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Background: It is important to diagnose a scaphoid fracture accurately and start the correct treatment in the shortest time possible. However, the fracture of bone may not be visible on x-ray. In such cases, patients are clinically diagnosed with suspected or occult scaphoid fractures. The aim of this study was to define a scoring system based on physical examination to demonstrate the risk for bone injury in patients with clinically suspected and occult scaphoid fractures with negative radiographs and anatomical snuff box tenderness and to decrease the costs and workforce loss due to unnecessary treatment and magnetic resonance imaging (MRI). Materials and Methods: Patients were initially evaluated by the attendant orthopedic physician in the emergency service with X-ray of the wrist, and ten wrist physical examination techniques were used. The X-rays of patients were evaluated by three orthopedic surgeons. Finally sixty patients, who were diagnosed as having no fracture by all three orthopedic surgeon, were included in the study. The wrists of these patients were evaluated with MRI. Results: There were 46 male (77%) and 14 female (23%) patients with a mean age of 21.5 years (range 7-61 years). About 3.3% had triquetrum fracture, 15% had bone edema in the scaphoid and radius, 18.3% had distal radius fracture, 31.6% had scaphoid fracture, and 31.8% had no bone injury. A scoring system was also proposed. It can be predicted that in the physical examination of the wrist if the total score is higher than 6.5, the probability of fracture is 2.87 (positive likelihood ratio) fold compared to scores below 6.5. Conclusions: Proposal of this new scoring system was thought to be useful for predicting the risk for bone injury in patients with clinically suspected scaphoid fractures and making decision regarding therapeutic options. WOS:000429265000013 29576647 Q4

WOS: 000371084600025, PubMed ID: 26374114, Aim There are many alternatives for post-operative pain relief in patients who have had general anaesthesia. The aim of this study was to evaluate the efficacy of intra-articular bupivacaine + morphine and bupivacaine + tenoxicam applications in post-operative pain control in patients undergoing knee arthroscopy with general anaesthesia. Method This was a prospective study. Standard anaesthesia procedures were applied to each patient, and the 240 patients chosen at random were then divided into two groups. Each group received a different combination of drugs for this double-blind study. The first group (group A: 120 patients) received 0.5 % bupivacaine 100 mg + tenoxicam 20 mg (22 ml); the second group (group B) received 0.5 % bupivacaine 100 mg + morphine 2 mg (22 ml); both groups received their drugs at the end of the intra-articular operation before tourniquet deflation. Before the operation, patients were asked about their post-operative pain at particular periods over the following 24 hours using the visual analogue scale (VAS) and the numeric rating scale (NRS). An additional analgaesic requirement and possible side effects were also recorded. Results Group A patients needed analgaesics sooner after operation than patients in group B. In Group B, VAS and NRS values were statistically higher compared with group A at the 12th hour. There were also fewer side effects seen in group A versus group B. Conclusion Effective and reliable results were obtained in post-operative pain control in bupivacaine added to the morphine or tenoxicam groups following arthroscopic meniscectomy. In the tenoxicam group, patients reported less pain, fewer side effects and less need for analgesics at 12 hours after the operation.

Purpose Treatment is easier and complications are less likely to occur if developmental dysplasia of the hip (DDH) is diagnosed early. In this study, we examined the early results of open reduction using a medial approach which we had modified for DDH and analyzed the success of this technique and the associated complication rates, with a focus on avascular necrosis (AVN). Methods This is an Institutional Review Board-approved retrospective review of all patients diagnosed with DDH and treated with a modified medial approach at a single institution from July 1999 to December 2010. The patients’ charts were analyzed for clinical and radiographic features. Results Fifty-five hips of 41 patients, all of whom were treated by open reduction using a modified medial approach due to DDH, were evaluated retrospectively. The mean age of the patients at surgery was 19 (range 11–28) months, and the average follow-up was 5.5 (range 3–9.5) years. AVN was the most important complication in terms of radiological outcomes as assessed according to the Kalamchi–McEwen classification. Radiologic results were excellent or good in 51 hips (92.7 %) and fair–plus in four (7.3 %). Type 1 temporary AVN was detected in only two hips (3.6 %), and the lesions had disappeared completely in the final control graphs of these two patients. A secondary intervention was needed for two hips (3.6 %) of the same patients who were operated on due to bilateral DDH. No other complications, such as infection, re-dislocation, or subluxation, were seen in the operated patients. Conclusions We believe that treatment for DDH using a modified medial approach during early childhood is an effective and reliable method with low AVN rates. As shown here, this method achieves great success in radiological and clinical outcomes after a minimum 3-year follow-up.

Background:There are limited cases of humerus medial condyle fracture in the literature treated by open reduction and percutaneous pinning. This study presents cases treated by open reduction and percutaneous pinning and discussed the problems reported in the literature.Methods: Nine cases were treated by open reduction and percutaneous pinning between 2006-2014. These cases were followed for nonunion, avascular necrosis, range of motion, nerve lesion and infection for 15.3 months (range 11 to 18 months).Results:No non-union, avascular necrosis, iatrogenic nerve lesion or infection developed in our cases. All patients gained full range of motion.Conclusions:This study presents that surgical technique and early timing of surgery prevents the complications.

Several proximal tibial osteotomy techniques for the medial compartment arthrosis of the knee are described and traced in their development. These techniques are of the closed wedge, dome and open wedge types. We detail the differences in planning and surgery as well the need for different fixation devices. This historical and technical description will benefit those surgeons wishing to undertake the procedure as an alternative to joint replacement strategies.

