Convex Short Segment Instrumentation and Hemi-Chevron Osteotomies for Putti Type 1 Thoracic Hemivertebrae A Simple Treatment Option for Patients Under 5 Years Old

Study Design:A case series depicting the results of a novel surgical technique.Objective:To prove that a minimally invasive surgical technique can effectively control and even correct congenital scoliosis caused by a fully segmented hemivertebra.Summary of Background Data:Congenital hemivertebrae have been treated by anterior and posterior growth arrest with/without fusion, anterior and posterior hemivertebrectomy, transpedicular hemivertebra excision, and transpedicular hemiepiphysiodesis. These approaches are complex and require experience. There is a need for a simple treatment method to treat these deformities.Methods:Twelve patients under 5 years of age with Putti type1 hemivertebrae were treated by posterior convex short segment instrumentation, partial chevron osteotomies, and fusion. Scoliosis, segmental scoliosis, kyphosis, segmental kyphosis, trunk shift were measured both preoperatively and postoperatively.Results:The mean correction of the segmental curve was 6 degrees (21%) which was maintained at the latest follow-up. The average final correction of the main curve was 23%. The trunk shift was 1.8 cm (range, 1-3 cm) preoperative and 1.4 cm (range, 0-2.5 cm) at the latest follow-up. The segmental angle of kyphosis averaged 11 degrees (range, -12 to 20 degrees) preoperative, and 14 degrees (range, 0-29 degrees) at the latest follow-up assessment. The values of the total thoracic kyphosis (T2-T12) were 29.5 degrees (range, 10-46 degrees) preoperative, 31 degrees (range, 10-44 degrees) postoperative, and 32 degrees (range, 16-45 degrees) at the last follow-up resulting in a mean improvement of 2 degrees. This improvement continued at the latest follow-up with a mean increase of 3 degrees.Conclusions:Transpedicular instrumentation is ideal for early correction in young children. The new posterior approach is much less invasive than the combined approaches or other posterior vertebrectomies and is well tolerated even in very young patients. The fusion segment is kept short. The deformities seem to stop progressing and this can avoid development of severe local deformities and secondary curves

The Use of Intralaminar Screws in Patients With Spinal Deformity

Study Design:Retrospective study.Objective:To demonstrate that intralaminar screws (ILS) can be used as supplements in spinal deformity surgery in the thoracic and lumbar levels in pediatric and adult patients.Summary of Background Data:Rigid posterior fixation of the spine is generally accomplished using pedicle screws, hooks, or wires. ILSs are useful tools when other spinal fixation techniques have failed or the bony anatomy precludes hook or screw placement.Materials and Methods:All spinal deformity patients (primary/revision) operated between 2007 and 2011 were retrospectively reviewed. The patients with ILS were included in the study. The anteroposterior and lateral standing x-rays were evaluated in terms of preoperative and postoperative coronal and sagittal deformities. The number and level of ILS, intraoperative complications, and postoperative complications were noted.Results:There were 20 patients (12 male and 8 female). The mean age was 21.75 years. The mean follow-up period was 17.4 months. Fifty-seven ILS were inserted. Seventeen screws were used in the uppermost to lowermost levels. Forty screws were used in the middle. There was 1 lamina fracture and screw pull out (1.75%). There were 3 canal violations (corrected intraoperative) and 2 instrument prominences which required implant removal. The mean preoperative/postoperative cobb angles were 78.5 degrees/27.8 degrees and the mean preoperative/postoperative kyphosis angles were 57.2 degrees/32.5 degrees, respectively. The loss of correction was 1.2 degrees. There were no neurological deficits and no instrument failures.Conclusions:ILS are safe and effective when used in deformity correction. However, biomechanical studies and randomized controlled trials are needed to conclude whether ILS will be considered a first-line technique, or will remain a technique for salvage situations

