Generalized epileptic seizure in an adolescent idiopathic scoliosis (AIS) patient with syringomyelia after deformity correction surgery

AbstractINTRODUCTIONAdolescent idiopathic scoliosis and epilepsy are pathologies rarely seen together. In this study we report an AIS case we operated in which epilepsy was seen post operatively. We want to emphasize the items one should pay attention in such cases.PRESENTATION OF CASEIn a 14-year-old girl with AIS and concomitant syringomyelia and spondylolisthesis, posterior deformity correction and fusion were performed. After stabilization the patient was discharged on the 10th day of discharge epileptic seizure appeared.DISCUSSIONIn scoliosis surgery, the mechanic stress and bleeding caused by the operation itself can cause neurological problems due to primary nervous system injury. The operation and bleeding during and after the operation, pulmonary and cardiac functional instability, metabolic imbalance can be the causes of epileptic seizures.CONCLUSIONEpilepsy seen after a major surgery like scoliosis surgery, can be either as a result of central nervous system origined vascular and hypoxic problems or metabolic. In our case we concluded that massive hemorrhage must have induced epilepsy. In neurologic consultations the case was considered as an incidental epileptic picture

Effects of caffeic acid phenethyl ester and melatonin on distraction osteogenesis: an experimental study

Aim: The aim of this experimental animal model study is to investigate the effects of caffeic acid phenethyl ester (CAPE) and melatonin on the maturation of newly-formed regenerated bone in distraction osteogenesis

Bilateral clavicle osteomyelitis: A case report

INTRODUCTION: Osteomyelitis of the clavicle is rare. Infection occurs from hematogenous spread or trauma. In adults infection is usually secondary due to an exogenous cause such as open fractures, surgery (iatrogenic) or spread from local tissue with infection. PRESENTATION OF CASE: The case is presented here of a 50-year old female with bilateral clavicular fractures, who was operated on with open reduction and internal fixation. At the 6-month follow-up, she had complaints of bilateral osteomyelitis which was successfully treated with resection of the infected segment of the bone, and antibiotic impregnated collagen. DISCUSSION: Predisposing factors include diabetes, intravenous drug abuse, tuberculosis or immune suppression. Management involves the removal of bone fixation, debridement of the bone and if there is a defect, coverage with a muscle flap is applied. CONCLUSION: In cases of clavicular osteomyelitis where infection continues despite debridement and antibiotic therapy, excision of the sequestered clavicular section is a successful treatment approach and has been seen to improve quality of life without any functional loss

Does computerized tomography change the treatment decision in pediatric medial epicondyle fractures?

The amount of displacement in medial epicondylar fracture is one of the most important criteria for treatment decision. The displacement of medial epicondyle fractures of the humerus may be underestimated by standard AP and lateral views of elbow. The aim of the current study is to show the clinical relavance of computerized tomography (CT) for medial epicondyle fractures.A retrospective analysis; on patients with medial epicondyle fracture; was performed.Measurement was made from 9 reviewer, for 12 case,on both radiographs and CT. The difference between measurement of AP Xray and frontal and axial CT scans was found statistically significant for both 1st and 2nd assessments(p=0.001). Treatment decision for operative treatment was found statistically higher after evaluation with CT for both first and second assessment.(p=0,0001). CT had great relavance on treatment decision for pediatric medial epicondylar fractures. There is also much better interobserver agreement for axial CT scans for treatment decision. 

Chronic wrist pain in a goalkeeper; bilateral scaphoid stress fracture: A case report

Introduction: Bilateral scaphoid stress fractures are uncommon, and rarely presented with chronic wrist pain. Most fractures of the scaphoid heal with immobilization. Presentation of case The case presented here is of a bilateral stress fractures of the carpal scaphoid in a 19-year-old male.The patient had been playing as a goalkeeper and presented with a 4-year history of chronic pain in both wrists. We had a successful result in the treatment of these stress fractures with long- arm thumb plaster cast.Discussion Most fractures of the scaphoid in the immature skeleton heal with immobilization. Approximately 88–95% of acute scaphoid fractures are said to heal with conservative treatment using cast immobilisation. Non-surgical treatment is successful for scaphoid fractures in children and for those fractures which are non-displaced, stable, and where there is no damage to other bones or ligaments. In stable fractures, union is achieved within 8–12 weeks.Conclusion Bilateral stress fractures of the scaphoid can be considered for the wrist pain, especially for the patients that had repetitive minor wrist trauma, and in spite of developments in surgical techniques and materials used, treatment by plaster casting should still be considered initially for non-displaced, stable scaphoid stress fractures

