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ABSTRACT: SUMMARY: We present herein a 2-year-old boy who suffered from chronic recurrent multifocal osteomyelitis for 6 months and was later diagnosed as acute lymphoblastic leukemia. In view of the rarity of bilateral symmetric and multifocal lesions in osteomyelitis in children, we suggest that leukemia should be investigated with bone marrow aspiration in such patients, even if complete blood count parameters are normal, and there is no hepatosplenomegaly.
Journal of Pediatric Hematology/Oncology 05/2010; 32(4):e151-2. · 1.16 Impact Factor
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ABSTRACT: In 1989, Tsukahara and colleagues described a single female with a provisionally unique pattern of malformation consisting of low intelligence, short stature, brachydactyly type A1, and characteristic facial features. We report on a second patient confirming Tsukahara syndrome as an established entity.
American Journal of Medical Genetics Part A 04/2010; 152A(4):947-9. · 2.39 Impact Factor
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ABSTRACT: The aim of this study was to compare the radiological outcome of open and close reduction and osteosynthesis methods in the treatment of type II and III supracondylar humerus fractures in childhood with respect to the immediate post-operative reduction quality in sagittal plane.
One hundred and forty four-pediatric patients with type IIb and III supracondylar humerus fractures treated at two centers between 1995 and 2005 were evaluated radiologically within a retrospective study. Seventy-six patients (54 boys, 22 girls, mean age 7.6, range 2-12) were treated by closed reduction and cross percutaneous pinning while 68 (49 boys, 19 girls, mean age 7.3, range 2-13) were treated by open reduction. The reduction quality of the open and closed groups was compared on immediate post-operative lateral radiographs by measuring of lateral humerocapitellar angle, anterior humeral line and anterior coronoid line criteria. The reduction quality was classified excellent, good, fair and poor according to the achievement of three, two, one or none of the criteria, respectively. Reductions classified as excellent and good were introduced as acceptable results.
At least one criterion was achieved in all the patients of both the groups. The mean humerocapitellar angle was 30.1 degrees in closed reduction group while the mean of it was 29.8 degrees in open reduced group. Radiograph of 48 (63.1%) patients with closed reduction were found to display the anterior humeral line intersecting the middle one-third of capitellum while this criteria was 45 (66%) in open reduction group. The anterior coronoid line was disturbed in three patients in each of both the groups. The reduction quality was evaluated to be excellent in 32 patients, good in 31, fair in 13 at the closed reduction group while these evaluations were 31, 20 and 17 in open reduction group, respectively. Successful reduction was achieved in 74.9% of the patients in closed reduction group and 75% of the patients in open reduction group.
It is concluded that there was no significant difference between closed and open reductions of pediatric displaced supracondylar fractures with regard to the radiological criteria of reduction quality in sagittal plane.
Archives of Orthopaedic and Trauma Surgery 08/2008; 128(7):739-44. · 1.37 Impact Factor
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ABSTRACT: Instrumentation and correction of severe congenital scoliosis, particularly in patients with spinal dysraphism, has been reported to cause a high potential rate of neurological compromise after instrumentation. The aim of this study was to evaluate the safety and efficacy of posterior instrumentation and correction of congenital scoliosis with accompanying spinal dysraphism.
Level IV therapeutic studies.
Retrospective x-ray measurements to analyze the efficacy and the evaluation of hospital charts to document the intraoperative and postoperative complications were performed for a consecutive patient series. Scoliosis Research Society-22 questionnaire was used to analyze the health-related quality of life.
Twenty-two patients (18 girls and 4 boys) formed the basis of the study. The average age was 12 years (range, 7-18 years) and the average follow-up period was 3.2 years (range, 2-10 years). The types of spinal dysraphism were diastematomyelia in 20 patients and syringomyelia with tethered cord in 2 patients. Twelve patients had previous surgery and 3 patients had simultaneous surgeries for spinal dysraphism. Posterior instrumentation with/without anterior release and fusion was performed in all patients. Major curve was corrected from an average of 71 degrees to 40 degrees (correction rate, 43.6%). The compensatory curve was corrected from an average of 47 degrees to 25 degrees (correction rate, 46.8%). The average loss of correction at final follow-up was 2.2 degrees for major curve and 3.5 degrees for the compensatory curve. The average scores for the 5 domains of Scoliosis Research Society-22 questionnaire were 3.5 for function, 3.9 for pain, 3.5 for self-image, 3.6 for mental health, 3.9 for satisfaction, and 3.6 for total. Neurological monitoring was conducted by using the wake-up test in all patients. The overall complication rate was 31%, including neurological compromise in 2 patients (9%).
Spinal instrumentation was effective for the control of deformity with a relatively higher rate of complications. However, with respect to high complication rate, the ideal solution for managing the congenital cases is still to prevent the progression of the curve with early intervention by using the optimal surgical approach for that particular patient.
