AIM In spinal surgery, high doses of radiation are delivered during surgical procedures that require fluoroscopic control. The aim of this study was to determine the amount of radiation delivered from the fluoroscopic unit and also the factors to reduce the amount of radiation during the surgery of adolescent idiopathic scoliosis patients. MATERIAL AND METHODS In this retrospective study 21 patients with adolescent idiopathic scoliosis treated by transpedicular screws between 2009 and 2012 were enrolled the study. Dose Area Product (DAP) values , number of views obtained during screw placement and other data were retrieved from the medical records of the patients. RESULTS The mean number of transpedicular screws used was 18. An average of 10,1 vertebrae were instrumented. The mean number of images obtained was 7.76. Mean fluoroscopy time was 7.95 seconds. The total mean DAP was 64.6 cGy.cm < sup > 2 < /sup > . CONCLUSION The amount of ionizing radiation transmitted to the patient and the surgical team can be reduced by freehand insertion, confirmation of screw position by AP and lateral fluoroscopic views including more than one segment, the use of K-wires as a guide in spinal segments with abnormal pedicular anatomy and neuromonitorization of the patient during the surgical correction of adolescent idiopathic scoliosis.

Methods A total of 76 consecutive adolescent idiopathic scoliosis patients who were treated with brace included in this study. 20 of 45 patients who were treated with SpineCor brace, and 13 of 31 patients who were treated with rigid brace, were able to finish pulmonary function test (PFT). PFT is administered to 33 patients before and immediately after wearing the brace. TLC, RV, RV/TLC, FVC, FEV1, FEV1/FVC, FEF25-75 parameters of PFT are compared between SpineCor and rigid brace patients.

Methods A total of 76 consecutive adolescent idiopathic scoliosis patients who were treated with brace were included in this study. 45 patients were treated with SpineCor brace, 31 patients were treated with rigid braces. After detailing braces and their costs, choice was made by patients’ family. Patient’s height, T1-Coccyx distance, gibbosity, and Cobb angles were documented at the beginning of the treatment and last control. At last visit SRS-22 questionnaire applied to the patients to evaluate clinical effect of braces.

Heterotopic ossification is a frequent complication after spinal cord injury. It usually develops around major weight bearing joints. However, ankylosing hip is a rare presentation. Various treatment methods have been reported and advocated as efficacious methods for management of heterotopic ossification. We report a case of ankylosing pelvitrochanteric heterotopic ossification treated with surgical excision before full maturation, postoperative radiation therapy and indomethacine without recurrence after 1 year. Treatment options are discussed in this particular case.

This study investigates efficacy and safety of routine cell salvage system use in adolescent idiopathic scoliosis patients undergoing primary posterior spinal fusion surgery with segmental spinal instrumentation. Forty-five consecutive adolescent idiopathic scoliosis patients undergoing posterior spinal fusion by two surgeons at a single hospital were studied. Intraoperative cell salvage system was used in 23 patients, and the control group was 22 patients who underwent surgery without cell salvage system. The cell salvage system was the Haemonetics Cell Saver 5. The primary outcome measures were intraoperative and perioperative allogeneic transfusion rate, difference between preoperative and discharge Hg and Hct levels. Average patient age was 14.65 ± 1.49 in cell saver group and 13.86 ± 2.0 in control group. In cell saver group, average intraoperative autotransfusion was 382.1 ± 175 ml. Average perioperative allogeneic blood transfusion need was 1.04 ± 0.7 unit in cell saver group and 2.5 ± 1.14 unit in control group. No transfusion reactions occurred in either group. Average hemoglobin level in cell saver group was 10.7 ± 0.86 and average hemoglobin level in control group was 10.7 ± 0.82 on discharge. Cell saver reduces perioperative transfusion rate in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis.

Scheuermann kyphosis is defined as thoracic kyphosis with an angle greater than 45° in association with wedging of an angle greater than 5° in 3 consecutive vertebrae. Hyperextension casts and bracing are used in the treatment of patients with incomplete skeletal maturation. However, conservative treatment is not efficient in kyphotic patients with an angle greater than 70°. In this study results of the patients performed posterior surgical treatment due to Scheuermann kyphosis between 2005 and 2009 were evaluated. In conclusion, fusion performed with posterior transpedicular screws is one of the alternative choices in the surgical treatment of Scheuermann kyphosis (>70°).

Adolescent idiopathic scoliosis appears during the adolescent growth spurt, a time when children are growing rapidly. In many cases the abnormal spinal curve is stable, although in some children the curve is progressive (meaning it becomes more severe over time). For unknown reasons, severe and progressive curves occur more frequently in girls than in boys. However, mild spinal curvature is equally common in girls and boys.

The abnormal sagittal deformity of spine is called kyphosis. Thoracic kyphosis above 50-60 degrees is accepted as abnormal. Kyphosis is the most common deformity in pathologic cases. Firstly we will give information about anatomy and biomechanics of spine, than about etiopathogenesis of posttraumatic kyphosis, sign and semptoms. Finally treanment principles and methods will be explained.