The mid-term results of treatment for tibial pilon fractures

BACKGROUN

Radiation in the orthopedic operating theatre

Objective: The aim of the study was to determine the amount of radiation exposure in the orthopedic operating theater, to show that the radiation dose was decreased with distance from the tube, and to inform personnel about protective measures. Methods: Ionised radiation was measured in the orthopedic operating theater where fluoroscopy was used between 18 February 2014 and 02 June 2014. Four dosimeters were placed at the head and foot of the operating table and at 200 cm from those areas at a height of 60 cm vertical to the floor. Results: At the end of 104 days, the total values were determined as 90.5 mrem at the foot of the table, 68.17 mrem at the head of the table, 7.5 mrem at 200 cm from the foot of the table, and 5.17 mrem at 200 cm from the head of the table. A significant decrease was observed in the values determined at a distance from the radiation source. Conclusion: The rate of radiation determined in the dosimeters decreased when distance from the radiation source increased. During the use of fluoroscopy in orthopedic surgery, the wearing of lead aprons, neck protectors, and glasses, in addition to maintaining a distance from the tube, will reduce the radiation exposure of individuals

Melatonin ve kafeik asit fenetil ester’in iskemik şartlarda kırık iyileşmesi üzerine etkisi: Deneysel çalışma

Amaç:Çalışmada melatonin ve kafeik asit fenetil ester (CAPE) antioksidan moleküllerinin iskemik ortamda kırık iyileşmesi üzerine etkisinin incelenmesi amaçlandı. Çalışma planı: Kırk dört erkek Wistar-albino sıçan tibiasında kırık oluşturulup intramedüller pinleme ile tespit uygulandı. Daha sonra sıçanlar rastgele kırık, kırık-iskemi, kırık-iskemi-melatonin ve kırık-iskemi-CAPE gruplarına ayrıldı. İskemi gruplarındaki sıçanların femoral arterleri 4.5 saat süreyle klemplendi. Cerrahi girişimden 6 hafta sonra sıçanlar sakrifiye edildi ve radyografik, histolojik ve biyomekanik değerlendirmeler yapıldı. Bulgular: Radyografik ve histolojik olarak, 6. hafta sonunda kırık-iskemi-CAPE grubu kırık-iskemi grubundan anlamlı olarak iyi sonuçlar verdi. Tüm gruplarda, tüm kırıkların radyolojik ve histolojik olarak tam iyileştiği saptandı. Maksimum kırılma kuvvetlerinin (N) karşılaştırılmasında, gruplar arasında (kırık-iskemi<kırık-iskemi-melatonin<kırık<kırık-iskemi-CAPE) anlamlı fark bulundu (p<0.005). Sertlik dereceleri (N/mm) açısından kırık ve kırık-iskemi-CAPE grupları arasında anlamlı fark bulunmazken, diğer tüm gruplar arasındaki fark anlamlıydı. Kırık, kırık-iskemi-melatonin ve kırık-iskemi-CAPE gruplarındaki sertlik dereceleri, kırık-iskemi grubundan anlamlı olarak daha yüksek bulundu (p<0.001). Çıkarımlar: Vasküler yaralanma veya kompartman sendromu ile komplike hale gelmiş tibia kırıklarında, iskeminin kırık iyileşmesi üzerine olan muhtemel olumsuz etkileri, melatonin ve CAPE ile ortadan kaldırılabilir.Objective:The aim of this study was to investigate the effects of antioxidant molecules Melatonin and Caffeic Acid Phenethyl Ester (CAPE) on fracture healing under ischemic conditions. Methods: A right tibia fracture was created and fixed with an intramedullary pin in forty four male Wistar-albino rats. The rats were then randomly allocated to fracture, fracture-ischemia, fracture- ischemia-melatonin, and fracture-ischemia-CAPE groups. Ischemia was created by clamping femoral arteries four and a half hours. Animals were killed and radiographic, histological and biomechanical evaluation was performed sixth week after surgery. Results: The radiological and histological scores of the fracture-ischemia-CAPE group were significantly better than the fracture- ischemia group at 6th week follow-up. Complete radiographical and histological healing of all fractures was detected in all groups. There was a significant difference between the maximum fracture force between the groups (fracture-ischemia&lt;fracture-ischemia-melatonin&lt;fracture&lt;fracture-ischemia-CAPE) (p&lt;0.005). Although difference was not statistically significant between fracture and fracture-ischemia-CAPE groups, all other groups revealed statistically significant difference with respect to toughness (N/mm). Fracture-ischemia group revealed the lowest toughness. Conclusion: Ischemia adversely affects the fracture healing of rat tibias. Melatonin and CAPE eradicate adverse effects of ischemia. Possible adverse effects of ischemia on fracture healing can be eradicated with melatonin and CAPE in patients with tibia fractures associated with vascular injury or compartment syndrome