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A ganglion cyst (GC) is a mucinous or gelatinous-filled benign tumor overlying a joint or tendon sheath, which commonly arises in the dorsal and volar wrist side but may occur anywhere in the body. Although cystic lesions around the knee are common, the occurrence of GCs are rare. Ganglia may arise from intra or extra-articular, soft tissue, intraosseous, or periosteal location. Symptoms may vary according to the size and location. After the more frequent performance of magnetic resonance imaging for the assessment of a knee joint, the number of incidental, asymptomatic lesions have been increasingly diagnosed. The etiology of GC remains unclear; however, trauma and a flaw in the joint tissues may explain its appearance. The authors report two cases of women aged 47 years and 37 years who presented pain and swelling in their left knees following arthroscopic partial medial meniscectomy. The former was surgically treated and had a favorable outcome, while the latter had conservative treatment and a gloomy outcome.

STUDY DESIGN: A single-center, retrospective patient review of clinical and radiological outcomes of microsurgical posterior lumbar interbody fusion and decompression, without posterior instrumentation, for the treatment of lateral recess stenosis. PURPOSE: This study documented the clinical and radiological results of microsurgical posterior lumbar interbody fusion and decompression of the lateral recess using interbody cages without posterior instrumentation for the treatment of lateral recess stenosis. OVERVIEW OF LITERATURE: Although microsurgery has some advantages, various complications have been reported following microsurgical decompression, including cage migration, pseudoarthrosis, neurologic deficits, and persistent pain. METHODS: A total of 34 patients (13 men, 21 women), with a mean age of 56.65±9.1 years (range, 40-77 years) confirmed spinal stability, and preoperative radiological findings of lateral recess stenosis, were included in the study. Interbody polyetheretherketone cages and auto grafts were used in all patients. Posterior instrumentation was not used because of limited resection of the posterior lumbar structures. Preoperative and postoperative radiographs, computed tomography scans, and magnetic resonance imaging were assessed and compared to images taken at the final follow-up. Functional recovery was also evaluated according to the Macnab criteria at the final follow-up. RESULTS: The average follow-up time was 35.05±8.65 months (range, 24-46 months). The clinical results, operative time, intraoperative blood loss, and duration of hospital stay were similar to previously published results; the fusion rate (85.2%) was decreased and the migration rate (5.8%) was increased, compared with prior reports. CONCLUSIONS: Although microsurgery has some advantages, migration and pseudoarthrosis remain challenges to achieving adequate lumbar interbody fusion.

Purpose To compare the outcomes and associated costs of the treatment of mallet fractures with either extension block pinning or open reduction and hook plate fixation. Methods We treated 22 patients for a mallet fracture that involved at least 25% of the distal phalanx articular surface. Three joints demonstrated concomitant volar subluxation. Extension block pinning was used to treat 16 fractures (group 1) and 6 were treated with open reduction and hook plate fixation (group 2). All patients were evaluated at the second, fourth, and sixth weeks after surgery. Collected data included range of motion, extensor lag, and pain status. Patients were asked to grade preoperative and postoperative pain levels on a visual analog scale. Functional outcomes were determined by Crawford criteria. We retrospectively performed a cost analysis using our institutional records. Results Mean follow-up was 12.7 months. Visual analog scale pain scores improved by a similar amount for both groups. Preoperative pain scores were 7.0 for group 1 and 7.5 for group 2. Postoperative levels were 2.0 and 2.0, respectively. Mean extensor lag was identical for both groups, 5°. Mean flexion was 70° for group 1 and 80° for group 2. Based on the Crawford criteria, group 1 had 5 patients rated as excellent, 6 as good, 3 as fair, and 2 as poor. Group 2 outcomes were 2 excellent, 2 good, and 2 fair. Five complications occurred in group 1, and 1 in group 2. Differences noted between groups were not statistically significant. Extension block pinning was more cost-effective than hook plate fixation. Conclusions We find extension block pinning to be an equally effective but more cost-efficient treatment than open reduction and hook plate fixation. Type of study/level of evidence Therapeutic III.