AimThe aim of this study was to compare the effect of short segment and long segment posterior fixation methods on deformity correction and preservtion of correction in lumbar burst fractures.Material and MethodsIn this study we evaluate 40 patients (9 female, 31 male) treated surgically due to lumbar burst fracture between 2000 and 2008.ResultsTwenty six L2 fractures, twelve L3 fractures of 38 patients were included in this study. Sagittal deformities after the fracture were evaluated by preoperatively, postoperatively and last follow up X-rays according to anterior corpus height loss (ACHL), sagittal index and local kyphosis angle (LKA).ConclusionsBetween two groups there were no statistically difference of ACHL and LKA. In follow up there were no differrence between correction loss of two groups.

SUMMARY AIM: this study evaluates how early diagnosis of congenital scoliosis affects results and complication rates of of surgical treatment. METHOD: We have evaluated the efficiency and effectivity of modern posterior spinal instrumentation methods in congenital scoliosis cases who were diagnosed and treated in Gulhane Military Medical Academy Orthopaedics and Traumatology Department. We have evaluated 53 patients (13 male,29 female) who were operated for congenital scoliosis between 1995 and 2009. Patients were divided into two groups according to the time of diagnosis to evaluate fusion levels, numbers of surgery, surgery methods, reduction rate, intraspinous and other system abnormalities and complications. RESULTS: 9 of 24 patients with diagnosis age before 5 and 11 of 29 patients with diagnosis age after 5 treated with single operation. Correction of main curve was %35.4 and compensatory curve was %13. Main curve correction of patients under 5 age was %36,3 and main curve correction of older group was %34,8 (p>0.05). Average number of fused levels in first group was 2,3±2,1 and in the older group 7,5±3,1. CONCLUSION: In patients before 5 age less invasive surgeries were needed to accomplish succesful treatment and early diagnosis of congenital scoliosis is the most important part of the treatment. KEY WORDS: Congenital ,Scoliosis, Posterior, Instrumentation

BACKGROUND:We evaluated and compared the efficacy of ozone (O(3)) and hyperbaric oxygen (HBO) therapies in an experimental rat model of osteomyelitis.MATERIALS AND METHODS:Forty-eight male Sprague-Dawley rats were divided into sham, osteomyelitis (control), vancomycin (V), vancomycin + HBO (VHB), vancomycin + O(3) (VO), and vancomycin + HBO + O(3) (VOHB) groups. Osteomyelitis was induced by a bone injection of 10(8) CFU/mL methicillin-resistant Staphylococcus aureus. HBO was administered daily at 2.8-atm pressure for 90 min; O(3) therapy was provided as intraperitoneal injections of 0.7 mg/kg O(3)/O(2) gas mixture once daily. Treatments were continued from d 7 to 21 after induction of osteomyelitis. Bone tissues and blood samples were harvested for biochemical, histopathologic, and microbiologic analyses.RESULTS:Rats in the sham, VO, and VOHB groups gained weight but those in the control, V, and VHB groups did not. Levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase were lower in the VHB, VO, and VOHB groups than in V and control groups. Levels of interleukin-10 and -1β and tumor necrosis factor-α were decreased in the VHB, VO, and VOHB groups; transforming growth factor-β was increased in these groups compared with V and control groups (P ≤ 0.001). Bacteria counts in VOHB were significantly lower than those in group of V (P = 0.012). Histopathologic scores in group VO were significantly lower than those in group V (P = 0.046).CONCLUSIONS:O(3) was as effective as HBO in decreasing oxidative parameters and inflammatory cytokines. Rats in the VO and VOHB groups gained more weight than did the other groups. Bacteria counts were significantly decreased in group VOHB compared with the other groups. Histopathologic scores in group VO were significantly decreased compared with the other groups.

The purpose of this study was to compare the clinical outcomes and wound complications in coccygectomy with or without subperiosteal resection. This retrospective study included 25 patients who underwent coccygectomy. Resection of all mobile coccygeal segments including the periosteum was performed in 11 patients (group 1) and resection was performed subperiostally sparing the periosteum in the remaining 14 patients (group 2). A visual analogue scale was used for pain assessment before and after the surgery both in sitting and standing positions. A questionnaire to evaluate subjective patient satisfaction was also used. The two groups were statistically similar in terms of age, sex, aetiology, duration of symptoms before surgery and follow-up time. Both surgical techniques resulted in a statistically similar clinical outcome. Overall, 84% of patients who underwent coccygectomy benefited from surgery. We observed four wound infections (two superficial and two deep) that caused delayed wound healing in group 1. The rate of infection in group 1 was statistically higher than in group 2. The results of this study suggest that periosteal preservation and closure are related to low risk of infection.

