AIM: To compare the clinical and functional outcomes between combined anterior and posterior 2-segment spinal fusion and posterior 3-segment spinal fusion in patients with thoracolumbar (TL) burst fractures at risk for posttraumatic kyphosis without neurological deficit. MATERIAL and METHODS: Twenty-seven patients with TL burst fracture, >20° kyphosis and/or 50% collapse, and posterior ligament injury, but without neurological deficit, were randomly assigned into posterior and combined groups. Posterior treatment was 3-segment (1 level below, fractured level and 2 levels above) posterior spinal fusion. Combined treatment was including 1 cranial and 1 caudal levels posterior spinal fusion, followed by anterior corpectomy, cage, and bone grafting. Patients were followed-up for a mean duration of 117.7 ± 8.7 months (range, 98-132 months). At the final follow-up, the clinical and functional means of the groups were compared using degree of kyphosis, visual analogue scale (VAS), and Roland-Morris and Oswestry scores. RESULTS: Mean patient age was 38.5 ± 2.4 years (range: 18-68 years). Fourteen and 13 patients were treated with the combined and posterior approach, respectively. Age (40.0 ± 10.3 and 37.0 ± 14.2 years; p=0.519), sex (female/male, 3:10 and 5:9; p=0.385), mechanism of injury (p=0.513), fractured levels (p=0.185), type of fracture (p=0.293), degree of kyphosis at initial admission (p=0.616), collapse (p=0.155), canal narrowing (p=0.280), follow-up (p=0.076) and accompanied limb fracture (p=0.374) were similar between groups. Duration of hospital stay was similar between two groups (p=0.102). However, blood loss was higher in combined group (195 ml versus 358ml, p=0.003). A 14.2° correction was achieved in the posterior group and 16.9° in the combined group (p=0.61). Loss of correction at the last follow-up visit was 2.1° with a final kyphosis of 7.2° in the posterior group, and 1.2° with a final kyphosis of 5.5° in the combined group. The differences in the correction of kyphosis (p=0.616), postop kyphosis (p=0.756), loss of correction (p=0.141) and final kyphosis (p=0.085) between the treatment groups were not significant. At the last follow-up visit of the posterior and combined groups, the VAS (16.4 ± 14.8 vs. 17.6 ± 16.6; p=0.685), Roland-Morris (27.2 ± 27.3 vs. 29.6 ± 20.5; p=0.519), and Oswestry scores (15.0 ± 13.1 vs. 17.7 ± 11.5; p=0.302) were similar. CONCLUSION: Both treatment methods are similar in terms of clinical and functional outcomes.

The purpose of this study was to determine the best predictive radiographic measurement method to identify the presence of osteoporosis and test the inter-observer and intra-observer reliability and validity of these methods in postmenopausal women. Materials and Methods: Ninety-two elderly female patients who presented with hip pain were included. Hip radiographs were used to determine the values of Singh index (SI), canal-to-calcar ratio (CCR), and cortical thickness index (CTI). All measurements were performed by two independent observers on two separate occasions, at least 4 weeks apart. Bone mineral density (BMD) was assessed by DEXA. In the first part of the analysis, reliability of the all measurement methods was tested. In the second part, correlation coefficient (Pearson r) was used to determine the relationship between the measurement methods and BMD. Finally ROC curve analysis was performed to determine the sensitivity, specificity, and threshold values for each radiographic measurement method. Results: Intra-observer reliability analysis of SI revealed kappa coefficient of 0.359 for observer A, and 0.224 for observer B. Inter-observer reliability analysis of SI revealed kappa coefficient of 0.070 for observer A and 0.051 for observer B. The intra-observer and inter-observer reliability was good and excellent for CTI and CCR for both observers (ICC: 0.920 and ICC: 0.936). There was no correlation between SI and BMD (p=0.818). On the other hand, there was a significant correlation between CTI and CCR and BMD (p=0.001). All measured indices were significantly different (p<0.05) between osteoporotic and non-osteoporotic patients. CTI value less than 0.3 or CCR value less than 0.47 reflects the presence of osteoporosis with 100% sensitivity and 98% specificity. Conclusion: SI is not reliable and do not correlate with BMD. However, both CTI and CCR showed good and excellent reliability, and each index correlated well with the real BMD values.

