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The aim of this experimental study was to evaluate the effect of expansive open-door laminoplasty with simple suture fixation on spinal canal diameter in a rabbit model.Twenty white New Zealand rabbits were operated on with C4-C7 Hirabayashi open-door laminoplasty. The spinal canal diameter was evaluated radiologically on preoperative day 1 and postoperative days 1 and 42.The mean spinal canal diameter was 6.42 mm preoperatively, 8.04 mm on postoperative day 1 and 8.02 mm at day 42. There was a significant difference between the mean preoperative and postoperative day 1 spinal canal diameter (p0.001). There was no significant difference between the mean spinal canal diameter at postoperative day 1 and 42 (p0.05).Our results suggest that the open-door laminoplasty with simple suture fixation is an effective method to expand the spinal canal diameter. No recurrent narrowing is expected in short term.

Osteonecrosis of the femoral head, a disease primarily affecting young adults, is often associated with the collapse of the articular surface and subsequent arthrosis. Some authors have reported good results with the use of vascularized and non-vascularized fibular grafts to treat osteonecrotic lesions of the femoral head. The aim of this study was to compare the results of vascularized fibular grafting with that of non-vascularized fibular grafting in the treatment of femoral head osteonecrosis.Between January 1999 and June 2008, 11 osteonecrotic hips of 8 patients who underwent vascularized fibular grafting and 15 osteonecrotic hips of 13 patients who underwent nonvascularized fibular grafting were compared according to etiology, stage, age, sex, preoperative and postoperative first year Harris hip and VAS scores.Steroid use was the most common etiologic factor, found in 26 hips of 21 patients in the entire patient population. There was no significant difference between the two groups according to their age, sex and preoperative Harris hip scores (p0.05). According to the Ficat staging system for radiological evaluation, 4 hips were Grade 2A, 4 hips were Grade 2B, and 3 hips were Grade 3 in the vascularized group and 8 hips were Grade 2A, 3 hips Grade 2B, 3 hips Grade 3 and one hip was identified as Grade 4 in the non-vascularized group. When the Harris hip and VAS scores of both groups were evaluated, the group treated by vascularized fibular grafting had significantly higher scores than the ones treated by non-vascularized fibular grafting in the other group (p0.05). Furthermore, when the Harris hip and VAS scores of preoperative and postoperative first year of vascularized fibular grafting patients were compared, there were significantly higher scores after the surgery.Although there was no significant radiological difference in the early results of both surgical techniques, the clinical results of vascularized fibular grafting treatment were significantly better than the results of non-vascularized fibular grafting treatment in the osteonecrosis of the femoral head. Vascularized fibular grafting improves the clinical status at an early period and prevents subchondral collapse.

We evaluated our treatment algorithm used in adult patients with tuberculous spondylitis together with long-term treatment results.The study included 55 adult patients (26 males, 29 females; mean age 50 years; range 23 to 71 years) with tuberculous spondylitis. The patients underwent four different treatment methods including non-operative treatment (NO, 6 patients), posterior debridement, fusion and instrumentation (PDFI, 21 patients), anterior debridement, instrumentation and fusion (ADIF, 21 patients), and finally, urgent radical debridement (RD, 11 patients) due to financial limitations of the patients. All the patients received antituberculous therapy for 12 months. On presentation, 17 patients (30.9%) had neurologic deficits (ADIF, 6 patients; RD, 11 patients). Neurologic assessment was made according to the Frankel grading system. The results were evaluated with respect to kyphosis, sagittal balance, neurologic recovery, and patient satisfaction. The mean follow-up period was 95.3 months (range 66 to 114 months).Radiographically, successful bone fusion was achieved in all the patients. Following treatment, all surgically treated groups exhibited decreases in the kyphotic angle. The mean correction was significantly greater in ADIF (17.5 degrees ) and PDFI (12.1 degrees ) groups compared to the RD group (4.9 degrees ) (p0.05). Final increases in the kyphotic angle were 0.7 degrees , 1.2 degrees , 1.4 degrees , and 1.6 degrees in NO, PDFI, ADIF, and RD groups, respectively. The mean sagittal deviations in the first postoperative month were +2 mm, +11 mm, +12 mm, and +14 mm in NO, PDFI, ADIF, and RD groups, respectively, which remained unchanged till the end of follow-up. Complete neurologic recovery was obtained in all but one patient. All the patients expressed satisfaction with the treatment. No recurrences or reactivation of disease were observed.This study showed that, with appropriate patient selection, the results of NO, PDFI, and ADIF were satisfactory and comparable.

