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Greulich-Pyle (GP) is one of the most used method for bone age determination (BAD) in various orthopedic, pediatric, radiological, and forensic situations. We aimed to investigate the inter- and intra-observer reliability of the GP method between the most relevant disciplines and its applicability to the Turkish population. One-hundred and eighty (90 boys, 90 girls) patients with a chronological age younger than 18 (mean 9.33) were included. X-rays mixed by the blinded investigator were evaluated by two orthopedists, two radiologists, and two pediatric endocrinologists to determine skeletal age according to the GP atlas. A month later the process was repeated. As a statistical method, Paired t-test was used for comparison, an Intraclass Correlation Coefficients test was used for reliability and a 95 % confidence interval was determined. Results were classified according to Landis-Koch. All results were consistent with chronological age (p<0.001), according to the investigators' evaluations compared with chronological age. At the initial evaluation, the interobserver reliability of the method was 0.999 (excellent); at the second evaluation, the interobserver reliability was 0.997 (excellent). The intra-observer reliability of the method was 'excellent' in all observers. When results were separately evaluated by gender, excellent intraobserver correlation and excellent correlation with chronological age were found among all researchers (>0.9). When X-rays were divided into three groups based on age ranges and evaluated, 'moderate' and 'good' correlations with chronological age were obtained during the peripubertal period. The GP method used in skeletal age determination has excellent inter- and intra-observer reliability. During the peripubertal period, potential discrepancies in bone age assessments should be kept in mind. This method can be used safely and reproducibly by the relevant specialists. [ABSTRACT FROM AUTHOR]

Objective. Patients with a C6 radiculopathy-mimicking complaint are always in the gray zone if the diagnosis is not clear. The aim of the study is to make the diagnosis clear if the neck and shoulder pain is caused by a dynamic stenosis of the neural foramen at the C5-C6 level. Methods. Patients with a C6 radiculopathy-mimicking complaint were included in the study. Patients had a cervical spine magnetic resonance imaging (MRI) at the normal limits, or a minimal protrusion at the C5-C6 level underwent a dynamic MRI procedure. We measured the foraminal area and spinal cord diameter (SCD) at the C5-C6 level by using the PACS system ROI irregular are determination integral embedded to PACS. Inter- and intraobserver reliability of measurements was evaluated. Results were analyzed statistically, and a p value< 0.05 was accepted as statistically meaningful. Results. A total of 23 patients between January 2019 and June 2019 were included in the study. There were 10 men and 13 women, and the mean age was 41.3 (range 33-53). Foraminal area decrease at C5-C6 in extension and increase in flexion when compared with the neutral position was statistically significant (p < 0.001). Foraminal area changes between the complaint side and the opposite side was not statistically different (p > 0.05). Interobserver and intraobserver reliability of measurements were classified as in almost perfect agreement. Conclusions. Our present work presented dynamic and positional foraminal changes in MRI with radiculopathy-mimicking patients. Soever, we did not find a difference between the clinical complaint side and the opposite side in radiculopathy-mimicking patients. Cervical radiculopathy pain should not be attributed only to foraminal sizes. PACS embedded irregular area measurement integral allows the easy measure of a big number of patients without additional set-up and digital work requirements. [ABSTRACT FROM AUTHOR]