Tibial pilon fractures usually result from high energy trauma and present as a challenge to the orthopedic surgeon. Accurate reduction of the joint with meticulous care for the surrounding soft tissues is mandatory. We present a case report in which an anterior cruciate ligament targeting device is used with a minimally invasive technique under arthroscopic and fluoroscopic guidance for Orthopaedic Trauma Association 43-B2.3 type pilon fracture treatment.

Objective: The aim of this study was to compare the outcomes of three reduction methods used during intramedullary nailing of the subtrochanteric femur fractures.Methods: This study included 45 patients with subtrochanteric femur fractures who were treated with intramedullary nailing. Twenty-two patients underwent clamp-assisted reduction, 11 reduction with cable cerclage, and 12 with blocking screws. Reduction techniques were compared with respect to the early postoperative alignment, one year postoperative alignment, time to full weight-bearing, time to union, Harris hip score at one year, operation and fluoroscopy times, blood transfusion amount, complications, and additional interventions.Results: The clamp-assisted reduction group had a statistically high mean time to full weight-bearing (p=0.038) and a low mean Harris hip score at one year (p=0.002). The blocking screw group’s operation times and fluoroscopy times were statistically long. There was no statistically significant difference between the clamp-assisted reduction and cable cerclage groups in terms of operation times and fluoroscopy times. On the other hand, there were statistically significant differences between the clamp-assisted reduction and blocking screw groups (p=0.0001 and p=0.0001, respectively) and between the cable cerclage and blocking screw groups (p=0.037 p=0.0001, respectively) in terms of operation times and fluoroscopy times. There was no statistically significant difference between the clamp-assisted reduction, cable cerclage and the blocking screw groups in terms of early postoperative alignment, one year postoperative alignment, time to union, complications or additional interventions.Conclusion: Clamp-assisted reduction leads to a longer time to weight-bearing and a poorer functional status at one year. Operation time and fluoroscopy time were longest in the blocking screw group., Amaç: Bu çalışmanın amacı subtrokanterik femur kırıklarının tedavisinde intramedüller çivi kullanılan üç redüksiyon tekniğinin sonuçlarını karşılaştırmak idi. Çalışma planı: İntramedüller çivi ile birlikte kemik klempi ile redüksiyon uygulanan 22, kablo serklaj uygulanan 11 ve bloklama vidası uygulanan 12 hasta olmak üzere toplam 45 subtrokanterik femur kırıklı hasta çalışmaya alındı. Redüksiyon teknikleri ameliyat sonrası erken dönem dizilim, ameliyat sonrası 1. yılda dizilim, tam yük verme süresi, kaynama süresi, 1. yıl sonu Harris kalça skoru, ameliyat süresi, skopi süresi, kan transfüzyonu miktarı, komplikasyon ve ilave girişim açısından istatistiksel olarak karşılaştırıldı. Bulgular: Kemik klempi grubunun tam yük verme süre ortalamaları istatistiksel olarak anlamlı derecede yüksek (p=0.038), 1. yılda Harris kalça skoru ortalamaları ise düşük bulundu (p=0.002). Bloklama vidası grubunda ameliyat ve skopi süreleri uzun idi. Kemik klempi ile kablo serklaj grupları arasında ameliyat süreleri ve skopi süreleri açısından anlamlı fark yokken, bloklama vidası grubu ile kemik klempi grubu arasında (sırasıyla p=0.0001, p=0.0001) ve bloklama vidası ile kablo serklaj arasında (sırasıyla p=0.037, p=0.0001) anlamlı fark vardı. Kemik klempi, kablo serklaj ve bloklama vidası grupları arasında, erken dönem dizilim, ameliyat sonrası 1. yılda dizilim, kaynama süresi, komplikasyon ve ilave girişim açısından istatistiksel olarak anlamlı farklılık gözlenmedi. Çıkarımlar: Kemik klempi ile redüksiyon yönteminde hasta ayağına daha geç yük vermekte ve 1. yıl sonundaki fonksiyonel durumu diğer gruplardan daha kötü olmaktadır. Bloklama vidası grubunda ameliyat ve skopi süreleri diğerlerinden daha uzundur.

Objectives: The aim of this prospective study was to evaluate the results of anatomical frame plate osteosynthesis in patients with Ada and Miller Type 2 or 4 scapula fractures. Methods: Eleven Ada and Miller Type 2 or 4 scapula fractures in nine patients were treated with anatomical frame plate osteosynthesis. The mean follow-up time was 39.8 (12–77) months. The results were evaluated using the Herscovici score. Results: No complications, such as neurovascular injury, postoperative hematoma, infection, delayed wound healing, implant failure, delayed union, or nonunion occurred. Based on the Herscovici score, the results were excellent. Conclusion: Osteosynthesis with anatomical frame plates appears to be a safe method that allows early range of motion and that provides excellent results in Ada and Miller Type 2 or 4 scapula fractures.