Aim: The aim of this study is to investigate the short and mid term effects of extracorporeal shock wave theraphy (ESWT) in lateral epicondylitis (LE). Method: Fifty six elbows of 48 patients (35 female, 13 male) which were applied ESWT at least for 3 sessions for lateral epicondylitis were retrospectively evaluated. VAS scores recorded before treatment and scores recorded at first week and 3rd month after treatment and clinical evaluation scores for LE of Werhaar et al were evaluated. Results: Significant recovery was found when pain levels before and after treatment were compared. The mean pain score before treatment decreased to 4,82±1,87 at 1st week and to 3,98±2,07 from 7,07±1,73. According to Verhaar LE evaluation score, the number of good and excellent scores were increased while the number of bad scores decreased. Conclusion: As ESWT is a painless, effective method with less side effects, it is a method to perform before surgery in cases which did not respond to other conservative treatment modalities. Key Words: Extracorporeal Shockwave therapy, Lateral Epicondylitis DOI: 10.12973/ejms.2014.126p

Osteoarthritis (OA) is the most common form of arthritis. Two-thirds of the population older than 60 years of age is suffering from OA with increasing frequency mainly due to the higher life expectancy. This condition is characterized by progressive joint destruction which leads to inactivity and loss of mobility. The provision of better treatment options depends on better understanding of the pathogenesis of OA. There- fore, recent studies have focused on pathogenesis of this disease. Multifactorial etiologic agents may cause OA. The different pathogenic mechanisms and effects of risk factors must be identificated for the development of new therapeutic strategies and for the implementation of correct and personalised treatments for patients. Keywords: Osteoarthritis, morbidity, risk factors DOI: 10.12973/ejms.2014.108p

Objective: The aim of this study was to evaluate the the deep wound infection rates between the patients who underwent primary total knee arthroplasty (TKA) with antibioticimpregnated bone cement (AIBC) and with only plane bone cement. Methods: The study included a total of 110 knees were operated and primary TKA was performed by three different surgeons to 104 patients with degenerative primary osteoarthritis using similar technique and prothesis. Patients were divided into two groups as follows: Cement treatment combined with gentamisin (group1) or without antibiotic loading (group 2). AIBC applied patients (group 1) consisted of 54 knees of 52 patients (43 females and 9 males; mean age: 63.00±4,35years) and plain bone cement (PBC) applied patients (group 2) consisted of 56 knees of 52 patients (44 females and 8 males; mean age: 62.00±5,25 years). The groups were adjusted to similar age, BMI and stage of gonarthrosis from a group of 243 patient operated with PBC. Pre- and post-operative knee scores (Hospital for Special Surgery, HSS) were compared. Additionally, patients were evaluated for the diagnosis of infection such as pain out of proportion, fever, local swelling, restricted range of motion, and aspiration of pus from the joint at follow-up. Results: We had overall delayed deep infection only in one (1.92%) knee in group 1. Infection occurred at a mean of 3 months after surgery. None of the patients had infection those were group 2. The odd ratio was infinite (∞) as we had no infection in group 2 which shows that using PBC or AIBC was no statistically significant difference between them. Postoperative functional score improved to a mean of 93.4 (79–100) as per the HSS score. The HSS score of patient that infected was 90 after 3 months of the surgery. Conclusion: AIBC or PBC use likely have not significantly affected the deep infection rates. The intensive attention to use of clean-air theatres, prophylactic antibiotics and occlusive clothing are sufficient to prevent the deep infection. Keywords: Deep wound infection, total knee arthroplasty, antibioticimpregnated bone cement DOI: 10.12973/ejms.2014.110p

Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are major surgical procedures which can cause high morbidity and even mortality. Among these complications is venous thrombo embolism (VTE) comprising deep vien thrombosis (DVT) and pulmonary embolism (PE). Therefore, after these operations, thromboprophylaxis is routinely used. However, it has some complications such as bleeding, adverse effect of chemical agents for using prevention of DVT. Anti-thrombotic prophylaxis includes: low molecular weight heparin (LMWH), fondaparinux, apixaban, dabigatran, rivaroxaban, low dose unfractionated heparin (LDUH), adjusted dose vitamin K antagonist (VKA), aspirin, or mechanical thromboprophylaxis devices. All over the World, orthopaedic surgeons consider a balance between thromboprophylaxis and bleeding. However, it has been still controversy about optimum prophylaxis for DVT. In this current paper, we aimed to review the literature under light of the current studies.

