Controversy still exists regarding how to reduce and fix a displaced tibial avulsion fracture. Open reduction and internal fixation may lead to morbidity due to soft-tissue injury and arthrotomy. As a result, arthroscopic techniques are increasing in popularity. In the literature, sutures, K wires, and screws are suggested to be used as the fixation devices. Screws cannot be used in small or comminuted fractures, whereas K wires and sutures may not provide strong stability. Recently, with the advent of ultrahigh molecular weight polyethylene sutures like FiberWire, it has become possible to use it as the fixation device in even comminuted avulsion fractures with acceptable reduction stability. In this paper, we describe a simple arthroscopic technique using a FiberWire to manage the displaced tibial eminence avulsion fracture.

Background: Approach to lower-thoracic spine for discectomy remains controversial. In this study, we compare primary and secondary outcomes of transpedicular (TP) and transthoracic (TT) approach for discectomy at lower thoracic levels in patients with neurological manifestations. Methods: In this retrospective study, 12 patients with TP or TT approach for lower thoracic discectomy with neurological manifestation, mainly foot drop, were included. During TP approach, cord manipulation was kept at minimum. Posterior fusion was performed in all patients. TT approach was performed by intended level thoracotomy, anterio-lateral fusion was achieved in this group. The postoperative primary and secondary outcomes of the approach were compared in these patients. SPSS software version 20 was used for analysis, and a P-value < 0.005 was considered significant. Results: Twelve patients with neurological manifestation were operated using either of the approaches. Six patients in TP group and four in TT group attained complete neurological recovery after 10.2 and 7.6 weeks, respectively. The mean operative time was 50% more in TT approach. Blood loss in TP approach was less than half, and patients were mobilized earlier with decreased hospital stay. All patients with TT approach needed postoperative intensive care unit (ICU) admission, two of them developed pulmonary complications and postsurgical intercostal neuralgia, and one had cerebrospinal fluid (CSF) leak and readmission within 30 days of discharge. Conclusions: Although TT approach offers excellent exposure for discs in lower thoracic levels, it is associated with increased morbidity and higher complication rates. On the other hand, TP approach offers ample exposure with reduced operative time and blood loss, as well as early mobilization and discharge.

Background: Lumbar Canal Stenosis (LCS) is the most common reason for spinal surgery in older patients. Identifying factors influencing the outcome of surgical management is important in clinical research. Objectives: This study aims to identify the factors affecting the outcome of surgical management for LCS. Materials & Methods: This prospective non-randomized cohort study was conducted at the spine center of Imam Khomeini Hospital in Tehran, Iran from March 2017 to January 2019 on 135 patients with symptomatic LCS, confirmed by MRI. Clinical and functional outcomes were measured using the 12-Item Short form Health Survey (SF-12), Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) the day before surgery, and 12 and 24 months after surgery. Radiographical parameters was assessed by measuring lumbar lordosis, sacral slope, pelvic tilt and pelvic incidence. Results: Of 135 patients, 120 completed the follow-up. Patients treated surgically had significantimprovement in SF-12, ODI and VAS scores after 2 years of follow-up. Higher values of BMI(P=0.031), symptom duration >1 year (P=0.045 for SF-12, P=0.031 for ODI), and smoking(P=0.033 for SF-12, P=0.028 for ODI) were associated with poor outcome. Patients with higher pre-operative SF-12, ODI and VAS scores (P=0.007 for SF-12, P=0.003 for ODI, P=0.050 for VAS) and lower lumbar lordosis (P=0.055) showed significant improvement after surgery. Conclusion: Patients with LCS showed significant improvement in outcomes afterdecompression surgery. Higher values of BMI, symptom duration >1 year, and smokingare associated with poor outcome, while higher pre-operative disability score and lowerlumbar lordosis are associated with better outcome after surgery.

We aim to report a patient with vertebral brown tumor in the context of primary hyperparathyroidism presented with shoulder pain. This is the first report of C5 involvement by Brown tumor in a primary hyperparathyroid patient and emphasizes the consideration of cervical vertebral evaluation in patients with persistent shoulder pain.