Safety and quality of surgical treatment of early onset scoliosis

Early onset scoliosis (EOS) is defined as abnormal lateral curvature of the spine diagnosed before the age of 10. Untreated EOS is prone to progression and may complicate the normal development of the thoracic cavity and lungs, leading to thoracic insufficiency syndrome. EOS is classified according to the etiology as congenital, neuromuscular, syndromic, or idiopathic early onset scoliosis. Surgical treatment is warranted in severe or progressing EOS. Growth-friendly treatment provides deformity correction while allowing spinal growth. The aim of this thesis was to study the outcomes of modern surgical treatment of EOS. We compared magnetically controlled growing rods (MCGR) and traditional growing rods (TGR) in severe EOS, compared passive Shilla instrumentation and MCGRs in syndromic and neuromuscular EOS, and studied the effect of growthfriendly surgical treatment in patients with and without growth limiting skeletal dysplasias. Modern surgical treatment of EOS has improved the outcomes and decreased the incidence of complications. Further research is still needed on the optimal instrumentation selection and planning the treatment especially with children with co-morbidities.Varhaisiän skolioosin kirurgisen hoidon tulokset Varhaisiän skolioosi määritellään selkärangan poikkeavana sivuttaissuunnan käyryytenä, joka on todettu ennen kymmentä ikävuotta. Hoitamaton varhaisiän skolioosi on altis etenemään ja voi vaikeuttaa rintaontelon ja keuhkojen normaalia kehitystä johtaen alikehittyneeseen rintaonteloon. Kirurgista hoitoa tarvitaan, kun kyseessä on vaikea käyryys tai etenevä skolioosi. Kasvuystävällinen hoito korjaa selkärangan virheasentoa mahdollistaen samalla selkärangan kasvun. Vertailimme magneettitankoja ja kirurgisesti pidennettäviä kasvutankoja potilailla, joilla oli vakava varhaisiän skolioosi. Lisäksi vertailimme passiivisen Shilla-instrumentaation ja magneettitankojen tuloksia potilailla, joilla oli syndroomaan liittyvä tai neuromuskulaarinen varhaisiän skolioosi. Tutkimme myös kasvuystävällisen kirurgisen hoidon vaikutusta potilailla, joilla oli kasvua rajoittava luustodysplasia, verrattuna potilaisiin, joilla skolioosiin ei liittynyt dysplasia. Varhaisiän skolioosin nykyaikainen kirurginen hoito on parantanut hoidon tuloksia ja vähentänyt komplikaatioiden määrää. Jatkotutkimusta tarvitaan yhä parhaan instrumentaation valintaan sekä hoidon suunnitteluun varsinkin niillä potilailla, joilla varhaisiän skolioosiin liittyy muita sairauksia

Traumatic Hip Dislocation in Pediatric Patients: Clinical Case Series and a Narrative Review of the Literature with an Emphasis on Primary and Long-Term Complications

Traumatic hip dislocation is a rare injury in pediatric populations. Dislocation may be associated with low-energy trauma, such as a minor fall. Traumatic hip dislocation is associated with severe complications, such as avascular necrosis of the femoral head. Timely diagnosis and reposition decrease the rate of complications. In this study we retrospectively assessed traumatic hip dislocations in pediatric patients during a 10-year timespan in a university hospital. There were eight cases of traumatic hip dislocations. All patients had a minimum follow-up of two years and were followed with MRI scans. One patient developed avascular necrosis during the follow-up which resolved conservatively. There were no other significant complications. In conclusion, traumatic hip dislocation is a rare injury which is associated with severe complications. Patients in our case series underwent a timely reposition. The complication rate was similar to previous reports

Traumatic Hip Dislocation in Pediatric Patients: Clinical Case Series and a Narrative Review of the Literature with an Emphasis on Primary and Long-Term Complications

Traumatic hip dislocation is a rare injury in pediatric populations. Dislocation may be associated with low-energy trauma, such as a minor fall. Traumatic hip dislocation is associated with severe complications, such as avascular necrosis of the femoral head. Timely diagnosis and reposition decrease the rate of complications. In this study we retrospectively assessed traumatic hip dislocations in pediatric patients during a 10-year timespan in a university hospital. There were eight cases of traumatic hip dislocations. All patients had a minimum follow-up of two years and were followed with MRI scans. One patient developed avascular necrosis during the follow-up which resolved conservatively. There were no other significant complications. In conclusion, traumatic hip dislocation is a rare injury which is associated with severe complications. Patients in our case series underwent a timely reposition. The complication rate was similar to previous reports

