Bosworth and modified Phemister techniques revisited. A comparison of intraarticular vs extraarticular fixation methods in the treatment of acute Rockwood type III acromioclavicular dislocations

Objective: The aim of this study was to compare the long-term clinical and radiological results of Acromioclavicular (AC) fixation with K-wires (the modified Phemister procedure) and Coracoclavicular (CC) fixation with the Bosworth screw in the surgical treatment of Type 3 AC joint dislocations. Methods: Thirty-two patients with complete set of medical records and who received surgical treatment between September 2005 and January 2009 due to acute Rockwood Type 3 AC joint dislocation and properly attended their follow-ups were retrospectively evaluated. Sixteen patients (13 males, 3 females; mean age: 38, range: 24–52 years) were treated with CC fixation with Bosworth screw (Group 1), and the other 16 (12 males, 4 females; mean age: 53.3, range: 38–64 years) with AC fixation using K-wires (Group 2). Results: The mean follow-up time was 96 months for Group 1 and 93 months for Group 2 patients (p > 0.05). The mean Constant–Murley score at the final follow-up was 84.7 in Group 1 and 87.3 in Group 2 (p = 0.069). Radiological evaluation of the patients revealed AC arthrosis in 2 and 3 patients in Group 1 and 2, respectively. In Group 2, one patient had a recurrent dislocation, three patients had AC arthrosis and two patients had ossification in the CC ligament (Fig. 2).There was no superficial or deep wound infection in Group 1, while two patients from Group 2 had a superficial wound infection. Conclusions: Our results suggest that both techniques are reliable and provide adequate reduction and similar outcomes in terms of functionality and pain levels, following the reduction of Type 3 AC joint dislocations. With lower rates of wound site infection in the early and AC arthrosis in the late postoperative period, CC fixation method with the Bosworth screw may be a better surgical option than AC fixation method with K-wires. Level of Evidence: Level III, Therapeutic study. Keywords: Acromioclavicular separation, Type 3 separation, Bosworth screw, Phemister procedur

Erken yaştaki çocuklarda skolyoz tedavisinde büyüyen rod tekniğinin klinik ve radyolojik sonuçları

Amaç: Bu çal›flman›n amac› skolyozu olan erken yafltaki çocuklarda büyüyen rod tedavisinin klinik ve radyolojik sonuçlar ve solunum fonksiyonlar› üzerine etkilerinin incelenmesidir. Çal›flma plan›: 1997-2007 y›llar› aras›nda ameliyat etti¤imiz 24 bayan, 1 erkek hasta geriye dönük ola- rak de¤erlendirildi. On alt› hastada çift büyüyen rod, 9 hastada ise tek büyüyen rod kullan›ld›. ‹lk cerra- hi esnas›nda hastalar›n yafl ortalamas› 7.38±3.8 idi. Konvansiyonel grafilerde Cobb aç›s›, T1-S1 omurga uzunlu¤u ve enstrümentasyon uzunlu¤u ölçüldü. Son kontrol esnas›nda hastalar›n solunum fonksiyonla- r› de¤erlendirildi. Bulgular: Hastalara ortalama 44.9 ayl›k süre içerisinde ortalama 4.2 say›da uzatma ifllemi uyguland›. Füzyon sonras› dönemde Cobb aç›s› ortalama 56.7 dereceden 25.1 dereceye geriledi. T1-S1 omurga uzunlu¤u bafllang›çta 27.2±3.4 cm iken, ilk ameliyat sonras› 34.9±3.6 cm, füzyon sonras›nda ise 38.6±3.7 cm olarak ölçüldü. Ortalama uzama miktar› y›lda 1±0.4 cm idi. Son kontroldeki solunum fonksiyonlar› ortalama de¤erleri FVC: 83.5±3.5, FEV: 84.8±5.3 ve FVC/FEV1: 1±0.046 olarak saptand›. On iki hasta- da komplikasyon görüldü. Komplikasyonlar›n sekizi materyal iliflkiliydi. Ç›kar›mlar: Omurga deformitelerinin tedavisinde büyüyen rod tedavisi, omurga yüksekli¤inin sa¤- lanmas› ve solunum fonksiyonlar›n›n gelifltirilmesi aç›s›ndan etkin bir tedavi yöntemidir