WOS:000386543000013, PubMed ID: 27849326, AMAÇ: Suprakondiler humerus kırıkları çocukluk döneminin en sık dirsek kırığıdır. Kapalı redüksiyon ve perkütan çivileme altın standart tedavi ola-rak kabul edilir. Bununla beraber bazen açık redüksiyon gerekebilir. Bu geriye dönük çalışmamızın amacı suprakondiler humerus kırıklarında triseps kasını kesen posterior ve lateral yaklaşımların klinik ve fonksiyonel sonuçlarını karşılaştırmaktır.GEREÇ VE YÖNTEM: Toplam 38 hasta posterior veya lateral insizyonla ameliyat edildi. Grup 1'de posterior insizyonlu 30 hasta, Grup 2'de lateral insizyonlu sekiz hasta mevcuttu. Kozmetik ve klinik sonuçları karşılaştırmak için Flynn kriterleri kullanıldı. Kırık kaynaması AP ve lateral grafilerle değerlendirildi. Hastalar ve ebeveynlerine dirseğini tam aktif olarak ne kadar sürede hareket ettirebildiği ve tedavi sürecinden tatmin durumları sorularak kayıt tutuldu.BULGULAR: Ortalama kaynama süresi Grup 1 ve Grup 2 için sırasıyla 44.1 gün ve 46.3 gün, tam veya tama yakın dirsek hareketlerine kavuşma süresi Grup 1 ve Grup 2 için sırasıyla atel çıkarımı sonrası 57.5 ve 55.7 gün olarak bulundu. Grup 1'deki 30 hastanın ve ebeveynin 21'i, Grup 2'deki sekiz hastanın ve ebeveynin altısı sonuçtan tam olarak tatmin olduklarını ifade ettiler. Grup 1'deki 30 hastanın 21'i, Grup 2'deki sekiz hastanın ve altısı her iki Flynn kriterlerine göre (kozmetik ve fonksiyonel) çok iyi grupta yer aldı.TARTIŞMA: Pediatrik suprakondiler humerus kırıklarının tedavisinde kapalı redüksiyon ve perkütan çivilemenin altın standart tedavi olduğuna ina-nıyoruz. Bu metodun uygulanamadığı olgularda trisepsi kesen posterior yaklaşımın daha kolay kırık redüksiyonu ve muhtemelen daha kısa ameliyat süresi gibi avantajlarından dolayı güvenli ve lateral yaklaşımla karşılaştırılabilir olduğunu düşünüyoruz., BACKGROUND: Supracondylar humerus fracture is the most common fracture of the elbow in children. Closed reduction and percutaneous pinning is considered to be the optimal treatment strategy; however, in some instances, open reduction may be necessary. The aim of this retrospective study was to compare clinical and functional results of triceps-splitting posterior versus lateral approach in pediatric supracondylar humerus fracture surgery.METHODS: A total of 38 patients underwent surgery; Group 1 consisted of 30 patients on whom posterior approach was used, while lateral approach was used on the 8 patients in Group 2. Flynn criteria were used to evaluate cosmetic and clinical results. Fracture healing was assessed with anteroposterior and lateral x-rays. Patients and parents were asked to describe time needed for complete return of full elbow range of motion (ROM) and overall satisfaction.RESULTS: Mean fracture union time was 44.1 days and 46.3 days, and time required to regain complete or near complete elbow ROM was 57.5 days and 55.7 days after splint removal for Group 1 and Group 2, respectively. Twenty-one of 30 patients (and parents) in Group 1, and 6 of 8 patients (and parents) in Group 2 were totally satisfied with the results. Twenty-one of 30 patients in Group 1, and 6 of 8 patients in Group 2 had excellent cosmetic and functional results according to Flynn outcome criteria.CONCLUSION: In cases of pediatric supracondylar humerus fracture, early closed reduction and percutaneous pinning is preferred; however, when this method is not applicable, triceps-splitting posterior approach is a safe and comparable method to lateral approach with advantages of easier fracture reduction and shorter operating time.

