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Background/aim The aim of this study was to compare the clinical and sonographic effects of the ultrasound (US) therapy, extracorporeal shock wave therapy (ESWT), and Kinesio taping (KT) in the lateral epicondylitis (LE). Materials and methods A total of 40 patients with LE were included in the present study. The patients were randomly assigned to 3 treatment groups: US (n = 13), ESWT (n = 14), and KT (n = 13) groups. Results The visual analog scale (VAS) scores significantly decreased in all groups (P < 0.05). Grip strength significantly increased after 8 weeks in only the KT group (P < 0.05). The Patient-Rated Tennis Elbow Evaluation Scale (PRTEE) scores significantly decreased after 2 weeks and after 8 weeks in the US group and ESWT groups, and after 8 weeks in the KT group (P < 0.05). Common extensor tendon (CET) thicknesses significantly decreased after 8 weeks in only the ESWT group (P < 0.05). Conclusion The US therapy, KT, and ESWT are effective in reducing pain and improving functionality. However, none of these treatment methods were found to be superior to others in reducing the pain and improving functionality.

This case report presents a 21-year-old male construction worker with ipsilatcral inferior shoulder and posterior elbow dislocations. accompanied with other injuries. Such a combination of injury undoubtedly occurs: however, to the best of our knowledge. this is the first reported case. The prompt closed reductions without waiting for anesthesia were accomplished without the help of an assistant using a novel technique. The patient returned to his job with considerable recovery of motion and strength despite his permanent paralysis of the deltoid muscle and he was still employed as a worker after four years. He was abducting his arm by using his accessory muscles, which contribute to abduction when arm is externally rotated. The maneuver described in the report can be used to reduce all inferior shoulder dislocations and it is worth to know that working at a job requiring high level of activity is still possible despite a permanent loss of axillary nerve function. WOS:000573941100031 2-s2.0-85091562966 PubMed: 32962598

OBJECTIVES: This study aims to assess early changes in physical activity and function after total hip arthroplasty (THA) using both subjective and objective methods, and to identify predictors of outcomes of THA. PATIENTS AND METHODS: Between October 2014 and October 2015, a total of 50 patients (14 males, 36 females; mean age 57.1±13.0 years; range, 31 to 75 years) with end-stage primary hip osteoarthritis who were scheduled for THA and 50 age- and sex-matched controls (10 males, 40 females; mean age 52.9±9.3 years; range, 36 to 75 years) were included in the study. Pain was evaluated using the Numeric Rating Scale (NRS), physical function using the Lequesne Index, physical capacity using the Six-Minute Walking Test (6MWT), and physical activity using both International Physical Activity Impact Questionnaire Short Form (IPAQ-SF) and step count monitor. Data at baseline and six weeks and six months were recorded. RESULTS: Pain severity was significantly lower after THA at six weeks and six months (NRS scores: 2.83 and 0.82, respectively; p

We report a very rare and extraordinary complication, metal head fatique fracture at the site of the socket tip deep border and coin like metal corpora libera in two cases with metal on metal total hip prosthesis. Catastrophic wear at the site of the deep border of the collum socket and coin like loose body originating from the crom-cobalt head resulted with metallosis, osteolysis and failure. The outcomes of the revision operations were satisfactory and the patients returned to their daily activity without discomfort in their hip. Headwear is a well-known result of the metal on metal articulation and may present with instability, metallosis, pain and mechanical symptoms. These incidents might be important to investigate for tribological performance of hip implants in biotribology science. We believe -3 sized metal head usage might be the reason of this catastrophic complication their usage should be avoided in metal on metal artroplasties.

