Most adults will experience low back pain during their lifetime, with most of these instances resolving or improving without sequelae in a few weeks. For the small number of patients with severe, recalcitrant pain, lumbar fusion may be required, particularly when concomitant leg pain or deformity is present. Lumbar interbody fusion surgery is the usual treatment for degenerative lumbar disease, but it requires a long recovery period. Many surgical techniques have been described in the literature for spondylolisthesis. The main objective is to create interbody fusion, decompression of normal structures and a stable vertebrae. TLIF surgical techniques has a long learning curve. Comorbidities of the patient may make surgery more difficult. Methods such as transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion, anterior lumbar interbody fusion and lateral lumbar interbody fusion are also available for interbody fusion in the literatüre. The aim of this review is to show which patients are more suitable for TLIF surgery and to discuss the advantages and disadvantages of TLIF surgery over other techniques.

We report a new surgical incision for spinal deformity in patients who had undergone meningomyelocele closure surgery. Six patients underwent kifectomy using an inverse Y incision. They all had multiple prior operations in the lumbar region due to dural meningomyeloceles. Four of the patients were girls. The primary indication for the reverse Y incision was a T12 and above posterior fusion defect and a large lumbar posterior fusion defect. These patients included four with kyphoscoliosis, one with lordoscoliosis, and one with lumbar kyphosis. The median age of the patients was 5.52 at the time of operation. The median follow up time was 17.3 months. Under appropriate indication, the reverse Y approach offers a reliable and successful solution for surgery.

Comparison of Primary Repair Techniques for MPFL Ruptures: Is Anchor Use Essential? - Cyprus Journal of Medical Sciences

COVID-19 has now alarmed the whole world, putting many countries’ health systems in trouble. We aimed to evaluate the affect of the new treatment strategy that shortens hospital stay in orthopedic trauma patients in pandemic.Trauma patients who underwent surgical treatment between March 15th-May 1st 2019 and 2020 were examined about time interval from admission to surgery, period from surgery to discharge and total hospital stay time. This cohort was compared to a retrospective cohort of patients admitted for the same reasons in the same period of the previous year. During COVID pandemia, 51 trauma patients operated with the mean period from admission to operation 1.45 days, faster than the previous year’s same period (3.76 days). From operation day to discharge time was 1.6 days in pandemic period and 4.3 days last year. The total hospitalization period (3,05 days) was significantly shorter in pandemic than the same period of the last year (8,06 days). (p<0.05). No complications and mortality were observed in any of our patients with faster trauma treatment strategy in pandemic. The operation of orthopedic trauma patients requiring surgery during a pandemic in a shorter time than normal time will not increase the complication and mortality, but will also help to use the bed more effectively by reducing the hospital stay.

Objective: The diagnosis of shoulder pathologies is a multidisciplinary process that includes physical examination, anamnesis and imaging techniques such as magnetic resonance imaging (MRI). Nevertheless, the inappropriate utilization of these imaging modalities engenders an unwarranted increase in workload and financial expenditure. The objective of the present study was to compare the appropriateness and diagnostic effectiveness of shoulder MRI requests for suspected rotator cuff tears across departments. Material and Methods: In this retrospective study, shoulder MRIs requested by five different physician groups with a preliminary diagnosis of rotator cuff pathology were analyzed: orthopedic specialists, orthopedic residents, physical therapy and rehabilitation (PTR) specialists, PTR residents, and physicians from other specialties (neurosurgery and internal medicine). MRI requests that included other preliminary diagnoses, as well as unreported or unconfirmed MRI scans, were excluded from the study. Results: A total of 712 MRIs were analyzed. Among the MRI examinations requested by orthopedic specialists, the rate of full-thickness rotator cuff tears was 21.4%, while the rate of partial-thickness tears was 16.7%. When both partial- and full-thickness tears were considered together, the overall rotator cuff tear rate was 38.1%. A statistically significant difference was observed in the detection rates of full-thickness tears between orthopedic physicians and other specialists (p = 0.029). A significant difference was also found between the groups in the diagnosis of isolated partial-thickness tears (p = 0.048). No significant difference was observed between orthopedic specialists and PTR specialists (p > 0.05). Among physicians from other specialties, despite MRI requests indicating a preliminary diagnosis of rotator cuff pathology, shoulder examinations were either not performed or inadequately documented. Conclusion: The study demonstrated that orthopedic and PTR specialists were significantly more likely to request MRIs appropriately. In the context of escalating healthcare expenditures, the implementation of restrictive regulations for non-specialist departments is recommended.

Background and Objectives: This study was conducted to investigate the effects of fragment size on clinical and radiological outcomes and the development of complications during the surgical treatment of pediatric lateral condyle fractures. Materials and Methods: This retrospective cohort study evaluated data from 47 pediatric patients with lateral condyle fractures, including demographic information, fracture type, range of motion, complications, radiographic assessments, capitellum size, and presence of a lateral bump. Clinical evaluations were performed using the Hardacre functional classification. To objectively investigate the effect of fragment size on prognosis, the total anterior–posterior (AP) and lateral fragment areas, as well as the corresponding AP and lateral capitellum areas (to provide an individualized constant for ratio calculation), were measured. The fractured fragment/capitellum area ratio was then calculated by dividing the fragment area by the respective capitellum area. All statistical analyses were conducted using a two-tailed significance threshold of p < 0.05, and corresponding 95% confidence intervals were calculated where applicable. Results: After a mean follow-up of 66 months (range: 12–142 months), no significant association was identified between the fractured fragment/capitellum area ratio and either the range of motion (p > 0.05) or the presence of a palpable lateral bump (p > 0.05). In contrast, a higher fractured fragment/capitellum area ratio was found to be significantly associated with the presence of radiographic complications (p = 0.01) and a larger final capitellar area (p = 0.02). Conclusions: The fractured fragment/capitellum area ratio, a newly defined parameter for quantifying initial fracture size in pediatric lateral condylar fractures, demonstrated no measurable effects on clinical outcomes, the presence of a lateral bump, or range of motion; however, it was significantly associated with the development of radiological complications and may represent an important predictor of subsequent capitellar hypertrophy. Level of Evidence: This study corresponds to Level III—retrospective cohort study.