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Background. Pulmonary embolism is a serious early complication of arthroplasty procedures that can develop after deep venous thrombosis. The present study aimed to compare rivaroxaban and enoxaparin in terms of preventing DV and PE, and also in this study, we compared the complications due to these drugs in patients undergoing elective arthroplasty. Materials and Methods. 214 patients were divided into three groups based on their treatment regimens. In group I, enoxaparin was used, in group II, rivaroxaban was used, and in group III, enoxaparin was used throughout hospitalization, and after hospital discharge, rivaroxaban was used. These three groups were compared according to the occurrence of deep venous thrombosis, pulmonary embolism, and major and minor complications. Results. Major postoperative complications occurred in 5, 15, and 6 patients in group I, II, and III, respectively. Minor postoperative complications occurred in 10, 24, and 11 patients in group I, II, and III, respectively. No significant difference was found among the three groups. Deep venous thrombosis or pulmonary embolism was not observed in any patient. Conclusion. Rivaroxaban was found to be as effective as enoxaparin in the prevention of deep venous thrombosis and other complications after arthroplasty. Moreover, oral rivaroxaban provided greater ease of use compared to subcutaneous enoxaparin. Based on these findings, we consider that rivaroxaban could be an effective alternative to enoxaparin.

WOS:000571474000002 PubMed: 33101795 Background and objective Bone marrow edema (BME) is a rare condition caused by insufficient osseous blood supply and may result in severe pain that has adverse effects on patients' life. To date, various conservative treatments have been recommended for the treatment of BME, including analgesics, immobilization of the affected extremity, and iloprost infusion. The aim of this retrospective study was to investigate the effectiveness of parenteral iloprost therapy in the treatment of BME detected in different skeletal locations. Materials and methods This retrospective study included 23 patients (17 men and six women) with BME who were classified as stage I-III according to the Association Research Circulation Osseous (ARCO) classification. BME was localized to the proximal femur in 13 (56.5%), the distal femur in four (17.4%), tarsal bone in four (17.4%), and tibial plateau in two (8.7%) patients. The mean age of the patients was 46.7 years and all the patients were evaluated with the Visual Analog scale (VAS), Functional Mobility Scale (FMS), and MRI. Results A significant improvement was observed in the post-treatment VAS and FMS scores of all patients compared to their pre-treatment scores. Moreover, the edema regressed completely in 60.9% of the patients at three months of MRI control. No serious side effects were observed during the treatment in any of the patients. However, transient side effects including headache, arrhythmia, and flushing were observed in five patients. Conclusion The present study indicated that iloprost therapy is an effective and safe option in the treatment of BME patients, particularly in the reduction of severe pain that has adverse effects on patients' social life, regardless of ARCO staging. Moreover, this therapy could be particularly useful in reducing pain, improving functional recovery, and achieving complete regression of the edema on MRI in ARCO stage I-II patients.

Introduction Although closed reduction and percutaneous pinning are the accepted treatment approaches in pediatric humerus supracondylar fractures, the treatment approach in fractures without closed reduction remains unclear. This study compared the results of three different cross-pinning treatment methods. Materials and methods A total of 62 patients (1-13 years old) who were operated for Gartland type 3 humerus supracondylar fractures between 2007 and 2016 were evaluated retrospectively. Of the patients evaluated, 24 patients had closed reduction, 25 patients had direct reduction from the medial, and 13 patients had direct reduction from the lateral and cross-pinning. The functional and cosmetic results of the patients were evaluated according to Flynn's criteria. In addition, the Baumann angle, lateral capitellohumeral angle (LCHA), and postoperative complications were compared among groups. Results Both functional and cosmetic results and the Bauman and LCHA angles were similar in all three groups. In patients with open reduction, the control duration was significantly longer than that in patients with closed reduction, and this difference was due to a recent increase in the surgeons' preference for closed surgery. Two patients underwent pin site infection and two patients developed nerve palsy. Only the first patient who developed ulnar nerve palsy recovered during follow-up. Secondary surgery was applied to the other patient who developed brachial artery occlusion with ulnar and median nerve paralysis, and they recovered during follow-up. Three patients who underwent open surgery from the medial, along with the two patients who had undergone open surgery, developed pinhole infection. These patients were subsequently recovered with antibiotherapy without further complications. A patient who underwent open lateral surgery developed compartment syndrome and fasciotomy was performed. Conclusion Closed reduction and percutaneous pinning are generally accepted approaches in the treatment of pediatric humerus supracondylar type 3 fractures. However, in cases where closed reduction cannot be achieved, pinning with the medial approach and taking the ulnar nerve and medial colon is a reliable method to avoid both ulnar nerve injury and cubitus varus.

