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Objective: The aim of this study is to better understand which type of fracture and localization have more painful or worse outcomes for the kyphoplasty procedure. Materials and Methods: Kyphoplasty cases operated between 2013 and 2018 were included in the study. The patients were contacted through the numbers registered in the hospital system. A questionnaire were asked to the patients. Patients were grouped according to gender, fracture level (T12-L1 and others) and fracture type (Osteoporotic, trauma, malignancy, unknown). Results: Fourty-one patients were included in the study. Three-quarters of the patients were women and average age was 62. Ninety-two percent of the patients stated that the pain of the procedure was tolerable. Seventy percent reported that their pain decreased after the procedure and 75% of the patients stated that they could have this procedure done again. Pain reduction and the desire to have same surgery again were significantly higher in female patients than in the male group (p

Objective: The aim of this study was to evaluate histopathological, functional and bone densitometry examinations of the beneficial effects of dexpanthenol (DEX) on nerve regeneration in a rat mode...

Objective This prospective study aimed to evaluate the changes in the sagittal alignment after total hip arthroplasty (THA) in patients with hip osteoarthritis (OA) secondary to Crowe type-IV developmental dysplasia of the hip (DDH) and whether THA would contribute to the relief of low-back pain (LBP). Methods A total of 27 patients (2 men and 25 women) with bilateral hip OA secondary to Crowe type-IV DDH were enrolled in this study. Their mean age at the time of surgery was 40,36±12,35. All patients underwent simultaneous, bilateral THA between January 2015 and December 2016. Clinical assessment included Oswestry disability index (ODI) score and Harris hip score (HHS), and pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and pelvic tilt (PT) were measured from radiographs. Results Preoperatively, all the patients had hip and low-back pain. Preoperative and final follow-up ODI scores were 48.3 and 3.9 (p=0.000), respectively. HHS changed from 43.54 to 92.68 (p=0.000). PT and PI significantly changed from -20.4°±20.4° to 3.2°±16.7° (p=0.001) and from 26.6°±35.1° to 47.4°±17.9° (p=0.001), respectively. There were no significant differences regarding the SS and LL measurements. Age or limb-length discrepancy was not significantly associated with the spinopelvic alignment measurements. Conclusion Restoring the function of the hip with THA is shown to improve hip-associated LBP, but the accompanying hyperlordosis does not change. THA in patients with bilateral Crowe type-IV hips relieves hip pain as well as associated LBP. Hyperlordosis of the lumbar vertebra does not change after surgery, but PI and PT changes are observed; this improvement might have a role in the relief of LBP. Level of evidence Level IV, Therapeutic study.

Study design A quality-control YouTube-based study using the recognized quality scoring systems. Objective In this study, our aim was to confirm the accuracy and quality of the information in kyphosis videos shared on YouTube. Summary of background data The Internet is a widely and increasingly used source for obtaining medical information both by patients and clinicians. YouTube, in particular, manifests itself as a leading source with its ease of access to information and visual advantage for Internet users. Methods The first 50 videos returned by the YouTube search engine in response to "kyphosis" keyword query were included in the study and categorized under seven and six groups, based on their source and content. The popularity of the videos was evaluated with a new index called the video power index (VPI). The quality, educational quality, and accuracy of the source of information were measured using the Journal of American Medical Association (JAMA) score, Global Quality Score (GQS), and Kyphosis-Specific Score (KSS). Results Videos had a mean duration of 397 seconds and a mean number of 131,644 views, with a total viewing number of 6,582,221. The source (uploader) in 36% of the videos was a trainer and the content in 46% of the videos was exercise training. Seventy-two percent of the videos were about postural kyphosis. Videos had a mean JAMA score of 1.36 (range: 1-4), GQS of 1.68 (range: 1-5), and KSS of 3.02 (range: 0-32). The academic group had the highest scores and the lowest VPIs. Conclusion Online information on kyphosis is low quality and its contents are of unknown source and accuracy. In order to keep the balance in sharing the right information with the patient, clinicians should possess knowledge about the online information related to their field and should contribute to the development of optimal medical videos. Level of evidence 3.

