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The aim of this study was to evaluate the mid-term clinical and radiological results of patients who underwent arthroscopic subscapularis (SSC) tendon repair and to address the possible effect of repair technique(single or double row), tear pattern, and concomitant procedures among supraspinatus tears and long head of biceps tendon (LHBT) pathologies on outcomes and failure parameters.45 patients (24 female; mean age = 55.9 years, age range = 37 - 78) who underwent arthroscopic repair of an SSC tear between January 2009 and December 2016 were retrospectively identified and included inthe study. Pre- and postoperative internal rotation strength and shoulder joint range of motion angles were measured. Clinical outcomes were assessed by Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES), Constant-Murley, Rotator cuff-quality of life (RC-QoL), and University of California Los Angles (UCLA) scores preoperatively and at the final follow-up.The mean follow-up was 45.2 (range = 36-104) months. 14 patients had isolated SSC tears. The mean preoperative VAS, ASES, Constant-Murley, RC-QoL, and UCLA scores for all patients were respectively 8.6, 21.2, 24, 28.9, and 12. Significant improvement was observed in each clinical outcome at the final follow-up: 0.96, 88.4, 86.4, 90.2, and 32.2, respectively. Improvement in outcome scores was more prominent in patients with Lafosse grade I and II SSC tendon tears repaired by singlerow technique and in patients with concomitant supraspinatus tendon repairs. The mean preoperativeinternal rotation strength according to theOxford scalewas 3.4 (±0.6) / 5 and raised to 4.7 (±0.4) / 5 at the final follow-up (P.001).Although concomitant biceps interventions significantly improved the outcome scores; this improvement was not clinically significant. Failure was only seen in 6 patients with high-grade (Lafosse III or IV) tears.Significant improvement in clinical outcomes and lower failure ratios were more prominent in patients with Lafosse grade I or II tears than grade III or IV. Concomitant biceps interventions made a positivecontribution to the clinical outcome. Early diagnosis and repair seem to be advantageous before low-grade SSC tendon tears turn into high-grade tears.Level IV, Therapeutic Study.

WOS:000565031500001 PubMed: 33569106 Introduction Paediatric elbow fractures constitute 10% of all paediatric fractures. Radiological interpretation of the immature elbow is difficult due to its cartilaginous structure. We aimed to describe an X-ray technique in paediatric patients to obtain true lateral elbow X-rays and to prevent the repeat X-ray shots. Materials and Methods Radiographs of 39 children, with a mean age of 48.17 months (range; 7-84 months), with elbow trauma were included. All elbow lateral radiographs were taken in the 90o flexion position. In the first group, radiographs were taken using the standard technique(lateral radiographs in shoulder internal rotation). In the second group, lateral radiographs of the elbow were taken while the patient was standing and the forearm was elevated passively with 90 degrees shoulder abduction and 90 degrees elbow flexion (standing salute position). Three criteria were examined from the graphs to determine the true lateral elbow graphy. Results In group 1 (n = 20) and group 2 (n = 19), lateral elbow radiographs were evaluated. No statistically significant differences were found between the groups, in terms of mean age and distal humeral fractures. In group 2; the presence of humeroulnar joint space, partial coronoid superposition of the radius head and presence of the hourglass formation were significantly higher. Discussion It is clear that radiographs taken in appropriate positions decreases diagnostic errors. In our study, the ratio of correct lateral radiographs was significantly higher in the radiograph group in the standing salute position, suggesting this method was safe for accurate lateral radiographs, in accordance with our hypothesis.

One of the factors affecting the healing of a meniscus repair is the primary stability of the tear. The purpose of this study is to compare single and double vertical loop (SVL vs. DVL) meniscal suture configurations by measuring elongation under cyclic loading and failure properties under ultimate load. We hypothesized that DVL configuration would have superior biomechanical properties than SVL. Twenty-two intact lateral menisci were harvested from patients who required total knee arthroplasty. A 20-mm longitudinal full-thickness cut was made 3 mm from the peripheral rim to simulate a longitudinal tear. Two groups were formed and group randomization was done according to patient age and gender (SVL group: mean age 68.3 years [range, 58–78 years], five males, six females; DVL group: mean age 67.4 years [range, 59–77 years], six males, five females). Cyclic loading was performed between 5 and 30 N at a frequency of 1 Hz for 500 cycles. Then, the meniscus repair construct was loaded until failure. Statistical analysis was performed using the t-test and the Mann–Whitney's U-test. During the early phases of cyclic loading, three specimens from each group failed because of suture pull out and are excluded from the study. At the end of 500 cycles, there was significantly less displacement in the DVL group than the SVL group (6.13 ± 1.04 vs. 9.3 ± 2.59 mm) (p 0.05). All specimens in SVL and five specimens in DVL groups failed in the form of suture pull out from the meniscus tissue. Longitudinal meniscal tears repaired with DVL configuration had less elongation value under cyclic loading compared with SVL configuration. Because of its superior biomechanical properties, it would be more secure to repair large and instable longitudinal meniscal tears by the DVL technique. This is a level II study.

