectives The aims of this study was first to investigate whether the bite size or the bite distance from the tear edge is of primary importance in mattress suture configuration for rotator cuff repair. Secondly, whether the use of a 450 left side bent Arthro-Pierce™ (Smith & Nephew, Andover, USA) during suture passage can be more effective on the strength of the configuration compared to a straight Arthro-Pierce™. Materials and methods Twenty-eight bovine infraspinatus muscle tendons were randomized into four groups. Group 1; 5 mm wide ‘bite size’ × 15 mm length ‘distance from the tear edges mattress’; Group 2: 7.5 mm × 10 mm; Group 3: 15 mm × 5 mm ‘using straight Arthro-Pierce™’ and Group 4: 5 mm × 15 mm using left sided 450 bent Arthro-Pierce™. The repair specimens underwent cyclic loading prior to loading the failure testing. Cyclic elongation (mm), peak-to-peak displacement (mm), ultimate load (N), stiffness (N/mm) and failure mode were recorded for each specimen. Results The mean ultimate load in Group 1 was higher compared to group 3. The peak to peak displacement was higher in Group 4 compared to Group 1 (p < 0.05). The predominant failure mode in Groups 1, 2 and 4 was suture rupture. The Group 3 most specimens failed due to suture cut through the tendon. Conclusion Bite size from the edge of the tendon seems to be more important than the width of the mattress. The curve of the suture passing device may also have an effect on the strength of the suture tendon interface.

Dual plating for fixation of humeral shaft fractures: A mechanical comparison of various combinations of plate lengths

Objective The role of plate configuration was found inconclusive on the biomechanical effects of the plate size and hole number for dual plate constructions in humeral shaft fractures. The purpose of this study was to test the biomechanical stability of various dual plate constructions. Methods Twenty-four left humeri (4th Generation Composite Humerus, Sawbones, Malmö, Sweden) with comminuted midshaft humeral fracture were used. Four groups of plate constructs were tested: laterally fixed 8-hole locking plate and screws were combined with anteriorly locking plates containing 0, 4, 6, or 8 holes in groups I, II, III, and IV, respectively. The alterations in axial, bending, and torsional angles were recorded. Results There were no fixation failures during axial, bending, or torsional stiffness testing within the elastic behavior limits. Axial stiffness was highest in Group IV. Torsional stiffness, posterior-to-anterior bending stiffness, lateral-to-medial bending stiffness, and medial-to-lateral bending stiffness were lowest in Group I. Conclusion The similar stiffness values for the 8-to-4 hole and 8-to-6 hole plate constructions indicate that the 8-to-4 hole construction is an option in young adults, while the stiffest 8-to-8 hole combination may be an option for osteoporotic patients.

The accuracy of emergency physician performed ultrasonography as a diagnostic tool for lateral malleolar fracture

Objective: Many studies in the literature related to the investigation of the sensitivity and specificity of ultrasound examinations in lateral malleolar fractures is limited. The aim of this study is to investigate the sensitivity and specificity of ultrasound examinations performed by emergency physicians in fractures who are presented to the emergency department with blunt lateral malleolar trauma. Method: Patients over 18 years of age who were admitted to the ED with lateral malleolar tenderness were enrolled to this study with convenience sampling. Ultrasonographic examination was performed by emergency physicians. Following the ultrasound examination, a two‐sided X‐ray was performed. In the case of inconsistency between the US exam and the X‐ray evaluated by the emergency physician, a CT was performed on the patients. The X‐ray or CT imaging evaluation of an orthopedic surgeon was accepted as the gold standard. Results: A hundred‐twenty patients were included in the study. Fractures in the lateral malleolus were detected in 47 patients. The sensitivity of X‐ray in the diagnosis of lateral malleolar fractures was 92.8%, (95% CI, 79.4–98.1) and the specificity was 100% (95% CI, 89.5–100), while the sensitivity of US exam was 100% (95% CI, 94.1–100), and the specificity was 93% (95% CI, 85–97.6). X‐ray gave false negative results in 3 patients, whereas US gave false positive results in 5 patients. Conclusion: In patients admitted to ED with lateral malleolus tenderness, the sensitivity of the ultrasound examination performed by emergency physicians regarding diagnosis of lateral malleolar fracture is higher than X‐ray.

Aneurysmal bone cyst healing response with intramedullary lengthening nail

We report the treatment process of a pediatric patient with deformity and shortening in the arm after a recurrent aggressive aneurysmal bone cyst (ABC) in the proximal humerus. The patient was treated with curettage of the lesion and lengthening on an intramedullary nail following an osteotomy just distal to the ABC. The period of lengthening was approximately 50 days. At the end of the treatment the lengthening goal was achieved without any neurovascular complication. There was a minimal loss in shoulder hyperabduction due to the deformity of the humeral head.

Biomechanical determination of the relationship between femoral neck lesion size and the risk of pathological fracture

Purpose Half of the pathological fractures of the proximal femur occur in the neck region. We evaluate the relationship between the defect size within the femoral neck and the risk of pathological fracture. Methods After creating metastasis-like lesions in the neck regions of 21 human cadaver femurs, compression was applied to simulate single-limp stance type loading. First, a loading of 600 Newtons (N) was applied to the 35%-defected femoral necks. If the bone fracture did not occur, the defect size was increased to 45% and the 600 N force was applied again. If no fracture was observed then the defect size was increased to 55% and the bones were loaded again. The 55%-defected bones with no fractures were loaded until a fracture was detected. Results There were no fractures with the 35%- and 45%-defected femurs until 600 N was applied. However, when the defect size was increased to 55%, 3 bones were fractured before reaching 600 N. The fractures occurred at an average of 455 N in the 3 bones. At a compression of 600 N, 18 bones (84%) were intact, and the loading was continued. 18 femurs with 55%-defected neck regions had an average endurance of 1270 N compression (range 750-2800 N). Conclusions This study showed that even very osteoporotic bones with large metastases can withstand high forces of compressive loading.