The results of closing wedge osteotomy with posterior instrumented fusion for the surgical treatment of congenital kyphosis

The purpose of this project is to design and fabricate a rotating cylinder 3D printer that allows manufacturing of complex cylindrical structures. Standard cartesian, extruded filament 3D printers have limited capability to produce strong parts due to z-axis layering and have trouble printing vertical lattice structures without plastic drooping. To address these limitations, a 3D printing lathe has been developed which prints on a removable rotating cylindrical surface. The project successfully met objectives to develop the mechanical motion system, extrude PLA plastic, and control the printer with GCode instructions

Ankilozan spondilitli hastalardaki kifotik deformitenin tedavisi için posterior kapalı kama osteotomisini takiben uzun segment posterior enstrümantasyon uygulaması

Ankilozan spondilit hastalığına bağlı omurgada görülen ilerleyici şeksiyon deformitesi sonucu gelişen kifozun tedavisi oldukça güçtür ve sagittal denge ve karşıya düz bakışın sağlanabilmesi için torakolomber osteotomiler göz önüne alınması gereken tedavi seçeneklerindendir. Bu geriye dönük çalışmadaki amaç, ankilozan spondilite bağlı olarak gelişmiş omurga kifozu tedavisi için uygulanan posterior kapalı kama osteotomisinin radyolojik ve klinik sonuçlarını değerlendirmektir. Bu çalışmaya 11 hasta dâhil edilmiştir. Ortalama 43.5 ± 18.7 aylık takip sonrası hastaların Cobb açısı ölçümleri ve klinik sonuçları değerlendirilmiştir. Ayrıca çalışmaya dahil edilen 11 hastadan 7’sinde SRS-22 anketiyle ağrı, klinik görünüm ve tedaviden tatmin düzeyleri de değerlendirilmiştir. Ameliyattan önce ortalama 87.3° ± 4.3° olan torakal kifozun, ameliyat sonrası 54.0° ± 9.5°’ye indirildiği (p<0.05) ve son takipte 4.2° ± 2.5° düzeltme kaybıyla 58.2° ± 9.1° olarak ölçüldüğü saptanmıştır. Ameliyattan önce ortalama 19.6° ± 6.3° olan lomber lordozun, ameliyat sonrası 39.6° ± 5.7°’ye yükseldiği ve son takipte ortalama 2.6° ± 2.3° kayıpla beraber 37.0° ± 5.5° olarak ölçüldüğü belirlenmiştir. Preoperatif, postoperatif ve final sagittal denge değerleri sırasıyla 6.6 ± 2.3 cm, 3.1 ± 1.5 cm ve 3.4 ± 1.6 cm olup, elde edilen düzelmenin istatistiki olarak anlamlı olduğu belirlenmiştir (p<0.05). Sagittal dengedeki düzelme kaybı, son kontrolde 0.23 ± 0.26 cm gibi oldukça düşük düzeyde olduğu anlaşılmıştır. Hiçbir hastada ölüm, nörolojik defisit, implant yetmezliği, enfeksiyon veya psödoartroz görülmedi, fakat bir hastada pulmoner emboli ve bir hastada kavşak kifozu tespit edildi. SRS-22 anketi uygulanan hastaların tamamında ağrı, görünüm, mental durum, fonksiyon ve tedaviden tatmin düzeylerinin 4 ve üzeri olduğu belirlenmiştir. Sonuç olarak ankilozan spondilite bağlı omurga kifozunun tedavisinde uygulanan kapalı kama osteotomisi ile birlikte uzun segment enstrümantasyon tatmin edici sagittal denge ve implant sağ kalımı açısından etkin bir yöntem olduğu fikri elde edilmiştir.The resulting spinal kyphosis due to the progressive flexion deformity in ankylosing spondylitis is a challenging issue where thoracolumbar osteotomies are to be of consideration in the correction of the global sagittal and gaze alignment as treatment modalities. The purpose of this retrospective clinical study was to evaluate the clinical and radiological results of posterior closing wedge osteotomy that we performed in the treatment of kyphotic deformities in the patients with ankylosing spondylitis. Eleven patients having kyphotic thoracolumbar deformities due to ankylosing spondylitis were included in the study and they were treated with posterior transpedicular closing wedge osteotomy followed by long-segment posterior instrumentation. After a mean follow-up period of 43.5 &plusmn; 18.7 months patients were evaluated in terms of Cobb angle measurements and clinical results. Additionaly, 7 of 11 patients were assessed in terms of SRS-22 questionnaire for pain, self image and satisfaction of treatment. The mean preoperative thoracic kyphosis which was 87.3&deg; &plusmn; 4.3&deg; improved to 54.0&deg; &plusmn; 9.5&deg; postoperatively (p&lt;0.05). At the final follow-up it was 58.2&deg; &plusmn; 9.1&deg; with an average correction loss of 4.2&deg; &plusmn; 2.5&deg;. The mean preoperative lumbar lordosis was 19.6&deg; &plusmn; 6.3&deg;. Than it improved to 39.6&deg; &plusmn; 5.7&deg; (p&lt;0.05) postoperatively and were 37.0&deg; &plusmn; 5.5&deg; at the final follow-up with an average correction loss of 2.6&deg; &plusmn; 2.3&deg;. Preoperative, postoperative and final mean sagittal balance values were 6.6 &plusmn; 2.3 cm, 3.1 &plusmn; 1.5 cm (p&lt;0.05) and 3.4 &plusmn; 1.6 cm, respectively. Loss of correction in sagittal balance was 0.23 &plusmn; 0.26 cm in the last control visit. In the all patients whom were applied SRS-22 questionnaire; the levels of pain, appearance, mental status, function and satisfaction of treatment revealed results of minimum 4 points. There was no death, neurological compromise, implant failure, pseudoarthrosis or infection, but one pulmonary embolism and one postoperative thoracic kyphosis proximally to the osteotomy level. We concluded that; posterior transpedicular closing wedge osteotomy followed by long-segment posterior instrumentation in the management of kyphotic deformities due to ankylosing spondylitis seems to be an effective procedure in terms of satisfactory sagittal balance and implant survival

