Influence of a Preoperative Conference on Surgeons' Decision-making for Adult Spinal Disorders: A Prospective Clinical Study From a Spine Hospital.

STUDY DESIGN: This was a prospective clinical study. OBJECTIVE: The aim of this study was to evaluate the influence of a preoperative conference on spine surgeons' decision-making in the treatment of adult spinal disorders. SUMMARY AND BACKGROUND DATA: There are several factors that spine surgeons have to consider when determining a surgical plan for the treatment of spinal disorders, which include surgical approach, application of fusion or nonfusion surgery, levels to be treated, treatment of accompanying spinal conditions, the need for further preoperative imaging, and the implant type to be used. MATERIALS AND METHODS: A consecutive series of patients with a variety of adult spinal disorders at a single spine hospital were analyzed. The imaging modalities and clinical examination history of these patients were presented at a daily preoperative conference attended by staff spine surgeons and spine surgery fellows at this spine hospital. The specific surgical plan before the preoperative conference and before the surgery were compared for each patient. RESULTS: A total of 506 consecutive patients were reviewed over a 4-month period. Changes in the surgical plan following the preoperative conference occurred in 29 cases (5.7%). Seventeen of these changes were minor modifications in the same surgical level, or inclusion/exclusion of adjacent or other levels in the surgical plan, without changing the planned surgical approach. The surgical approach changed in a total of 12 cases (2.3%). Statistical analysis showed that the surgeons with experience of <10 years and orthopedic surgeons changed their surgical plan more often after the preoperative conference (P<0.05). CONCLUSIONS: Preoperative conference for the surgical treatment of adult spinal disorders influenced the surgical plan in 5.7% of surgeries. This type of daily preoperative conference seems to have only a minor impact on spine surgeons' decision-making, but, instead, it could be used to provide training and insight to better a fellow or resident's education at the spine institution. LEVEL OF EVIDENCE: Level IV.

A complex variant of Lisfranc joint complex injury.

We report an unusual case of a variant of Lisfranc injury, plantar dislocation of the medial cuneiform with plantar fracture-dislocation of the intermediate cuneiform and dorsal fracture-dislocation of the lateral cuneiform, which has never been reported, to our knowledge. The entire pathologic abnormality was treated by open reduction and fixation with Kirschner wires, which were removed 8 weeks postoperatively because of pin-tract infection. Complex regional pain syndrome, which was a problem early in the recovery process, is now in remission, and at the 25-month follow-up examination, the patient was almost symptom free.

[Treatment of medial epicondyle fractures accompanying elbow dislocations in children]. / Cocuklarda dirsek çikigina eslik eden medial epikondil kiriklarinin tedavisi.

OBJECTIVES: We evaluated the clinical and radiographic results of treatment for medial epicondyle fractures accompanying elbow dislocations in children. METHODS: The study included 10 children (9 boys, 1 girl; mean age 12 years; range 1.5 to 15 years) with medial epicondyle fractures accompanying elbow dislocations. Three patients had posteromedial and seven patients had posterolateral dislocations. Three patients were treated conservatively, while four patients and three patients underwent early and late surgical treatment before or after the seventh day of injury, respectively. Surgery was indicated due to entrapment of the medial epicondyle fragments in three patients, and to instability in four patients with more than 5 mm of displacement. At surgery, a posteromedial incision was used and ulnar nerve exploration was performed. The results were evaluated using the Mayo elbow performance score. The mean follow-up period was 28 months (range 3 to 103 months). RESULTS: Union of the medial epicondyle fractures was achieved between four to six weeks in all the patients. The mean Mayo elbow performance score was 93.5. Late surgery was associated with a score of 80 in two patients and 75 in one patient, the remaining patients had an excellent result (100 points). Full range of elbow motion was achieved in all the patients treated conservatively and with early surgery; however, following late surgery, two patients had extension and flexion losses of 5 degrees and 10 degrees , respectively. None of the patients had instability postoperatively. CONCLUSION: Patients with entrapment of the medial epicondylar fragment in the joint and with a displacement of more than 5 mm should undergo surgery, while those with a displacement of 5 mm or less can be treated conservatively.