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Background: The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly people with osteoporosis. Although dynamic hip screw fixation is the gold standard for the treatment of stable intertrochanteric femur fractures, treatment of unstable intertrochanteric femur fractures still remains controversial. Intramedullary devices such as Gamma nail or proximal femoral nail and proximal anatomic femur plates are in use for the treatment of intertrochanteric femur fractures. There are still many investigations to find the optimal implant to treat these fractures with minimum complications. For this reason, we aimed to perform a biomechanical comparison of the proximal femoral nail and the locking proximal anatomic femoral plate in the treatment of unstable intertrochanteric fractures. Materials and Methods: Twenty synthetic, third generation human femur models, obtained for this purpose, were divided into two groups of 10 bones each. Femurs were provided as a standard representation of AO/Orthopedic Trauma Associationtype 31-A2 unstable fractures. Two types of implantations were inserted: the proximal femoral intramedullary nail in the first group and the locking anatomic femoral plate in the second group. Axial load was applied to the fracture models through the femoral head using a material testing machine, and the biomechanical properties of the implant types were compared. Result: Nail and plate models were locked distally at the same level. Axial steady load with a 5 mm/m velocity was applied through the mechanical axis of femur bone models. Axial loading in the proximal femoral intramedullary nail group was 1.78-fold greater compared to the plate group. All bones that had the plate applied were fractured in the portion containing the distal locking screw. Conclusion: The proximal femoral intramedullary nail provides more stability and allows for earlier weight bearing than the locking plate when used for the treatment of unstable intertrochanteric fractures of the femur. Clinicians should be cautious for early weight bearing with locking plate for unstable intertrochanteric femur fractures. [ABSTRACT FROM AUTHOR]

Introduction: To investigate the effects of subacromial tenoxicam injection during physical therapy after rotator cuff tear and subacromial decompression. Materials and methods: This is a prospective controlled clinical study. Fourteen patients who had a moderate-size rotator cuff tear were included in the study. Two injections of tenoxicam were made to patients in the tenoxicam group into the subacromial space, and two injections of serum physiologic were made to patients in the control group. The same rehabilitation program was done to both of the two groups. Passive anterior shoulder flexion was evaluated, and VAS score was noted at the end of 3 weeks following the operation. The first week of painless full range of motion achieved was noted. Results: The mean passive anterior shoulder flexion was 137.1° (range, 130-145°) for tenoxicam group and 121.4° for control group. The mean VAS score was 2.42 (range, 1-3) for tenoxicam group and 4 (range, 3-5) for the control group. The mean first week of painless full range of motion was being achieved in 6.14 (range, 6-7) in the tenoxicam group and 8.28 (range, 8-9) in the control group. Statistically significant difference was observed between the tenoxicam and control groups in terms of the mean passive anterior shoulder flexion, the VAS score during flexion and the first day of painless full range of motion achieved. Discussion: Subacromial tenoxicam injection after rotator cuff tear and subacromial decompression may help the physical therapy. [ABSTRACT FROM AUTHOR]

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Chronic old unreduced anterior dislocations are extremely rare. We report a case of 75-year-old lady who was seen in policlinic with the symptoms of severe pain and limited shoulder range of motion in which radiographies revealed anteroinferior missed shoulder dislocation. Open reduction with Bankart repair was done, and patient was able to return her daily activities 6 weeks after the operation. To us, if the shoulder was found to be instable after reduction, anteroinferior glenohumeral ligament tear should be looked for, and if it exists should be repaired. [ABSTRACT FROM AUTHOR]

The treatment of unstable trochanteric femoral fractures is still challenging, and the proximal femoral nails are becoming more commonly used. The proximal femoral nailing is usually performed on a fracture table under traction which is associated with some possible complications. In our study, we tried to present the results of proximal nailing surgery performed in the lateral decubitus position and manual traction on a radiolucent table without the fracture table traction. [ABSTRACT FROM AUTHOR]

Chronic recurrent multifocal osteomyelitis (CRMO) is not a well known disorder among nonpediatricians. The aim of this study is to retrospectively evaluate the clinical outcomes of twenty-two CRMO patients presenting to two referral centres. This retrospective study included twenty-two children (12 males, 10 females; mean age 13 years; range 7–17 years). The diagnosis was based on clinical, radiological, and pathological findings. Data were retrieved from hospital charts. The mean delay in diagnosis was 26 months (range, 0–96 months). The mean follow-up after diagnosis was 27.4 months (range, 6–47 months). Symptoms included pain, limping, local swelling, morning stiffness, and fever. 18 patients had multifocal and 4 patients had unifocal disease. Bone lesions were detected with whole-body or local MRI (Magnetic Resonance Imaging). The mean number of bone lesions was 2.5 (range, 1–8). Ten cases underwent biopsy to exclude malignancy and infection. Prior to diagnosis, cast immobilization or curettage was erroneously performed in four patients. One patient suffered from vertebral compression fracture. There is no growth disturbance or deformity in any patient. This study demonstrated that early recognition of the disease can be improved by using Bristol criteria which should be evaluated by a multidisciplinary team rather than one single specialist. In this way, the reliability of these criteria is improved and the treatment could be given earlier with decreased delay in diagnosis. This multidisciplinary approach is also important for decision for biopsy, timely aggressive medical treatment, and follow-up of the disease to minimise possible complications. [ABSTRACT FROM AUTHOR]