Aim: In surgical treatment of instability, constrained acetabular inserts are frequently used in hip arthroplasty. However the reasons why surgeons avoid constrained acetabular components are the concern of an increased rate of loosening possibly due to impingement and the concern of decreased range of motion. This study aims to investigate the influence of constrained acetabular insert usage on hip range of motions and functional results.Material and Methods: Twenty-eight patients who needed revision hip arthroplasty were included. Patients were divided into two groups according to acetabular insert used in surgery (constrained and non-constrained). Mean follow-up period was 61±7 months (range, 50-74) in constrained group and 59±7 (range, 50-72) in non-constrained group. Hip range of motion and harris hip scores were recorded pre-operatively and at final follow-up.Results: The final avarage flexion, abduction, adduction, external rotation and internal rotation was respectively 78°±15°, 43°±4°, 28°±3°, 30°±7°,19°±8° in constrained group (n=15) and 75°±14°, 40°±6°, 26°±5°, 30°±12°, 17°±6° in non-constrained group (n=13). The difference between groups was not statistically significant. Harris hip score increased in both groups and there was no significant difference between groups (p=0.730).Conclusion: Findings of this mid term study showed that hip range of motions and functional results in patients with constrained acetabular inserts are not inferior than the patients with non-constrained inserts., Amaç: Kısıtlayıcı asetabular insertler, instabilitenin cerrahi tedavisinde sıklıkla kullanılmaktadır. Bununla birlikte, gevşeme sıklığını artıracağı ve kalça eklem hareket açıklığını azaltacağı endişesi ile cerrahlar arasında daha az tercih edilmektedir. Bu çalışmanın amacı, kısıtlayıcı asetabular komponent kullanımının kalça eklem hareket açıklığı ve fonksiyonel sonuçlar üzerindeki etkisinin incelenmesidir Gereç ve Yöntemler: Revizyon kalça artroplastisi uygulanan 28 hasta çalışmaya dahil edildi. Hastalar kullanılan insert tipine göre kısıtlayıcı ve kısıtlayıcı olmayan şeklinde iki gruba ayrıldı. Ortalama takip süresi kısıtlayıcı grupta 61±7 (50-74) ay, kısıtlayıcı olmayan grupta 59±7 (50-72) aydı.Kalça eklem hareket açıklıkları ve harris kalça skorları ameliyat öncesi ve sonrası son kontrolde kaydedildi.Bulgular: Ortalama fleksiyon, abdüksiyon, addüksiyon, dış rotasyon ve iç rotasyon değerleri kısıtlayıcı grupta (n=15) sırası ile 78°±15°, 43°±4°, 28°±3°, 30°±7°,19°±8° iken, kısıtlayıcı olmayan grupta (n=13) 75°±14°, 40°±6°, 26°±5°, 30°±12°, 17°±6° idi. Gruplar arasındaki fark istatistiksel olarak anlamlı değildi (p>0.05). Harris kalça skorları her iki grupta da ameliyat öncesine göre anlamlı artış gösterdi, gruplar arasında anlamlı farklılık yoktu (p>0.05).Sonuç: Bu çalışmanın bulguları, kısıtlayıcı asetabular insert kullanılan hastalardaki kalça eklem hareket açıklıkları ve fonksiyonel sonuçların, orta dönemde, kısıtlayıcı olmayanlara göre daha az olmadığını göstermiştir.

Yabanci maddelerin insan vucudu icinde yer degistirmesi nadir gorulen bir durum olup, goc mekanizmasi hicbir zaman tam olarak aciklanamamistir. Kalca bolgesinden av tufegi ile yaralanan hastanin kalbinde dort adet sacma tanesine rastlanmasi nedeniyle bu olgu rapor edilmeye deger bulunmustur. Av tufegiyle yaralanma tanisiyla acil servise getirilen hastanin muayenesinde; gluteal bolgede cok sayida sacma giris deligi oldugu, gogus ve sirt bolgelerinde herhangi bir yaralanma izi olmadigi tespit edildi. Cekilen radyografilerde; kalca ve uyluk bolgelerinde cok sayida sacma tanesi mevcuttu. Rutin olarak cekilen akciger grafisinde mediastende kalbe uyan bolgede, dort adet sacma tanesi izlendi ve bu nedenle olusabilecek komplikasyonlar acisindan takip edildi. Ozellikle sacma ile olan atesli silah yaralanmalarinda, yaralanma bolgesi fark etmeksizin sacma tanelerinin yer degistirebilecegi goz onune alinarak beklenmedik komplikasyonlarla karsilasilabilecegi goz onune alinmalidir.

