The importance of treating traumatic brain injury (TBI) is well known worldwide. Although many studies have been conducted in this topic, there is still much uncertainty about the effectiveness of surgical treatment in TBI. Recently, good randomized controlled trial (RCT) papers about the effectiveness of decompressive craniectomy (DC) in TBI has been published. In this article, we will review the overall contents of the DC (historical base, surgical technic, rationale, complications) and the results of the recently published RCT paper.

ObjectiveComputed tomography (CT), rather than conventional 2-dimensional radiography, was used to scan and measure pelvic parameters. The results were compared with measurements using X-ray.MethodsPelvic parameters were measured using both CT and X-ray in 254 patients who underwent both abdomino-pelvic CT and X-ray at the pelvic site. We assessed the similarity of the pelvic parameters between the 2 exams, as well as the correlations of pelvic parameters with sex and age.ResultsThe mean values of the subjects’ pelvic parameters measured on X-ray were: sacral slope (SS), 31.6°; pelvic tilt (PT), 18.6°; and pelvic incidence (PI), 50.2°. The mean values measured on CT were: SS, 35.1°; PT, 11.9°; and PI, 47.0°. PT was found to be 4.07° higher on X-ray and 2.98° higher on CT in women, with these differences being statistically significant (p<0.001, p<0.001). PI was 4.10° higher on X-ray and 2.78° higher on CT in women, with these differences also being statistically significant (p<0.001, p=0.009). We also observed a correlation between age and PI. For men, this correlation coefficient was 0.199 measured using X-ray and 0.184 measured using CT. For women, this correlation coefficient was 0.423 measured using X-ray and 0.372 measured using CT.ConclusionWhen measured using CT compared to X-ray, SS increased by 3.5°, PT decreased by 6.7°, and PI decreased by 3.2°. There were also statistically significant differences in PT and PI between male and female subjects, while PI was found to increase with age.

The purpose of this study was to compare the range of motion (ROM) after spinal fusion according to the levels of lumbar spinal fusion (L4/5 and/or L5/S1). Methods: One hundred fifty-six patients were included in this study after undergoing thoracolumbar or lumbar fusion from April 2010 to December 2016. All patients had a numerical rating scale less than 4. We categorized the patients according to the fusion level for statistical purposes: 86 patients in group I with L4/5 or L3/4/5 fusion, 24 in group II with only L5/S1 fusion, 34 in group III with L4/5/S1 or L3/4/5/S1 fusion, and 12 in group IV with T10-S1 fusion for lesions. The ROM was evaluated by physicians of the rehabilitation medicine department using a blinded method, and the result was compared between each group. The student t-test was used in the statistical analysis. Results: The ROM of lumbar flexion was not different between each group, except for groups I and IV (p=0.038). The ROM of lumbar extension was statistically affected by fusion at the L4/5 or L5/S1 level. The ROM of lumbar lateral flexion had a tendency of being affected by fusion at the L4/5 or L5/S1 level. The ROM of lumbar lateral rotation was not affected by fusion at the L4/5 or L5/S1 level. Conclusion: The results suggest that the lower lumbar segments (L4/5 and especially L5/S1) contribute to spinal ROM (extension and lateral flexion), but these segments alone do not play significant roles in spinal flexion movements.

Background: The aim of this study was to investigate what should be considered when diagnosing and treating displaced extra-articular fractures based on plain radiographs. Methods: We included 181 extra-articular distal radius fractures with marked displacement requiring surgery, which were diagnosed with posteroanterior (PA) + lateral (Lat) + oblique views (obl). We compared the plain radiographs with CT scans to determine whether the diagnosis was properly made. We described the types of articular involvement incidentally found on CT scans and how the articular involvement was treated. We tested the inter-observer and intra-observer reliability with three orthopedic surgeons. Results: Forty-two (32%) out of 181 displaced extra-articular fractures diagnosed by plain radiographs had intra-articular involvement on CT scans. Dorso-ulnar intra-articular fragment was most commonly found. Thirty-three (78.6%) out of 42 intra-articular involvements required additional reduction and a dorsal approach was used in eight patients. Inter-observer and intra-observer reliability ranged from “substantial” to “almost perfect”. Conclusions: When treating displaced extra-articular fractures requiring surgery, CT scans might be necessary to find intra-articular involvement and at least, an oblique view showing the dorso-ulnar corner of the articular surface should be added. Surgeons should consider that extra-articular fractures with marked displacement, which are diagnosed by plain radiographs alone, might have intra-articular involvement requiring additional reduction or fixation via a different incision.

Lazarus sign, a complex reflex movement of the upper limbs after brain death, is a rare occurrence. We report two patients who showed a Lazarus sign following a diagnosis of brain death. It has been accepted that cardiac arrest usually occurs within 1 week after brain death; however, the two patients described herein survived for over 100 days after brain death was diagnosed. This report is intended to examine the relationship between the Lazarus sign and long-term survival after brain death, as well as to share our rare experience.