BACKGROUND: Prospective study. OBJECTIVE: To determine the change in spinal sagittal parameters which may occur throughout the day in healthy population. METHODS: Thirty-five healthy hospital employees were enrolled in the study. Two standing left lateral orthoroentgenograms were obtained at 8.00 a.m and at 6.00 p.m. Six spinopelvic parameters were measured on the X-rays. Thereafter, the subjects were divided into two cohorts according to their BMI as low BMI and high BMI. RESULTS: Thirty-five subjects with a mean age of 25.97 ± 8.21 were evaluated. No significant change was found between morning and evening measurements for any of the parameters. Direct relationship was shown between thoracic kyphosis (TK) and lumbar lordosis (LL), lumbar lordosis and sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI) minus lumbar lordosis, sagittal vertebral axis (SVA) and pelvic incidence minus lumbar lordosis. In addition an inverse relationship was found between sacral slope and pelvic tilt, sacral slope and pelvic incidence minus lumbar lordosis, thoracic kyphosis and pelvic incidence minus lumbar lordosis, sacral slope and pelvic tilt, sagittal vertebral axis and lumbar lordosis ( p < 0.05). Sagittal vertebral axis were found to be higher in the high BMI group, and daily change was lower but the differences were not statistically significant. Only the change in pelvic tilt value was found to be statistically significant in low BMI group. CONCLUSION: Routine workload in a hospital environment does not cause significant change in the spinopelvic parameters throughout the day. [ABSTRACT FROM AUTHOR]

Introduction Femoral neck stress fractures are not uncommon. Several causes exist about these fractures. Osteomalacia is one of the most common cause of insufficiency fractures and coxa vara can produce a focal concentration of mechanical stress in the femoral neck and may cause stress fractures. This case study is about the co-existence of these two pathologies in a patient with bilateral femoral neck stress fracture. Presentation of case A 26-year-old woman admitted to our department with a complaint of bilateral groin pain and diagnosed as bilateral coxa vara and osteomalacia. Medical treatment for osteomalacia and staged bilateral Pauwels’ osteotomy was performed. After 2 years of follow-up, good result was obtained. Discussion There are several risk factors for stress fractures and osteomalacia and coxa vara are two of the causes. Osteomalacia results in softening of the bones and coxa vara can produce a focal concentration of stresses in the femoral neck. Conclusion Joint and bone pain without any trauma should be investigated and bone metabolism disorders should be kept in mind. There might be co-existing factors related with stress fractures, and they must be treated simultaneously. [ABSTRACT FROM AUTHOR]

Introduction Bilateral femoral neck fractures without major trauma are rare and related to several conditions. Insufficiency fractures due to the use of anti-epileptic drug are one of the rare causes. This case study is about bilateral femoral neck insufficiency fractures resulting from chronic use of anti-epileptic drug. Presentation of case A 26-year-old woman was referred to our emergency department with a complaint of bilateral groin pain and a 12-year history of irregular carbamazepine use. The diagnosis was bilateral femoral neck insufficiency fractures due to irregular long-term carbamazepine use. One-stage bilateral dynamic hip screw osteosynthesis was performed. After 2 years of follow up, good result was obtained. Discussion There are several risk factors for insufficiency fracture, and antiepileptic drug related osteoporosis is one of the reason. These drugs have negative effect on bone methabolism and bone mineral density. Conclusion To our knowledge, this is the first case in the literature of bilateral femoral neck insufficiency fracture due to chronic carbamazepine use. Joint and bone pain with a history of long-term use of anti-epileptic drug should be investigated carefully, and insufficiency fractures should be kept in mind. [ABSTRACT FROM AUTHOR]

A 16-year-old boy who had been diagnosed previously as Aarskog-Scott syndrome (AAS), referred to our clinic with shoulder asymmetry for 1 year. Results of spine examination showed a 52°° right thoracic curve at T3-T11. Surgery was planned, and T1-L1 posterior instrumentation and fusion were performed. After surgery, satisfactory correction was achieved, and during 10 years follow-up, the patient had no complaints. AAS is a X-linked genetic disorder with facial, genital, and skeletal manifestations. Scoliosis is not reported as a typical finding of AAS, and there is no reported case in the English literature. Due to mutation affecting the developing skeleton tissue, spinal deformities may develop. In our case, concave side fusion was seen at the deformity. Although we do not know any specific pattern of the scoliotic deformity of this syndrome, surgical correction of the deformity can be difficult because of the premature fusion at these levels. [ABSTRACT FROM AUTHOR]