aytac, gunes/0000-0003-4902-2844 WOS:000522643800019 PubMed: 32130480 Purpose To compare five different repair techniques for extensor tendon zone III modified Kessler (MK), double-modified Kessler (DMK), modified Kessler epitendinous (MKE), double-modified Kessler epitendinous (DMKE), and running-interlocking horizontal mattress (RIHM) in terms of shortening, stiffness, gap formation, and ultimate load to failure. Methods A total of 35 human cadaver fingers were randomly assigned to five suture techniques with 7 fingers each and were tested under dynamic and static loading conditions. Results DMK was found to be superior over MK in terms of ultimate load to failure (36 N vs. 24 N, respectively), shortening (1.75 vs. 2.20 mm, respectively) and gap formation. However, these two methods had similar characteristics in terms of stiffness. The addition of epitendinous sutures to the repair methods resulted in approximately 40% increase in ultimate load to failure, whereas epitendinous sutures had no effect on shortening. DMKE was found to be superior over MKE in terms of shortening (1.77 vs. 2.22 mm, respectively). However, these two methods had similar characteristics in terms of mean ultimate load to failure and stiffness. RIHM was found to be superior over the other four methods in terms of ultimate load to failure (89 N), stiffness, and shortening (0.75 mm). Conclusion RIHM was found to be stronger and more durable for extensor tendon zone III than the other techniques in terms of ultimate load to failure and stiffness.

Objective: There has been no consensus in literature for the ideal flexor tendon repair technique. The results of zone 2 flexor tendon lacerations repaired primarily by 4 strand Modified Kessler core suture and epitendinous interlocking suture technique followed by Modified Kleinert protocol were investigated. Methods: 128 fingers of 89 patients who had flexor tendon laceration in zone 2 built the working group. Functional outcomes were evaluated using the Strickland formula. A statistical analysis was made between Strickland scores and some parameters such as age, gender, follow-up time, co-existing injury existence, repair time, single or multiple finger injury, tendon rupture and the effect of FDS injury and repair. Results: Excellent, good, fair, poor results were obtained from 71 (55.5%), 46 (35.9%), 8 (6.3%), 3 (2.3%) fingers, respectively. Time of the repair has a significant effect on the strickland scores. Surgery performed within the first 24 hours following the injury gave better results. 3 fingers (2.3%) had tendon ruptures. Existence of ruptures affected the results significantly. Co-existing injuries were found that they did not have any effect on the results. In the fingers in which both FDP and FDS tendons were lacerated, no significant relationship was found between only FDP repair, both FDP and FDS repair and single FDS slip repair. Additionally no significant relationships between follow-up time, gender, single or multiple finger injury and Strickland scores were observed. 13 fingers (10.1%) had PIP joint contracture above 20°. Conclusion: The low rupture rate (2.3%) and 91.4% ‘good’ and ‘excellent’ scoring rates in our series support the idea that modified Kessler 4-strand core suture and epitendinous interlocking suture repair combined with modified Kleinert protocol gives satisfactory results. Repair time is one of the most important factors affecting the functional results and surgery should not be delayed if there is an experienced surgeon available. Level of evidence: Level IV, therapeutic study. Keywords: Flexor tendon, Zone 2, Core suture, Strickland, Kleinert, Kessler