Multiple enchondromatosis (Ollier's disease) is a rare disease characterized by widespread enchondromas. In general, the short tubular bones of the hand are involved, with progressive lesions resulting in cosmetic problems and functional deformities. Diaphysectomy and reconstruction with structural autografts or allografts are usually recommended in the treatment of extensive enchondromas involving the fingers. Curettage and grafting and ray amputation are other surgical procedures that can be applied depending on the severity of involvement. A 25-year-old woman with enchondromatosis presented with severe swelling and deformities on her fingers in both hands. The majority of the lesions were managed by diaphysectomy and reconstruction with structural grafts; ray amputation, curettage and grafting were performed for more severe lesions. During a long-term follow-up (left hand 6 years, right hand 5.5 years) cosmetic and functional results were acceptable.

Diagnosis and management of chronic dislocations of the glenohumeral joint remain challenging. These dislocations usually occur in debilitated patients with a poor bone quality and they often have a decreased rehabilitation potential. Treatment can only be successful with early recognition of the condition, careful patient selection, and implementation of appropriate surgical techniques. This article reviews current information on clinical evaluation, preoperative radiologic investigations, and treatment strategies in patients with chronic dislocations of the glenohumeral joint and associated articular surface defects.

Shoulder complaints are one of the leading reasons for a doctor's visit in athletes involved in overhead activities, and among them, dislocation and subluxation are very frequent clinical presentations. Although diagnosis and management of shoulder problems are more clear-cut in traumatic cases, atraumatic cases may be quite troublesome. In order to facilitate the interval between the presentation of complaints and institution of appropriate treatment, many issues should be appreciated including the anatomy, etiology, pathogenesis, clinical evaluation, and treatment of shoulder disorders. This review aims to outline the current approach to shoulder problems arising from instability in the light of the most recent literature.

Biomechanical studies have shown that the biceps tendon and the superior labrum have significant contributions to the glenohumeral stability. Since superior labrum anterior-posterior (SLAP) lesions pose diagnostic difficulties, they should be kept in mind when evaluating a painful shoulder. Although magnetic resonance arthrography is of great use in diagnostic studies, diagnostic arthroscopy is still the best method for these lesions. Treatment may vary depending on the type of the lesion. As our knowledge about the glenohumeral anatomy enhances, success rates of the arthroscopic treatment of SLAP lesions will increase.

We evaluated the results of surgical management of hip instability in children with spina bifida (SB).Twenty-eight hips of 26 patients (16 girls, 10 boys; mean age 4.5 years; range 3 to 6 years) were surgically managed for hip instability (subluxation/dislocation) associated with SB. Twenty-four patients (2 bilateral dislocations) had low-level lesions (L4-sacral) and a potential to walk, of which 16 patients presented with unilateral dislocation with functional problems including significant (2 cm) limb-length discrepancy and scoliosis. Two patients had high-level lesions (thoracic-L3) associated with unilateral dislocations and were unable to walk. Those with a high-level lesion and some patients (9/26 hips) with a low-level lesion also had hip flexion contractures. Treatment included open reduction, pelvic osteotomy, proximal femoral osteotomy when necessary, and a spica cast. The patients were clinically and radiographically monitored for a mean of 38 months (range 30 to 48 months).Of 16 patients with functional problems, 14 patients had improvement in their gait patterns, while limb-length discrepancy and scoliosis persisted in two. The remaining 10 patients maintained their preoperative functional statuses. The mean range of motion of the hips decreased postoperatively; however, none of them developed joint stiffness. Early postoperative complications included superficial wound infections in three patients, and distal femoral diaphyseal fractures in two patients. Three patients required removal of the implants in the sixth month due to subcutaneous prominence thereof. Late radiographs of three patients showed recurrent subluxations, which did not require any intervention.Although surgical treatment of hip problems associated with high-level lesions may be unrewarding in children with SB, those associated with low-level lesions can be successfully managed with proper surgical indications.

Transient osteoporosis of the hip is a rare disease of unknown etiology. It is usually seen in middle-aged men and women in the third trimester of pregnancy and is associated with hip pain. It typically runs a benign course with eventual resolution of symptoms. We report three patients who presented with unilateral hip pain that started in the third trimester of pregnancy. Diagnosis of transient osteoporosis of the hip was made with the help of clinical and radiologic studies. Treatment was comprised of pain control therapy with diclofenac sodium (100 mg/day) for three months, bed rest for a month followed by mobilization with a walking aid. The follow-up period was at least 24 months. Clinical improvement occurred in the third month in one patient, and at the end of six months in the remaining patients. Complete radiologic improvement was seen at the end of 12 months.

