Aim: Supine lateral bending radiographs are the standard methods of evaluating curve flexibility before surgery in idiopathic scoliosis. Supine traction radiographs have also been used at the authors’ institution in addition to the supine lateral bending radiographs before surgery, believing that it is usually more helpful to analyze the response of the main and compensatory curves to corrective forces. The purpose of this prospective study was to use and evaluate the results of traction radiographs taken before general anesthesia (BGA) and under general anesthesia (UGA).

Material and Method: 25 patients required surgical treatment with idiopathic scoliosis were evaluated prospectively. Thirteen were female. The average age was 12.87 years. We designed a new electronic traction table in order to take the longitudinal traction and three-points lateral pressure radiographs. We situated the patient on the table and measured the patient’s weight. Then we made a longitudinal and lateral traction while asking the possible neurologic symptoms. If there was not any symptom we stopped at the seventy percent of the patient’s weight for the longitudinal and at the fifty percent for the lateral pressure. These radiographs had been taken before and under general anesthesia (UGA). The influence of the traction radiographies on the decision for surgery and its correlation with postoperative result was examined.

Results: Longitudinal traction radiographs taken consciously provided the best amount of flexibility, with no significant difference from traction with the patient UGA (p = 0.17) but with significant difference from bending radiographs (p < 0.002). No significant difference was demonstrated between the traction radiographies taken before and under general anesthesia and postoperative correction (P = 0.14).

Conclusion: The curve flexibility in supine traction films taken with the patient BGA was nearly equal to the curve flexibility in supine traction films taken with the patient UGA in all patients and all types of curves. Thus, there is no need to obtain a normal supine traction film for flexibility analysis under general anesthesia. By this way; the surgeons will be able to give the patient a definitive plan before surgery because the decision can be finalized after seeing the traction radiographs with the patient before the general anesthesia and operation time will be shorter.

Aim: Assessment of curve flexibility is important in decision making before surgical correction of scoliosis. Supine bending radiographs are presently the gold standard technique by which flexibility is assessed, but their reliability has been questioned. Our aim was to compare the usefulness of supine side bending and traction radiographs (with new electronic traction table) in assessing curve flexibility, examining the correlation of each technique with postoperative correction, determining fusion levels in patients undergoing posterior spinal fusion.

Material and Method: 25 patients required surgical treatment with idiopathic scoliosis were evaluated prospectively. Thirteen were female. The average age was 12.87 years. Preoperative radiologic evaluation consisted of standing anteroposterior, lateral, supine lateral bending and traction graphs by electronic traction table.

We designed a new electronic traction table in order to take the longitudinal traction and three-points lateral pressure radiographs. We situated the patient on the table and measured the patient’s weight. Then we made a longitudinal and lateral traction while asking the possible neurologic symptoms. If there was not any symptom we stopped at the seventy percent of the patient’s weight for the longitudinal and at the fifty percent for the lateral pressure. These radiographs had been taken before and under general anesthesia (UGA).

The correction obtained in the Cobb angle between the bending and traction radiographs was compared. The influence of the traction radiography on the decision for surgery and its correlation with postoperative result was examined.

Results: Longitudinal traction radiographs taken consciously provided the best amount of flexibility, with no significant difference from traction with the patient UGA (p = 0.17) but with significant difference from bending radiographs (p < 0.002). Better flexibility in traction radiographs helped us eliminate the need for anterior release in 5 patients. We decreased the fusion levels proximally or distally after all in 12 patients. No significant difference was demonstrated between the traction radiography and postoperative correction (P = 0.14).

Conclusion: Flexibility obtained at traction radiographs with the patient conscious and UGA is clearly better in numerical values, and closer to the amount of surgical correction than the amount of flexibility at three-points lateral pressure radiographs and side-bending radiographs

This method benefits patients by allowing them to avoid anterior release surgery, assessing the fusion levels and helps predict postoperative correction. Longer follow ups are needed to see whether there is decompensation or not.

Aim: Accurate placement of the distal screws into the interlocking nails is a demanding procedure due in part to inaccuracy of the targeting device supplied with the system and to deformation of the nail during insertion. Distal locking can be time consuming and expose the surgeon to unnecessary increased ionization radiation. The described technique allows the distal femoral screw holes to be localized accurately with minimal radiation exposure. Our technique requires no aiming device and no assistant. The only equipment needed is another IM nail at the same length.

Materials and Methods: We describe our new protocol in a subgroup of 20 patients, among those attended to our institution during the last 1.5 years treated with reamed, locked intramedullary nailing. After placement of the nail in a tibia or femur, a second interlocking nail at the same length is placed along side the limb. Using the proximal insertion jig provided with the system, proximal holes of the internal nail are locked with long screws passing through the nail-mounted outrigger to the far cortex. After avoiding the outrigger motion and rod torsion, distal screws are locked. Proximal holes’ locking is then accomplished.

Results: In 20 consecutive distally locked nailing (eight tibiae and 12 femora), the technique was easily mastered. In the operation, there had been taken antero-posterior and lateral graphies in order to evaluate the reduction, the length of the nail and the screws.

Conclusion: The advantages of this protocol are; decreasing the roentgenogram exposure and minimizing the operating time when compared to freehand techniques. This technique can be a safe alternative to the common distal targeting techniques. It can be used when an image intensifier is unavailable.