The transmission of blood-borne pathogens during surgery is a major concern. Surgical gloves are the primary barrier between the surgeon and the patient. Surgical procedures that need manual handling of bony surfaces or sharp instruments have the highest risk of glove perforations. The frequencies and the sites of surgical glove perforations in arthroplasty procedures were assessed.We assessed the surgical glove perforations in total hip and knee arthroplasty procedures. Double standard latex gloves were used. A total of 983 outer and 511 inner gloves were tested. The gloves of all the surgical team members were tested for perforations during the first and second hours of surgery.There were 18.4% outer and 8.4% inner glove perforations. The most frequent site of perforation was the second digit of the nondominant hand (25.5%). We found that hip and knee arthroplasty had significantly more glove perforation risk for the surgeon in the first half of the operation rather than the second half, and 57.8% of the perforations were at the index finger and the thumb.Arthroplasty procedures still have high glove perforation rates despite the use of double gloving with frequent changes. Extra augmentation of the gloves in selected areas of the hand, in addition to double gloving, may be safer and more cost-effective than double gloving alone.

Introduction To investigate the effects of subacromial tenoxicam injection during physical therapy after rotator cuff tear and subacromial decompression.

Treatment of reverse oblique trochanteric femoral fractures is still challenging. We present the results of our proximal nailing surgery performed for reverse obliquity intertrochanteric fractures using two lag screws and evaluated the quality of the reduction, operative time, complications and functional status of the patients. Fifteen patients with AO/OTA 31 A-A3 fractures were treated by proximal femoral nailing in our trauma centre. The mean Harris hip score was 74.66 (range 65-96) and the mean Barthel activity score was 15.71 (range 12-20). The mean duration of surgery was 48 minutes and the average consolidation time was 8.6 weeks. No intraoperative complications or postoperative technical failures and no stress shielding as evidenced by the lack of cortical hypertrophy at the level of the tip of the implant were detected. Intramedullary nailing with proximal femoral nails may be a good option in the treatment of reverse obliquity intertrochanteric fractures.

A bilateral total knee prosthesis procedure can be performed simultaneously in patients with bilateral gonarthrosis. The purpose of this study was to evaluate the differences in component alignment between the simultaneous bilateral TKA and unilateral TKA. A total of 20 patients out of 40 underwent simultaneous bilateral TKA, whereas 20 patients had unilateral TKA. The component alignments were compared radiographically. There was no statistically significant difference in the component alignment between the simultaneous bilateral TKA group and the unilateral TKA group. In conclusion, component alignment of the patients with simultaneous bilateral TKA is similar to that of unilateral TKA. © 2010 Springer-Verlag.

SUMMARY Renal osteodystrophy (ROD) is the skeletal complication of chronic kidney disease. Secondary hyperparathyroidism and 125 dihydroxy vitamin D3 deficiency are the major causative factors in ROD. Musculoskeletal problems remain among the main limitations of the quality of life of renal failure patients. In this report, a 60-year-old male with four extremity fractures due to a minor trauma was presented. The patient had been receiving haemodialysis for seven years due to hypertensive nephropathy. Our case emphasises the importance of multispecialty approach to the investigation and treatment of patients with ROD.

Simultaneous quadruple extremity fractures are rare and can be termed as “floating body” injury. A review of the literature produced only one previous report of this rare combination which could not be operated. We presented a 40-year-old female patient with bilateral humerus and femur fractures associated concomitant injuries such as nondisplaced acetabular fracture, rib fractures and traumatic tendon ruptures. She was operated by arthroscopically assisted retrograde intramedullary nailing for femur fractures as well as by external fixators for humerus fractures. She was able to walk with full weight-bearing without any assistance at the end of the first postoperative year. Early fixation of the fractures in floating body injury using retrograde intramedullary nailing and external fixator is successful treatment method.

Cushing’s disease, or endogenous hypercortisolism, is an endocrine disorder caused by high levels of cortisol in the blood from a variety of causes; and it may be associated with nontraumatic osteonecrosis of the hip joint. There are several reports about this rare combination in the literature in which it was concluded that osteonecrosis may appear as a rare presenting manifestation of Cushing’s disease. However it may also be a late sequela of this endocrine disorder. There are various treatment options for hip osteonecrosis, including core decompression, vascularized or nonvascularized bone grafting, rotational osteotomy, limited resurfacing of the femoral head, and total hip arthroplasty. The choice of treatment option depends on the patient’s age, the cause of osteonecrosis, the extent of femoral head involvement, and the condition of the acetabular articular cartilage. The results of total hip replacement and hemiarthroplasty have generally been poor. Therefore, many authors prefer to delay or eliminate the need for hip replacement by treating osteonecrosis with bone-preserving procedures. Bone grafting of the femoral head through a so-called trapdoor in the articular cartilage and subchondral bone has been used to treat late-stage hip osteonecrosis secondary to various etiologies. However there is no information in these reports about the results of this procedure for the treatment of hip osteonecrosis secondary to endogenous hypercortisolism. We present a patient who was operated on with bone-preserving procedures for bilateral osteonecrosis of the femoral heads that had developed secondary to Cushing’s disease. Case report