To evaluate the midterm outcome and the degree of satisfaction of patients who underwent reconstruction of dorsal hand and finger defects with reverse flow radial fasciocutaneous forearm flaps and to test whether or not this is a reliable method which can be applied without the need for microsurgery. Eleven patients were admitted with post-traumatic complex hand defects and treated by reconstruction with reverse flow radial fasciocutaneous forearm flaps from January 2010 to May 2013. The patient demographics, size of the hand and finger defects, and complications were recorded. The functional status of each of the patients was evaluated using the quick disabilities of the arm, shoulder and hand (DASH) scoring system, and patient satisfaction was assessed using Likert scores. The patients comprised nine males and two females with a mean age of 30.7 ± 9.7 years. The mean follow-up period was 18.4 ± 5.2 months. The average defect size was 41 ± 14.3 cm². None of the patients had circulation defects caused by the sacrifice of the radial artery. The mean quick DASH score was determined as 30.2 ± 15.3. The Likert patient satisfaction evaluation was good in one patient, and very good in ten patients. All flaps survived well with only two complications; superficial skin necrosis occurred at the suture site in one patient and venous insufficiency occurred in the other patient. Both complications recovered with secondary healing following wound debridement. The reverse-flow radial forearm flap is a reliable method in the management of dorsal defects of the hand and does not require micro-surgical techniques.

Purpose: Anterior knee pain is a common musculoskeletal condition amongst young adult population. Lower extremity structural factors, such as increased femoral anteversion and lateral tibial torsion, may contribute to patellofemoral malalignment and anterior knee pain. The aim of this study was to evaluate the lower extremity structural factors and related patellofemoral alignment parameters that play a role in the aetiology of anterior knee pain. Methods: This study involved three groups: patients with unilateral symptomatic knees (n = 35), asymptomatic contralateral knees in the same patients and a control group (n = 40). All subjects were physically examined, and Q-angles were measured. The lower extremities of all subjects were imaged by a very low-dose CT scan, and the symptomatic knees of patients were compared with their asymptomatic contralateral knees and with the healthy knees of controls regarding femoral anteversion, tibial torsion, sulcus angle, patellar tilt angle and lateral patellar displacement. Results: Regarding the Q-angle, femoral anteversion and lateral tibial torsion, no significant differences were found between the symptomatic and asymptomatic knees, whereas significant differences were found between the symptomatic knees and controls. The symptomatic group demonstrated significantly greater sulcus angle only in 30° of knee flexion than did the controls. Conclusion: Patients with unilateral anterior knee pain may have similar morphology at their contralateral asymptomatic lower extremity, and different morphology compared with healthy controls. Lower extremity rotational deformities may increase the risk of anterior knee pain; however, these deformities alone are not sufficient to cause knee pain, and may be predisposing factor rather than a direct aetiology. Level of evidence: Diagnostic study, Level III. © 2015, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).

The bucket-handle meniscal tear is a specific type of meniscal injuries which has specific signs on MRI. An attached fragment displaced away from the meniscus with any type of tear causes bucket-handle tear of the meniscus. Magnetic resonance imaging (MRI) is the most commonly used diagnostic tool for meniscal injuries. We present a case of free medial meniscal fragment which mimics the dislocated bucket-handle tear on MRI. The presence of “fragment within the intercondylar notch sign” and “the absence of the bow tie sign” may be an indication of a free meniscal fragment. This should be considered during diagnosis.