WOS: 000414707200001 PubMed: 29093436 Background: Surgical treatment of acetabular fracture and the anatomic reconstruction of the hip joint are difficult to achieve due to the complex pelvic anatomy, and surgical training requires a prolonged and steep learning curve. The aim of this study was to evaluate the effects of an applied training course, including cadaveric dissection, for the surgical treatment of acetabular fractures. Material/Methods: This retrospective study included 35 patients who underwent surgical treatment for acetabulum fractures between 2012-2016. Patients were divided into three groups during two training courses, for the first two years and second two years. The surgical treatment was performed through single or combined standard approaches, according to the fracture pattern. The radiological outcome was evaluated using Matta's criteria to grade postoperative reduction and final radiological outcome and the restoration of the hip joint center (HJC). The clinical outcome was evaluated using the modified the Merle d'Aubigne-Postel (DAP) hip score. Results: Both post-course groups had statistically better functional and radiological outcomes compared with the precourse group. Depending on the learning curve, the mean duration of surgery decreased from 153 minutes to 82.3 minutes. Although there was no statistical difference between groups in the vertical shift of the HJC, there was a statistically significant in the amount of horizontal shift of the HJC in the second two years of training, compared with the other groups. Conclusions: Functional and radiological outcome of surgical treatment of acetabular fracture may be improved with increased training, depending on the learning curve.

Background and objectives: Pediatric tibial shaft fractures often have satisfactory outcomes after closed reduction and casting. However, surgical treatment may be required in unstable or open fractures. Titanium elastic nails (TENs) are a good option for the surgical treatment of pediatric tibial fractures due to their advantages such as short hospitalization periods, easy applicability, early weight bearing, and early union. In this study, we evaluated radiological and functional outcomes in pediatric patients with tibial shaft fractures that underwent fixation with TENs. Materials and methods: A total of twenty tibial shaft fractures that were treated with TENs in our clinic between 2013 and 2017 were retrospectively reviewed. The mean age at injury was 8.9 &plusmn, 2.78 (range of 3&ndash, 14) years. Seven (35%) out of 20 fractures were open fractures, of which one fracture was classified as Grade I and six fractures were classified as Grade II. In each patient, antegrade nailing was performed by inserting a TEN in the medial and another TEN in the lateral side of the proximal metaphysis. Clinical outcomes including union, alignment, leg-length inequality, and complications were evaluated using modified Flynn&rsquo, s criteria. Results: The mean time to union was 10.85 &plusmn, 3.39 (range of 6&ndash, 20) weeks. No patient had a sagittal or coronal angulation of over 10&deg, One patient had a leg-length inequality of 10 mm. Among three patients with open fractures, two of them had superficial wound infections and the other patient had a deep wound infection. All the infections were successfully treated with appropriate antibiotic therapies. Four other patients had pin tract irritation that required no intervention. No significant difference was observed between patients with open and closed fractures with regard to the clinical and radiological findings although patients with open fractures had a significantly higher complication rate compared to patients with closed fractures (p &lt, 0.05). No patient had a restricted range of motion of the ankle and knee joints. Twelve (60%) patients had an excellent outcome, and eight (40%) patients had a satisfactory outcome. Conclusions: Intramedullary fixation with TENs provides favorable outcomes and reduced complication rates in the treatment of unstable pediatric tibial shaft fractures that cannot be reduced with conservative treatment modalities or cannot be casted due to the presence of an edema or open wound.

WOS: 000361650300007 PubMed: 26133944 Background Hyaluronic acid and glycosaminoglycans have shown positive effects in improving lateral epicondylitis and other tendinosis conditions. Therefore, we designed a prospective, randomized study to compare the effects of a combined sodium hyaluronate and chondroitin sulfate (HA + CS) injection versus a triamcinolone injection in the treatment of lateral epicondylitis. Methods In total, 57 consecutive patients with clinically diagnosed lateral epicondylitis were divided randomly into two groups. In the HA + CS group, 25 patients received a single injection of a solution containing an HA + CS combination and prilocaine HCl, while the 32 patients in the triamcinolone group received a single injection of a solution of triamcinolone and prilocaine HCl. We evaluated the pain and function outcome measures using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire at the beginning of the study, and 3 and 6 months after the injection. Additionally, the Minimum Clinically Important Difference values and percentage changes in the PRTEE subscale scores between the assessments were calculated. Results No serious adverse events were reported throughout the study. The mean pain and function scores for the HA + CS and triamcinolone groups had significantly improved at 3 months, but the mean function scores in the HA + CS group were statistically significantly better when compared to the triamcinolone group. At 6 months, both groups had significantly improved mean pain and function scores, compared to the baseline scores; however, the mean pain and function scores in the 6-month HA + CS treatment group were better than in the 6-month triamcinolone group. The relative change for the mean total score in the HA + CS group was much better when compared with the triamcinolone group, and the HA + CS treatment group showed clinically significant improvement when compared with triamcinolone group at 3 and 6 months. Conclusions This study supports the idea that for a single injection treatment of patients with lateral epicondylitis, a combination injection of HA + CS may offer better pain benefits for 6 months after injection, when compared to triamcinolone. Type of study/level of evidence Level II, Randomized Clinical Trial, Prospective Comparative Study.