Study design A retrospective clinical study. Purpose To analyze the surgical outcomes of intraoperative halo-femoral traction (HFT) in patients with adolescent idiopathic scoliosis (AIS) with Cobb angles between 70° and 90° and flexibility l35%. Overview of literature Numerous methods have been described to achieve adequate correction and successful results in the surgical treatment of AIS patients with a Cobb angle g70°. However, few studies have evaluated the results of HFT in AIS patients with Cobb angles between 70° and 90° and flexibility l35%. Methods The study comprised 24 AIS patients (18 females, six males; mean age, 17.4 years; mean preoperative Cobb angle, 80.1°; range, 70°-90°) who underwent surgery using intraoperative HFT. Neurological status was constantly assessed during the surgery using intraoperative neurophysiological monitoring. Results The mean follow-up period was 33.5 months. Radiographic outcomes demonstrated 85.7% correction of the major Cobb angle. Coronal and sagittal balance was achieved in all the patients, and shoulder levels were equalized. The traction was discontinued when a decrease in spinal cord potentials was observed during the surgery. Conclusions Intraoperative HFT is an effective and reliable method for the management of scoliosis curves between 70° and 90°. The most significant advantages of the method are avoidance of the morbidities related to anterior surgery, osteotomy, or vertebral column resection; its contribution in helping achieve adequate reduction and optimum balance by the gradually increased corrective force, lack of any need for extreme correction force during instrumentation; and the high correction rates achieved.

Background: There have been many studies that reported various treatment options about recurrent disc herniation, recurrent sciatica, and low back pain following discectomy. However, evaluation and treatment algorithm of post-discectomy pain syndrome (PDPS) could not be standardized. The purpose of this study was to report the results of patients with PDPS who were treated with various treatment options with a minimum 2-year follow-up. Methods: We retrospectively evaluated 54 of 75 patients with PDPS who had no response to 12 weeks of conservative treatment between 2009 and 2014. Fifteen of 21 patients with re-herniation who did not respond to non-surgical treatments benefited from re-discectomy. Twenty-seven patients eventually underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery and 12 patients, who had no need for surgery, responded well to the non-surgical treatments. All patients were evaluated using the 10-point visual analog scale (VAS) and Oswestry Disability Index (ODI) preoperatively and at the post-treatment or postoperative follow-ups. Results: Pre-treatment mean VAS score of the patients who benefited from non-surgical treatments was 7.9. The mean VAS score decreased to 2.1 at the final follow-up. The mean pre-treatment ODI was 46%, which decreased to 25.9% at the final follow-up. Preoperative mean VAS score of the patients who were treated with MIS-TLIF surgery was 8.1. The average VAS score decreased to 1.8 at the final follow-up. The mean preoperative ODI was 48%, which decreased to 24.2% at the final follow-up. Conclusions: Twelve of 54 patients with PDPS regardless of underlying etiology benefited from non-surgical treatments. Fifteen of 21 patients with re-herniation benefited from re-discectomy. MIS-TLIF is found as a highly effective procedure for the relief of post-discectomy pain that is resistant to non-surgical treatment options and for patients who had a second re-herniation.

Background: The development of paraplegia and kyphosis are two important problems related to spinal tuberculosis (Pott’s disease) in children. The current study aims to present two pediatric Pott’s disease, point out the progression of this disease in children, surgical options and surgical outcomes.Materials and methods: Two cases of childhood Pott’s disease were referred to our department with progressive neurological deficits (both of children were experienced bilateral weakness in lower extremities; grade C according to Frankel scale) during short periods (less than one month per each). Both cases’ MRIs are demonstrated abscesses in thoracic spine. Both patients are treated surgically. We discussed in this study the technical notes in both cases, especially in 2- year-old child.Results: Both cases were treated surgically after decompressing nerve roots and thecal sac posterior instrumentation was applied. Microbiological examination of both samples revealed on M.Tuberculosis. Orthoses are applied three months after operations. Antituberculosis medication protocol was applied. Preoperative paraparesis had recovered completely and muscle strengths all returned to normal in both children. There is no loss of correction during the follow-up periods.Conclusion: Spinal tuberculosis is a dynamic disease that may lead to severe deformities in childhood. Especially in cases where two or more vertebrae are affected, early surgical treatment is essential to prevent severe kyphosis. Surgical intervention accompanied with antituberculosis medications protocol is essential to cure treatment in pediatric population. In children aged ≤6 years and more than one vertebrae were affected, fıbula can be used to allow growth of the child vertebral column.

