A Comparison of high viscosity and low viscosity bone cement vertebroplasty for severe osteoporotic vertebral compression fractures

Introduction: Our aim in this clinical trial was to compare the safety and efficacy of highviscosity cement (HVC) with low-viscosity cement (LVC) for the treatment of osteoporotic vertebrae fractures in terms of pain, functional capacity and cement leakage in the percutaneous vertebroplasty procedure (PVP). Methods: From March 2013 to February 2015, 76 patients with vertebrae compression fracture who were admitted into hospital and treated with PVP were reviewed. Pre- and postoperative clinical characteristics of each patient were obtained by using The Visual Analog Scale (VAS) score to evaluate back pain, Oswestry Disability Index (ODI) as a functional assessment. Cement leakage,injected cement volume and the complications assessed due to medical records. Results: VAS and ODI scores improved (P0.05).Paravertebral cement leakage was significantly higher in the LVC group (P<0.05). Pulmonary cement embolism was also significantly higher in LVC group (P<0.05). Conclusion: HVC had lower complication rates with similar clinical results in the comparison with LVC.Publisher's Versio

Evaluation of the coronal malposition of the volar locking plate in the treatment of distal radius fractures

Background and objectives: Literature does not show any studies regarding plate placement problems in the coronal plane of patients with volar plating due to distal radius fracture diagnosis. We aimed to investigate the functional and laboratory results of the coronal malposition of the volar locking plate in patients with distal radius fracture treated with internal fixation. Methods: In this retrospective study, we included patients who had volar plate fixation, were aged between 18 and 80, had no pathological fracture, had a minimum of six months of follow-up, and had the same rehabilitation protocol. We consider the angle subtended on the coronal axis between the distal radius long axis and the distal radius locking plate as coronal malposition. We named the coronal malposition angle the "AYE Angle." Patients with an AYE angle of over 1 degree were evaluated under group 1. Patients with an AYE angle of 0-1 degrees were evaluated under group 2. Radiological parameters were taken from AP-Lateral X-ray views. Superficial University System of Georgia (USG) examinations were applied to detect tendon problems. The DASH and QUICK-DASH scoring systems were used for clinical evaluation. Grip strength was measured with a dynamometer in all patients. All results were compared between the two groups. Results: Thirteen patients were female and 27 patients were male. Nineteen patients who had coronal malposition were added to group 1, while 21 patients who had no coronal malposition were added to group 2. Fifteen patients had normal USG results in group 2, while 18 patients had edema around the flexor pollicis longus (FPL) tendon as a result of USG in group 1. Statistically, a significant difference was detected between the two groups in terms of the amount of tenosynovitis around FPL (p=0.01). A statistically significant relationship was found between USG grading and malposition grading. The study revealed that a higher rate of USG grade 2 was found in patients with malposition grade 2 (90.9%), while a higher rate of USG grade 1 (50%) was observed in patients with malposition grade 1 (p=0.01). A statistically significant difference was not found between Soong grading and USG in terms of the level of tenosynovitis around the FPL tendon. The amount of tenosynovitis detected around the FPL tendon was 62.5% for Soong and grade 0 level, 60.7% for grade 1 level, and 50% for grade 2 level. There was no statistically significant difference between the two groups in the DASH and QUICK-DASH scoring systems (p=0.96). There was no statistically significant difference between the two groups in the grip strength (p=0.52). Conclusion: Coronal plate position in the treatment of the distal radius fracture is important to avoid potential flexor tendon problems. The volar plate position should be adjusted properly both in the coronal and sagittal axes

Humerus Cisim Kırıklarının Kilitli Kompresyon Plakları ile Tedavi Etkinliğinin Değerlendirmesi

