Apical instrumentation alters the rotational correction in adolescent idiopathic scoliosis

The aim of this study was to retrospectively evaluate the effect of apical vertebral instrumentation in the axial plane in the surgical treatment of idiopathic scoliosis. Seventy-six consecutive patients with King type 11 idiopathic scoliosis, treated with posterior spinal instrumentation, were included in the study. The mean age of the patients was 14.5 years (range 10-18 years), and the mean follow-up was 49 (range 28-74) months. Preoperative radiological evaluation was performed with postero-anterior, lateral, traction and side-bending radiographs. Vertebral rotation was measured with a Perdriolle torsion meter. Patients were retrospectively divided into two groups according to the presence of apical vertebra instrumentation. Group 1 consisted of 43 patients in whom the upper and lower neutral and intermediate vertebrae of thoracic curves had been instrumented on the concave side. Group 2 consisted of 33 patients who had received instrumentation of the apical vertebra on the concave side in addition to the instrumentation configuration of group 1. Posterior fusion was added in all patients. Cobb and Perdriolle measurements were compared between the two groups preoperatively and at the last follow-up. Preoperative age and gender distribution, Cobb angle and rotational measurements, and correction ratios on side-bending films were similar in the two groups. Although the differences between the two groups in preoperative mean values of both Cobb angle and apical rotation were not statistically significant (P>0.05), mean values of apical rotation were significantly different postoperatively (P<0.05). At the same time, apical derotation ratios differed significantly between the two groups (P=0.000). We conclude that instrumentation of the apical vertebra provides better derotation at the apex

Bilateral trochanteric fractures of the femur in a patient with chronic renal failure

We report a spontaneous intertrochanteric fracture with bilateral avulsion of the greater trochanter in a patient with chronic renal failure

Deleterious effects of local corticosteroid injections on the Achilles tendon of rats

The purpose of this study was to examine the pathological changes in the Achilles tendon and its paratenon after intratendinous corticosteroid injections and to reveal the effects of this drug on healthy tendon. We also sought for the effects of these injections compared with compression with a clamp on the Achilles tendons of the rats. Fifty-two Achilles tendons in 26 male Wistar rats were included in the study. Betamethasone injections were applied to the left tendons at different intervals, while the right tendons served for compression with mosquito clamps for varied periods. At the end of 30 days, all of the tendons were excised and examined histopathologically according to a semiquantitative scoring system. Histopathologic evaluation demonstrated some degree of degeneration in both groups. Statistical analysis showed no significant difference among the two groups, but in macroscopic evaluation, the tendons in the betamethasone group demonstrated enlargement and strong adhesion to the subcutaneous tissue. We conclude that intratendinous betamethasone injections are as harmful as compression with a clamp and can be used as a degeneration-producing model in further studies. Enlargement of the tendon mass and strong adhesion to the subcutaneous tissue can be due to injection of the betamethasone partly outside the tendon

Primary Pyomyositis Mimicking Transient Synovitis of the Hip in a Child: A Case Report

Pyomyositis, which is an uncommon pyogenic infection of skeletal muscle, is a rare, but potentially serious disease in children. Pyomyositis can be easily confused with more benign conditions, thus serious complications including compartment syndrome, contiguous osteomyelitis, extension into and destruction of an adjacent joint, sepsis and death may occur. Early diagnosis established with magnetic resonance imaging or computed tomography, prompt drainage of the abscess, microbiological studies and appropriate intravenous antibiotic treatment prevent complications and provide successful management of pyomyositis in children. In this paper, we present a case with gluteal pyomyositis who was initially misdiagnosed as transient synovitis and suffered from contiguous osteomyelitis due to delay in diagnosis