No abstract

RDW is a parameter measured via routine blood testing. We think that RDW measurement should be used in the planning of the treatment of hip fractures and in scoring systems used to estimate post-operative mortality.

Study Design. Nonrandomized, retrospective, comparative, and single-center trial. Objective. The aim of this study is to compare the long-term clinical and radiographic results of thoracolumbar burst fractures in neurologically intact patients, treated surgically or nonsurgically with the aim to optimize their management. Summary of Background Data. There is an ongoing controversy regarding the treatment of thoracolumbar burst fractures (TLBF) (A3, A4) in neurologically intact patients. Surgical treatment as well as conservative treatment methods are advised to this specific group of patients, while contrasting results exist in the literature. Methods. Forty-five neurologically intact patients with TLBF (A3 or A4) (2010–2016) were included. Twenty-one patients with a mean age of 34.3 and a mean follow-up period of 63.1 months were treated surgically with short segment posterior fixation (group 1), while 24 patients with a mean age of 45.7 and a mean follow-up period of 67.1 months were treated conservatively (group 2) with thoracolumbosacral orthesis. Results. At the final follow-up groups 1 and 2 had an average segmental kyphosis of 4.09°/11.65° (P = 0.027), an average loss of kyphosis of 2.04°/4.03° (P = 0.038), an average loss of anterior/posterior vertebral body height of %12.89/%2.84/%17.94/%7.62 (P = 0.027/ P = 0.03), a median JOA score of (16.6/16.75) (P = 0.198), a median ODI score of (11.7/12.1) (P = 0.25), a median VAS score of (1.9/2.3) (P = 0.3), SF-36 PCS of (56.74/56.67) (P = 0.25), SF-36 MCS of (55.47/55.5) (P = 0.3), mean durations of hospital stay of 9–11 days (P = 0.3), respectively. Conclusion. While there is an ongoing controversy regarding the management of stable thoracolumbar burst fractures in neurologically intact patients in the literature, this study concluded that surgical management of stable thoracolumbar burst fractures in neurologically intact patients provided better radiolographic outcomes, despite the result, that the difference between surgically and nonsurgically treated patients in terms of clinical outcome parameters and quality of life was not statistically significant. Level of Evidence: 3

Dega acetabuloplasty at the time of open reduction is effective in improving the acetabular coverage of the femoral head, hence improving the stability of reduction and preventing possible surgery in the future for residual acetabular dysplasia in older children with Tönnis grade 3 and 4 developmental dysplasia of the hip (DDH). The aim of this study was to assess the radiological results of open reduction combined with Dega osteotomy in DDH. Twenty-two children's 26 hips were operated on at a mean age of 38±20.4 SD months and followed up for an average of 42 (range 24-108) months. Thirteen hips (50%) were operated on with concomitant open reduction and capsulorrhaphy, and 13 hips (50%) were treated with concomitant open reduction, capsulorrhaphy and femoral shortening osteotomy. Radiological examination included acetabular index (AI) and centre edge angle measurements. The mean preoperative AI was 39.4±6.9° SD, which improved to 18.3±4.5° SD postoperatively, and AI was measured as 15±3.5° SD at the latest follow-up. There was a significant difference in the mean AI values between the last follow-up and the preoperative measurements (P<0.05). The mean centre edge angle was 31±5.6° SD postoperatively, and it was 31±6.2° SD at follow-up. There was no significant difference between the two values. Two hips were noted to have lateralization of the femoral head due to coxa valga anteverta. One of them was operated with a femoral varus osteotomy. The Dega osteotomy combined with anterior open reduction and femoral osteotomies is a safe and effective acetabular osteotomy for surgical treatment of severe DDH such as Tönnis grade 3 and 4 dislocations.

ElderlyHip fracture Mortality Comorbidity a b s t r a c t Aims: The purpose of this study was to report a less seen age-group (>90) of hip fractures and to assess the predictors of functional loss, complications and mortality.Methods: Thirty-two patients at a mean age of 92.8 (±2.7) were treated in a single institution and reported at a mean follow-up of 2.02 (±1.35) years. Conclusion: Hip fractures are challenging in extremely old patients and associated with increased mortality and disability.

Autologous erythrocyte replacement was possible using the cell saver method. However, there was no decrement in allogeneic blood replacement using cell saver in the surgical treatment of adolescent idiopathic scoliosis.

AIM: To compare posterior surgery alone versus combined anterior and posterior surgery for the management of spinal tuberculosis. MATERIAL and METHODS: Data from 31 consecutive patients who underwent surgery for spinal tuberculosis were analyzed retrospectively. Patients were divided into two groups as group A (posterior surgery alone) or group B (combined anterior and posterior surgery), and groups were compared in terms of invasiveness of the procedure, spinal deformity, fusion, neurological status, and postoperative complications. RESULTS: Group A included 16 patients (mean age: 56 years, range: 29-75) with a mean follow-up period of 29 months (range 12-60) while group B included 15 patients (mean age: 60 years, range: 35-73) with a mean follow-up period of 28 months (range 12-60). Procedurally, average operation time and mean length of hospitalization were shorter, and mean blood loss was lower in group A (p<0.05) compared to group B. Postoperative bone fusion took significantly (p<0.05) longer time in group A (10.5 ± 2.1 months)than in group B (9.3 ± 3.1 months), and all patients with a neurological deficit recovered completely during the postoperative period. No significant differences were observed between two groups with respect to postoperative complications (p>0.05). CONCLUSION: Combined anterior-posterior surgery may not be required for treating vertebral tuberculosis as posterior surgery alone appears to be sufficient.

ObjectiveThe aim of this study was to analyse the effectiveness of single dose of 20 mg/kg intravenous tranexamic acid (TXA), in reducing the blood loss in patients undergoing total knee arthroplasty (TKA).Material and method70 patients (65.5 ± 8.1 years old) that have undergone TKA were divided in two groups. The 20 mg/kg IV TXA was given before the skin incision to one group (study group). On the control group, TKA was performed without TXA. The demographic data, body mass index, amount of bleeding and erythrocyte infusion during the operation, hemoglobin and hematocrit values (preoperative and 48th hour), the amount of drainage after the operation were compared between the groups.ResultsThe total amount of bleeding in the study group was 634.03 ± 182.88 ml and 1166.42 ± 295.92 ml in the control group (p < 0.001). Perioperative bleeding was 252.01 ± 144.13 ml in the study group and 431.33 ± 209.10 ml in the control group (p = 0.018). The drainage after the operation was 311.11 ± 141.64 ml at the 24th hour in the study group, 640.74 ± 279.43 ml at the 24th hour in the control group (p < 0.001). The drainage after 24th hour was 97.96 ± 115.86 ml in the study group and 112.96 ± 64.43 ml in the control group (p = 0.584).ConclusionA high, single dose of TXA intravenously given to the patient prior to the TKA significantly reduces the bleeding during the operation and within the postoperative 24 h. There is no significant change in the bleeding amount after the 24th hour following the operation.