Results of complete hemivertebra excision followed by circumferential fusion and anterior or posterior instrumentation in patients with type-IA formation defect

To evaluate the results of surgical treatment in patients with unlocked full-segmented hemivertebra treated by excision. Twenty-six patients with a mean age of 12.4±1.7 years were included in the study. The mean duration of follow-up was 47.8±21.9 months. Diagnosis of type-IA hemivertebra was established by clinical, radiological, CT, and MRI evaluation. Preoperatively, patients were randomly allocated into two groups. In the first group, patients underwent anterior hemivertebrectomy initially; this was followed by posterior excision of the hemivertebra, posterior instrumentation, and fusion. In the second group, posterior components of the hemivertebra were excised at first, then the hemivertebra body was excised anteriorly, and this was followed by anterior instrumentation and fusion. For both groups, compression was applied to the convex side while distraction was applied to the concave side. Frontal and sagittal plane analysis of radiograms obtained preoperatively, postoperatively, and after a minimum period of 2 years was performed. The balance was analyzed clinically and radiologically by the measurement of the lateral trunk shift (LT) and shift of head (SH). The mean preoperative and postoperative Cobb angles were 45.5°∓11.4° and 16.8°∓7.9°, respectively, and postoperatively, a mean correction rate of 64.4±13.9% was obtained (P=0.00). The mean correction rate was 61.2±13.3% (19.2°∓7.6°) for the last follow-up visit. Sagittal plane analysis demonstrated either conservation of physiological sagittal contours or a normalizing effect following excision of hemivertebra combined with anterior or posterior instrumentation. When postoperative balance values were compared, a statistically significant correction was found in terms of LT and SH values. Although none of the patients had complete balance (SH: 0 mm) or balanced curves (0 mm<SH<15 mm) preoperatively, 20 (76.9%) of the patients had a balanced trunk after surgical intervention. Circumferential fusion could be achieved in all cases. No neurological complication developed, the only complication was delayed wound healing. In view of these data, it is concluded that these techniques can be safely used for this patient group at low thoracic, thoracolumbar, and lumbar levels of vertebral column with high correction rates