Metastatic melanoma (MM) is one of the most lethal types of cancer. Although novel immunotherapeutics have been developed recently, still, these drugs fail to save the lives of a third of MM patients. Electrochemotherapy (ECT) is a local treatment of cancer based on a combination of electroporesis and low-dose chemotherapy. In this case report, we present the treatment history of a MM patient treated successfully with ECT and immunotherapy combination as a fifth-line treatment. Our patient was a 39 year-old woman who was diagnosed with nodulary melanoma stage II. Due to a local recurrence, she was given interferon-α treatment. After 6 months, her disease relapsed in the axillary lymph nodes, and temozolamide treatment 150 mg/m2 was initiated. After six cycles on temozolamide, she progressed both in the axillary site and in the lungs. Her BRAF mutation analysis revealed V600E positivity. Hence, BRAF inhibitor-vemurafenib 2'4 tablets per day was initiated. Within 3 months, she responded dramatically both in the axillary site and in the lungs. At the ninth month of treatment, she progressed again, at which time ipilimumab 3 mg/kg was started as a fourth line treatment. However, shortly after, she progressed again and developed a solitary brain metastasis. She was operated and had whole brain radiotherapy. At that point, nivolumab, an antiprogrammed cell death ligand-1 blocker, was the only remaining option. She showed a biphenotypical response to nivolumab; a mass on the anterior axilla was progressing while the other lymph nodes had regressed. Owing to the accessibility of the subcutaneous lesion with external electrodes, ECT was performed using IGEA Cliniprator device through a hexagonal electrode on the progressive mass, while on nivolumab treatment. A complete response was achieved, with no evidence of disease at 4 years since her local recurrence. Eradication of symptomatic, refractory lesions using ECT meets an important clinical need. Whenever a disseminated disease presents with cutaneous/subcutaneous lesions, high efficacy of ECT should be deployed to augment tumor immunogenicity and complement systemic immunotherapies.

The application of pedicle screws with cement to strengthen the fixation of the osteoporotic spine has increasingly gained popularity. However, the technique has also led to an increase in cement-related complications.The aim of the present study was to compare the clinical and radiological results of the patients with degenerative spinal pathologies who were treated with pedicle screws and cement injections on all segments versus those who were treated with cement injections only on the strategic vertebrae selected.A retrospective clinical study.The sample consists of 31 patients who underwent spinal surgery due to degenerative spinal pathologies.Patients were assessed for the adequate spinal fusion and cement-related complication parameters.Thirty-one patients with a minimum follow-up period of 2 years were divided into two groups and evaluated. Group A consisted of 17 patients (14 females, 3 males; mean age: 68.1 years) with cemented pedicle screws and Group B consisted of 14 patients (12 females, 2 males; mean age: 67.2 years) with cemented screws on selected vertebrae alone. Selection of the strategic vertebrae was made by taking the most stressed regions in the fusion site into account. Prophylactic vertebroplasty was performed in all patients in Group A and on strategic segments in Group B to avoid an adjacent segment fracture. Early- and late-term complications during the follow-up period were recorded.Mean follow-up period was 51.8 (range: 31 to 80) months in Group A and 41.2 (range: 26 to 61) months in Group B. Cemented pedicle screws were bilaterally placed on 94 vertebrae in Group A. In Group B, cement was applied on 28 of 80 vertebrae. Including the prophylactic vertebroplasties, a total of 111 cement applications were performed in Group A and 38 in Group B. Cement embolism, symptomatic chest discomfort, and duration of surgery were significantly higher in Group A (p.05). No adjacent segment fracture in the proximal or distal vertebra, implant failure, or loss of correction was seen throughout the follow-up period.The application of cemented pedicle screws on all segments of the osteoporotic spine increases the cement volume and rate of cement-related complications. Cementing the strategic vertebrae alone will enhance the fixation strength and endurance and decrease the complications caused by cement application.