Bilek güreşi sırasında humerusun spiral kırığı

Arm wrestling contests have become a common pub and even professional sport. Although armwrestling injuries are not common, several have been reported in the medical literature. In this case, spiral fracture of the humerus with large free fragments which had occurred during arm wrestling and occurring mechanism of injury was attracted attention. It is concluded that arm wrestling should not be considered a completely harmless sport and it appears appropriate to warn public and arm wrestler against arm wrestling.Bilek güreşi müsabakaları halk arasında ve hatta profesyonel sporcular arasında yaygın bir şekilde yapılmaktadır. Bilek güreşi yaralanmaları çok sık olmamasına rağmen, tıbbi literatürde bir kaç yayın rapor edilmiştir. Bu vakada bilek gü- reşi sırasında meydana gelen, serbest kemik parçası olan humerusun spiral cisim kırığına ve travmanın oluş mekanizmasına dikkat çekildi. Bilek güreşinin tamamiyle zarasız bir spor olarak düşünülmemesi gerektiği ve bilek güreşine karşı bu sporla uğraşan profesyonel sporcuların ve halkın uyarılmasının uygun olduğu sonucuna varıldı

Kyphectomy for congenital kyphosis due to meningomyelocele: a case treated with a modified approach to skin healing

This study is a case report of a meningomyelocele patient with congenital kyphosis who was treated with kyphectomy and a special approach to soft tissue healing. The objective of this study is to show a step by step approach to surgical treatment and postoperative care of a meningomyelocele patient with congenital kyphosis. In meningomyelocele the incidence of kyphosis is around 12-20%. It may cause recurrent skin ulcerations, impaired sitting balance and respiratory compromise. Kyphectomy has first been described by Sharrard. This surgery is prone to complications including pseudoarthrosis, skin healing problems, recurrence of deformity and deep infections. A 15-year-old male presented with congenital kyphosis due to meningomyelocele. He had back pain, deformity and bedsores at the apex of the deformity. The wound cultures showed Staphylococcus epidermidis colonisation at the apex. He was given appropriate antibiotic prophylaxis. During surgery, the apex of the deformity was exposed through a spindle-shaped incision. After instrumentation and excision of the apex, correction was carried out by cantilever technique. Two screws were inserted to the bodies of L3 and T11. After the operation, the skin was closed in a reverse cross fashion. He was sent to hyperbaric oxygen treatment for prevention of a subsequent skin infection and for rapid healing of skin flaps post operation. The patient's deformity was corrected from a preoperative Cobb angle of 135 degrees 15 degrees postoperative. The skin healed without any problems. Preoperative culture and appropriate antibiotic prophylaxis, spindle-shaped incision, reverse cross-skin closure and postoperative hyperbaric oxygen treatment can be useful adjuncts to treatment in congenital kyphosis patients with myelomeningocele to prevent postoperative wound healing and infection problems. Reduction screws and intracorporeal compression screws help to reduce the amount of screws and aid in corection of the deformity

Tophaceous Gout with Atypical Localization without Hyperuricemia or an Inflammatory Gout Attack

Tophaceous gout which typically develops following recurrent acute attacks, accounts for 10% of all gout cases. Although gout is known as a condition which primarily affects male gender, 5% of the patients are women with the majority being postmenopausal during the first attack. Tophaceous gout is frequently polyarticular in women. A solitary tophus which is seen as a soft tissue mass without inflammatory joint disease can be confused with neoplastic conditions. In this article, we report a 30-year-old female case of tophaceous gout with atypical localization presenting without hyperuricemia or an acute inflammatory gout attack

Convex Short Segment Instrumentation and Hemi-Chevron Osteotomies for Putti Type 1 Thoracic Hemivertebrae A Simple Treatment Option for Patients Under 5 Years Old

