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Background/aim: This study aimed to compare radiological and functional outcomes of patients who had single-bundle anterior cruciate ligament (ACL) reconstruction with autologous hamstring tendon grafts using transtibial (TT) versus anteromedial (AM) femoral tunnel drilling techniques. Materials and methods: Sixty patients who had been operated on between 2010 and 2013 were enrolled in this study. Tunnel positions and widenings in the femur and tibia were evaluated with radiographs, arthrometric measurements with a Rolimeter arthrometer (Aircast, Summit, NJ, USA), stability assessment with Lachman and reverse pivot shift tests, and functional assessment with the International Knee Documentation Committee and Tegner and Lysholm scoring systems. Results: Tunnel enlargement in the sagittal and coronal planes of the femur was higher with the TT technique (P < 0.0001) and that of the coronal planes of the tibia was also higher with the TT technique (P = 0.01). During the assessment with the Rolimeter, the difference between sides was significant with the TT technique (P = 0.013). Positive results of the Lachman and reverse pivot shift tests were more frequent with the TT technique (P < 0.05), and the Lysholm scores were higher with the AM technique (P = 0.001). Conclusion: ACL reconstruction with hamstring autografts by either TT or AM technique demonstrated similar and excellent results in terms of functional outcomes at the end of the first postoperative year. The TT group had increased tunnel enlargement, which may have uncertain long-term outcomes, compared with the AM group.

The aim of this study was to determine the sensitivity and specificity of plain radiography in the detection of developmental dysplasia of the hip, using hip ultrasonography as a reference standard. A retrospective review was made in 44 infants ranging in age from 4 weeks to 50 weeks (mean age: 21.7 weeks). Both radiographic and ultrasonographic images were obtained for 86 hips. Radiography and ultrasonography were found to be significantly correlated in terms of classification of developmental dysplasia of the hip presence or absence (p < 0.0001, Fisher's exact test). With ultrasonography accepted as the standard for the diagnosis of developmental dysplasia of the hip, radiography had a sensitivity of 61% and a specificity of 87%. The results of this study suggest that the two imaging methods give similar overall results, but that low grade dysplasia detected on ultrasonography may go undetected on radiography.

Idiopathic hypoparathyroidism is an uncommon disease caused by insufficient secretion of parathyroid hormone. Idiopathic hypoparathyroidism may cause various musculoskeletal findings, including diffuse ligamentous and entheseal ossifications. Diffuse idiopathic skeletal hyperostosis is a disorder of the elderly characterized by ossification of the anterior longitudinal ligament of the spine and various extraspinal ligaments. We present a 50-year-old man with idiopathic hypoparathyroidism who had been diagnosed as having DISH at 40 years of age. Resistant neck, left shoulder, and left hip pain did not improve with calcium and calcitriol treatment after diagnosis of idiopathic hypoparathyroidism.

Scapular mobility plays a central role in normal shoulder function, and alterations in scapular mobility have been suggested as a factor in impingement syndrome. We therefore measured the effect of restricted scapular mobility during arm abduction on acromiohumeral and coracohumeral distances. For the control measurements, healthy volunteers (n = 10, all male, age range 25-35 years) underwent multislice computed tomography in a supine position, with the humerus actively maintained in the scapular plane at 45 degrees internal rotation and 60, 90 or 120 degrees abduction. To restrict scapular mobility a custom-made brace was then placed on each volunteer and fastened firmly with bandages, and the measurements were repeated. From the three-dimensional images the acromiohumeral and coracohumeral distances were measured. With the humerus in 90 degrees abduction, the acromiohumeral distance was significantly reduced (Student's t test). This result suggests that impingement syndrome may have a functional component.

In long bones, the most common site for metastases is the proximal femur. For lesions involving this region, osteosynthetic devices frequently fail, and for this reason, endoprosthetic reconstruction may be the optimal choice for treatment. Here, we present a series of 44 patients in whom 45 endoprosthetic reconstructions were performed for metastatic disease. In 28 patients (63.63%), endoprosthetic reconstruction was performed for pathologic fractures, and in 16 patients (36.37%), it was performed for impending fractures indicated by complaints of pain and problems with walking. Full weight bearing was achieved in the early postoperative period in 72.09% of our patients, and sufficient pain control was obtained in all patients. Four patients did not survive past the first 72 hours after surgery, and 11 more patients died within 2 months after surgery. A total of 29 patients (65.9%) survived to the 2-month follow-up visit, and of these, only 12 patients (27.2%) survived past the first postoperative year. We believe that in patients with metastatic disease in the proximal femur, endoprosthetic reconstruction can provide early and stable fixation with pain reduction and good functional results.