Purpose The aim of this retrospective study was to investigate the effectiveness of medial unicompartmental knee arthroplasty (UKA) by showing the results of the radiological and clinical outcomes of the patients. Materials and methods Seventy-two knees of 54 patients who underwent UKA between September 2005 and March 2011 for medial knee arthritis with a minimum follow-up of six months were evaluated. Range of motion (ROM), Hospital for Special Surgery (HSS) knee score, Knee Society Score (KSS), and Oxford Knee Score (OKS) were investigated both preoperatively and postoperatively. On the other hand, Oxford radiographic evaluation criteria were used to evaluate prostheses radiologically at the final follow-up. Results The average age was 53.4 years (47 to 79 years). The average follow-up time was 39.8 months (8 to 72 months). There was a significant difference between preoperative and postoperative ROM, HSS, and OKS (p

Objective: The aim of this study was to assess appropriateness of the sizes of available cervical disc prostheses based on tomographic measurement of human cervical vertebrae. Methods: The anatomic dimensions of the C3–C7 segments were measured on 50 patients (age range 26–47 years) with computerized tomography scan and compared with the sizes of the popular cervical total disc prostheses (CTDP) at the market [Bryan (Medtronic), Prodisc-C (Synthes), Prestige LP (Medtronic), Discover (DePuy)]. The mediolateral and anteriorposterior diameters of the upper and lower endplates were measured with a digital measuring system. Results: Overall, 43.7% of the largest implant footprints were smaller in the anterior-posterior diameter and 42.6% in the mediolateral diameter were smaller than cervical endplate measurements. Discrepancy of the level C5/C6 and C6/C7 was calculated as 56.2% at the anteroposterior diameter and 43.8% at the center of mediolateral diameter. Conclusion: Large disparity has been found between the sizes of devices and cervical anatomic data.Companies that produce CTDP should take care of the anatomical dimensions and generate different sizes of CTDP. Spine surgeon should be familiar with the size mismatch in CTDP that may affect the clinical and radiological outcome of the surgery. Keywords: Discrepancy, Cervical disc prostheses, Anatomical cervical dimensions, Mismatch, Cervical degenerative disc disease

Introduction: Despite the developments in implant technology and imaging methods and the advances in surgical techniques, there are still potential problems and complications of transpedicular screw application. This is a morphometric study to examine the proximity of the T12 vertebra to the thoracic aorta. Our aim was to define the appropriate length of the pedicle screw to be used in the 12th thoracic vertebra, using computed tomography (CT) data. Methods: Randomly selected cases from the same ethnic group in a specific age group were examined in terms of the length from the anterior vertebral body and the screw entry point of the T12 vertebra to the thoracic aorta. In light of these data, a statistical analysis was made for the selection of the most appropriate screw length. Results: A statistically significant difference was detected in the distance from the T12 left screw entry point to the aorta between males and females (p=0.001). No statistically significant correlation was found between age and the distance between the left screw entry point and the aorta (p=0.105). Also, no statistically significant difference was detected between the T12 vertebral body-aorta distance in males and in females (p=0.212). The relationship between the shortest aorta-vertebral body distance and age was not statistically significant (p=0.7). Similarly, there was no statistically significant difference between the left screw entry point-aorta distance and the aorta-vertebral body shortest distance (p=0.731). Conclusions: Significant differences were observed between males and females in terms of the distance between the T12 vertebra left screw entry point and the thoracic aorta (p=0.001). Thus, we can assert the need for the preoperative evaluation of patients with computed tomography in selecting the appropriate screw length and avoiding complications.