Giriş: Bu çalışmamızda, humerus cisim kırıklarının tedavisinde uyguladığımız kilitli plak ile osteosentezin etkinliğini değerlendirdik. Gereç ve Yöntem: Humerus cisim kırığı nedeniyle opere edilen 30 hastanın (19 erkek, 11 kadın) ortalama yaşı 36,2 yıl (23-66 yıl) idi. Tüm hastalara 3,5'luk kilitli kompresyon plağı ile osteosentez uygulandı. 4 hastamızda preop radial sinir arazı saptandı. Nöropraksi olarak değerlendirilen bu lezyonlara cerrahi bir işlem yapılmayıp postoperatif el bileği ve parmakları ekstansiyonda tutan dinamik splint uygulandı. Fonksiyonel sonuçlar StewartHundley ölçütlerine göre değerlendirildi. Hastaların ortalama takip süresi ortalama 32 ay (12-60 ay) idi. Bulgular: Bir hasta dışında tüm hastalarımızda ortalama 14 haftada (10-24 hafta) radyolojik iyileşme sağlandı. İki hastamızda kaynama gecikmesi saptandı, bu hastaların ortalama kaynama süresi 21 hafta olarak tespit edildi, AO sınıflamasına göre parçalı ve yumuşak doku hasarının fazla olduğu C1 sınıfı kırıklar idi. Bir hastamızda psödoartoz gelişti. Bu hastaya primer cerrahi dışında iliak kanattan alınan greft ile beraber plak-vida ile psödoartroz cerrahisi yapıldı. 18. haftada radyolojik olarak kaynama sağlandı. Preop radial sinir arazı olan 4 olguya erken radial sinir eksprolasyonu ve plak vida ile fiksasyon yapıldıktan sonra dinamik el bileği splinti uygulandı ve tüm hastalarda 4 ay içinde tam düzelme sağlandı. Stewart-Hundley ölçütlerine göre 27 olguda (%90) iyi, 2'sinde (%6,6) orta, 1'inde (%3,3) kötü sonuç elde edildi. Bir olgumuzda cerrahi operasyona bağlı olarak radial sinir arazı gelişti ve cerrahi sonrası üçüncü ayda tam düzelme sağlandı. Bir olguda oral antibiyotik tedavisi ile düzelen yüzeyel cilt enfeksiyonu gelişti. Hiç bir olgumuzda implant çıkarmayı gerektirecek derin yumuşak doku enfeksiyonuna rastlanmadı. Sonuç: Humerus cisim kırıklarının tedavisinde kilitli plak osteosentez ile uygun hasta ve doğru teknik kullanıldığında, yeterli fiksasyon ve erken hareket sağlanmakta, tatmin edici radyolojik ve fonksiyonel sonuç alınmaktadır.Introduction: In this study, we evaluated the efficacy of osteosynthesis by using locking plate in the treatment of humerus shaft fractures. Material and Methods: The mean age of 30 patients (19 male, 11 female) operated for humerus shaft fractures was 36.2 (23-66) years. A 3.5 locking compression plate was applied to all patients. We found radial nerve damage in 4 patients preoperatively. These lesions were considered neuropraxia and a dynamic splint was applied in order to keep wrist and fingers in extension after operation. Functional evaluation based on Stewart-Hundley criteria. The mean follow up period was 32 months (12-60 months). Results: Except 1 patient, all patients showed radiological healing in 14 weeks on average (10 week-24 week). Two patients showed union retardation, and the mean union time of these patients was 21 weeks. These were class C1 fractures with larger soft tissue damage and multifragments. One patient developed pseudoarthrosis. Besides primary surgery, this patient underwent a pseudoarthrosis surgery with plate-screw and iliac grafting. Radiological union was achieved at the 18th week. Four patients with preoperative radial nerve damage underwent early radial nerve exploration and plate-screw fixation. Then, dynamic wrist splint was applied. All of them healed in 4 months. Based on Stewart-Hundley criteria, the result was good in 27 (90%) cases, moderate in 2 (6.6%) patients, and bad in 1 (3.3%) patient. Radial nerve damage due to surgery occurred in 1 patient who achieved full recovery 3 months after surgery. A superficial skin infection was developed in 1 patient and it was managed with oral antibiotic therapy. None of the patients developed deep soft tissue infection which requires removal of the implant. Conclusion: In the treatment of humerus shaft fractures, osteosynthesis with locking plate may result in satisfactory radiologic and functional outcomes providing sufficient fixation and early mobilization when used with correct technique in adequate patient