A 14-year-old was admitted with right groin pain which has started after kicking ball in a football game one week before. He had limited active and passive hip extension. A plain AP radiograph of the pelvis revealed a bone fragment displaced inferiorly about 1 cm from the right anterior inferior iliac spine. The patient was treated conservatively with analgesics and limited weight bearing. Four weeks later, range of motion was normal without pain and at eighth week the hip flexors regained full strength.

Extravasation of contrast material is a well-recognized complication of contrast-enhanced imaging studies. Most extravasations result only in minimal swelling or erythema; however, severe skin necrosis, ulceration and compartment syndrome may occur with extravasation of large volumes. This article presents a patient in whom extravasation developed after computed tomography (CT) contrast material was injected intravenously in the dorsum of the hand. Compartment syndrome was diagnosed, and the patient underwent fasciotomy. In follow-up, the patient regained full use of the hand. Although the use of contrast material has significantly improved the diagnostic accuracy of CT, anaphylaxis and contrast material extravasation are important complications. Selection of non-ionic contrast material, careful evaluation of the intravenous administration site and close monitoring of the patient during contrast material injection may help minimize or prevent extravasation injuries.

We describe a patient with a giant cell tumor in the talar head and neck of the left foot who was diagnosed as having osteochondritis dissecans and treated with arthroscopic drilling in this same location 3 years earlier. Giant cell tumors can be confused with several conditions, including giant cell reparative granulomas, brown tumors, and aneurysmal bone cysts. Giant cell tumors of bone typically occur in the epiphysis of long bones, including the distal femur and proximal tibia. They are uncommonly found in the small bones of the foot or ankle, and talar involvement is rare. Despite this rarity, the radiographic appearance and clinical signs of talar lesions should be considered in the differential diagnosis of nontraumatic conditions in the foot.

Preparation of starch microspheres using epichlorohydrin is a time consuming method and requires around 18 hr for cross-linking reaction. To reduce reaction time, terbutaline sulfate (TBS) loaded degradable starch microspheres (DSM) were prepared using formaldehyde as the cross-linking agent. All microspheres were spherical in shape and had a porous, rough surface with a mean particle size of 18-24 microm. Whatever the cross-linking time, it was seen that the release of the TBS was not complete during the release experiments. The influence of enzyme on the degradation of microspheres was moderate. Following intravenous administration, initial uptake of microspheres by the lung was higher than those of other organs.

A total of 16 patients in our clinic (six women, ten men; mean age 54.87 years, range 38-78 years) were diagnosed as having a sacrococcygeal chordoma. Pain was the presenting symptom in all patients. In five patients, the chordoma was inoperable. A total of 11 patients were followed-up for a mean period of 64.8 months (range 7-152 months). Five patients were lost to follow-up (3 in the operable group and two in the inoperable group). The three remaining inoperable patients received radiation therapy. The eight remaining operable patients underwent a total of 12 operations (four anterior and posterior, eight posterior only). Five of these patients received adjuvant radiotherapy and two patients received both radiotherapy and chemotherapy. In follow-up, eight patients had evidence of disease and one patient remained disease-free. Problems encountered during therapy and follow-up included urinary incontinence (72%), rectal incontinence (36%), wound infection (36%), and lower extremity muscle weakness (36%). Two patients died from metastases to the lung. Of the remaining nine patients, eight were ambulatory, with seven needing support to walk. One patient was unable to walk at all due to lower extremity muscle weakness.

Background: Wound infection after median sternotomy for cardiac or thoracic surgery is a serious complication, and there is a lack of agreement regarding the best treatment method. We present our results in patients with mediastinitis treated with longitudinally affixed titanium plates on sternal halves., Methods: The technique was composite closure using titanium fixation plates to buttress the sternum in combination with circumferential stainless steel wires. The series included 21 patients who developed sternal non-union resulting from mediastinitis. Mobilization of muscular flaps was performed in 8 cases. This technique also consists of sternal and soft tissue debridement and wound closure over mediastinal tubes with continuous irrigation and drainage. Antibiotherapy based on culture and sensitivity data continued for 4 to 7 weeks., Results: Twenty patients achieved complete wound healing without further operative intervention or major complication. Nineteen patients treated with this technique survived. One patient died from sepsis after developing residual focus of chondritis and undergoing wide resection of cartilage, and 1 patient died from complications of severe stroke., Conclusion: We had good success using aggressive early debridement, closure of the sternal halves with titanium plates, mobilization of muscular flaps, high-volume mediastinal irrigation, and intravenous antibiotics. This approach was a successful salvage technique for revision cases in achieving sternal stability and union when standard methods of closure failed or were unlikely to succeed.