The subjective concerns and needs of patients who have experienced trauma are important to recovery. However, the mental status of patients with isolated musculoskeletal trauma is not known. Is the mental status of such patients different and does the severity, site, and type of trauma affect this difference? We evaluated the mental status of 195 patients hospitalized for isolated musculoskeletal trauma and determined the characteristics of the factors that affect mental status; 197 patients hospitalized for elective surgery and not exposed to acute trauma constituted the control group. We administered the Mini-Mental State Examination to study and control groups within the first 24 hours of hospitalization. Age, gender, and educational status in the study and control groups were recorded. In addition, the severity, site, and type of trauma in the study group were recorded. Mini-Mental State Examination scores of the trauma group were lower than those of the control group. Mini-Mental State Examination scores decreased with increasing trauma severity. The mental status of the patients sustaining isolated musculoskeletal trauma was affected by the severity, site, and type of trauma. Level of Evidence: Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Rhabdomyolysis following pneumotic tourniquet use is an extremely rare complication. In this case report, we aimed to present an unusual tourniquet complication following proximal tibial osteotomy. A 55-year-old female patient was operated on for genu varum in our clinic. Postoperatively, an anuria developed, and liver and kidney function test levels increased. The patient was diagnosed with acute rhabdomyolysis, and an aggressive treatment was begun., Bu çalışmada; proksimal tibia osteotomi cerrahisi sonrasında karşılaşılan olağan dışı bir turnike komplikasyonunu sunmayı amaçladık. Elli beş yaşındaki kadın hasta genu varum nedeniyle kliniğimizde ameliyat edildi. Ameliyat sonrası dönemde anüri gelişti. Böbrek ve karaciğer fonksiyon test değerlerinde yükselme gözlendi. Akut rabdomiyoliz tanısı konularak agresif tedavi başlandı

Hoffa fracture associated with ipsilateral femoral shaft fractures is a rare clinical entity. We present a previously unreported multi-trauma case with a unique fracture combination of ipsilateral Hoffa, tibial eminence, femoral shaft and Malgaigne fractures. The Malgaigne fracture was treated non-operatively while the other three fractures were operated with arthroscopic and assisted techniques. Despite the use of minimally invasive techniques, the patient experienced postoperative soft tissue problems. In follow-up, all fractures healed with a good functional outcome. The application of a minimally invasive technique in such a high-energy trauma is crucial for prevention of soft tissue complications., Hoffa kırıklarının femur şaft kırıkları ile birlikte izlenmesi nadir bir klinik tablodur. Bu sunumda, aynı tarafta Hoffa, tibial eminens, femoral şaft ve Malgaigne kırıklarının birlikte izlendiği, literatürde bildirilmemiş nadir bir çoklu travma olgusu sunulmaktadır. Konservatif olarak tedavi edilen Malgaigne kırığı dışında kalan üç farklı kırık artroskopi destekli teknikler kullanılarak tedavi edilmiştir. Minimal invaziv tekniklerin kullanılmasına karşın, olguda yumuşak doku problemleri ile karşılaşılmış, takiplerde tüm kırıklar iyi fonksiyonel sonuçlar ile iyileşmiştir. Yüksek enerjili benzer travma olgularında minimal invaziv tekniklerin uygulanması yumuşak doku komplikasyonlarının engellenmesi açısından büyük önem taşımaktadır.

Objective: The aim of this study was to determine whether or not there is an association between attention deficit and hyperactivity disorder (ADHD) and Perthes disease.Methods: The study included 3 groups of patients: Perthes patients, trauma patients, and orthopedic patients without Perthes disease or history of trauma. Each group was comprised of 56 males and 4 females. Patients were evaluated for present or past diseases, exposure to second-hand smoke, the age at which they had begun to walk, history of trauma prior to Perthes diagnosis in the Perthes group, weight, height and body mass index (BMI). Eighteen questions on the DSM-4 (Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition) ADHD checklist was used in the psychiatric evaluation of patients. The rate of ADHD was compared between groups.Results: Attention deficit and hyperactivity disorder was diagnosed in 7 patients in the Perthes group, 3 in the trauma group, and 3 in the non-trauma group; and this difference was not significant (p=0.160).Conclusion: There were no significant differences in the rate of ADHD between trauma and non-trauma groups of Perthes patients, which suggests no association between ADHD and Perthes disease., Amaç: Bu çalışmanın amacı dikkat eksikliği ve hiperaktivite bozukluğu (DEHB) ile Perthes hastalığı ile arasında bir ilişki olup olmadığının belirlenmesi idi.Çalışma planı: Hastalar 3 gruba ayrıldı. Birinci grup Perthes hastalarından, ikinci grup travma hastalarından ve üçüncü grup travması veya Perthes hastalığı olmayan ortopedi hastalarından oluşmaktaydı. Her grupta 56 erkek ve 4 kız yer almaktaydı. Hastalar mevcut ya da geçmiş hastalıkları, pasif sigara içiciliği, yürümeye başladıkları yaş, Perthes hastaları grubunda Perthes tanısı öncesi travma öyküsü, ağırlık, boy ve vücut kitle indeksi (VKİ) gibi faktörler ele alınarak değerlendirildiler. Hastaların psikiyatrik durum değerlendirmesinde DEHB için DSM-4 (Diagnostic and Statistical Manual of Mental Disorders - Dördüncü Baskı) kriterlerinde yer alan 18 soruluk listeden yararlanıldı. Elde edilen DEHB oranları gruplar arasında karşılaştırıldı.Bulgular: Perthes hastalarının 7’si, travma geçiren hastaların 3’ü ve travma geçirmeyen hastalarının 3’ünde DEHB saptanırken, gruplar arasındaki fark anlamlı bulunmadı (p=0.160).Çıkarımlar: Çalışmamıza göre travma geçiren ve geçirmeyen Perthes hastalarında DEHB görülme insidansı arasında anlamlı bir fark olmaması, DEHB ile Perthes hastalığı arasında bir ilişki olmadığını göstermektedir.