Journal of Pediatric Orthopaedics 07/2007; 27(4):380-6. · 1.16 Impact Factor
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ABSTRACT: The objectives of the study were to compare the results of surgical procedures, amputation and limb-sparing surgery, and to assess the influence of preoperative chemotherapeutic regimens on the survival of pediatric patients with osteosarcoma. We retrospectively analyzed 69 patients treated at our institution between January 1985 and April 2004. The primary treatment modalities were limb-sparing surgery or amputation with or without preoperative chemotherapy. The need for postoperative chemotherapy was determined by the histological response, the tumor margins, and the burdens created by the metastatic disease. The age range was 5.3 to 18.6 years (median, 13.3 years); with a male-female ratio of 0.9. The most common lesion site was the femur, found in 39 patients. Fourteen of the patients had metastases involving the lungs or other bones at the time of diagnosis. Preoperative chemotherapy was done in 45 patients. Most of the patients were treated with cisplatin + adriamycin (27/69, 39.1%). Forty-two patients were surgically treated by amputation and 19 with limb-sparing surgery. Four patients had surgical resection of masses located at sites other than the extremities, and in 4 patients, surgery was not possible. The overall survival rate for the whole group was 32.6%. The overall survival rates were 27.2% and 66.9% for the patients treated with amputation and limb-sparing surgery, respectively. Osteosarcoma has a poor prognosis. Based on our 20-year experience, limb-sparing surgery as surgical management and the cisplatin + adriamycin preoperative chemotherapy regimen seem to be a promising modality for the patients with osteosarcoma.
Journal of Pediatric Orthopaedics 04/2007; 27(2):241-6. · 1.16 Impact Factor
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The Journal of trauma 11/2002; 53(4):722-4. · 2.48 Impact Factor
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ABSTRACT: Dynamic computerized tomography (DCT) has been accepted to be the standard diagnostic method of atlantoaxial rotatory subluxation (AARS) although its reliability and reproducibility has not been shown yet. The purpose of this study was to evaluate the intraobserver reproducibility and interobserver reliability of DCT. Standard DCT scans of 18 patients with acute torticollis and 12 normal subjects were examined two times in between a time interval of 1 month by three specialists and a last-year resident to define any existing AARS. The interobserver reliability kappa coefficient was -0.015 (poor) for the first examination and 0.327(fair) for the second one. The intraobserver reproducibility kappa coefficients were 0.135 (slight), -0.204 (poor), 1.00 (almost perfect), and 0.474 (moderate) respectively. It was found that DCT has a poor reliability and reproducibility in diagnosing AARS in patients with acute torticollis. Therefore, its routine use is not cost effective in patients with acute torticollis where the deformity usually resolves by a simple cervical mobilization.
Journal of Pediatric Orthopaedics 10/2002; 22(6):763-5. · 1.16 Impact Factor
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ABSTRACT: Short-segment posterior instrumentation for the treatment of thoracolumbar burst fractures has been reported with a high rate of failure. Transpedicular intracorporeal grafting in combination with short-segment instrumentation has been offered as an alternative to prevent failure. However, concern still remains about the potential complication of further canal narrowing or failure of remodeling with this technique. The purpose of this prospective, randomized, controlled study is to evaluate the effect of transpedicular intracorporeal grafting on spinal canal restoration and remodeling in a group of patients treated with short-segment instrumentation for thoracolumbar burst fractures. Twenty-one patients with thoracolumbar burst fractures were randomised into transpedicular grafting (TPG) (n=11) and non- transpedicular grafting (NTPG) (n=10) groups, and were prospectively followed for an average of 50 months (range 25-85 months). Groups were similar in age, type of fracture, load sharing classification and kyphotic deformity. Preoperative, postoperative and follow-up computed tomographic (CT) images through the level of pedicles were obtained, corrected for differences in magnification, and digitized. Areas of the spinal canals were measured and normalized by the estimated area at that level (average of adjacent levels). Average kyphosis was 19.7Lj.2 at presentation, was corrected to 1.9dž.9 by operation, but was found to have deteriorated to 9.1Lj.4 at final follow-up. There were no differences between groups regarding the evolution of sagittal deformity. Spinal canal narrowing was 38.5ᆦ.2% at presentation, 22.1ᆧ.8% postoperatively, and it further improved to -2.5ᆤ.7% at follow-up, similar for both groups. Our results demonstrate that transpedicular intracorporeal grafting in the treatment of burst fractures does not have a detectable effect on the rate of reconstruction of the canal area or on remodeling. Spinal canal remodeling was observed to occur in all patients regardless of grafting.
European Spine Journal 11/2001; 10(6):512-516. · 1.97 Impact Factor
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ABSTRACT: The authors studied 32 patients to delineate the reliability of well-defined but frequently extended indications to define the ideal patient who will benefit from convex growth arrest. Mean age at the time of convex growth arrest was 29 (range 6-72) months, and average follow-up was 40 (24-120) months. Mean Cobb angle was 55 degrees (31-105 degrees) before surgery and 50 degrees (13-107 degrees) at final follow-up. Thirteen patients (41%) had a true epiphysiodesis effect, while 15 (47%) had fusion and 4 (12%) had progression. The age at surgery, magnitude, length and location of the curve, presence of intraspinal anomaly, and presence of sagittal plane or rib deformity were investigated in terms of the outcome, but none of these parameters was found to have an effect on the outcome. In conclusion, convex growth arrest is a safe and effective method in the management of the young patients with congenital spinal deformities. It can be performed for the balanced and cosmetically acceptable deformities of patients younger than 5 years of age regardless of the type, length, magnitude, and location of the curve, the existence of associated rib fusion, or the presence of sagittal plane abnormality.
Journal of Pediatric Orthopaedics 24(6):658-66. · 1.16 Impact Factor