ObjectivesThe purpose of this study was to develop an accurate, reliable and easily applicable method for determining the anatomical location of the joint line during revision knee arthroplasty.MethodsThe transepicondylar width (TEW), the perpendicular distance between the medial and lateral epicondyles and the distal articular surfaces (DMAD, DLAD) and the distance between the medial and lateral epicondyles and the posterior articular surfaces (PMAD, DLAD) were measured in 40 knees from 20 formalin-fixed adult cadavers (11 male and nine female; mean age at death 56.9 years, sd 9.4; 34 to 69). The ratios of the DMAD, PMAD, DLAD and PLAD to TEW were calculated.ResultsThe mean TEW, DMAD, PMAD, DLAD and PLAD were 82.76 mm (standard deviation (sd) 7.74), 28.95 mm (sd 3.3), 28.57 mm (sd 3), 23.97 mm (sd 3.27) and 24.42 mm (sd 3.14), respectively. The ratios between the TEW and the articular distances (DMAD/TEW, DLAD/TEW, PMAD/TEW and PLAD/TEW) were calculated and their means were 0.35 (sd 0.02), 0.34 (sd 0.02), 0.28 (sd 0.03) and 0.29 (sd 0.03), respectively.ConclusionThis method provides a simple, reproducible and reliable technique enabling accurate anatomical joint line restoration during revision total knee arthroplasty. Cite this article: B. Ozkurt, T. Sen, D. Cankaya, S. Kendir, K. Basarır, Y. Tabak. The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty. Bone Joint Res 2016;5:280–286. DOI: 10.1302/2046-3758.57.BJR-2016-0002.R1.

Background: Hinged knee prosthesis is an effective treatment method as a salvage procedure in marked ligamentous insufficiency and severe bone defects. Joint line determination and restoration are difficult due to large bone defects and distorted anatomy. We evaluated the impact of joint line alteration on the outcome in rotating hinge knee arthroplasty (RHKA). Materials and Methods: 35 patients who had rotating hinged knee prosthesis applied between 2008 and 2013 were evaluated in this retrospective study. The patients were studied radiologically and clinically. Five patients were lost to followup and two patients died, leaving a total of 28 (7 male, 21 female) patients for final evaluation. The average age of the patients was 66.19 ± 8.35 years (range 52–83 years). The patients were evaluated clinically with Knee Society knee and functional score and patellar score. The joint line positions were evaluated radiographically with femoral epicondylar ratio method. The outcomes were also evaluated according to age, body weight and gender. Student's t-test, independent t-test, and the Wilcoxon signed rank test were used in the statistical analysis. Results: The mean Knee Society knee and functional score significantly improved from preoperative 19.52 ± 11.77 and 12.5 ± 15.66 respectively to 72.46 ± 14.01 and 70.36 ± 9.22 respectively postoperatively (P < 0.001). The mean range of motion of the knee improved from 55.95° ± 25.08° preoperatively to 92.14° ± 13.47° postoperatively (P < 0.001). Joint line position was restored in 20 patients (71.4%). Joint line alteration did not affect Knee Society Scores (KSSs) in contrast to patellar scores. Additionally, KSS was better in the patients with body mass index ≤30 at followup (P = 0.022 and P = 0.045). Conclusion: RHKA is an effective salvage procedure for serious instability and large bone defects. Restoration of the joint line improves the patellar score although it had no effect on the clinical outcome.