Aim Hand trauma may lead to multiple fingertip defects, causing functional restrictions. We evaluated the use of reverse-flow homodigital flap reconstruction of the distal phalanx and pulp defects associated with multiple finger injuries. Methods We retrospectively evaluated 11 male patients who presented at our emergency department (January 2011–March 2013) with multiple fingertip injuries and who were treated with a reverse-flow homodigital flap. Evaluations included age, sex, defect size, flap survival rate, complications, cold intolerance, two-point discrimination, range of motion (ROM), quick disabilities of the arm, shoulder, and hand (DASH) score, and return to work time. Results Completely, 22 reverse-flow homodigital flaps were applied to at least two fingertip injuries at the distal phalanx. Ten flaps survived postoperatively. The exception was partial flap loss on one finger. The mean follow-up was 14.2 months. At the final follow-up, the mean static two-point discrimination value was 10.3 mm. Mean ROMs of interphalangeal joints were 65.31° (distal) and 105.77° (proximal). Donor sites were covered with full-thickness skin grafts from the wrist or antecubital area. There were no complications related to the donor site and no development of cold intolerance in any finger. The mean quick DASH score was 4.12. All patients returned to work in an average of 8.3 weeks. Conclusions The reconstruction of multiple fingertip injuries with reverse-flow homodigital flaps is a safe, effective method that can be combined with other local finger flaps. These flaps can be applied to two consecutive fingers without reducing finger length or function.

Calcaneal fractures are the most frequent tarsal fractures and represent 2% of all adult fractures. A high-energy trauma which causes axial loading is the most common cause of calcaneal fractures. The majority of these fractures are intra-articular. Particularly patients with displaced intra-articular calcaneal fractures must be evaluated for multiple traumatic injuries. The spine, contralateral lower extremity and the wrist fractures may accompany with calcaneal fractures. The most common symptom of calcaneal fractures is pain. Swelling is frequently encountered. Erythema and fracture blisters are other findings. Conventional radiological images should include anteroposterior, axial, lateral and oblique views. The subtalar joint, the calcaneocuboid joint and posterior facet should be assessed in radiologic images. Calcaneal fractures may involve extensive complications. Subtalar joint stiffness and arthritis, heel widening, peroneal impingement, implant-related problems and heel pad pain are the potential complications. The complex anatomy of the calcaneus should be well understood for assesing a calcaneal injury. Evaluation of the radiological findings and classification of the fracture must be performed before determining the treatment method. There is a large number and variety of classification systems that have been described for calcaneal fractures. There is a lack of consensus on treatment and operative technique in calcaneal fractures. The treatment of calcaneal fractures must be planned according to different factors such as type of trauma, classification of the fracture, skin condition and injury mechanism. No treatment, conservative treatment, open reduction and internal fixation, primary subtalar arthrodesis, delayed primary arthrodesis and calcanectomy are treatment options. Also minimally invasive techniques have developed over time. Restoring articular congruity and hindfoot morphology are the aims of calcaneal fracture treatment. Most of recent studies show that open reduction and internal fixation has better outcome in selected patients. Good evaluation, preoperative planning and appropriate treatment bring out better results.

Medial opening-wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. The abnormal load on the medial compartment of the knee is directed to the lateral compartment with this procedure. A gap occurs on the proximal tibia while providing adequate correction. Filling this gap with bone grafts or synthetic materials has gained wide acceptance for preventing bone union problems or osteotomy site collapse. The aim of this study is to report our results of MOWHTOs performed without any bone graft or any other synthetic materials.We evaluated 41 MOWHTOs that have been performed between 2009 and 2012 with no use of any grafts or synthetic materials and spacer. Age of the patients ranged from 43 to 67. Thirty-five of the patients were females and three of them were males. The follow-up time was 6 months.Seven knees had opening at the osteotomy site10 mm, 26 knees had 10-12.5 mm, and eight knees had12.5 mm (range 7.5-14 mm, mean 11.07 mm). All osteotomies united without loss of correction. The mean bone union time was 12.8 weeks. We did not have any major complication regarding the technique.The results of our study have shown that we can achieve satisfactory and good results by performing MOWHTO procedure without using any bone grafts or synthetic materials and spacer.

