Investigation of Possible Reasons of Failed Treatment of Conservative Thoracolumbar Osteoporotic Vertebral Fractures.

AIM: To investigate the possible reasons of failed conservative treatment of osteoporotic thoracolumbar vertebral compression fractures (VCFs). Sagittal balance impairment may weaken union by increasing the load on the fracture line. Most osteoporotic vertebral fractures occur in the thoracolumbar and mid-thoracic regions. MATERIAL AND METHODS: We investigated the records of patients aged > 60 years who underwent treatment for osteoporotic thoracolumbar VCFs between 2012 and 2020. The patients were divided into two groups: those who required surgical treatment due to the failure of conservative treatment and those who were successfully treated with conservative treatment. All the patients underwent lateral radiography and computer tomography of the whole spine at their initial and final visit. The radiographic parameters of spine and presence of sarcopenia, age, and gender were compared between the groups. RESULTS: Of the study subjects, the mean age of 13 females and 7 males in whom conservative treatment was successful was 67.4 years and the mean follow-up period was 23.5 months, while in 18 females and 5 males who underwent surgical treatment due to the failure of conservative treatment, the mean age was 68.7 years and the mean follow-up period was 22.1 months. No significant differences between the groups regarding age and gender were observed. However, significant differences were observed between the groups regarding the presence of sarcopenia and thoracic kyphosis, thoracolumbar kyphosis and distance from the center of the fractured vertebra to the plumb line (DSVA). CONCLUSION: Sarcopenia and DSVA were significantly higher in the surgical treatment group. Receiver operating characteristic analysis demonstrated that the sensitivity and specificity of DSVA for identifying high-risk patients for failed conservative treatment of osteoporotic thoracolumbar VCFs were 100% and 95%, respectively, with an optimum diagnostic cutoff value of 6.5 mm.

Are critical shoulder angle and acromion index correlated to the size of a rotator cuff tear.

PURPOSE: Scapular morphology is an extrinsic factor playing role in rotator cuff tear (RCT) etiology. The objective of this study was to evaluate the relationship between critical shoulder angle (CSA) and acromion index (AI) with partial-bursal side and full thickness RCT and the size of the RCT. HYPOTHESIS: The hypothesis was that CSA and AI would be greater in partial bursal-side RCT and full-thickness RCT patients and would increase with the size of the RCT. METHODS: This retrospective study assessed 218 patients who had standard shoulder radiographs and magnetic resonance imaging. Patients were divided into three groups: intact rotator cuff (68), partial bursal-side RCT (34) and full-thickness RCT (116). In the second part, full-thickness RCT patients were divided into four groups according to RCT size; small (<1cm), medium (1-3cm), large (3-5cm) and massive (>5cm). AI and CSA measurements were evaluated from radiographs. RESULTS: The mean CSA was 32.8̊ in control group, 34.3̊ in partial group and 36.9̊ in full-thickness group. The mean AI was 0.66, 0.68 and 0.72 respectively. Significant difference was found in AI and CSA between full thickness RCT and intact RC group (p<0.01), and partial RCT and full thickness RCT group (p<0.05) in paired comparisons. In full thickness RCT size groups the mean CSA was 34.2̊, 36.4̊, 39.0̊ and 40.8̊ and mean AI was 0.70, 0.71, 0.73 and 0.79 respectively. Significant difference was found between small-large, small-massive, medium-massive groups for CSA in paired comparisons and between small-massive, medium-massive groups for AI. CONCLUSION: CSA and AI were significantly greater in full-thickness RCT patients and the size of the RCT increased with CSA and AI. The greater CSA and AI could be predictors for larger RCT. LEVEL OF EVIDENCE: III; Cross-Sectional Design; Prognosis Study.

Simultaneous Bilateral Quadriceps Tendon Rupture in a Patient with Diffuse Idiopathic Skeletal Hyperostosis after Minimal Trauma: Eight-Year Follow-Up.

INTRODUCTION: The purpose of this report was to describe a very rare case of simultaneous bilateral quadriceps tendon rupture seen in a patient who was diagnosed as having diffuse idiopathic skeletal hyperostosis. CASE PRESENTATION: A man aged 64 years presented to the emergency department with bilateral quadriceps tendon rupture. Surgical repair was performed with suture anchors and a stainless steel cable. His legs were immobilized in casts for six weeks. After removal of the casts, physiotherapy was started. Four months after surgery, he was able to walk with 0°-120° range of motion and active extension. He was followed up for 8 years without rerupture or other complications. CONCLUSION: Bilateral rupture of the quadriceps tendon is a rare condition and generally related to metabolic disorders. Diffuse idiopathic skeletal hyperostosis is a metabolic disorder that causes bilateral quadriceps tendon rupture, and it accounted for the differential diagnosis of the underlying condition.