Aim: Although internal fixation of forearm fractures by dynamic compression plates had been studied extensively, the details of optimal fixation by locking compression plates are not clearly defined. Besides the factors affecting the functional outcome is still the subject of considerable debate. The present study is designed to evaluate factors affecting the outcomes of adult forearm fractures treated via locking compression plate. Method: The patients with Gustillo Anderson type 3 open fractures or the ones treated in intensive care unit were excluded and thirty-six forearm fractures treated by locking compression plate were prospectively followed. Disability Arm Shoulder Hand (DASH) and Anderson criteria scores for assessment of outcomes obtained at sixth month were evaluated. The patients were followed up for 4 (3-6) years on average. Findings: In 18 (50%) patients, fractures were caused by simple fall. The mean healing time of the fractures was 13.2 ± 2.1 weeks. Patients, who smoked or had open fractures or complications, had longer healing time. Mean DASH score was calculated as 13.9 ± 5.9. Upon presence of open fracture or postoperative complication there was a significant deterioration in scores. Although the cause of the injury had some effect on functional results the mechanism (whether the injury was direct or indirect) made no difference. Conclusion: Fracture type was the most important factor affecting both healing time and outcome. Being an open fracture or the presence of postoperative complication deteriorates the outcome. The functional results were somewhat poorer in fractures caused by simple fall., Amaç: Önkol kırıklarının dinamik kompresyon plağı kullanılarak yapılan internal tespiti ile ilgili birçok çalışma bulunmakla birlikte, kilitli kompresyon plakları ile yapılacak en uygun fiksasyonun detayları henüz yeterince tanımlanmamıştır. Ayrıca fonksiyonel sonucu etkileyen faktörler halen tartışma konusudur. Bu çalışmanın amacı, kilitli kompresyon plağı kullanılarak tedavi edilen önkol kırıklarının klinik sonuçlarına etkiyen faktörleri değerlendirmektir. Yöntem: Gustillo Anderson tip 3 açık kırığı olan veya yoğun bakımda yatan hastalar hariç tutularak, kilitli kompresyon plağı ile tedavi edilen 36 önkol kırığı hastası prospektif olarak değerlendirildi. Altıncı ayda Disability Arm Shoulder Hand (DASH) skoru ve klinik sonuçların değerlendirilmesi için kullanılan Anderson kriterleri skorları ile değerlendirildi. Hastalar ortalama 4 (3-6) yıl takip edildi. Bulgular: On sekiz hastada (%50) kırık nedeni basit düşmeydi. Ortalama iyileşme süresi 13.2±2.1 hafta olarak bulundu. Sigara içen hastaların veya açık kırığı olanların ya da ameliyat sonrası komplikasyon gelişen hastaların iyileşme süresi daha uzundu. Ortalama DASH skoru 13.9±5.9 hesaplandı. Açık kırık veya komplikasyon varlığının skorlar üzerinde anlamlı olumsuz etki yaptığı belirlendi. Yaralanma nedeninin fonksiyonel sonuçlara az da olsa etkisi olmasına rağmen yaralanma mekanizmasının (direkt ya da dolaylı olmasının) istatistiksel anlamlı bir etkisi saptanmadı. Sonuç: Hem iyileşme zamanı hem de klinik sonuçlara etki eden en önemli faktörün kırık tipi olduğu tespit edildi. Açık kırık yada ameliyat sonrası komplikasyon varlığı sonuçları kötü yönde etkilemektedir. Basit düşmeye bağlı gelişen kırıklarda fonksiyonel sonuçlar biraz daha kötü olmaktadır.

Background:Patients suffering from knee osteoarthritis lead a less active life than their healthy peers. It is well known that insufficient physical activity is the most common cause of chronic diseases. However, there is not enough research to enlighten the effect of increased functional capacity on cardiac functions after Total Knee Arthroplasty (TKA). This study aimed to investigate whether the orthopedic surgeons can predict that the patients will be healthier after TKA in terms of cardiac functions or not?Methods:109 patients who underwent TKA were prospectively followed for one year. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and short form 36 (SF-36) surveys, BMI measures, average step count per day, the six-minute walking test (6MWT), the Five-Times-Sit-to-Stand Test (FTSST) and Doppler echocardiography were performed both in the preoperative and postoperative period.Results:After TKA, there was a substantial improvement in terms of WOMAC and SF36 survey scores. The average step count increased from 2199.6±690.8 steps/day to 4124.3±1638.8 steps/day. 6MWT and FTSST improved significantly as well. The average brisk walking time was 174.23±95.11 minutes/week. The means of early and late mitral inflow velocity ratios (E/A and Em/Am ratios) increased from 0.71±0.12 to 0.77±0.13 and from 0.66±0.13 to 0.76± 0.15 at the first year follow-up visit, respectively (pConclusion:In the first year, objective physical capacity measures increased together with the expected improvements in disease-specific and generic measures. After TKA, left ventricular diastolic functions may be considered to have recovered in the light of the healing signsviaechocardiography.

