Elif Reyyan Cadircibasi

Study Design: This is a retrospective comparative cohort study. Objectives: The aim of this study was to compare the radiologic and functional outcomes of patients undergoing short-segment instrumentation for lumbar spinal stenosis, specifically those treated with posterior instrumentation and decompression alone versus those treated with posterior instrumentation, decompression, and transforaminal lumbar interbody fusion (TLIF). Summary of Background Data: TLIF is often added to improve stability and fusion in lumbar spinal stenosis surgery. However, the additional clinical benefit of TLIF in short-segment degenerative lumbar stenosis remains controversial due to its association with increased operating time and perioperative morbidity. Methods: Twenty-four underwent TLIF in combination with posterior spinal instrumentation (PSI), whereas 26 received only PSI and decompression. Surgical duration, postoperative complications, symptom duration, intrahospital blood transfusion requirements, complications, radiologic images and fusion levels were retrospectively analyzed. The ODI and VAS scores were evaluated preoperatively and at the final follow-up. Results: There were no statistically significant differences between the groups in terms of age, symptom duration, follow-up, preoperative or postoperative VAS and ODI scores, ASA scores, complication, number of fusions, or length of hospital stay. However, the operative duration was significantly longer and blood transfusion rates were significantly higher in the TLIF group than in the control group ( P <0.05). Conclusion: PSI with TLIF provides superior radiologic fusion outcomes in short-segment spinal stenosis surgery but does not offer a clear clinical advantage over PSI with decompression. Furthermore, it may result in longer operative duration, greater intraoperative blood loss, and may contribute to higher hospital costs.

Introduction: Non-traumatic hip pain in pediatric patients necessitates urgent evaluation due to a wide differential diagnosis, as misdiagnosis can lead to severe complications. This case report details the first known documentation in literature where intra-articular hip bleeding was the initial presentation of hemophilia in an infant, emphasizing the importance of recognizing hematological disorders amid typical orthopedic presentations. Case Report: A 6-month-old male infant with no significant medical history presented with unexplained pain and irritability. Clinical examination demonstrated restricted motion in the right hip, and imaging studies revealed hip effusion. Initial laboratory findings indicated a negative C-reactive protein; however, the activated partial thromboplastin time was prolonged, raising suspicion for a bleeding diathesis. Joint aspiration yielded hemorrhagic fluid, and subsequent tests confirmed a critically low level of coagulation factor VIII, leading to a diagnosis of hemophilia. The patient underwent treatment with factor VIII and was managed with a Pavlik harness, successfully restoring hip stabilization and range of motion. Conclusion: This case highlights the critical need for healthcare providers to consider hemophilia in the differential diagnosis for infants presenting with hip effusion and abnormalities in hemostasis parameters. By documenting a rare case where hemophilia mimicked infection or inflammation, this report aims to improve awareness and diagnostic protocols in pediatric orthopedics. The findings advocate for a cautious approach to invasive procedures in infants when a bleeding disorder has not been ruled out, ultimately enhancing clinical outcomes and advancing our understanding of disease etiology in similar presentations. Keywords: Hemophilia, septic arthritis, hip effusion, pediatric orthopedics, differential diagnosis

Background: While gravity-assisted ankle stress AP (GAASA) images have proven effective in evaluating deep deltoid ligament injuries, their efficacy in assessing syndesmosis injuries remains unclear. We aimed to investigate the diagnostic performance of GAASA images in detecting syndesmosis injuries. Methods: This study reviewed records of patients aged 16+ with unilateral ankle fractures in a single-center ER from 2022 to 2023. Three orthopedic surgeons evaluated standard AP and lateral X-rays, ankle mortise, and GAASA and bilateral ankle CT images in blinded sessions for syndesmosis injuries. Evaluations were repeated to assess the inter- and intra-rater reliability. Results: A total of 121 patients with suspected syndesmosis injuries were included in this study. The average age of the patients was 49.9 ± 16.6 years. Syndesmosis injuries were present in 32.2% of cases. The inter-observer reliability was the highest for GAASA images (κ = 0.701) and mortise radiographs (κ = 0.735), and lowest for CT images (κ = 0.426). GAASA images had a sensitivity of 82% and specificity of 68%. Mortise images had 55% sensitivity and 81% specificity. GAASA images showed better discriminatory power for syndesmosis injuries compared to mortise and CT images. Conclusions: GAASA images demonstrated superior sensitivity and better negative predictive values in detecting syndesmosis injuries compared to mortise radiographs and CT images. While GAASA may serve as a useful adjunct for evaluating syndesmosis injuries, its interpretation requires careful clinical correlation, and it should not be considered a replacement for standard imaging in all cases. GAASA may be of particular value in emergency or resource-limited settings where CT is not readily available, offering a practical option for ruling out injury in many patients.