Repair of acute Achilles tendon ruptures using Lynn method

Objectives: Efficiency assessment of Lynn method onopen primary repair of acute Achilles tendon ruptures.Methods: Data were evaluated from 19 patients whotreated with the Lynne method due to acute Achilles tendonrupture. Average follow-up length was 12.3 months(range 8-15 months). Dominant side was the right sideby all patients and all patients were males. Plantaris tendonaugmentation was applied after end-to-end repair bymodified Kessler suture technique.Results: The mean postoperative AOFAS score (TheAmerican Orthopaedic Foot and Ankle Society hindfootclinical outcome scores) was 93.5 (range 82-100). Theaverage of Achilles tendon postoperative assessmentscore, as developed by Thermann and colleagues, was93.3. Both assessment scores were between 90-100 andwere evaluated as very good. None of the patients developedpost-operative wound infection. The Thompson testwas negative on all patients and bilateral motor strengthwas 5/5.Conclusion: Lynn method, especially in young and activepatients with acute Achilles tendon rupture is a methodthat should be considered in treatment protocols.Key words: Achilles tendon, Lynn method, AOFAS scor

Implant-Related Complications Do Not Interfere with Corrections with the Shilla Technique in Early Onset Scoliosis: Preliminary Results

Growth-preservation techniques are utilized in early onset scoliosis (EOS) cases requiring surgical intervention. The Shilla technique corrects the deformity by reducing additional surgeries with its growth-guidance effect. As with other techniques, various problems can be encountered following the administration of the Shilla technique. The aim of this study was to examine the effect of complications encountered with the Shilla treatment on correction and growth. Sixteen patients with a follow-up period of at least one year after receiving Shilla growth guidance for EOS were included in this retrospective study. No complications occurred, and no unplanned surgery was required in 50% of the cases. Of the remaining eight patients with postoperative implant-related complications (50%), six (37.5%) required unplanned surgery; this consequently caused implant failure in the proximal region in five cases (31.25%) and deep tissue infection around the implant in one case (6.25%). Deformity correction, spine length, and quality-of-life scores significantly improved in EOS through Shilla growth guidance. In terms of spinal growth and deformity correction, there were no significant differences between patients with implant-related problems and individuals without occurrences. Although implant-related problems were detected in our dataset and corresponding unexpected surgeries were necessary, these complications had no significant unfavorable influence on correction and spine growth

Discrepancy between cervical disc prostheses and anatomical cervical dimensions

Objective: The aim of this study was to assess appropriateness of the sizes of available cervical disc prostheses based on tomographic measurement of human cervical vertebrae. Methods: The anatomic dimensions of the C3–C7 segments were measured on 50 patients (age range 26–47 years) with computerized tomography scan and compared with the sizes of the popular cervical total disc prostheses (CTDP) at the market [Bryan (Medtronic), Prodisc-C (Synthes), Prestige LP (Medtronic), Discover (DePuy)]. The mediolateral and anteriorposterior diameters of the upper and lower endplates were measured with a digital measuring system. Results: Overall, 43.7% of the largest implant footprints were smaller in the anterior-posterior diameter and 42.6% in the mediolateral diameter were smaller than cervical endplate measurements. Discrepancy of the level C5/C6 and C6/C7 was calculated as 56.2% at the anteroposterior diameter and 43.8% at the center of mediolateral diameter. Conclusion: Large disparity has been found between the sizes of devices and cervical anatomic data.Companies that produce CTDP should take care of the anatomical dimensions and generate different sizes of CTDP. Spine surgeon should be familiar with the size mismatch in CTDP that may affect the clinical and radiological outcome of the surgery. Keywords: Discrepancy, Cervical disc prostheses, Anatomical cervical dimensions, Mismatch, Cervical degenerative disc diseas