Background Comminuted fractures can occur due to severe traumas. The treatment of these fractures that may cause serious morbidity and sometimes mortality is N-butyl cyanoacrylate. It has been reported that this adhesive provides sufficient rigid fixation for bone healing. This study aims to examine cyanoacrylate radiologically and histologically to determine whether it provides adequate recovery in segmental fractures. The secondary objective is to evaluate N-butyl cyanoacrylate, an adhesive material that can hold the fragments on the fracture line together following reduction. Methods Sixteen Sprague–Dawley rats were divided in two groups as control (n = 8) and experimental (n = 8) groups. In the control group, segmental fractures were made and fixated with K-wire. In the experimental group, the same surgical procedure was applied and also fragments were stabilized with N-butyl cyanoacrylate. Results On the sixth week, we did not see any statistically significant difference in the radiological scoring between groups. However, the pathological scores of the control group were statistically higher than the cyanoacrylate group. Conclusions We found that cyanoacrylate was rapidly and easily applied in the segmental fractures but did not cause any superior radiological and clinical results compared to the control group. The cyanoacrylate had low viscosity, and it was not capable enough to fill the defects formed between osteotomy surfaces. However, it did not adversely affect fracture healing as seen in biopsies taken as a result of follow-ups.

Objective: The aim of our study was to examine the effect of suction drains on knee after arthroscopic partial meniscectomy with partial fat pad removal or synovectomy.Methods: We performed arthroscopic partial meniscectomy for posterior tears of the medial meniscus and partial fat pad or synovium shaving in 72 patients. Following surgery, a suction drain was not used in 40 patients (Group A) and used in 32 (Group B). Both groups were similar in terms of age, gender, and total operation time. The patients were evaluated at 1, 2, and 4 weeks postoperatively for the presence of a knee effusion.Results: No significant difference was observed in the grade of effusion and the average percent change in the effusion grade between Groups A and B at 1, 2, and 4 weeks postoperatively.Conclusion: Use of a suction drain did not influence the postoperative effusion or the clinical course of the effusion after arthroscopic partial meniscectomy with partial fat pad removal or synovectomy., Amaç: Çalışmamızın amacı, parsiyel yağ yastığı eksizyonu veya sinovektomi ile birlike yapılan artroskopik parsiyel menisektomi cerrahisi sonrası dren kullanımının diz efüzyonuna etkisini incelemekti. Çalışma planı: Medial menisküs yırtığı olan 72 hastaya artroskopik parsiyel menisektomi ve parsiyel yağ yastığı eksizyonu ya da parsiyel sinovektomi yapıldı. Cerrahi sonrası dren kullanılmayan 40 hasta Grup A, kullanılan 32 hasta ise Grup B olarak sınıflandırıldı. Yaş, cinsiyet ve toplam cerrahi süresi bakımından gruplar benzerdi. Diz efüzyonunu saptamak amacıyla hastalar ameliyat sonrası 1., 2. ve 4. haftalarda değerlendirildiler. Bulgular: Cerrahi sonrası 1., 2. ve 4. haftalarda Grup A ve B arasında efüzyon derecesi ve efüzyon derecesinde ortalama yüzde değişimi açısından anlamlı bir fark gözlenmedi. Çıkarımlar: Yağ yastığının kısmen eksize edildiği ya da sinovektomi yapılan artroskopik parsiyel menisektomi cerrahisi sonrası dren kullanımı ameliyat sonrası efüzyon veya efüzyonun klinik seyri açısından bir fark yaratmamaktadır.

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.

Objective: To report a case of bilateral secondary coxarthrosis in a patient with a history of pelvic irradiation for sarcoma botryoides. Clinical Presentation and Intervention: The patient had surgery and radiation therapy for sarcoma botryoides when she was 18 months old. Left and right cementless total hip arthroplasties were performed at the age of 36 and 40 years, respectively. Harris hip scores improved from 28.4 to 93 on the left hip after 84 months of follow-up and from 29.5 to 91.3 on the right hip after 38 months of follow-up. Conclusion: Cementless total hip arthroplasty may be considered for irradiated hips, if radiation damage in bone has been stable for a long period of time.

Bone marrow oedema has a long recovery time. Conservative and surgical treatments have been used. This study aimed at identifying a profile of patients who may benefit from nonsurgical management. We compared the results of periodic clinical and radiological examinations of patients who visited our clinic with knee pain and were diagnosed with bone marrow oedema following magnetic resonance imaging (MRI) examinations. Clinically, the patients were evaluated using the Lysholm knee score and a visual analogue scale. The study included 67 patients (31 males, 36 females) who were followed for 6-24 months. Patient age, gender, body mass index, affected area, and concomitant intra-articular pathology were analysed. Of the 67 patients, 63 were treated conservatively, and four underwent decompression. Patients with involvement of both the medial femoral condyle and tibial plateau were found to be more resistant to treatment than those in which only the tibial plateau was affected. Intra-articular pathologies were frequently noted together with bone marrow oedema, causing knee pain to persist after the bone marrow oedema had subsided.