Study Design:A case series depicting the results of a novel surgical technique.Objective:To prove that a minimally invasive surgical technique can effectively control and even correct congenital scoliosis caused by a fully segmented hemivertebra.Summary of Background Data:Congenital hemivertebrae have been treated by anterior and posterior growth arrest with/without fusion, anterior and posterior hemivertebrectomy, transpedicular hemivertebra excision, and transpedicular hemiepiphysiodesis. These approaches are complex and require experience. There is a need for a simple treatment method to treat these deformities.Methods:Twelve patients under 5 years of age with Putti type1 hemivertebrae were treated by posterior convex short segment instrumentation, partial chevron osteotomies, and fusion. Scoliosis, segmental scoliosis, kyphosis, segmental kyphosis, trunk shift were measured both preoperatively and postoperatively.Results:The mean correction of the segmental curve was 6 degrees (21%) which was maintained at the latest follow-up. The average final correction of the main curve was 23%. The trunk shift was 1.8 cm (range, 1-3 cm) preoperative and 1.4 cm (range, 0-2.5 cm) at the latest follow-up. The segmental angle of kyphosis averaged 11 degrees (range, -12 to 20 degrees) preoperative, and 14 degrees (range, 0-29 degrees) at the latest follow-up assessment. The values of the total thoracic kyphosis (T2-T12) were 29.5 degrees (range, 10-46 degrees) preoperative, 31 degrees (range, 10-44 degrees) postoperative, and 32 degrees (range, 16-45 degrees) at the last follow-up resulting in a mean improvement of 2 degrees. This improvement continued at the latest follow-up with a mean increase of 3 degrees.Conclusions:Transpedicular instrumentation is ideal for early correction in young children. The new posterior approach is much less invasive than the combined approaches or other posterior vertebrectomies and is well tolerated even in very young patients. The fusion segment is kept short. The deformities seem to stop progressing and this can avoid development of severe local deformities and secondary curves

The comparison of the effects of intraoperative bleeding control and postoperative drain clamping methods on the postoperative blood loss and the need for transfusion following total knee arthroplasty

WOS: 000294278700010PubMed: 21765233Objective: We aimed to determine and compare the effects of intraoperative bleeding control and two hours postoperative drain clamping method on postoperative wound drainage and the need for donor blood transfusion following total knee arthroplasty (TKA). Methods: Seventy-one patients who underwent TKA were randomly assigned into two groups. Fourty-four knees of 32 patients comprised Group A and 51 knees of 39 patients comprised Group B. In Group A, no bleeding control was done and postoperatively, the drain was clamped for 2 hours. Then it was unclamped to begin aspiration after the 2nd hour. In Group B, the bleeding was controlled intraoperatively, and the drain was not clamped after the surgery. Drains were removed 48 hours after the surgery in both groups. Bilateral and unilateral arthroplasty patients were evaluated separately. The groups were compared for their preoperative and postoperative 3-day haemoglobin (Hb) levels, total drainage amount and total number of blood transfusions. Results: The haemoglobin levels were similar in both groups preoperatively and at the 1st, 2nd and 3rd postoperative days. In Group A, the wound drainage was 696.1 +/- 235.4 ml in unilateral TKA patients and was 1010.8 +/- 535.5 ml in bilateral arthroplasty patients. In Group B, the wound drainage was 710.1 +/- 380.1 ml in unilateral TKA patients and was 878.3 +/- 489.6 ml in bilateral arthroplasty patients. The mean number of transfusions was 1.41 units with no significant differences between the groups. Conclusion: The two hour drain clamping method without intraoperative bleeding control does not seem to affect the amount of blood loss and the need for transfusion when compared to intraoperative bleeding control in total knee arthroplasty patients. Hovewer, it is a simple and feasible method and can be used to decrease the operation time

Bilek güreşi sırasında humerusun spiral kırığı

Arm wrestling contests have become a common pub and even professional sport. Although armwrestling injuries are not common, several have been reported in the medical literature. In this case, spiral fracture of the humerus with large free fragments which had occurred during arm wrestling and occurring mechanism of injury was attracted attention. It is concluded that arm wrestling should not be considered a completely harmless sport and it appears appropriate to warn public and arm wrestler against arm wrestling.Bilek güreşi müsabakaları halk arasında ve hatta profesyonel sporcular arasında yaygın bir şekilde yapılmaktadır. Bilek güreşi yaralanmaları çok sık olmamasına rağmen, tıbbi literatürde bir kaç yayın rapor edilmiştir. Bu vakada bilek gü- reşi sırasında meydana gelen, serbest kemik parçası olan humerusun spiral cisim kırığına ve travmanın oluş mekanizmasına dikkat çekildi. Bilek güreşinin tamamiyle zarasız bir spor olarak düşünülmemesi gerektiği ve bilek güreşine karşı bu sporla uğraşan profesyonel sporcuların ve halkın uyarılmasının uygun olduğu sonucuna varıldı