BackgroundTo determine the relationship between superior disc-endplate complex injury and correction loss after surgery in a group of young adult patients with a stable thoracolumbar burst fracture.MethodsThe study group was comprised of young adult patients who had undergone short-segment posterior fixation and bone grafting under the diagnosis of a stable thoracolumbar burst fracture from March 2008 to February 2014. Follow-up was available for more than 1 year. Before surgery, magnetic resonance imaging was performed to determine injury to the anterior longitudinal ligament, posterior longitudinal ligament, and superior and inferior intervertebral discs and endplates. Correction loss was evaluated by the Cobb angle, intervertebral disc height, upper intervertebral disc angle, vertebral wedge angle, and vertebral body height.ResultsNo significant relation was noted between correction loss and an injury to the anterior longitudinal ligament, posterior longitudinal ligament, inferior intervertebral disc/endplate, and fracture site, whereas an injury to the superior endplate alone and superior disc-endplate complex showed a significant association. Specifically, a superior intervertebral disc-endplate complex injury showed statistically significant relation to postoperative changes in Cobb angle (p = 0.026) and vertebral wedge angle (p = 0.047).ConclusionsA superior intervertebral disc-endplate complex injury may have an influence on the prognosis after short-segment fixation in young adult patients with a stable thoracolumbar burst fracture.

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Purpose: To evaluate the interstitial and appositional growth of greater trochanter post-screw apophysiodesis in Legg-Calve-Perthes (LCP) disease. Materials and Methods: A total of 17 patients, who were diagnosed with LCP and underwent greater trochanter screw apophysiodesis and metal removal between December 2003 and December 2012, and were followed-up for at least 4 years, were selected. Anterioposterior radiologic images were taken in each process of apophysiodesis, metal removal, and last follow-up. From such images, articulotrochanter tip distance (ATD), trochanter tip-screw distance (TSD), trochanter tip-trochanter lower margin distance (TLD), and screw-trochanter lower margin distance (SLD) were measured. Appositional growth and greater trochanter growth rates were compared using paired t-test, independent t-test, and correlation analysis. Results: The average ATD of the affected and unaffected sides was 14.2 and 16.8 mm, respectively at apophysiodesis and 9.2 and 14.8 mm at the last follow-up, with a significantly greater decrease observed on the affected side the unaffected side (p=0.030). TLD of the affected side during the follow-up increased 11.0 mm, from an average of 30.8 to 41.8 mm, while the un-affected side increased 14.3 mm, from an average of 26.7 to 41.0 mm. The growth of greater trochanter after the operation in the affected side was 76.7% of that in unaffected side. The ratio of TLD of the affected side to the unaffected side was significantly reduced, from 1.15 to 1.02 (p=0.014) at the final follow-up. TSD was significantly increased from 4.5 to 14.4 mm at metal removal (p＜0.001) and increased to 17.0 mm at the last follow-up. Moreover, the ratio of TSD to SLD was significantly increased from 0.20 to 0.74 at metal removal (p＜0.001) and increased to 0.84 at the final follow-up. Conclusion:The results of this study showed that screw apophysiodesis can suppress the overall growth, but not the appositional growth of the greater trochanter. Therefore, screw apophysiodesis may not be a good procedure to inhibit the growth of greater trochanter

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. A 77-year-old man was referred for the evaluation of general weakness and leukocytosis. Computed tomography showed a 9.5×6.5-cm cavitary lesion with an air-fluid level near the stomach, which was thought to be a perigastric abscess. Upper endoscopy revealed a fistula on the greater curvature at the mid body of the stomach. The margin of the fistula opening was clearly demarcated, and yellow turbid fluid oozing from the fistula was seen. Laparoscopic wedge resection was performed at the perforated area of the stomach.

Department of Orthopedic Surgery, Dong-A University College of Medicine, Busan, KoreaPurpose: Lumbar fusion surgery was performed on transfusion-free patients and hemodynamic changes were analyzed. Materials and Methods:A total of 36 transfusion-free patients who had undergone lumbar fusion surgery using recombinant human erythropoietin (rHuEPO) before surgery from April 2007 to March 2014 were included in the study. Hemoglobin and hematocrit levels were measured before surgery, immediately after surgery, 12 hours after surgery, on day 1, day 2, day 3, and day 7. Changes in levels were investigated and the factors affecting the changes in hemoglobin levels were analyzed. Results: Changes in hemoglobin and hematocrit were -18.11% before surgery and -22.92% on day 7, respectively, and they tended to recover from day 2 after surgery. Depending on the patient's age, gender, body mass index, blood loss, and surgery method (presence of lumbar interbody fusion), the changes in hemoglobin level did not show statistically significant differences; however, significant differences were observed in the surgical time and extent of the operation. Conclusion: Transfusion alternatives during lumbar spinal fusion are deemed safe methods, leading to good, postoperative hemodynamic outcomes. However, the surgical time and extent of the operation must be determined before surgery.