The results of this study show that free oxygen radical damage in the presence of infection has an important role in reflux nephropathy.

vVK100 polymer, as a local antibiotic delivery system, seems to be an effective method for the treatment of implant-related chronic MRSA osteomyelitis.

KOSE, O.; ERASLAN, A.; ERGUN, A.; EGERCI, O. F. & ERCAN, E. C.Prevalence of bipartite patella in Turkish population; analysis of bilateral knee radiographs in 897 subjects. Int. J. Morphol., 33(3):1108-1113, 2015. SUMMARY:Bipartite patella is a normal anatomic variant of patella. There are various data about the prevalence of bipartite patella in the literature. The aim of this study was to investigate its prevalence, type distribution and sex predilection in Turkish population. Bilateral knee radiographs were retrospectively reviewed of 897 consecutive adult patients. Cases with bipartite patella were categorized according to the Oohashi classification. Medical records were examined in order to differentiate symptomatic and asymptomatic bipartite patellae. We contacted symptomatic patients by telephone to learn continuity of knee pain. We identified 11 cases (7 male, 4 female) of bipartite patella among the 283 male and 614 female patients. No bilateral cases were identified. The prevalence of bipartite patella was 1.22% overall, 2.47% in males, and 0.65% in females. The most common type was superolateral bipartite patella as seen in 9 patients (81.8%). One subject had lateral bipartite and one subject had superolateral tripartite patella. Painful bipartite patella was found in only 2 patients (18%). One of them had continuing symptoms even after 12 months. In conclusion, we found that the prevalence of bipartite patella in Turkish population was approximately 1%. Both inclusion of only adult (skeletally mature) subjects and assessment with bilateral imaging increased the reliability of this value. In accordance with the literature, bipartite patella was found significantly more frequent in males and mostly in superolateral type. More studies are needed in order to obtain the prevalence, type and sex distribution of bipartite patella in different populations.

An experimental study was planned to evaluate 99mTc-citrate, 67Ga-citrate and 99mTc(V) dimercaptosuccinic acid (DMSA) as agents for the visualization of acute appendicitis. Appendiceal ligation was performed through a midline incision in 24 rabbits. Twenty-four hours later the animals were divided into three equal groups. The rabbits were injected through the aurical vein with 1 mCi (37 MBq) 99mTc-citrate in group I, 0.5 mCi (18.5 MBq) 67Ga-citrate in group II and 1 mCi (37 MBq) 99mTc(V) DMSA in group III. After 3 h, static images of the rabbits were obtained with a gamma camera. There were positive images in seven, six and five rabbits in groups I, II and III respectively. The image quality was better in group I than in the other groups. Also, the mean uptake in group I was significantly higher than those of other two groups (P < 0.05). There was no significant difference between groups II and III (P > 0.05). All rabbits had appendicitis confirmed histologically. In conclusion, these results show that 99mTc-citrate is preferable to 67Ga-citrate and 99mTc(V) DMSA for the differential diagnosis of acute abdominal inflammations such as appendicitis, because of higher concentration ratios, simple and rapid preparation, low cost, excretion mainly through the kidneys and fast blood clearance.

Several different pathologies may play a role in the etiology of posterior interosseous nerve (PIN) palsy such as trauma, radial tunnel syndrome, tumors, vasculitis, septic arthritis, and rheumatoid synovitis. The most common atraumatic factor is the compression of the nerve through its anatomic path. Parosteal lipoma around the proximal radius is the leading solid tumor seen among the neoplastic lesions. Although it is common, there are only case reports or few case series reported in the current literature and a comprehensive review is missing. Herein a rare case of PIN palsy due to parosteal lipoma of the proximal radius is presented together with a thorough literature review. A 48-year-old woman was presented with elbow pain and wrist drop that lasted for ten months. Electrodiagnostic and imaging findings lead to a diagnosis of PIN palsy due to parosteal lipoma seated over the proximal radius. Total surgical excision was performed, and the patient had been followed up for one year. Removal of the lipoma failed to recover the patient's symptoms. We reviewed all the reported cases and discussed, epidemiology, clinical findings, imaging studies, electrodiagnostic studies, pathology, treatment and prognosis of PIN palsy due to parosteal lipoma.

No abstract