Gurger, Murat/0000-0002-7510-7203 WOS: 000391829400001 PubMed: 28154666 Introduction: Curettage of the cyst and bone grafting are the most common methods used in the treatment of unicameral bone cysts (UBC) and aneurysmal bone cysts (ABC). Recurrence of these cysts is often associated with insufficient curettage of the cyst during surgery. In this study, we aimed to evaluate the effect of insufficient curettage on recurrence in patients with UBC and ABC. Methods: The retrospective study included 18 patients with UBC and 14 patients with ABC that were surgically treated by curettage and bone grafting in our clinic between 2006-2013. Mean age was 19.80 (range, 4-50) years in the patients with UBC and 21.76 (range, 4-56) in the patients with ABC. The diagnosis of the cysts was established both clinically and radiologically. Mean follow-up period was 36 (range, 6-60) months both in the patients with UBC and ABC. The patients with recurrence underwent a second curettage and grafting procedure. Healing and recurrence were evaluated according to modified Neer's scale. Results: Recurrence occurred in 8 patients. Of these, 5 patients underwent a second curettage and grafting procedure and 3 patients were lost to follow-up. Complete healing occurred in all the patients that underwent a second curettage and grafting procedure. Conclusion: The achievement of complete healing in the patients that underwent a second curettage and grafting procedure indicates that the recurrence of UBC and ABC is associated with insufficient curettage. s

Sancar Serbest,1 Ugur Tiftikci,1 Haci Bayram Tosun,2 Seyit Ali Gumustas,2 Abuzer Uludag2 1Department of Orthopaedics and Traumatology, Faculty of Medicine, Kırıkkale University, Kırıkkale, 2Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey Objectives: Platelet volume has been defined to be a marker that shows thrombocyte activation and function and it is measured as mean platelet volume (MPV). MPV shows the mean volume of circulating thrombocytes and it is one of the routine parameters in complete blood count. Increased thrombocyte volume is associated with thrombocyte activation. Patients and methods: This study included 76 patients who were operated on due to fractures of long tubular bones. Patients who had union without any additional interventions were defined as group I, and patients who needed additional interventions due to nonunion or inadequate union were defined as group II. The control group included healthy volunteers who did not have a fracture. Hematologic test values of the patients that were obtained at admission to emergency ward were recorded Results: The groups were not statistically different in terms of age, sex, and the affected extremity. There were significant differences between group I and group II in terms of mean erythrocyte sedimentation rate, C-reactive protein, and MPV values (P

Background. Lymphedema delays the healing of any wound by negatively affecting its inflammatory period. Whether it affects bone healing in a similar negative manner is unknown. Therefore, we experimentally investigated the effect of lymphedema on fracture recovery. Methods. We used thirty 200- to 250-g Sprague-Dawley rats for the experiment. The rats were randomly divided into two groups of 15 rats each for the experimental lymphedema and control groups. Lymphedema development was confirmed by measuring the circumference and diameter of the extremities together with lymphoscintigraphy. Twenty days after the development of lymphedema, a fracture model was created in both groups in the right tibia with mid-diaphyseal osteotomy and fixing with an intramedullary Kirschner wire. After 6 weeks, all rats were sacrificed and the callus tissue that formed along the osteotomy was compared between groups with respect to radiographic, histological, and biomechanical characteristics. Results. The three-point bending test yielded an average stiffness value of 1227N/mm (n = 6) in the control group and 284N/mm (n = 7) in the experimental lymphedema group (P < 0.05). At the end of week 6, radiographic evaluation showed that solid knitting was obtained in the control group, whereas in the lymphedema group delayed or no knitting was observed. In the control group, histological investigation revealed normal callus morphology. Trabecular bone was normal and osteoblast and osteoclast activity was clearly evident. The bone was stained homogeneously with hematoxylin and eosin, and ossification was within normal limits. In the lymphedema group, however, the histological appearance was mostly that of scar tissue. In addition, osteoblast and osteoclast activity was much less visible or absent. Conclusions. Lymphedema negatively affected bone healing in rats. However, the mechanism of this negative effect and its occurrence in humans are still unknown. Further experimental and clinical studies are needed to support and extend our findings. © 2007 The Japanese Orthopaedic Association.