In this study, we aimed to evaluate the contribution of single-photon emission computerized tomography/computed tomography (SPECT/CT) to three-phase planar bone scintigraphy/SPECT in the assessment of aseptic and septic prosthesis loosening in patients with painful hip and knee prostheses.Fifty patients who had undergone arthroplasties (20 hips and 30 knees) and were suspected to have complications and had undergone revision surgery were included in this study. Technetium-99m methylene diphosphonate three-phase bone scintigraphy and SPECT/CT were performed at the region of prostheses in all patients. Planar bone/SPECT and SPECT/CT images were separately assessed by two nuclear medicine physicians. SPECT/CT findings were compared with the findings of planar images/SPECT. Both planar bone scan/SPECT and SPECT/CT findings were divided into three groups: aseptic loosening, septic loosening, and miscellaneous. In all patients, scintigraphic diagnosis was confirmed by surgical findings.SPECT/CT changed the diagnosis and treatment plan in 8/50 (16%) patients. SPECT/CT was significantly better than planar scan/SPECT imaging for the diagnosis of aseptic and septic loosening in both joints (κ value: 0.477 for planar scan/SPECT; κ value: 0.717 for SPECT/CT). Moreover, both planar scan/SPECT and SPECT/CT were statistically successful in knee prostheses than in hip prostheses (κ value: 0.271 vs. 0.579 for planar/SPECT; κ value: 0.579 vs. 0.80 for SPECT/CT). For the hip, SPECT/CT was successful on the acetabular component than on the femoral component. For the knee, the results of SPECT/CT were similar for the femoral and tibial components.SPECT/CT increases diagnostic accuracy in the evaluation of aseptic and septic loosening in hip and knee prostheses compared with three-phase bone scintigraphy/SPECT.

Hematomas caused by surgery or trauma that persist and expand slowly for more than a month are defined as chronic expanding hematomas (CEH). Magnetic resonance imaging (MRI) is useful for the diagnosis. Total excision with the pseudocapsule is the treatment method. Pseudoaneurysms result from arterial wall disruptions and can be mistaken for CEH. We present a rare case report of a 45-year-old man with a large, painful swelling in his left popliteal fossa. He had a puncture wound by a nail 11 years ago and a gradually expanding mass occurred in his popliteal fossa. A pseudoaneurysm was detected and operated a year later. After surgery, a gradually expanding mass recurred in his popliteal fossa. On the arteriography, the popliteal artery was occluded and the blood flow was maintained with collateral vessels. On MRI, an enormous swelling of 115 × 107 × 196 cm in diameter was seen. It was diagnosed as CEH and was excised completely protecting the collateral vessels and there was no recurrence after a year from the surgery.

Background Unstable intertrochanteric fractures remain a challenging problem in elderly individuals due to high failure rates associated with internal fixation. Hemiarthroplasty is one treatment option for intertrochanteric femur fractures in elderly patients. The aim of the present study was to compare the reliability of cementless and cemented hemiarthroplasty for unstable intertrochanteric femur fractures in elderly patients. Methods Elderly patients with AO type 31-A2 intertrochanteric femur fractures were treated with cemented (n=40) or cementless (n=46) hemiarthroplasty. Duration of surgery, amount of blood loss and blood transfusion, Harris hip scores, rate of loosening of the femoral component, duration of hospital stay after surgery and mortality rates were recorded. Results There were no significant differences between the groups in length of hospital stays, Harris hip scores, amount of blood transfusions, implant loosening and follow-up mortality rates. Walking ability was better in the cemented group in the early follow-up period. Duration of surgery, amount of blood loss and perioperative mortality rates were significantly lower in the cementless group than in the cemented group. Conclusion Cementless hemiarthroplasty is a reliable treatment choice for unstable intertrochanteric femur fractures in elderly patients with early mobilization, acceptable functional results, low implant loosening rates, shorter surgery time, lesser blood loss and lower perioperative mortality rate.

Objectives This study aims to evaluate patients diagnosed with malignant fibrous histiocytoma and investigate the possible prognostic factors associated with duration of survival. Patients and methods The study, which was conducted between May 1994 and September 2013, included 14 patients diagnosed as malignant fibrous histiocytoma (12 males, 2 females; median age 48 years; range 17 to 64 years). We evaluated patients' demographic features, location of the pathology, histological findings, surgical margins, and treatment modalities and investigated the effects of these parameters on survival. Results Femur was the most frequently involved bone, followed by tibia and humerus. The median follow-up duration of the patients was 129 months. We performed limb salvage surgeries in 13 patients and amputation in one patient. Surgical margins were marginal in three patients and postoperative radiotherapy was performed for local control of the disease. Although there was no local recurrence in these patients, distant metastasis developed in two patients, indicating the importance of surgical margin as a significant factor on survival. Five-year survival rate was 81.9% in patients with wide surgical margins and 33.3% in patients with marginal margins. Conclusion Surgical excision with wide margins and adjuvant chemotherapy provided adequate control of the disease and longer survival. The only prognostic factor statistically significantly associated with duration of survival was surgical margins. Neoadjuvant chemotherapy may be used when there is a suspicion of not obtaining adequately wide surgical margin perioperatively due to close association with neurovascular structures.