Injuries after an electric shock, such as dermal burns, motor and sensory nerve deficits, fractures and dislocations, are reported in the literature. Posterior dislocation of the shoulder after electric-shock is the common musculoskeletal injury. Bilateral dislocation, either anterior or posterior, is rarely seen and reported. We report a case of bilateral shoulder fracture dislocation in opposite directions following an electric-shock and discuss the mechanism, the diagnosis and the treatment.

In 20 New Zealand rabbits (two groups of 10 rabbits each), hind limb circumference and anterior compartment pressure were measured following ketamin anaesthesia (time zero). During the same anaesthesia, closed transverse proximal tibial shaft fractures were created in both groups. Twenty-four hours after the fractures, during a second anaesthesia, limb circumference and compartment pressure were measured as before, and fractured limbs were fixed to the rabbits' bodies. At the same time, treatment was started: one group received external application of saturated salt solution and the other group received intermittent ice application. During 48 hours of treatment (from 24 to 72 hours) in the saturated salt solution group, the mean limb circumference decreased from 125.70 +/- 9.93 mm to 115.70 +/- 8.78 mm (p = 0.005) and the mean compartment pressure decreased from 18.30 +/- 1.70 mmHg to 12.40 +/- 1.77 mmHg (p = 0.005). In the control group, the mean limb circumference decreased from 127.85 +/- 7.47 mm to 122.00 +/- 6.83 mm (not significant) and the mean compartment pressure decreased from 19.57 +/- 1.27 mmHg to 17.85 +/- 2.67 mmHg (not significant). In short, differences in compartment pressure and limb circumference before and after treatment were statistically significant in the saturated salt solution group (p = 0.005) but not in the control group.

Objectives: Bone defects after resection or curettage of musculoskeletal tumors are commonly reconstructed with the use of structural fibular autografts or allografts with considerable success. In this study, we compared the clinical and radiographic results of nonvascularized autografts and allografts., Methods: Fifty-seven patients (30 males, 27 females; mean age 22.8 years; range 5 to 57 years) underwent reconstruction with a structural fibular autograft (n=30) or allograft (n=27) following tumor resection. Of the tumor defects, 24 were segmental and 33 were cavitary. All the patients who had segmental reconstruction were treated with internal fixation, except for one patient who had internal fixation and monolateral external fixator for femoral reconstruction. The results were evaluated with respect to union, time to union, and complications. The mean follow-up period was 46 months; 48.4 and 42.3 months in the allograft and autograft groups, respectively., Results: Radiographically, union was obtained in 46 patients (80.7%) within a mean of 5.9 months (6.8 months in 20 autografts, and 5.1 months in 26 allografts). Nonunion (19.3%) occurred in four allografts and seven autografts. No significant difference was found between the two fibular grafts in terms of union (p>0.05). Graft rupture was detected in six patients (5 autografts, 1 allograft) all of which were due to minor traumas. Complications were encountered in eight patients (14%) including transient peroneal nerve injury (n=3), wrist subluxation (n=2), infection (n=2), and Madelung's deformity., Conclusion: Reconstruction of cavitary and segmental bone defects with autogenous or allogenous nonvascularized fibular grafts is a reliable method, with high success rates.