Knowing the relationship between diagnoses is important in knee arthroscopy in terms of defining possible treatment modalities preoperatively. The purpose of our study was to define the diagnoses made intraoperatively through knee arthroscopy and the relationships between them. We evaluated the results of knee arthroscopies performed over a 10-year period. The sites and sizes of chondral lesions, the existence of anterior cruciate ligament (ACL) injury, and the sites of meniscal lesions were noted for a total of 1,774 patients. The relationships between these lesions were evaluated statistically. Chondral lesions and posterior medial meniscal tears were predominant in females, whereas complete ACL tears were predominant in males. ACL tears were commonly accompanied by medial and lateral meniscal bucket-handle tears. In cases with advanced chondral lesions, medial and lateral posterior meniscal and lateral anterior meniscal tears were more common. According to our results, posterior tears of the medial menisci, medial and lateral femoral condyles, lateral tibial plateau type 3 or 4 cartilage lesions, and the rate of diagnostic arthroscopy were higher in females, while middle substance and bucket-handle tears of medial menisci and total rupture of the ACL were more common in males. ACL injuries were seen to coexist with medial or lateral menisci bucket-handle tears, with no relationship between the site or size of the chondral lesions. A relationship between medial and lateral meniscal tears and the site of femoral and tibial chondral surface lesions was detected.

This study aims to investigate whether the usage of fondaparinux sodium may result in major hemorrhages following major orthopedic surgery.Forty-three patients (30 females and 13 males; mean age 66 years; range 34 to 94 years) at the age of18 years who were scheduled for major orthopedic surgery were included. Total hip arthroplasty, total knee arthroplasty and proximal femur fracture surgeries were defined as the major orthopedic surgeries. Prophylaxis was administered with 2.5 mg fondaparinux sodium once daily subcutaneously. Prophylaxis was initiated at 6-8 hours after the closure of incision. During the prophylaxis period (31±3 days), the patients were monitored for symptomatic deep venous thrombosis. Serum creatinine, platelet and hemoglobin levels were measured at the baseline and in the first week and at one month postoperatively. Wound healing time, healing complications, and major/minor hemorrhages seen during the prophylaxis period were recorded.During the follow-up, none of the patients had symptomatic deep vein thrombosis or symptomatic pulmonary embolism. Two patients (4.6%) had delayed wound healing, while four (9.3%) had minor ecchymosis. No major hemorrhages were observed in any patients.With the long-term use of fondaparinux, we did not observe any major hemorrhagic complications. However, further large-scale studies including control groups are required to establish the effects of long-term use of fondaparinux.

Aims: The aim of our study was to compare the effects of suprascapular nerve block in patients with frozen shoulder and diabetes mellitus unresponsive to intraarticular steroid injections. Settings and Design: Ten patients without improvement of sign and symptoms after intraarticular injections were made a suprascapular nerve block. Methods: Pain levels and active range of movement of patients were recorded at initial attendance and after 1, 4, and 12 weeks. All patients′ simple pain scores, total pain scores, and range of motion of their shoulders were improved significantly after suprascapular nerve block. Statistical Analysis: In this study, the statistical analyses were performed by using the SPSS 8.0 program (SPSS Software, SPSS Inc., USA). To compare pre- and post-injection results of simple pain score, total pain score, shoulder abduction and external rotation, Wilcoxon test was used. Results: Patient′s simple pain scores, total pain scores also abduction, external rotation and internal rotation angles were improved significantly after suprascapular nerve block. Conclusion: Effective results after suprascapular nerve blockage was obtained for the treatment of refractory frozen shoulder cases.

The aim of this study is to compare distal tibial fractures (4–10 cm proximal to the plafond) treated by intramedullary nailing with those treated by percutaneous locked plating and to assess the clinical and radiographic results, complication rates, and the need for secondary procedures. Thirty-six patients received percutaneous locked plate treatment and 25 patients received intramedullary nail treatment. The results obtained from these two treatment methods were assessed by comparing infection rates, starting time for wight-bearing, local implant irritation, union and malunion rates and along with secondary procedures. In the percutaneous locked plate group, two deep infections, four superficial infections, two nonunions, one malunion and 10 local implant irritations were observed. In the intramedullary nail group, one nonunion, four malunions and two local implant irritations were observed. The incidence of deep and superficial infections, local implant irritations and secondary procedures in the percutaneous locked plate group was greater than those in the intramedullary nail group. The time to full weight bearing was shorter in the intramedullary nail group. There was no significant statistical difference in malunion and nonunion rates between the two groups. The need for secondary procedures was more common in group receiving the percutaneous locked plate treatment and the time to full weight bearing was shorter in the intramedullary nail group.

We present an unusual case of periosteal chondroma of the middle phalanx in the right ring finger that presented as a subcutaneous mass in a 21-year-old man. It was treated by marginal excision, with no postoperative local recurrence.

Hyperlipidemia is a major risk factor for coronary heart disease. The most commonly used antihyperlipidemic drugs are 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins), of which atorvastatin is one of the most widely used. Little is known about the relationship between tendinopathy and HMG CoA reductase inhibitors (statins) or the effects of atorvastatin use on tendon healing following surgical repair of tendon rupture. We hypothesized that atorvastatin negatively affects this healing process. The Achilles tendons of 16 New Zealand rabbits were ruptured surgically and repaired with sutures. Eight of the rabbits were given oral atorvastatin. The other 8 served as a surgical control group. Six weeks postoperatively, all the rabbits were sacrificed, and the repaired tendons were removed. After standard histological preparation, fibroblastic activity, revascularization, collagenization, collagen construction, and inflammatory-cell infiltration were evaluated. On comparing the atorvastatin and surgical control groups, we observed no difference in fibroblastic activity. Although it did not reach statistical significance in our study, a difference was noted in revascularization, collagenization, and inflammatory cell infiltration; and a statistical difference was observed in collagen construction. Doubt remains about the adverse effect of atorvastatin use during tendon healing. Further investigations in animal and human models are needed on the effects of tendon healing when atorvastatin is administered for a longer time frame prior to the injury.