Objective: To determine the outcomes after combined inside-out and all-inside repair technique of bucket-handle meniscus tears. Methods: A retrospective review was made of patients with bucket-handle meniscus tears repaired with combined techniques, using the all-inside technique in posterior meniscal tears and the inside-out technique in the middle part of the meniscal tears. Meniscal healing was assessed clinically using Barrett's criteria and MRI. Results: The study comprised 52 patients with a mean age of 28.4 years old (range, 19-52 years old). The mean follow-up period was 31.3 months (range, 24-59 months). Two patients had ACL re-rupture, and complete meniscal healing was achieved in all but one patient. Although improved from preoperative status, Tegner and Lysholm scores were lower in the ACL reconstructed patients than in the intact ACL patients. Conclusion: Combined inside-out and all-inside meniscal repair technique is a successful and cost-effective treatment method in bucket-handle meniscus tears. Level of Evidence IV, Therapeutic Study.

Objectives: Osteogenic sarcoma has a well recognized double peak of incidence, beside being the most common childhood malignancy of bone, there is a significant second peak in the seventh and eighth decades of life. We sought to review the clinical and hisopathological features also chemotherapy regimens in this particular group of patients and to determine possible prognostic factors. Materials and Methods: We reviewed 287 patients of osteosarcoma treated between 1986 and 2010.Patients were considered eligible for the present study if they fulfilled the following criteria: primary OS, typical histological and radiographic features of OS, no prior history of cancer or treatments elsewhere, and no prior history of pre-existing bone abnormalities. Results: The Kaplan-Meier survival curve for the entire group including 95% confidence limits at two and five years. The overall two- and five-year survival rates were 76.2% and 72.8%, respectively. Surgical margin was a significant factor affecting survival. Also pathological fracture was a significant factor affecting the survival. Discussion: The decreasing incidence of OS over the age of 40 years and the expectation that these elderly patients may not tolerate aggressive modern chemotherapy means that the patients with OS over the age of 40 years may must often excluded from current trials of treatment. Osteogenic sarcoma remains a challenging disease to treat. A multidisciplinary approach is the best method for treating OS in patients older than 40 years. The poor clinical outcome in elderly patients with primary OS reported previously is difficult to understand. Level of Evidence: Level 3 Keyword: Osteogenic Sarcoma, Elderly Patients DOI: 10.3944/AOTT.2016.16.0035 This abstract belongs to the un-edited version of the article and is only for informative purposes. Published version may differ from the current version.

INTRODUCTIONFracture of the tibial baseplate following total knee arthroplasty is very rare given the developments in modern prosthesis design. Tibial baseplate fracture secondary to polyethylene wear, osteolysis and component malalignment in an elderly obese patient is reported in the present article.PRESENTATION OF CASEA 69-year-old woman had undergone total knee arthroplasty eleven years prior to presentation and reported nine months of chronic pain, which was caused by a neglected fracture of the baseplate.DISCUSSIONWe discuss the prevention of implant fracture after total knee arthroplasty and address the risk factors associated with this complication.CONCLUSIONThe present case emphasizes the importance of properly informing patients and encouraging them to report such complaints immediately to allow for early revision and prevention of component fracture, especially in patients with risk factors such as obesity and component, malalignment.

This article describes a case of bilateral congenital knee dislocation treated with bilateral total knee arthroplasty. The patient had pain and disability while walking before the operation. Implants used in the surgery were constrained stems and they were applied with bone cement. After 6 years of follow-up, her joint range of motion at both knees was satisfactory and she was pain-free. The patient’s Knee Society Score and Functional Score improved from preoperative values of 12 and 0 for the right knee and 20 and 0 for the left knee to postoperative values of 55 and 15 for the right knee and 65 and 30 for the left knee. In the late presenting cases of the congenital knee dislocation, total knee arthroplasty has proved to be one of the treatment options with satisfactory outcomes.

