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    Dural tears in lumbar burst fractures with greenstick lamina fractures
    (2001) Aydınlı, Ufuk; Karaeminoğulları, Oǧuz; Tişkaya, K.; Öztürk, Çağatay
    STUDY DESIGN: This study investigated the incidence, predictions, and treatment principles of greenstick lamina fractures in lumbar burst fractures. OBJECTIVE: To determine the incidence of dural tears in lumbar burst fracture with greenstick lamina fracture and to find out if any specific clinical and radiographic factors or intraoperative pathologic findings are predictive of dural tears and nerve root entrapment. SUMMARY OF BACKGROUND DATA: A retrospective review was conducted on 45 patients with 47 lumbar burst fractures treated operatively. Ages ranged from 15 to 70 years (average, 33 years). The duration of follow-up ranged from 32 months to 8 years (average, 52 months). METHODS: All clinical charts and radiologic data of these patients were reviewed. Age, sex, etiology, and all the radiologic parameters were analyzed for their association with greenstick lamina fracture and dural tear. Student's t test and multiple logistic regression analysis were used for statistical analysis. RESULTS: Greenstick lamina fracture occurred in 20 (42.5%) of 47 burst fractures. Dural tear was detected in 9 (19%) of 47 burst fractures and was predominantly higher in L3 (6 of 9 burst fractures). According to multiple logistic regression analysis of the data, a 20% increase in the interpedicular distance gives a 79% probability of greenstick lamina fracture. The distance between the edges of greenstick lamina fractures was obviously higher in fractures with dural tear. Neurologic status was completely normal before surgery in three of the patients with dural tear and nerve root entrapment. CONCLUSIONS: It is not possible to detect dural tear and nerve root entrapment in greenstick lamina fracture before surgery. Therefore, if there is any suspicion of such an occurrence, it should be the rule to begin with posterior approach and use the open book technique to expose the dura safely before any reduction maneuver.
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    Prophylactic intramedullary nailing in monostotic fibrous dysplasia
    (2008) Demiralp, Bahtiyar; Öztürk, Çağatay; Özturan Kutay Engin; Sanisoğlu, Selim Yavuz; Çiçek, İlker
    Fibrous dysplasia of bone is an enigma with no known cure. Treatment currently consists of curettage and bone-grafting in an attempt to eradicate the lesion and to prevent progressive deformity. This study presents the results of prophylactic intramedullary nailing in 10 patients with monostotic fibrous dysplasia, pain increasing with movement, and scintigraphically established activity. Ten patients with monostotic fibrous dysplasia in their upper or lower extremities treated between 2001 and 2003 were included in the study. Seven patients were male and 3 were female; their mean age was 26.9 years. The mean duration of follow-up was 33.5 months. Closed intramedullary nail without reaming was used in all cases. Bone grafting was not performed. Patients were allowed full weight bearing on the affected extremities on the second postoperative day. Mean VAS for functional pain was 5.33 ± 0.65 preoperatively and 2.26 ± 0.57 at final follow-up (p < 0.05). Radiographs showed no changes in lesion size, and the intramedullary fixation appeared to be stable. Prophylactic intramedullary nailing appeared to be beneficial in monostotic fibrous dysplasia with scintigraphically proven activity and functional pain. It also avoids problems that may occur following pathological fracture. © 2008, Acta Orthopædica Belgica.