The Usefulness of Employing an Electronic Traction Table to Determine Flexibility in Adolescent Idiopathic Scoliosis.

AIM: The aim of the study was to develop new equipment for the assessment of the flexibility of the spine with different forces. This new system should provide a different perspective to adolescent idiopathic scoliosis (AIS) for the selection of fusion levels and surgical success. MATERIAL AND METHODS: Eighteen patients suffering from AIS who were scheduled to undergo posterior instrumented spinal fusion in our clinic were recruited in this study. The Electronic Traction Table (ETT) that was designed in our clinic was used to evaluate the radiogical and clinical parameters of the spine. RESULTS: The significant prescriptive angle of major Cobb angles between postoperative angles were longitudinal traction and lateral pushing Cobb angles. Longitudinal traction and lateral pushing angles were more correlated with correction ratios. There was a significant difference between longitudinal traction minor Cobb angle, longitudinal traction lateral pushing minor Cobb angle and postoperative minor Cobb angles. CONCLUSION: The deformity is needed to balance both tractional and rotational forces and useful technique to evaluate curve flexibility before the operation. Electronic traction table is a new device for determining preoperative flexibility with longitudinal traction and lateral pushing radiographs. It can be useful for choosing selective fusion levels at the proximal and distal end of the vertebral column.

Intracompartmental pressure changes after anterolateral bridge plating of tibial fractures.

OBJECTIVE: Compartment syndrome is one of the most devastating complications in orthopedics both for the patient and the treating physician. Among the many causes, trauma and its treatment are the most common reasons for compartment syndrome, which most frequently occurs in the lower leg following tibial fractures. Since bridge plating of difficult metadiaphyseal tibial fractures is becoming increasingly popular, serious concerns have been raised about the increased intracompartmental pressures and possible compartment syndrome. METHODS: This study investigated the intracompartmental pressure changes in anterolateral compartment of the leg during and immediately after anterolateral bridge plating of tibial fractures. Intracompartmental pressures were measured before and during plate application, just after the completion of fixation, and immediately and 4-5 min after the tourniquet release in 22 isolated closed comminuted tibial fractures. RESULTS: Baseline anterolateral compartment pressures were higher than those on the uninjured side (9.3 vs 27.8 mmHg). Pressures were 69.5, 57.4, 65.8, and 56.8 mmHg, respectively, for the other measurements times. None of the patients received prophylactic fasciotomy, and none developed clinical compartment syndrome. CONCLUSION: We found that anterolateral compartmental pressures were higher than pressures on the uninjured side in all patients. Although there is a considerable increase in intracompartmental pressures during and immediately after anterolateral percutaneous bridge plating of comminuted tibial fractures, intraoperative prophylactic fasciotomy is not routinely needed. One should monitor the patients on the first postoperative day for signs of compartment syndrome. Fasciotomy decisions should be based on both clinical symptoms and serial intracompartmental pressure measurements rather than a single measurement.

[Superfluous computed tomography utilization for the evaluation of the pelvis and spinal column in an orthopedic emergency department]. / Acil ortopedi ve travmatoloji polikliniginde omurga ve pelvis degerlendirmesi için gereksiz bilgisayarli tomografi kullanimi.

OBJECTIVES: This study was designed to investigate the frequency of requests for computed tomography (CT) examination of the spinal column and pelvis in our emergency orthopedic department, the reasons of requests, and the rates of positive and negative CT examinations. METHODS: We retrospectively reviewed patients for whom a request for CT examination was made by the emergency orthopedic department within a year (September 2005- 2006). The reasons for CT requests, findings in CT reports, and age and sex of the patients were recorded. Findings unrelated and related to the original request denoted a negative and positive CT examination, respectively. RESULTS: Of 24,378 admissions to our emergency orthopedic department, a CT scan was requested in 1,295 patients (5.3%). In 817 patients (63.1%), CT examination involved the pelvis or the spinal column. Of these, 418 CT scans (51.2%) yielded a negative result. The mean age of the patients with a negative CT scan was significantly lower than those having a positive CT scan (40.7 vs 45.1 years; p=0.001). There was no significant difference with respect to sex between patients having negative and positive CT findings (p=0.670). Compared to pelvis CT scans, the frequency of negative CTs was significantly higher for spinal column examinations (p<0.001). The incidence of negative CT scans for upper thoracic and cervical vertebrae was significantly higher than that found for lower thoracic and lumbar regions (p<0.001). CONCLUSION: The high incidence of negative CT scans documented for pelvic and spinal column examinations underlines the need for measures to avoid superfluous CT requests in emergency departments.

[Comparison of plate-screw fixation and intramedullary fixation with inflatable nails in the treatment of acute humeral shaft fractures]. / Akut humerus cisim kiriklarinin cerrahi tedavisinde plak vida ile sisebilen intramedüller çivi yöntemlerinin karsilastirilmasi.

OBJECTIVES: We compared the results of plate-screw fixation and intramedullary fixation with inflatable nails for the treatment of acute humeral diaphyseal fractures. METHODS: The study included 34 patients (20 females, 14 males; mean age 36.4 years; range 18 to 62 years) who were selected from patients treated with plate-screw fixation or inflatable intramedullary nails. The groups were matched for age, sex, severity of fracture, and the type of humeral fracture. Eighteen fractures were treated in each group. Classification of humeral fractures and open fractures were made according to the AO and Gustilo-Anderson systems, respectively. Functional evaluations were made at postoperative six and 12 months using Constant shoulder and Mayo elbow performance scores. All the patients were administered the Short-Form 36 (SF-36) questionnaire at 12 months. The two groups were compared with respect to operation time, perioperative need for blood transfusion, time to union, complications, and shoulder and elbow functions. RESULTS: The mean operation time was significantly shorter (25.3 min vs 66.1 min; p<0.001) and the need for blood transfusion was significantly less (p=0.001) with inflatable intramedullary nails. Constant shoulder and Mayo elbow scores did not differ significantly between the two groups. Implant failure was only encountered with plate-screw fixation in three patients. Union problems were observed in five patients (3 plate-screw, 2 intramedullary nail). Following plate-screw fixation, two patients developed superficial infection, two patients developed transient radial paralysis. CONCLUSIONS: Inflatable intramedullary nails can be used safely in the treatment of acute humeral diaphyseal fractures without increasing union problems and complications.