Terbutaline sulphate (TBS) is widely used in the treatment of bronchial asthma, chronic bronchitis and emphysema. Because of its short biological half life and dosing schedule, a long acting TBS formulation is required to improve patient compliance. The objective of this study was to develop a TBS containing biodegradable microsphere formulation. Poly(D,L-lactide-co-glycolide) (PLGA) and poly(L-lactic acid) (L-PLA) were chosen as matrix materials. A solvent evaporation method was used for preparation of microspheres. Surface morphology, particle size distribution and encapsulation efficiency were investigated. In vitro release studies were performed in pH 7.4 phosphate buffer. In vitro distribution of microspheres were studied in the Swiss albino male mice. All microspheres were spherical in shape and had a porous surface with mean diameters of 9-21 microm. The encapsulation efficiency was influenced by the polymer type, but not the molecular weight. About 90% of the initial amount was trapped in PLGA microspheres, and the remainder was on the surface. In the case of L-PLA, 50% of the total drug was associated with the surface of microspheres. The In vitro release pattern was biphasic characterized by an initial burst phase followed by a slower phase. The L-PLA microspheres released approximately 92% of the initial payload in 72 h. On the other hand, TBS release was increased with an increase in the molecular weight of PLGA. Biodistribution of L-PLA microspheres was characterized by an initially high uptake (35%) by the lungs. All these results suggest that L-PLA and PLGA microspheres have the potential to be used for passive lung targeting.

Terbutaline sulfate is widely used as a bronchodilator for the treatment of bronchial asthma, chronic bronchitis and emphysema. As it has a short biological half-life, a long acting terbutaline sulfate formulation is desirable to improve patient compliance. Bovine serum albumin microspheres were prepared by an emulsion polymerization method using glutaraldehyde as the crosslinking agent. All microspheres were spherical and smooth with the mean particle size in the range of 22-30 microm. Drug release from the BSA microspheres displayed a biphasic pattern characterized by an initial fast release, followed by a slower release. The released amount was decreased with an increase in the glutaraldehyde concentration. In the absence of trypsin, the time required for complete degradation of microspheres was increased from 144 to 264 h when the glutaraldehyde concentration increased from 0.1 to 0.7 ml. In the presence of trypsin, a linear relationship was obtained between the degradation rates and trypsin concentrations, indicating that saturation was not reached under the experimental conditions. Biodistribution studies indicated that the degree of uptake by the lungs was higher than that of the other organs. All these results demonstrated that terbutaline sulfate loaded microspheres can be used for passive lung targeting.

The benefits of various minerals and vitamins on fracture healing have been demonstrated in animal models. Vitamin C is an essential substance in fracture healing but has not been studied previously on an experimental basis. Sixteen rats were grouped randomly into control and vitamin C-supplemented groups. The right tibias of all rats were fractured by digital manipulation. One group received single high dose of vitamin C intramuscularly. On the 5th, 10th, 15th, and 20th days, two rats from each group were killed and the tibias examined under light microscopy. It was seen that the vitamin C-supplemented group went through the stages of fracture healing faster compared with the control group.

Radioembolization is used in diagnostic imaging of the lungs and for radioembolization therapy of hepatic tumours. Presently, 99mTc labelled macroaggregates or microspheres of human serum albumin (HAM) are used for this purpose. Poly lactic acid (PLA) is biodegradable, like HAM, and, unlike HAM, is not a blood product. The aim of the present study was to evaluate the uptake and biodegradation of PLA microspheres in lungs. PLA (MW = 48720 Da) microspheres of 1.0-100 microm (mean = 39.5 microm) in diameter were prepared by solvent evaporation from methylene chloride. They were labelled with 99mTc by stannous chloride reduction at pH 3, with an efficiency of 98% and a stability of 96% at 24 h. For biodistribution studies, 15 mice were i.v. injected with 20 microCi 99mTc-PLA microspheres in 0.1 ml and sacrificed at 15 min, 1, 3, 6 and 24 h (three at each time point). All the organs were removed, weighed and counted against a standard prepared from 1/100 dilution of the injected radioactivity. Some mice were similarly injected and sacrificed at 30 min, 15 and 30 days. The lungs were removed and frozen, and 10 microm sections were obtained, stained with haemotoxylin and eosin and examined under a light microscope. Five rabbits were i.v. injected with 1 mCi of 99mTc-PLA microspheres. Scintigrams were obtained at various intervals up to 24 h. In mice, the lung uptake was significant at 30 min-1h post-injection. In rabbits, the lungs were the only organs visualized up to 24 h. Microscopic examination of tissue sections demonstrated slow biodegradation of PLA particles. In conclusion; (1) The high lung uptake obtained in mice and rabbits indicates the suitability of PLA microspheres for lung imaging, and (2) although the slow biodegradation rate might be a disadvantage in patients with lung disorders in diagnostic studies, it may be an advantage in therapeutic applications with radionuclides which have long physical half lives.