Intraneural ganglion cyst of the ulnar nerve in an unusual location: A case report.

INTRODUCTION: Intraneural ganglion cysts are benign, mucinous, non-neoplastic lesions of the peripheral nerves. While the most common location of intraneural ganglion cysts is the ulnar nerve and its branches, intraneural ganglion cyst involving the superficial branch of the ulnar nerve has not yet been reported. PRESENTATION OF CASE: A-25-year-old woman presented with pain and a palpable mass in the hypothenar region of the volar side of her right hand. Her neuromuscular examination was normal. The pain was unresponsive to nonsurgical treatments. After confirming with imaging modalities, the initial diagnosis was considered as an intraneural ganglion cyst arising from superficial ulnar nerve. Excision of the ganglion and exploration of the articular branch (if seen in operation) decision was undertaken by the senior author. Whether MRI or intraoperative exploration, not identified an articular branch. DISCUSSION: Intraneural ganglion cysts of peripheral nerves may be seen in miscellaneous locations in the body. However, to our knowledge, an intraneural ganglion cyst involving the superficial branch of the ulnar nerve is unique. While a variety of theories have been proposed to enlighten the etiopathogenesis of intraneural ganglia, the latest and most affirmed is the unifying articular (synovial) theory. CONCLUSION: Intraneural ganglion cysts may be seen on the hypothenar side of the palm. The etiology and treatment of choice are closely associated with each other in this rare disorder. It is important to realize a related articular branch, otherwise the origin of cyst formation remains, and this may cause other para-articular cysts.

Ponseti technique for the correction of idiopathic clubfeet presenting up to 1 year of age. A preliminary study in children with untreated or complex deformities.

INTRODUCTION: The aim of this study is to evaluate the effectiveness of the Ponseti method in children presenting before 1 year of age with either untreated or complex (initially treated unsuccessfully by other conservative methods) idiopathic clubfeet. PATIENTS AND METHODS: The authors report 134 feet of 92 patients with Dimeglio grade 2, 3, or 4 deformities treated with the Ponseti method. Twenty-four percent of feet were of complex deformities at initial presentation to the authors' clinics. RESULTS: At a mean follow-up of 46 months (range 24-89) we avoided joint release surgery in 97% of feet. Sixty-seven percent required a percutaneous tenotomy of the Achilles tendon. Relapse rate was 31% (41 feet). We treated 2 relapses by restarting the use of orthosis, 17 with re-casting, 18 with anterior tibial tendon transfer following a second relapse, and 4 feet with extensive joint surgery. Compliance with the use of orthosis was identified as the most important risk factor (P<0.0001) for relapses. Previous unsuccessful treatment attempts by other conservative methods did not adversely affect the results unless the cases had iatrogenic deformities. Cases with iatrogenic deformities from previous treatment had a significantly increased risk of non-compliance and relapse. Experience of the treating surgeon and cast complications were also related to relapses. CONCLUSION: Our results show that the Ponseti technique is reproducible and effective in children at least up to 12 months of age. It can also produce good correction in children presenting with complex idiopathic deformities. Therefore, extensive joint releases should not be considered immediately in such cases. The treating surgeon should be meticulous in using the technique and ensure compliance to foot abduction brace in order to avoid recurrences.

Tensile strength of ligaments after thermal shrinkage depending on time and immobilization: in vivo study in the rabbit.

The effects of immobilization on healing collagenous tissue treated with thermal shrinkage are investigated in an in vivo rabbit model. Thermal shrinkage was performed on 45 of 50 medial collateral ligaments in 25 mature New Zealand rabbit knees. In half of the knees, the joints were immobilized. Animals were killed at 0, 3, 6, and 9 weeks postoperatively. Failure loads of ligaments were determined, and morphologic changes were evaluated by electron microscopy. The failure load of shrunken ligaments was significantly lower than that of the intact ligaments on the day of operation (P<.05). Shrunken ligaments reached their highest failure loads in the third week within the first 9 weeks. The immobilized ligaments remained weaker than the mobile group, but this difference was statistically significant only in the ninth week (P<.05). Immobilization seems to have negative effects on the healing ligament. Ideal timing for remobilization is still controversial, and abandoning immobilization protocols for longer than 3 weeks should be considered.