WOS: 000388364000005, PubMed: 27826460, Background: To evaluate the efficiency of the percutaneous 18-G needle technique in releasing the fibro-osseous sheath over the first dorsal extensor compartment of the hand. Methods: Using anatomic landmarks, percutaneous release was performed with an 18-G needle on 48 wrists of 24 cadavers. The specimens were then dissected and examined for the completeness of the first dorsal extensor compartment release and any tendon or neurovascular injuries. The tunnel length, number of abductor pollicis longus and extensor pollicis brevis tendons, presence of an intertendinous septum, and the effects of these parameters on percutaneous release were evaluated. Results: Percutaneous release was performed on all of the wrists, and the evaluation of the adequacy of release revealed 25 complete releases, 21 partial releases, and 2 missed releases. There were 19 cases of tendon complications. No neurovascular injuries were noted. The mean tunnel length was 2.66 +/- 30 cm, and the mean number of tendons was 2.75 +/- 0.86. A septum was present in 33.3% of cases. Tunnel length and tendon number had no statistically significant effect on release, whereas the presence of a septum was significantly associated with inadequate tunnel release and the development of tendon complications. Conclusions: Percutaneous release of the first dorsal extensor compartment using an 18-G needle was associated with high rates of incomplete release and tendon damage in the presence of an intertendinous septum. Further study is required under ultrasound guidance to determine the usefulness of percutaneous release in the first dorsal extensor compartment. Clinical Relevance: Release with a percutaneous needle tip in De Quervain's syndrome may provide the advantages of better cosmetic results with less scar formation and an early return to work.

Objectives: Medial opening-wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. The abnormal load on the medial compartment of the knee relocates to the lateral compartment with this procedure. A gap occurs on the proximal tibia during the correction of varus deformity. Filling this gap with bone grafts or synthetic materials has gained wide acceptance for preventing nonunion or osteotomy site collapse. The aim of this study is to report our results of MOWHTOs performed without any bone graft or any other synthetic materials. Methods: We evaluated 41 MOWHTOs performed between 2009 and 2012 with no use of bone grafts, synthetic materials or spacers. Age of the patients ranged from 43 to 67. Thirty five of the patients were female and 3 of them were male. The follow-up time was 6 months. Results: There were no any non-unions or loss of correction. The mean bone union time was 12,8 weeks. No major complications were seen. Conclusion: The results of our study has shown that achieve satisfactory results can be obtained in MOWHTO without using any bone graft, synthetic materials or spacer.

The purpose of this study was to investigate the mechanical strength of both monoplanar and biplanar medial opening-wedge high tibial osteotomy (MOWHTO) procedures and assess the risk of lateral cortex disruption for both techniques. Twelve synthetic tibia models with cortical shells were used as test models. Saw cuts for monoplanar MOWHTO and biplanar MOWHTO were generated on the test models in equal numbers (n = 6 for both groups). Wedge opening load and wedge gap distance were evaluated via compressive tests. The mean gap distance just before the lateral cortex fracture in the monoplanar group was 14.7 +/- 2.9 mm, which was significantly narrower than that in the biplanar group of 19.1 +/- 2.0 mm (p = 0.015). The mean load just before the occurrence of lateral cortex fracture of 32.4 +/- 3.2 N in the monoplanar osteotomy group was significantly lower than that in the biplanar osteotomy group of 111.8 +/- 9.3 N (p = 0.009). Performing a MOWHTO via the biplanar rather than the monoplanar technique allows larger-sized wedges to be opened with less risk of lateral cortical fracture. Thus, larger gaps can be opened and higher angle corrections can be achieved using the biplanar osteotomy procedure. From a clinical viewpoint, the biplanar osteotomy technique reduced the risk of lateral cortical hinge fracture during MOWHTO.