OBJECTIVES The aim of this study was to report our functional results after an intramedullary Kirschner wires (K-wires) and tension band wiring combination for the treatment of a large group of humeral head fractures was performed. PATIENTS AND METHODS Seventy-four patients (54 females, 20 males; mean age 42 years; range 24 to 73 years) who had proximal humerus fractures were treated with an intramedullary K-wire and tension band technique and were retrospectively analyzed. Fracture patterns were according to Neer classification type II in 43 patients, type III in 23 patients and type IV in five patients. The Constant-Murley shoulder score test was used to evaluate the function of both shoulders. The outcome was graded according to Neer's criteria. The pain score was determined with a 10-point visual analog scale. RESULTS All fractures were healed (radiologically and clinically) within 3.6 months (range 2.5 to 4.7 months) after the surgery. In one patient, the cerclage wire was broken and in eight patients, K-wires produced impingement like symptoms that required a second procedure (wire removal) after healing. The results of the patients with regard to Constant-Murley score and Neer criteria were indifferent when the 6th and the 12th month data were compared (p<0.05). Visual analog scale scores of the patients between the two control visits were significant different (p>0.05). CONCLUSION The type of fixation depends on the bone quality and the degree of comminution. But the recent trend is towards osteosynthesis -the limited, less invasive technique- which is performed with minimal soft tissue dissection and minimal osteosynthesis. It allows less stripping of bone and therefore preservation of the blood supply to the humeral head. This procedure is simple to perform and provides good postoperative results.

INTRODUCTION:The reason we report this case is that spine injuries may well occur due to landmines similar to other injuries like traumatic limb amputations and more over they may be overlooked.CASE PRESENTATION:The patient was 29-years-old Turkish male and was a member of the military. He detonated the landmine that caused his injuries while in a conflict zone. He had a right below knee and left above knee traumatic amputations. He had also mild intermittent pain in his lower back. There were no focal neurological findings such as weakness, altered sensibility, or alteration in the function of the bowel or bladder. Radiographs of the lumbar spine revealed an L2 burst fracture. Computed tomography scans and magnetic resonance imaging of the lumbar spine demonstrated a burst fracture of the L2 vertebrae and moderate compression in the anterior portion of the thecal sac due to the fracture fragment. Because of the stabile nature of the L2 burst fracture and lack of neurological disturbance, operative decompression, instrumentation and fusion was not performed. After healing of the stumps, the patient was mobilized with immediate prostheses and a thoracolumbosacral brace.CONCLUSION:Spine injuries should not be overlooked when evaluating patients after landmine explosions. After the patient has been stabilized, the secondary screening and radiographic evaluations should also comprise the thoracic, thoracolumbar and lumbar spine when treating patients after landmine injuries.

The most seen potential of disaster in Turkey is earthquake. After the earthquakes, because of mass casualty, many injured patients are taken to the hospitals in a short time. By the help of triage that is prepared with hospital disas- ter plans, accepting emergent patients with the highest priority enables to reduce mortality and morbidity. Hospital disaster plan exercises were organized in Gulhane Military Medical Academy, School of Medicine (Ankara/Turkey) in June 2005. The patients who are composed of students from GMMA School of Medicine, High School of Nursing, Health School of NGO's, were made up with moulage kit and cosmetics. Personnel in charge and triage team of the area were selected from voluntary hospital staffs. Because of scenerio after earthquakes one thousand patients were transported to the hospital by helicopters and ambulances. Then hospital disaster plan was acti- vated. Decontamination procedure was applied to suspicious thirty injured men according to the scenerio. Triage team's decisions were evaluated after exercises. After the exercises, lessons learned and feed-backs were evaluated. As a conclusion, with the help of such exercises, the performance of organizations concerning mass casulalities in hos- pitals will be better.

Objectives The purpose of this study was to compare the efficiency of the hyperpronation and supination–flexion maneuvers in the reduction of the pulled elbow. Methods Sixty-six patients with pulled elbow were randomized for reduction with either hyperpronation or supination–flexion maneuvers. When the first attempt failed, a second attempt was performed with the same reduction maneuver. After failure of the second attempt the reduction maneuver was changed to the alternate method. The success rate of the reductions and the subjective rating on the difficulty of the reduction by the physician were recorded and analyzed statistically. Results Thirty-two of 34 patients (94%) in the hyperpronation group and 22 of 32 patients (69%) in the supination–flexion group were reduced at first attempt (P=0.007). Two patients in the hyperpronation group and seven patients in the supination–flexion group were reduced at the second attempt. Reduction rates were statistically similar (P=0.06). Three patients in the supination–flexion group had failed reduction at the second attempt and the reduction maneuver needed to be changed. They were successfully reduced with hyperpronation maneuver at the first attempt. Final success rate of the hyperpronation maneuver at the first attempt was statistically higher than the supination–flexion maneuver (P=0.004). Furthermore, the hyperpronation maneuver was rated significantly easier than the supination–flexion maneuver by physicians (P=0.003). Conclusion Although final reduction rates were similar, the hyperpronation maneuver was more efficient at the first attempt, easier for physicians and less painful for the children.