Background: This study analyzed the range of motion of the first metatarsophalangeal joint following the chevron procedure with increased stabilization using a modified capsuloperiosteal flap in the treatment of hallux valgus cases. Materials and Methods: Forty-three feet of 40 patients were treated with modified chevron osteotomies. The patient selection criteria included failure of conservative treatment, painful deformity, age between 18 and 50, hallux valgus and intermetatarsal angles less than 40 degrees and 17 degrees, respectively, and no osteoarthritic changes of the metatarsophalangeal joint. The passive range of motion of the first metatarsophalangeal joint was compared to the hallux valgus and intermetatarsal angles. Results: The mean age of patients was 30.9 ± 9.0 (range, 18 to 46) years. The preoperative mean hallux valgus angle was 32.2 (range, 22 to 40 degrees), whereas postoperatively it was 13.1 (range, 3 to 22 degrees). The preoperative mean passive total range of motion, dorsiflexion and plantar flexion were found to be 80.2 (range, 71 to 99 degrees), 66.8 (51 to 86) degrees and 13.4 (range, 7 to 23 degrees), respectively, whereas postoperatively these values were 69.2 (range, 48 to 85 degrees), 58.6 (range, 43 to 75) degrees and 10.8 (range, 1 to 20 degrees). According to Bonney and MacNab subjective scores, the feet were evaluated as follows: 12 as excellent, 26 as good, and 5 as moderate. According to objective scores, the evaluation was as follows: 27 as excellent, 14 as good, 1 as moderate, and 1 as poor. Conclusion: We believe that the chevron procedure reinforced by modified capsuloperiosteal flap causes minimal irritation and damage to adjacent soft tissues. Furthermore, we conclude that this method is a benefical means of managing moderate hallux vagus deformities by decreasing the stiffness after surgery.

Innominate osteotomy of Salter remains the most commonly used pelvic osteotomy for children in the age of 18 months to 6 years. Kirschner wire is inserted across the osteotomy site to fix the bone graft. We present an unusual case of migration of Kirschner wire through the abdominal region. Migration of pins to the femoral head is well-known complication. To our knowledge, this is the first case reporting migration of Kirschner wire through the abdominal region.

Chondroblastoma is a rare bone tumor of cartilaginous origin. Metatarsal involvement is very rare, with a few cases. We presented a case of chondroblastoma localized in the fourth metatarsal bone. The patient presented with persistent pain of eight-month duration on the lateral side of his foot, which developed after an inversion ankle sprain. Radiological examination showed a large osteolytic lesion with sclerotic margins in the fourth metatarsal bone. The lesion was treated with extra-articular curettage and autogenous bone grafting. During a 17-year follow-up, the patient had no complaints, and there were no clinical or radiological findings of local recurrence or metastasis.

The treatment of thoracolumbar fractures remains controversial. A review of the literature showed that short-segment posterior fixation (SSPF) alone led to a high incidence of implant failure and correction loss. The aim of this retrospective study was to compare the outcomes of the SS- and long-segment posterior fixation (LSPF) in unstable thoracolumbar junction burst fractures (T12-L2) in Magerl Type A fractures. The patients were divided into two groups according to the number of instrumented levels. Group I included 32 patients treated by SSPF (four screws: one level above and below the fracture), and Group II included 31 patients treated by LSPF (eight screws: two levels above and below the fracture). Clinical outcomes and radiological parameters (sagittal index, SI; and canal compromise, CC) were compared according to demographic features, localizations, load-sharing classification (LSC) and Magerl subgroups, statistically. The fractures with more than 10 degrees correction loss at sagittal plane were analyzed in each group. The groups were similar with regard to age, gender, LSC, SI, and CC preoperatively. The mean follow-ups were similar for both groups, 36 and 33 months, respectively. In Group II, the correction values of SI, and CC were more significant than in Group I. More than 10 degrees correction loss occurred in six of the 32 fractures in Group I and in two of the 31 patients in Group II. SSPF was found inadequate in patients with high load sharing scores. Although radiological outcomes (SI and CC remodeling) were better in Group II for all fracture types and localizations, the clinical outcomes (according to Denis functional scores) were similar except Magerl type A33 fractures. We recommend that, especially in patients, who need more mobility, with LSC point 7 or less with Magerl Type A31 and A32 fractures (LSC point 6 or less in Magerl Type A3.3) without neurological deficit, SSPF achieves adequate fixation, without implant failure and correction loss. In Magerl Type A33 fractures with LSC point 7 or more (LSC points 8-9 in Magerl Type A31 and A32) without severe neurologic deficit, LSPF is more beneficial.