WOS: 000369533200041 PubMed: 26402835 Congenital clasped thumb is a progressive flexion and adduction deformity presenting with heterogeneous congenital anomalies. Although the disease is rare, diagnosis is usually delayed due to natural location of thumb within the palm in first 3 months of life.A 4-year-old girl with congenital clasped thumb deformity due to absence of extensor pollicis brevis tendon whose treatment consisted of extensor indicis proprius (EIP) transfer and z-plasty reconstruction to first web space.The patient was so happy with both cosmetic appearance and functional status. There was not any limitation at interphalangeal or metacarpophalangeal (MCP) joints of the thumb and the result was. Stability of MCP joint was full and power for grasping any object was much better than the original status.In cases of isolated clasped thumb deformity associated with absence of tendon whose treatment attempts with splinting and physical treatment have failed, EIP tendon transfer and reconstruction of contracture in first web space with z-plasty is an easy and successful method to obtain functional improvement.

Synovial chondromatosis is the process of progressive metaplasia associated with formation of cartilage in synovial membranes of joints, tendon sheaths or bursae. It is a rare, chronic, benign disease with unknown etiology which involves single joint. It is generally seen in large joints like knee, hip and, ankle. Wrist involvement is very rare. More common diagnoses with calcified foci and effusion in a joint like rheumatoid arthritis, osteoarthritis, synovial osteochondromatosis, chondrocalcinosis, calcifications that occur after septic arthritis and synovial chondrosarcoma may interfere with this condition. And high recurrence rate makes the treatment challenging for orthopaedic surgeon. Treatment consists of surgically removing loose bodies and partial or total synovectomy. Here, we present a 31 years old male patient referred to our clinic with painfull recurrent wrist mass. And patient was reoperated for synovial chondromatosis of wrist 17 months after the first operation. We represented the preoperative findings and histopathologic confirmation of synovial chondromatosis. We didnt encounter any recurrence in the follow up period nearly 5 years after tumor removal and synovectomy. We will also discuss differential diagnosis and treatment according to updated literature. [Hand Microsurg 2018; 7(2.000): 109-111]

The restoration of gliding function following tendon injury is a major problem for hand surgeons (1). Various synthetic materials, such as FocalSeal-L (2), Seprafilm® (3), glycosaminoglycan hydrogel films (4), polyethylene film (5), and carbodiimide derivatized gelatin/hyaluronic acid (6) have been used to prevent this problem. However, some materials failed because they stimulated a severe inflammatory response or allowed ingrowth of adhesion around the edges of the material. Other materials prevented nutrient diffusion to the healing tendon leading to tendon necrosis (2). Targeting local cells that contribute to restrictive adhesion may play an important role in preventing peritendinous adhesion and improving functional results. Hyaluronic acid and many other substances, such as aprotinin (7), 5-fluorouracil (8), mannose-6-phosphate (9), and beta-aminopropionitrile (10) have been used to resolve this problem (11). Glycosaminoglycans (GAGs) such as sodium hyaluronate (HA) and glucosamine N-chondroitin sulfate (glcN-CS) are polysaccharides with aminoglucose content and are found in the extracellular matrix of all vertebrates as well as in some bacteria (12). GAGs provide a well-hydrated pericellular environment. In this way, they may contribute to the wound healing process by creating an appropriate environment for growth, leading to the accumulation of other matrix proteins, the formation of growth and differentiation factors, and cell migration (4). Furthermore, GAGs influence specific interactions that affect important processes such as the formation of collagen fibrils, cell-cell interactions, growth factors binding, and cell regulation by influencing physical processes such as ion transport, nutrient diffusion, and water retention (13). Sodium hyaluronate is a widely used agent, and local administration of HA aims at preventing adhesion following tendon repair (14,15). Oral applications of glcN-CS have also been reported to be beneficial in tendon healing and in preventing adhesion (16,17). Intravesical instillation of the sodium hyaluronate and chondroitin sulfate (CS) combination has been used for treating chronic cystitis (18). However, few studies have been conducted on the use of HA and CS combination (HA+CS) as a local injection in orthopedic practice. In a review of the literature, three studies were found on the use of HA and CS for treating osteoarthritis (19,20) and on the effects of HA and CS on the formation of adhesion following tendon repair (21). Given this background, we hypothesized that a combined composite solution of sodium hyaluronate and chondroitin sulphate might be effective in preventing peritendinous adhesion after extrasynovial tendon repair such as Achilles tendon. In this study, we aimed at analyzing the effects of the local application of the HA+CS combination solution injection on peritendinous adhesion and the tendon healing process.