Shilla growth guidance compared with magnetically controlled growing rods in the treatment of neuromuscular and syndromic early-onset scoliosis

Peer reviewe

Alcohol intoxication and lack of helmet use are common in electric scooter-related traumatic brain injuries : a consecutive patient series from a tertiary university hospital

Purpose Clinicians have increasingly encountered traumatic brain injuries (TBI) related to electric scooter (ES) accidents. In this study, we aim to identify the modifiable risk factors for ES-related TBIs. Methods A retrospective cohort of consecutive patients treated for ES-related traumatic brain injuries in a tertiary university hospital between May 2019 and September 2021 was identified and employed for the study. The characteristics of the accidents along with the clinical and imaging findings of the injuries were collected from the patient charts. Results During the study period, 104 TBIs related to ES accidents were identified. There was a high occurrence of accidents late at night and on Saturdays. In four cases, the patient's helmet use was mentioned (3.8%). Seventy-four patients (71%) were intoxicated. At the scene of the accident, seventy-seven (74%) of the patients had a Glasgow Coma Scale score of 13-15, three patients (3%) had a score of 9-12, and two patients (2%) had a score of 3-8. The majority (83%) of TBIs were diagnosed as concussions. Eighteen patients had evidence of intracranial injuries in the imagining. Two patients required neurosurgical procedures. The estimated population standardized incidence increased from 7.0/100,000 (95% CI 3.5-11/100,000) in 2019 to 27/100,000 (95% CI 20-34/100,000) in 2021. Conclusions Alcohol intoxication and the lack of a helmet were common in TBIs caused by ES accidents. Most of the accidents occurred late at night. Targeting these modifiable factors could decrease the incidence of ES-related TBIs.Peer reviewe

Beam-Like rods do not Provide Additional Improvement to Thoracic Kyphosis Restoration when Compared to Sagittal Reinforced rods in Adolescents Undergoing Spinal Fusion with Pedicle Screw Instrumentation for Idiopathic Scoliosis

Publisher Copyright: © 2022 The AuthorsObjective: Operative treatment of adolescent idiopathic scoliosis (AIS) with posterior spinal fusion aims for three-dimensional correction of coronal curve and thoracic kyphosis. Our aim was to compare two different designs of asymmetrical rods in adolescents who underwent a posterior spinal fusion with pedicle screw instrumentation for AIS with an emphasis on thoracic kyphosis restoration. Methods: This study was made with 76 consecutive adolescents (mean age 15.6 years, SD 2.0). Thirty-nine patients were operated with sagittal reinforced rods and 37 patients were operated with beam-like rods. The clinical and radiological results were assessed preoperatively, postoperatively, and during the follow-up visits at the outpatient clinic 6 months and 2 years after the surgery. Results: At the last follow-up, the mean (SD) major thoracic curves were 13° (6.2°) and 13° (6.0°) (P = 0.717). Correction percentages were 75% in the sagittal reinforced group and 73% in the beam-like rod group (P = 0.517). The mean (SD) thoracic kyphosis was 24° (11°) and 22° (7.8°) at the two year follow-up in the sagittal reinforced rod group and beamlike rod group (P = 0.517). There was a slight negative correlation between the major curve correction and thoracic kyphosis change in both groups, although this was not statistically significant (R = −0.19, P = 0.094 in the sagittal reinforced rod group, R=−0.16, P = 0.180 in the beam like rod group). Conclusions: There are no significant differences in the coronal or sagittal deformity restoration in adolescent patients who underwent a posterior spinal fusion with sagittal reinforced rods and beam-like rods for adolescent idiopathic scoliosis.Peer reviewe

Intraoperative 3D Imaging Reduces Pedicle Screw Related Complications and Reoperations in Adolescents Undergoing Posterior Spinal Fusion for Idiopathic Scoliosis : A Retrospective Study

