Purpose Pre-operative knowledge of hamstring graft size for anterior cruciate ligament reconstruction (ACL) is of clinical importance and useful in making appropriate decisions about graft choice. This study investigated if there is any correlation between anthropometric measurements such as height, weight, body mass index, thigh length, and circumference with the size of hamstring tendon graft in anterior cruciate ligament reconstruction. Methods The anthropometric data of 50 consecutive adult males, who underwent primary ACL reconstruction using quadruple hamstring autograft, were collected prospectively. Data analysis using Pearson's correlation test was performed and multiple logistic regression analysis was used to investigate any correlation not detected by Pearson's test and to eliminate confounders. Results Patient's height and thigh length demonstrated a positive correlation with gracilis graft length (r = .464, P = .001, r = .456, P = .001, respectively) and semitendinosus graft length (r = .541, P = 000, r = .578, P = .000, respectively). While the patient's age was the only independent factor which had a positive correlation with the quadrupled hamstring graft diameter (r = .412, P = .004), multiple regression analysis showed abdominal girth had a significant negative correlation with gracilis (P = .04) and semitendinosus (P = .006) graft thickness. Conclusion This study demonstrated that some anthropometric measurements had a positive correlation with the hamstring graft length and diameter in male patients. Hence, these results provide preliminary support for the use of some anthropometric measurements in the preoperative planning and prediction of the hamstring graft length and diameter in anterior cruciate ligament reconstruction.

Background: Lumbar isthmic spondylolisthesis (IS) in adults is defined as the forward slippage of a vertebra onto the top of the vertebra, resulting from a defect in the pars intraarticular, and can be low grade or high grade. Persistent back pain or neurological deficit are indications for surgical intervention. Surgery can be done from back, front, or both, with or without fusion, instrumentation, or decompression, and short or long segment. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, several databases were searched through August 2017 for any observational or experimental studies that evaluated combined anterior-posterior approach versus posterior alone in management of IS. Primary outcome was fusion rate, whereas secondary outcomes included functional outcomes (Visual Analogue Scale [VAS] and Oswestry Disability Index [ODI] score), complication rate (infection, neurological), and reoperation rate. Descriptive, quantitative, and qualitative data were extracted. Most of the cases were low-grade IS. Results: Of the 645 articles identified, 6 studies were eligible for the meta-analysis, with a total of 397 patients with IS, 198 in the combined (anterior interbody fusion [ALIF] þ postero-lateral fusion [PLF]) group and 199 in the posterior (transformational interbody fusion [TLIF]/ postero-lateral interbody fusion [PLIF] þ PLF) group, average age of 47.2 years, and 185:212 male : female ratio. Although the fusion rate reached 100% in some studies, the pooled odds ratio (OR) of fusion rate (OR ¼ 1.02, 95% confidence interval [CI]: 0.294, 3.552, P ¼ .972) did not reach statistical significance between (ALIF þ PLF) versus (TLIF/PLIF þ PLF). The estimated pooled standardized mean difference (SMD) showed less blood loss in the anterior approach compared to the posterior approach (SMD ¼À0.528, 95% CI: À0.777, À0.278, P , .001), with no difference in operative time and length of hospital stay. Despite both groups showing significant improvement in pain and functional scores at final follow up, ODI and VAS were not significantly different between groups with ODI (SMD ¼À0.644, 95% CI: À1.948, 0.621, P ¼ .311) and VAS (SMD ¼ 0.113, 95% CI: À0.173, 0.400, P ¼ .439). The complication rate for the anterior approach was higher than the posterior, whereas reoperation rate was higher in the posterior approach than the anterior. Conclusions: No significant difference between anterior and posterior approaches was found in the global assessment of fusion rate and clinical outcomes, despite a higher rate of complications using the anterior approach. Level of Evidence: 3. Clinical Relevance: Both anterior and posterior approach are a valid option for treatment of isthemic spondylolisthesis Lumbar Spine

Background Pediatric pelvic fractures (PPF) are uncommon among children requiring hospitalization after blunt trauma. The present study explored our experience for the prevalence, patients demographics, clinical characteristics, injury pattern and management of pediatric pelvic fractures in a level I trauma center. Methods This is a retrospective review of prospectively collected data obtained from trauma registry database for all pediatrics trauma patients of age ≤18 years. Data were analyzed according to different aspects relevant to the clinical applications such as Torode classification for pelvic ring fracture (Type I–IV), open versus closed triradiate cartilage, and surgical versus non-surgical management. Results During the study period (3 and half years), a total of 119 PPF cases were admitted at the trauma center (11% of total pediatric admissions); the majority had pelvic ring fractures (91.6%) and 8.4% had an acetabular fracture. The mean age of patients was 11.5 ± 5.7, and the majority were males (78.2%). One hundred and four fractures were classified as type I (5.8%), type II (13.5%), type III (68.3%) and type IV (12.5%). Patients in the surgical group were more likely to have higher pelvis AIS (p = 0.001), type IV fractures, acetabular fractures and closed triradiate cartilage as compared to the conservative group. Type III fractures and open triradiate cartilage were significantly higher in the conservative group (p < 0.05). Patients with closed triradiate cartilage frequently sustained spine, head injuries, acetabular fracture and had higher mean ISS and pelvis AIS (p < 0.01) than the open group. However, the rate of in-hospital complications and mortality were comparable among different groups. The overall mortality rate was 2.5%. Conclusion PPF are uncommon and mainly caused by high-impact trauma associated with multisystem injuries. The majority of PPF are stable, despite the underlying high-energy mechanism. Management of PPF depends on the severity of fracture as patients with higher grade fractures require surgical intervention. Furthermore, larger prospective study is needed to understand the age-related pattern and management of PPF.

Study design Systematic review and meta-analysis. Objective To compare outcomes and complication rates in patients undergoing bariatric surgery (BS) prior to spine surgery. Methods A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines comparing the outcomes of spine surgery between subjects with prior bariatric surgery to those who were considered obese with no prior bariatric surgery. Results A total of 183, 570 patients were included in the 4 studies meeting inclusion criteria. The mean patient age was 52.9 years, and the majority were female (68%). The two groups consisted of a total of 36, 876 patients with prior BS and 146, 694 obese patients without prior BS. The overall rate of complications in the prior BS group was 6.4% (4.5%–38.7%) compared to 11.9% (11.2%–55.4%) in the non-prior BS obese group with a statistically significant difference between the two groups. The prior BS group had lower rates of renal, neurological, and thromboembolic complications, with a lower mortality and readmission rate. In a subgroup undergoing cervical spine surgery, patients with prior BS had fewer cardiac, GI, and total complications. For patients undergoing thoracolumbar spine surgery, patients with prior BS had fewer thromboembolic and total complications. Conclusion Patients undergoing bariatric surgery prior to spine surgery had fewer renal, neurological, and thromboembolic complications as well as a decreased mortality and readmission rate.