Patient: Male, 13 Final Diagnosis: Isolated capitate bone fracture Symptoms: — Medication: — Clinical Procedure: — Specialty: — Objective: Unusual clinical course Background: Carpal fractures often appear in men under the age of 40 years. Isolated fracture of the capitate without dislocation is very rare and comprises 1% of all carpal fractures. Nonunion of capitate mostly resulted from delay in diagnosis and lack of initial treatment. Case Report: We reported the case of a 13-year-old boy who had a late-diagnosed capitate fracture. We put the wrist in a short-arm cast for 3 months. After the immobilization with the cast has been finalized, range of motion and strengthening exercises were started. One year after the trauma, we saw total union of the fracture. Conclusions: Diagnosis of carpal bone fracture may be missed, especially in skeletally immature patients. To prevent late diagnosis in skeletally immature patients, early control radiography should be taken. If further examination is needed, computed tomography should be performed. We can achieve good results with cast immobilization in this age group of patients. As a result, although the author has been advised surgical treatment for nonunion of capitate fracture, conservative treatment should be considered.

Sacral dislocation is an uncommon form of injury in childhood. A 4-year-old girl who was injured in a motor vehicle accident was seen in the emergency room. On physical examination, ecchymosis and tenderness in the abdomen and sacral region was identified. Radiographs revealed no pelvic pathology. CT was performed owing to the patient's sacral and abdominal tenderness. Dislocations were identified at the sacral third and fourth vertebrae without any fractures. The patient was discharged 10 days later with a recommendation for 6 weeks bed rest and an appointment for an outpatient follow-up examination. At the post-traumatic second-month examination, the patient was walking normally. In the radiograph and MRI that were taken a year later, the dislocation was observed to have fused completely, and no pressure was seen on any anatomical structure. No functional pathology was identified during the interview with the family.

Hemophilic pseudotumor is a rare complication of hemophilia. We describe a 14-year-old young male with hemophilic pseudotumor in the second and fifth fingers of the left hand. We treated him only with radiotherapy. A total dose of 2000 cGy in 10 fractions was administered in 2 weeks. Factor VIII was not given. After 4 months, complete healing was seen. The patient was followed up at 24 months, and there was no evidence of recurrence and no bone growth disturbance. Based on our experience and a review of the literature, radiotherapy can be an effective alternative modality in treating hemophilic pseudotumor.

INTRODUCTION Nonpigmented villonodular synovitis (non-PVNS) is a benign proliferative disease involving the synovium. It is a rare condition that is little recognized. Non-PVNS has been reported as a cause of total knee replacement failure. PRESENTATION OF CASE We report a case of extensive diffuse non-PVNS in a patient with tibial component loosening after total knee replacement and review the related literature. DISCUSSION It is reported that pigmented villonodular synovitis (PVNS) occurs less frequently than non-PVNS after knee replacement. However, there are many more case reports of PVNS than non-PVNS after knee arthroplasty in the English-language literature. CONCLUSION Previously, there were no reported cases of extensive diffuse non-PVNS after total knee arthroplasty (TKA). This case study highlights an unusual case of non-PVNS as a cause of TKA failure. We propose that non-PVNS should be considered as a differential diagnosis in patients after TKA who present with recurrent pain and effusion/hemarthrosis of the knee, and that it is one of the causes of implant loosening after TKA.