Kemigin primer malin fibroz histiyositomu (KPMFH) ust ekstremite ozellikle de bilek cevresinde cok cok nadir yerlesim gosterir. Kemigin primer malin fibroz histiyositomunun tedavisinin temelini lezyonun genis olarak rezeksiyonu ile kemoterapi combine edilmesi olusturur. Bu yazida, radius alt kesiminde KPMFH tespit edilen ve cerrahi ile kemoterapi combine edilerek basari ile tedavi edilen bir hasta sunuldu. Lezyon ekstraartikuler olarak kurete edildi. Yuz on dort aylik takip ve kontrolu sonrasinda hastada hicbir lokal nuks veya metastaza ait klinik ve radyolojik bulgu saptanmadi.

The results of closed and open reduction via posterior approach with percutaneous pinning of posteromedial displaced supracondylar humerus fractures in children were evaluated. Fifty-five consecutive patients with Gartland type III fractures were reviewed. The mean follow-up period was 22 months (12-48 months). The closed reduction group consisted of 32 patients and the open reduction group with the posterior approach using the triceps-sparing method consisted of 23 patients. Both groups were stabilized with cross Kirschner wire fixation and followed the same protocol. In comparison with closed reduction, despite the fact that better bone alignment was obtained with open reduction, longer union time (7 vs. 5.8 weeks), significantly reduced range of motion of the elbow (12.3 degrees vs. 3.8 degrees), poorer functional outcomes and bad cosmetics because of hypertrophic scar tissue of the skin were found. The patients were analyzed according to their Bauman angle and Flynn criteria: good or excellent functional and cosmetic results were 91% in the closed reduction group but 52% in the open reduction group. On the basis of results of this study, closed reduction and percutaneous fixation of the posteromedial totally displaced fractures are preferable to open reduction with posterior approach.

Displaced fractures of the diaphyseal forearm in children are often treated conservatively, but there is relatively high incidence of redisplacement, malunion and consequent limitation of function. This retrospective study was performed to determine means for minimalising the complications of intramedullary Kirschner (K)-wire fixation used in the treatment of unstable, diaphyseal forearm fractures by pointing out those which most frequently occur with this treatment choice. This treatment method was applied in 48 children with a mean age of 10.3 (range, 5-14) years. A limited open reduction to one or both bones was necessary for insertion of the intramedullary wire in 20 (40%) patients. Although 24 complications, such as pin site infection, loss of forearm rotation, superficial branch of radial nerve palsy, delayed union, nonunion, hardware migration, and K-wire penetration to the opposite cortex, were recorded in 18 patients, 46 patients (96%) had excellent or good, 1 patient (2%) had fair and 1 patient (2%) had poor outcome using the grading scheme adapted by Price. Except for the patient in whom the fracture was not united, the average union time was 6.3 weeks in children less than 10 years and 7.8 weeks in those above 10 years of age. Despite these minor complications, percutaneous intramedullary fixation with K-wires and proper technique is an appropriate, effective and safe operation for unstable diaphyseal fractures of the forearm in children who cannot be treated by closed manipulation.

Purpose Posterior-cruciate-ligament-retaining (PCR) and posterior-cruciate-ligament-stabilized (PS) arthroplasties are two major common practices in total knee arthroplasty (TKA). The hypothesis of the present study was that compared with the PCR technique, the PS technique is associated with a higher amount of postoperative blood loss and greater need for blood transfusion in cemented TKA. Methods In this prospective, randomized study, 100 patients diagnosed with primary knee osteoarthritis were randomly assigned to either the PCR group (Group I) or the PS group (Group II). The exclusion criteria were rheumatological joint disease, previous knee surgery, anticoagulant therapy and hypertension. There were no significant differences in age, body mass index and gender, between the groups. The haemoglobin and haematocrit levels of each patient were recorded preoperatively and on postoperative days 1, 3 and 5. The postoperative suction drainage and blood transfusion volumes were also recorded. Results There were no statistically significant differences in haemoglobin or haematocrit levels between the groups on postoperative days 1, 3 and 5. There were also no statistically significant differences in the total measured blood loss volume, postoperative drainage amounts or transfusion rates between the groups. Conclusion Use of the PS technique during cemented TKA does not appear to influence the amount of perioperative blood loss or the need for postoperative blood transfusion in general. The clinical relevance of this study is that the difference in blood loss between the PCR and PS techniques does not need to be considered by surgeons when performing TKA. Level of evidence I.