ABSTRACT
STUDY DESIGN: Sensitivity, specificity, and predictive value analyses of a method that can be used to detect pedicular wall perforation during pedicle screw insertion were assessed. OBJECTIVE: To determine the accuracy of observing the fatty material expelled during pedicle screw insertion for detecting pedicular wall perforations. SUMMARY OF BACKGROUND DATA: Although many methods for safe and accurate insertion of a pedicle screw are described, the rates of misplacement still are high, and complications may occur from improper placement of pedicle screws. Computer-assisted insertion techniques are reported to be very accurate, but these techniques are not yet commonly available. METHODS: In this study, 74 pedicle screw insertions were observed for the material expelled after drilling for the pedicle screw. The outflows of blood and fatty particles were recorded separately. The position of the pedicle screws after surgery was verified by computed tomography. The specificity, sensitivity, positive and negative predictive values, and kappa statistics were assessed. RESULTS: Visible fatty particles were observed during 51 pedicle screw insertions. The histologic analysis showed that the fatty particles were coming from the bone marrow of the corpus. For the observation of fatty particles in detecting perforations along the pedicle screw pathway, the specificity was 98%, the sensitivity 73%, the positive predictive value 84%, the negative predictive value 95%, and the kappa statistic 0.74. CONCLUSIONS: The observation of fatty particles in the blood that comes out after drilling for the pedicle screw may indicate that there is no perforation along the pedicle screw pathway. The observation is easy to perform and does not require any special instruments. Therefore, it can be used alone or in combination with other methods to improve the accuracy of pedicle screw insertion.
Subject(s)
Bone Screws/adverse effects , Spinal Fusion/adverse effects , Spine/pathology , Adipose Tissue , Adolescent , Adult , Child , Female , Humans , Male , Postoperative Complications , Predictive Value of Tests , Sensitivity and Specificity , Spinal Diseases/surgery , Spinal Fusion/methods , Surgical EquipmentABSTRACT
A retrospective analysis of 434 patients with vertebral tuberculosis who were treated surgically was performed with special reference to the preoperative duration of chemotherapy. Of these, 376 underwent 4 weeks of a chemotherapy regimen with isoniazid, rifampin and ethamburol, and in 2 re-activation of the disease was observed. The remaining 58 underwent operation for neurological impairment with 6-18 h of the same chemotherapy regimen, and in no case did re-activation occur. These results suggest a shorter duration of chemotherapy may be utilised in all patients undergoing surgical treatment for vertebral tuberculosis, providing a thorough debridement is performed, leaving no necrotic or infected tissue behind.
Subject(s)
Antitubercular Agents/therapeutic use , Debridement/methods , Ethambutol/therapeutic use , Isoniazid/therapeutic use , Premedication/methods , Preoperative Care/methods , Rifampin/therapeutic use , Tuberculosis, Spinal/drug therapy , Tuberculosis, Spinal/surgery , Adolescent , Adult , Aged , Child , Combined Modality Therapy , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Patient Selection , Recurrence , Retrospective Studies , Time Factors , Treatment Outcome , Tuberculosis, Spinal/diagnosisABSTRACT
The aim of this study is to search the effects of tibial torsion on flexible flatfoot. For this purpose, 20 children with flexible flatfoot and external tibial torsion were determined as a study group. The control group which consisted of 10 children with flexible flatfoot without rotational problems was included in the study. Plantar flexion angle of talus, talo-1. metatarsal angle and dorsoplantar talocalcaneal angle were measured on standing foot radiographs. Tibial torsion was measured by computed tomography. Plantar flexion angle of talus and dorsoplantar talocalcaneal angle were found significantly lower in the study group (p<0.005 and p<0.005 respectively), although talo-1. metatarsal angle was not significantly different between the groups (p=.2917). Naviculocuneiform sag was prominent in all cases of study group. In conclusion, abnormal external tibial torsion may affect the foot deformity and this can change the benign nature of the flexible flatfoot.
Subject(s)
Flatfoot/complications , Flatfoot/physiopathology , Subtalar Joint/physiopathology , Tibia/physiopathology , Case-Control Studies , Child , Child, Preschool , Female , Flatfoot/diagnostic imaging , Gait , Humans , Male , Prognosis , Range of Motion, Articular , Rotation , Tomography, X-Ray Computed , Torsion Abnormality/complications , Torsion Abnormality/diagnostic imaging , Torsion Abnormality/physiopathologyABSTRACT
We report a spontaneous intertrochanteric fracture with bilateral avulsion of the greater trochanter in a patient with chronic renal failure.
