No abstract

Purpose Neer type II distal clavicle fractures are associated with a high rate of non-union or malunion due to impaired coracoclavicular ligament stability. The purpose of this study was to assess the clinical and radiological outcomes of arthroscopically assisted indirect osteosynthesis for type II distal clavicle fractures using a cortical suture button device. Methods Seventeen patients Neer type II fractures of the distal clavicle were treated surgically using cortical suture button ixation between 2012 and 2017. The clinical and radiological results were assessed using the American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant-Murley score and visual analogue scale (VAS) score. Results Anatomic reduction and bone healing were achieved in all patients at the inal follow-up. The median age of the patients was 31 years (range 19-57). The mean follow-up was 25.9 months (range 14-64). The average delay before surgery was 2 days (range 1-4). At the inal follow-up, the mean ASES, Constant-Murley score and VAS score were 92.6 ± 3.2 (range 84.9-96.6), 96.2 ± 2.4 (range 92-100) and 0.47 ± 0.51 (range 0-1), respectively. All patients were able to resume work as well as sport activities. The postoperative complications included two coracoid process fractures, and none of the patients required additional surgery related to the index procedure. Conclusion All arthroscopic coracoclavicular button ixation of Neer type II distal clavicle fractures would provide suicient stability and union with satisfactory radiological and clinical outcomes. This arthroscopic ixation technique would be more eicient than other osteosynthesis methods because it is a minimally invasive surgery with a low complication rate. Level of evidence III.

We describe a case of multifocal relapsing hydatid cyst following multilevel thoracic corpectomy and 360° instrumentation surgery. A 41-year-old male patient presented with cord compression and paraplegia due to a multiseptated cystic lesion at T10-11 level. The cyst was excised with a combined anterior and posterior approach and 360° stabilization was performed. The patient received albendazole for 1 year after the surgery.The patient presented with paraparesis 5 years after the surgery. Cystic lesions between C2-T1 and T10-11 were detected on the spinal MRI and the patient was operated with removal of the lesions on both levels and adjuvant local 20% hypertonic saline application. The patient received albendazole for the postoperative 6 months.After 3 months from the surgery, the patient’s paraparesis recovered. There was no recurrence after 2 years from the last surgery.

To analyze the effect of tibiofemoral mechanical axis (TFMA) deviation severity on clinical outcomes after total knee arthroplasty (TKA). Methods: We retrospectively reviewed the patients who underwent primary TKA between January 2002 and December 2010. After applying inclusion/exclusion criteria, we evaluated 70 knees of 51 patients. The mean AE SD follow-up period was 7.08 AE 1.34 years. The knees were divided into 3 groups based on TFMAs. The first group, identified as "well aligned," included the TFMAs that were neutral within 3 (0 AE 3 ) of alignment. The second group, identified as "outliers 1," included the slightly deviated TFMAs (À3 to À6 valgus and +3 to +6 varus). The third group, identified as "outliers 2," included the severely deviated TFMAs of more than 6 from neutral alignment (<À6 valgus and > + 6 varus). The clinical outcomes of each group were compared by evaluating the Oxford Knee Score (OKS), visual analog scale (VAS), and Short Form-36 physical component summary (SF-36 PCS) and mental component summary (SF-36 MCS) scores. Results: We found that OKS, SF-36 PCS, and SF-36 MCS were nearly the same in the well-aligned and outliers 1 groups but worse in the outliers 2 group. VAS scores were nearly the same in all groups. (p > 0.05) Conclusion: Function scores were impaired when the TFMA deviated more than 6 from neutral. However, the differences in clinical outcomes between well-aligned knees and those of outliers were not found to be statistically significant in the medium term.

BackgroundThis study aimed to extend clinical documentation of cerebral calculi by reporting six cases of cerebral calculi with distinct etiologies and localizations. MethodsWe evaluated the age, sex distribution, presenting symptoms, neurological examination findings, pathology results, and location of the calcifications of six patients with intracranial calcifications.ResultsThree of the six patients with brain stones were female (50%), and three were male (50%). The patient ages ranged from 12 to 46 years. A radiological examination of each patient’s cranium was performed with pre-operative cranial computed tomography and magnetic resonance imaging. All of the lesions were completely excised. The patients’ pathologies were determined to be distinct hyalinization, dystrophic calcification, hamartoma, ossification developing from widespread pituitary adenoma tissue, benign mesenchymal neoplasia, a mass consisting of sporadically ossified fibrous tissue, and angiomatous meningioma with distinct hyalinization and fibrosis.ConclusionsIntracranial calcifications are a common phenomenon in neurosurgical practice. However, brain stones, as well as solid calcifications also termed cerebral calculi, are rarely encountered. Brain stones can be classified on the basis of their etiology and localization. Additionally, we suggest that lesions smaller than 1 cm might be classified as calcifications and those greater than 1 cm as brain stones. We further suggest that the differentiation between calcification and brain stones might be based on size. These pathologies typically manifest as seizures and are occasionally identified during routine brain tomography. Meningiomas constitute an important portion of extra-axial calcifications, whereas tumorous and vascular causes are more prevalent among intra-axial calcifications.

ObjectiveThe purpose of this study was to evaluate the effect of resident level of training on fluoroscopy duration in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning (CRPP).MethodsAfter classifying the surgeons according to their seniorities, the duration of fluoroscopy time of 80 patients with extension type III supracondylar fractures during reduction and pinning was recorded.ResultsThe time duration of reduction procedures was similar in all groups with respect to the surgical experience; however, time durations of percutaneous pinning procedures were found statistically different between groups (p=0.042).ConclusionSurgical experience is very important in the management of supracondylar humeral fractures in children, especially in percutaneous pinning rather than closed reduction.

Grisel's syndrome is non-traumatic inflammatory subluxation of the atlantoaxial joints presenting clinically as torticollis, neck pain, and reduced neck mobility. Several pathogens have been implicated in its etiology. Early diagnosis and treatment are vital for Grisel's syndrome to avoid serious neurological complications. This study reports the case of a 6-year-old girl who complained of pain and curvature of the neck following an upper respiratory tract influenza infection. Notably, the patient's neck pain and curvature worsened toward the end of her normal day for a week. This pattern is rare, but it represents an important example of Grisel's syndrome as a condition that varies through the day.

Hydatid cysts are rarely located in the central nervous system. Treatment involves surgical and medical interventions. In this article, we present the first published case of a giant hydatid cyst with an extraaxial intrasellar location. This is the first such case to be reported in the literature. The cyst caused somnolence, general affective disorder, panhypopituitarism, and progressive loss of vision.