The patellar tendon length changes and patella infera occurs in medial open wedge osteotomies. We hypothesized that patellar tendon length in the sagittal plane would not change in a proximal medial tibial biplanar retrotubercle open wedge osteotomy. Proximal medial tibial biplanar retrotubercle open wedge osteotomies were conducted on 23 knees of 22 patients; the mean patient age was 59 ± 7 years (range, 53-69 years). The surgical procedure used had some technical distinctions from those used in literature. The mean follow-up was 37 ± 11 months (range, 19-58 months). Preoperative and postoperative Hospital for Special Surgery Scoring System (HSS) scores, radiological tibial slope, Insall-Salvati, Blackburne-Peel, and Caton indices, femoro-tibial anatomical axis angle, the angle between the femoral condyle and tibial plateau, and the angle between the tibial plateau and tibial axis were measured and compared statistically. Postoperative HSS scores were statistically higher than the preoperative HSS scores. The femoro-tibial axis angle, the angle between the femoral condyle and tibial plateau, and the angle between the tibial plateau and tibial axes decreased significantly. No statistical difference was observed between the preoperative and postoperative Insall-Salvati, Blackburne-Peel, or Caton indices. When we performed proximal medial tibial biplanar retrotubercle open wedge osteotomy, clinical and radiological recovery was observed but patellar height did not change.

This article presents a case of an 82-year-old woman with Alzheimer's disease who was treated with a modular unipolar hemiarthroplasty for a right femoral neck fracture, which she voluntarily dislocated 3 times in the first postoperative week. The hip was stable in all directions, even in 60 degrees internal rotation, 0 degrees abduction, and 90 degrees flexion. The patient was mobilized 1 day postoperatively with full weight bearing. She dislocated her hip on postoperative day 3 while lying on her bed. After the dislocation, reduction under sedation was done again followed by a botulinum toxin injection of 50 IU to her adductor muscle group (including adductor longus, brevis, and magnus). The patient was mobilized after the injection and she had no difficulty walking. During the 6 months after the injection, no dislocation occurred again. Botulinum toxin decreases muscle activity by blocking the release of acetylcholine at the neuromuscular junction, thereby rendering the muscle unable to contract for up to 3 to 4 months. This method of botulinum injection can be applied to noncompliant patients with mental problems as an alternative conservative and surgical approaches.

A 17-year-old man fell from a height of 10 m onto his right forefoot and sustained ipsilateral calcaneal, comminuted cuboid, and second, third, and fourth metatarsal neck fractures and first metatarsophalangeal joint open dislocation. This report discusses this rare injury. The authors believe that initial debridement with immediate surgical fixation and reduction with appropriate antibiotic treatment saved the patient’s extremity.

Hip arthroscopy was first described in 1931 by Burman, and in recent years the applications have extended to labral surgery, osteochondroplasty, and a variety of other procedures. Hip arthroscopy may also be employed to extract loose or foreign bodies from the hip, and may be associated with more rapid recovery than an open procedure. We present a case of arthroscopic bullet removal from the hip in a 24-year-old man.

Background The aim of the study was to determine whether osteomyelitis of the femur or septic arthritis of the knee develops after retrograde intramedullary nailing of the femur performed within 7 days of supracondylar femur fracture, secondary to gunshot wounds, without skin defects. Methods Fifteen patients with a mean age of 27.8 years (range, 18-52 years), with supracondylar fractures of the femur due to gunshot wounds and without skin defects. Retrograde intramedullary nails were inserted through the intercondylar notch of the femur. We evaluated whether osteomyelitis of the femur or ipsilateral septic arthritis of the knee joint developed postoperatively. Results None of the patients who were followed up for a mean period of 11.7 months (range, 9-16 months) showed evidence of ipsilateral septic arthritis of the knee or osteomyelitis of the femur. Conclusion Retrograde intramedullary nailing of the femur can be performed in patients with supracondylar fractures of the femur due to gunshot wounds, and without skin defects, in the first 7 days after the trauma. Neither osteomyelitis of the femur nor septic arthritis of the knee develops in these patients.

In radius neck fractures, reduction manipulations applied on the radial head with percutaneous K-wires may lead to epiphysis or physis damage. In this study, 16 cases were evaluated without using any percutaneous manipulations upon the displaced radius head. Rather, an Ender-pin-like, curve-tipped K-wire was inserted intramedullarly (Metaizeau technique) after a certain amount of reduction by manual manipulation under fluoroscopic guidance. Complete reduction was obtained with wire rotations in 16 patients. A total of 16 patients with open growth plates with an average age of 8 years were enrolled within the scope of the study. Thirteen patients (81.25%) showed excellent clinical results, two patients (12.5%) showed good results, and one patient (6.25%) showed average results. None of the cases exhibited poor results. A single K-wire was used in nine cases, whereas two K-wires were used for fixation rigidity in seven cases with larger medullas. No sign of neurovascular deficit, synostosis, or infection was observed in any of the cases. In conclusion, the use of two wires in patients with larger medullas and emphasis on the importance of closed reduction, even without percutaneous K-wire manipulation, might lead to the development of a new treatment approach for pediatric patients with radial head fractures. © 2010 Wolters Kluwer Health | Lippincott.