Introduction. Paraplegia and kyphotic deformity are two major disease-related problems of spinal tuberculosis, especially in the early age disease. In this study a 2-year-old boy who underwent surgical decompression, correction, and 360° instrumented fusion via simultaneous anterior-posterior technique for Pott’s disease was reported.Case Report. A 2-year-and-9-month-old boy presented with severe back pain and paraparesis of one-month duration. Thoracic magnetic resonance imaging demonstrated destruction with a large paraspinal abscess involving T5-T6-T7 levels, compressing the spinal cord. The paraspinal abscess drained and three-level corpectomy was performed at T5-6-7 with transthoracic approach. Anterior instrumentation and fusion was performed with structural 1 autogenous fibula and rib graft using screw-rod system. In prone position pedicle screws were inserted at T4 and T8 levels and rods were placed. Six months after surgery, there was no weakness or paraparesis and no correction loss at the end of follow-up period.Discussion. In cases of vertebral osteomyelitis with severe anterior column destruction in the very early child ages the use of anterior structural grafts and instrumentation in combination with posterior instrumentation is safe and effective in maintenance of the correction achieved and allows efficient stabilization and early mobilization.

Distal radius fractures are the most common fractures in the elderly, yet the treatment is controversial and still debated in the literature. Twenty four patients aged older than sixty with distal radial fractures were treated by dorsal nail plate. We compared them with twenty four similar matched patients treated by percutaneous Kirschner wiring surgical method. The patients were operated on by a surgeon experienced in carrying out hand surgery. The purpose of this retrospective review was to compare the clinical and radiological outcomes in elderly patients with displaced distal radial fractures who were treated with either the dorsal nail plate or percutaneous Kirschner wiring surgical procedures. Both groups had high union rates and low complication rates for the treatment of displaced distal radius fractures in elderly patients. However, better functional results can be expected in dorsal nail plate.

Background Fractures of the proximal humerus that limit function are quite common. The objective of this retrospective study was to compare deltoid splitting and deltopectoral approaches by using the same fixation method. Methods Eighty-six patients who underwent surgical treatment between September 2005 and July 2011 were included into the study group. Deltoid splitting approach was used by exploring the axillary nerve on Group A patients as described by Codman, and deltopectoral approach was used on Group B patients. Group A consisted of a total of fifty-six patients of whom twenty-two were male and thirty-four were female patients, with a mean age of 62.5 years (range, 26 to 90 years). Group B consisted of a total of thirty patients of whom fourteen were male and sixteen were female patients, with a mean age of 54.8 years (range, 24 to 84 years). PHILOS plate system was utilized as an internal fixation tool in all patients. Functional results and complications of the two groups were compared using Constant scores. Results It was observed that humeral head and tubercular fragment reduction were better with lateral deltoid splitting approach, and Constant shoulder scores were higher in the early stages (66.8-57.4 consecutively; p>0.05). Discussion Deltoid splitting approach, especially with AO/ASIF B and C type fractures, enables reduction and plate fixing under 270 degree control of the proximal humerus without forceful retraction and soft tissue damage, providing easy access to posterior tubercular fragment. Compared to deltopectoral approach, patients treated with deltoid splitting approach achieved higher Constant scores at an earlier stage. Lateral deltoid splitting approach, by exploring the axillary nerve, is a useful surgical technique which provides an expansive and multi-dimensional control without risking the deltoid muscle function and the axillary nerve.