Widely used surgical treatment for adolescent idiopathic scoliosis (AIS) is posterior spinal fusion using pedicle screw instrumentation (PSI). Two-dimensional (2D) or three-dimensional (3D) navigation is used to track the screw positioning during surgery. In this study, we evaluated the screw misplacement, complications, and need for reoperations of intraoperative 3D as compared to 2D imaging in AIS patients. There were 198 adolescents, of which 101 (51%) were evaluated with 2D imaging and 97 (49%) with 3D imaging. Outcome parameters included radiographic correction, health-related quality of life (HRQOL), complications, and reoperations. The mean age was 15.5 (SD 2.1) years at the time of the surgery. Forty-four (45%) patients in the 3D group and 13 (13%) patients in the 2D group had at least one pedicle screw repositioned in the index operation (p < 0.001). Six (6%) patients in the 2D group, and none in the 3D group had a neurological complication (p = 0.015). Five (5%) patients in the 2D group and none in the 3D group required reoperation (p = 0.009). There were no significant differences in HRQOL score at two-year follow-up between the groups. In conclusion, intraoperative 3D imaging reduced pedicle screw-related complications and reoperations in AIS patients undergoing PSI as compared with 2D imaging.Peer reviewe

Longitudinal Validity and Minimal Important Change for the Modified Lower Extremity Functional Scale (LEFS) in Orthopedic Foot and Ankle Patients

The lower extremity functional scale (LEFS) is a patient-reported outcome measure for lower extremity disorders. Aim of this study was to assess the longitudinal validity including responsiveness and test-retest reliability of the revised 15-item version, and to define the minimal important change (MIC) of the modified LEFS in a generic sample of orthopedic foot and ankle patients who underwent surgery. Responsiveness, effect size, and standardized response mean were measured by determining the score change between the baseline and 6 months administration of the LEFS from 156 patients. There was no significant difference between preoperative (median 78, interquartile range [IQR] 64.2-90.3) and postoperative (median 75.0, IQR 61.7-95.0) scores. Both effect size and standardized response mean were low (0.06 and 0.06, respectively). Test-retest reliability of the LEFS was satisfactory. Intraclass correlation coefficient was 0.85 (95% confidence interval 0.81-0.88). MIC value could not be estimated due to the lack of significant score change. The modified LEFS presented with relatively low longitudinal validity in a cohort of generic orthopedic foot and ankle patients. The findings of this study indicate that the modified LEFS might not be the optimal instrument in assessing the clinical change over time for these patients. (c) 2021 The Author(s). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)Peer reviewe

Bacterial biofilm in salivary stones

PurposeTo assess the susceptibility of salivary stones to bacterial biofilm formation, which may be involved in the development of salivary gland infection, and to investigate a relation between microbiological aspects and patient characteristics.MethodsThis prospective study comprises of 54 patients with sialolithiasis attended in Helsinki University Hospital during 2014-2016. A total of 55 salivary stones were removed, and studied for biofilm formation using fluorescence microscopy and sonication. The isolated organisms were quantified and identified using matrix-assisted laser desorption ionization time-of-flight mass spectrometry.ResultsBiofilm formation was confirmed on the surface of 39 (70.9%) stones. A total of 96 microorganisms were isolated from 45 salivary stones (81.8%). Two or more organisms were isolated in 33 (73.3%) cases. The main isolates were Streptococcus mitis/oralis (n=27; 28.1%), followed by Streptococcusanginosus (n=10; 9.6%), Rothia spp. (n=8; 8.3%), Streptococcusconstellatus (n=7; 7.3%), and Streptococcusgordonii (n=6; 6.2%). In all patients showing pre-operative (12 cases) or peri-operative (three cases) drainage of pus, the presence of biofilm was detected in microscopy (p=0.004). Four patients showed post-operative infection, and in three of them (75.0%), the presence of biofilm was detected. Increased number of pus drainage was found among patients with reflux symptoms or use of proton-pump inhibitors.ConclusionsSalivary stones are susceptible to bacterial biofilm formation, which could be related with the development and severity of the inflammation and the refractory nature of the disease. Sonication of salivary gland stones could be a useful method for finding the etiology of the chronic infection.Peer reviewe