We presented our experience with the diagnosis and treatment of low back pain in children.We retrospectively reviewed 29 children (15 girls, 14 boys; mean age 12 years; range 9 to 17 years) who were treated for low back pain and had appropriate follow-ups. Etiologic causes were sought by clinical evaluation, radiologic studies, and laboratory tests. Patients with unknown etiology underwent symptomatic treatment. The mean follow-up period was 42 months (range 12 to 96 months).Etiology was determined in 26 patients (89%), which included spondylolysis/spondylolisthesis (n=8), Scheuermann's disease (n=6), neoplasia (n=5), discitis/vertebral osteomyelitis (n=4), and lumbar disc herniation (n=3). Spondylolysis was managed conservatively, except for one patient who had in situ spinal fusion for associated spondylolisthesis. Five patients with Scheuermann's disease were treated conservatively, while one patient required spinal fusion. Surgical treatment with biopsy, curettage, and bone grafting was performed for all neoplasias, but one which was followed-up conservatively. Two patients with discitis were managed with antibiotic treatment and two patients with vertebral osteomyelitis (Pott's abscess) underwent both medical treatment and surgical drainage and stabilization with strut graft. Lumbar disc herniation was treated conservatively in two patients, while one had surgical treatment with excision of disc fragments and limited laminectomy. Finally, all the patients became asymptomatic on final examinations.Serious consideration should be given to persistent low back pain in children. Clinical, radiologic, and laboratory findings can be elaborated into etiologic diagnoses and complete relief can be achieved with appropriate treatment.

We evaluated the long-term results of rotator cuff tears treated by open surgical repair.Ninety shoulders of 88 patients (36 females, 52 males; mean age 57 years; range 36 to 75 years) with rotator cuff tears were treated by open surgical repair and acromioplasty. A three-staged rehabilitation program was implemented following surgery. Objective evaluations were made with the use of the Constant-Murley scoring system. Pain was assessed through a visual analog scale. The mean follow-up period was 61 months (range 24 to 102 months).The mean Constant-Murley score increased from preoperative 41.7 (range 12 to 82) to postoperative 79.7 (range 42 to 100) (p0.0001). The mean preoperative and postoperative pain scores were 7.5 (range 4 to 10) and 1.25 (range 0 to 5), respectively (p0.0001). Only eight patients (9%) showed dissatisfaction with the surgical outcome. The remaining 80 patients (91%) were satisfied with the outcome and returned to their previous night comfort and daily activities. None of the patients had postoperative nerve palsy or limitations in shoulder functions. Two patients (2.2%) developed superficial soft tissue infections that disappeared following multiple wound debridements.Our long-term results favor open surgical repair and acromioplasty in the treatment of patients with rotator cuff tears.

We evaluated the results of arthroscopic or open anterior acromioplasty after a mean follow-up of two years in the treatment of impingement syndrome.The study included 145 patients who underwent anterior acromioplasty through open surgery (90 patients; mean age 56 years; range 36 to 70 years) or arthroscopic surgery (55 patients; mean age 49 years; range 32 to 58 years). Comparisons were made between both groups with regard to preoperative and postoperative Constant scores, activity, pain, range of motion, and strength scores, and durations for postoperative pain, hospital stay, and return to work. The mean follow-up was 24 months (range 12 to 60 months) for both groups.The mean Constant scores increased from preoperative 32.6 to postoperative 80.5 and from 25.5 to 83.1 with open and arthroscopic surgery, respectively. No significant differences were found between the two groups with regard to pre- and postoperative Constant scores, activity, pain, range of motion, and strength scores (p0.05). However, patients who underwent arthroscopic surgery exhibited shorter durations in the following: hospital stay (1.36 vs 1.72 days), delay in return to work (9 vs 16 days), and postoperative pain (6 vs 8 weeks) (p0.05). According to subjective patient evaluations, arthroscopic results were good or excellent in 47 patients (85.5%), satisfactory in six patients (10.9%), and poor in two patients (4.6%); open surgery results were good or excellent in 76 patients (84.4%), satisfactory in 10 patients (11%), and poor in four patients (4.6%).Both treatment options seem to be equally effective in the treatment of impingement syndrome in the absence of rotator cuff tears.

During the past decade, arthroscopy has become an accepted tool for the evaluation and management of shoulder disorders. The glenohumeral joint, subacromial space, acromioclavicular joint, and even the scapulothoracic articulation can be assessed through arthroscopy. Proper portal placement allows a safe access without risk for neurovascular, tendon, or articular injuries. Anterior acromioplasty is probably the most common arthroscopic procedure performed in the shoulder, with reported results similar to open techniques. This article focuses on the arthroscopic treatment of impingement syndrome in the light of published data, together with its technical aspects.

A thirty-nine-year-old man presented with a complaint of low back pain with a history of 20 years. Cervical and thoracolumbar radiographs showed wide calcification areas and ankylosis in the intervertebral discs. Observation of blue-gray pigmentation around his nose and ears suggested a diagnosis of ochronosis, which was confirmed by the detection of high levels of homogentisic acid in the urine and dark urine color following alkalization. Ochronosis should be included in the differential diagnosis in patients with chronic low back pain, calcified intervertebral discs, and black pigmentation in cartilagenous and collagenous tissues.