Background: The goal of this study was to report the results of selective open reduction and internal fixation of fractures of the posterior malleolus with a posterolateral approach and to compare the results of the 2 techniques. Methods: We prospectively evaluated 40 patients who underwent posterior malleolar fracture fixation between 2008 and 2012. The patients were treated with a posterolateral approach. We assigned alternating patients to receive plate fixation and the next screw fixation, consecutively, based on the order in which they presented to our institution. Fixation of the posterior malleolus was made with lag screws in 20 patients and a buttress plate in 20 patients. We used American Orthopaedic Foot and Ankle Society (AOFAS) scores, range of motion (ROM) of the ankle, and radiographic evaluations as the main outcome measurements. The mean follow-up was 38.2 (range, 24-51) months. Results: Full union without any loss of reduction was obtained in 38 of the 40 patients. We detected a union with a step-off of 3 mm in 1 patient in the screw group and a step-off of 2 mm in 1 patient in the plate group. At the final follow-up, the mean AOFAS score of the patients regardless of fixation type was 94.1 (range, 85-100). The statistical results showed no significant difference between the patients regardless of the fixation type of the posterior malleolus in terms of AOFAS scores and ROM of the ankle ( P > .05). Conclusions: Good (AOFAS score of 94/100) and equivalent (within 3 points) results were obtained using the 2 techniques (screws or plate) for fixation after open reduction of posterior malleolar fragments. Level of Evidence: Level II, prospective case series.

Mehmet Fatih Korkmaz,1 Mehmet Nuri Erdem,2 Zeliha Disli,3 Engin Burak Selcuk,4 Mustafa Karakaplan,1 Abdullah Gogus5 1Department of Orthopedics and Traumatology, Inonu University School of Medicine, Malatya, Turkey; 2Department of Orthopedics and Traumatology, Nisantasi University School of Medicine, Istanbul, Turkey; 3Department of Anesthesiology, Malatya Government Hospital, Malatya, Turkey; 4Department of Family Medicine, Inonu University School of Medicine, Malatya, Turkey; 5Department of Orthopedics and Traumatology, Florence Nightingale Hospital, Istanbul, Turkey Purpose: In this study, we aimed to report the results of a retrospective study carried out at our institute regarding cases of patients who had suffered proximal femoral fractures between January 2002 and February 2007, and who were treated with a proximal femoral nail. Materials and methods: One hundred consecutive cases were included in the study. A case documentation form was used to obtain intraoperative data including age, sex, mechanism of injury, type of fracture according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) classification and the American Society of Anesthesiologists' (ASA) physical status classification (ASA grade). Clinical and radiographic examinations were performed at the time of admission and at the 6th week; subsequent visits were organized on the 3rd month, 6th month, and 12th month, and in patients with longer follow-up and annually postoperatively. The Harris score of hip function was used, and any change in the position of the implants and the progress of the fracture union, which was determined radiologically, was noted. Results: The mean age of the patients was 77.66 years (range: 37–98 years), and the sex distribution was 32 males and 68 females. Seventy-three fractures were reduced by closed means, whereas 27 needed limited open reduction. The mean follow-up time for the study group was 31.3 months (range: 12–75 months). Postoperative radiographs showed a near-anatomical fracture reduction in 78% of patients. The Harris hip score was negatively correlated with the ASA score and patient age. No cases of implant failure were observed. Three patients died before discharge (one due to pulmonary embolism, two due to cardiac arrest), and five patients died due to unrelated medical conditions within the first 3 months of the follow-up. Conclusion: Our study showed that proximal femoral nail is a reliable fixation with good fracture union, and it is not associated with major complications in any type of trochanteric femoral fracture. Keywords: ASA, femoral fracture, Harris score, proximal femoral nail

Background Calcification in the great toe tendon is a rare disorder that is characterized by the deposition of calcium on degenerative collagen fibrils. Case presentations In this report, we present two cases of calcific tendonitis: one in the adductor hallucis and the other in the flexor hallucis longus tendon. We preferred computed tomography-guided steroid injection in our cases because of pain unresponsive to conservative treatment. Patients were free of symptoms at the follow-up visit, 4 weeks after injection. Conclusion Calcification of the hallux tendons is a rare disorder. Treatment of tendonitis consists of nonsteroidal anti-inflammatory drugs. Local anesthetic and steroid injection may be considered in cases unresponsive to conservative treatment. Because of the anatomic location of tendons, injection could be difficult. Computed tomography guidance may improve the success rate of injections.