WOS:000274542500004 PubMed: 20170854 Background: Tip-apex distance greater than 25 mm is accepted as a strong predictor of screw cut-out in patients with intertrochanteric femoral fracture treated by dynamic hip screw. The aim of this retrospective study was to evaluate the position of the screw in the femoral head and its effect on cut-out failure especially in patients with inconvenient tip-apex distance. Patients and methods: Sixty-five patients (42 males, 23 females; mean age of 57.6 years) operated by dynamic hip screw for intertrochanteric femoral fractures were divided in two groups taking into consideration the tip-apex distance less (Group A; 14 patients) or more (Group B; 51 patients) than 25 mm. Patient's age and gender, follow-up period, fracture type, degree of osteoporosis, reduction quality of the fracture, position of the screw in the femoral head, number of patients with cut-out failure and Harris hip score were compared. Results: The average follow-up time was 41.7 months. The mean tip-apex distance was 17.14 mm in Group A and 36.67 mm in Group B. One (7.1%) patient in Group A and three (5.8%) patients in Group B had screw cut-out. Except the screw position, no statistical differences were observed between two groups with regards to study data's. The screw was placed in femoral head more inferiorly (p = 0.045) on frontal and more posteriorly (p = 0.013) on sagital planes in Group B, while central placement of the screw was present in Group A. The common characteristic of three patients with screw cut-out in Group B was the position of the screw which was located in femoral head more superiorly and anteriorly after an acceptable fracture reduction. Conclusions: Peripheral placement of the screw in femoral head increases tip-apex distance. However, posterior and inferior locations may help to support posteromedial cortex and calcar femoral in unstable intertrochanteric fractures and reduce the risk of cut-out failure. Level of evidence: Level IV, retrospective series. (C) 2009 Elsevier Masson SAS. All rights reserved.

A 20-year-old man with bilateral absence of patella, thinness of the left femoral neck, femoral and tibial shaft was reported. This clinical presentation has not been reported in the English language literature. We propose that the unusual association observed in our patient may represent a distinguishing clinical presentation from previously reported aplastic patella syndromes. © 2010 Japanese Teratology Society.

Osteoid osteoma of the scapula is a rare benign lesion. This is a case report of a subchondral osteoid osteoma that involved the anterior rim of glenoid. Surgical approach in this atypical area may seem difficult. The excision of the lesion and grafting was performed by a deltopectoral approach. One year after the surgery, the patient remains pain free and has full range of motion with no recurrence of the tumour.

Posterior dislocation of the shoulder is a rare clinical entity with incidence of 6 per 1,000,000. It is more common in middle-aged men [1] and more than half of all cases may initially be missed [2]. Posterior shoulder dislocation is related to internal rotation, flexion, and abduction forcing of the shoulder secondary to grand mal seizure, electric shock, or trauma [3]. One case of posterior dislocation secondary to a seizure caused by a brain tumor has been reported [4]. Bilateral anterior dislocation because of hypoglycemic coma is very rare [5], and, to our knowledge, no case reports of bilateral posterior shoulder dislocation owing to hypoglycemic coma have been published.

Intramedullary nailing with expandable nails is one of the techniques available for the treatment of fractures of long bones. Concerns regarding bony union have been reported in medical literature, but no case of femoral nail breakage secondary to delayed union has been reported to date. We present a case of a broken expandable femoral nail secondary to delayed union, and we describe the technique used for its extraction.

Introduction Congenital peripheral constriction ring originating from soft tissues of the leg that is characterized with compression in the soft tissue usually involving the deep fascia surrounding the leg at the time of birth is occasionally observed in lower extremity. At the region of the constriction, fractures of tibia and fibula and foot deformities like clubfoot can be observed. Case presentation In our report, 6-month and 8-month old infants with congenital constriction band and ipsilateral clubfoot were presented. They were treated with multiple Z plasties for their constricting bands and Ponseti method of serial casting for their clubfoot deformities. Conclusion Congenital-constricting bands can be effectively released with multiple Z plasties. Ponseti method of correcting club foots of various causes can be applied to club foot deformities accompanying constricting bands.

Minimally invasive percutaneous plate osteosynthesis (MIPPO) has well-documented biological advantages and appears to be a reasonable treatment option for complex femoral and tibial fractures. However additional radiation exposure during reduction of the fracture, application of the plate to the bone and screw fixation is one of the disadvantages of this technique. We describe a technical trick for screw fixation in MIPPO with locking compression plates which decreases the duration of fluoroscopy use during the operation.

Arthroscopic-assisted reduction is one recommended technique for pediatric distal tibial epiphyseal fractures. A 15-year-old male patient with a triplane distal tibial epiphyseal fracture (Tillaux type) was scheduled for arthroscopic reduction and pinning, which failed to provide adequate fracture reduction. Open surgery was subsequently performed, which revealed a capsular interposition in the fracture line attributable to an anterior capsular tear of the ankle. The possibility of capsular interposition should always be taken into consideration when problems such as those described in this case presentation are encountered in such patients. This is precisely why direct visualization either through arthroscopy or open arthrotomy is sometimes necessary. (J Am Podiatr Med Assoc 99(5): 435–437, 2009)