Pain is a protective mechanism. Congenital insensitivity to pain syndrome is a very rare disease in which there is no ability to feel physical pain. It has been reported that it occurs with an incidence of 1 in 125 million newborn. Patients with congenital insensitivity to pain may have various orthopedic complications such as recurrent fractures, osteomyelitis and neuropathic joints. The most frequently affected body parts are lower extremities. Besides, curvature of spine can be seen. Injuries in epiphyseal points may cause incompatibility of extremity. Charcot joints may develop, which can lead to neuropathic arthropathy as a result of insensitivity to pain. Here, we present a patient with traumatic fracture-dislocation on left hip that neglected the treatment, had a bilateral femur fracture and then had septic arthritis of knee.

Amaç: Bu calışmada kliniğimizde kapalı reduksiyon pelvipedal alcı ile tedavi edilen hastaların reduksiyon sırasındaki yaşının kısa dönemde klinik ve radyolojik sonuclara etkisini tartışmayı amacladık. Yöntem: Nisan 2004-Aralık 2011 tarihleri arasında kapalı reduksiyon ve pelvipedal alçı uygulaması ile tedavi edilmiş GKD’li 81 hastanın 126 kalcası değerlendirildi. Tedaviye başlanıldığında 0-6 ay arasında olanlar grup 1.6-12 ay arasında olanlar grup 2, 12-18 ay arasında olanlar grup 3 ve 18 aydan büyük olanlar grup 4 olarak adlandırıldı. Gruplar kapalı reduksiyonun elde edilmesi, yeniden çıkık gelişimi, takiplerinde asetabuler displazi nedeni ile pelvik osteotomi uygulanması, son kontrollerindeki fizik muayene ve radyoloji bulguları dikkate alınarak Mc Kay sınıflandırma sistemi ve Tonnis’in tarifflediği asetabuler displazi acısından kendi aralarında karşılaştırıldı. Bulgular: Tedaviye başlanıldığında hastaların ortalama yaşları 11.5 ay ve ortalama takip suremiz 35.1 ay idi. Grup 1’de24 kalca (%19.1), grup 2’de43 kalca (%34.1), grup 3’de 28 kalca (%22.2) ve grup 4’de 31 kalca (%24.6) mevcuttu. Grup 1 ve 2’deki hastaların hepsinde kapalı reduksiyon elde edilirken, grup 3’de 2 kalcada (%5.6), grup 4’de ise 4 kalca-da (%12.9) kapalı reduksiyon elde edilemedi. Tum gruplarda birer hastada takiplerinde yeniden çıkık gelişti. Yeniden çıkık gelişme oranı gruplara göre sırası ile %4.1; %2.3; %3.5 ve %3.2 idi. Takiplerinde asetabuler displazinin devam etmesi nedeni ile grup 1’ de 1 (%4.1), grup 2’ de 4 (%9.3), grup 3’ de 2 (%7.1) ve grup 4’ de 6 kalçada (%19.3) pelvik osteotomi uygulandı. Mc Kay sınıflandırma sistemine göre grup 1’deki kalcaların 18’inde (%81.8) cok iyi, 4’unde (%18.2) iyi; grup 2’deki kalcaların 33’unde (%86.8) cok iyi, 5’inde (%13.2) iyi; grup 3’deki kalcaların 20’sinde (%87) cok iyi, 3’unde iyi (%13) ve grup 4’deki kalçaların 14’unde (%70) cok iyi, 3’unde (%15) iyi ve 3’unde (%15) orta sonuc mevcuttu. Tonnis’ in tarif ettiği asetabuler displazi derecelendirmesine göre 27 kalçada evre 4 displazi mevcuttu. Ciddi, evre 4 displazili kalça sayısı grup 1’de 2 (% 8.7); grup 2’de 5 (%11.9), grup 3’de 5 (%20) ve grup 4’de 15 (%57.7) idi. Tum hastalarda reduksiyon oncesine gore son kontroldeki grafilerde asetabular indeks acısından anlamlı fark mevcuttu (p < 0.001). Kapalı reduksiyon elde edilememe acısından grup 3 ve 4 diğer gruplardan anlamlı farklılık gösteriyordu (p=0.005). Klinik parametreler acısından yaşlar arasında istatiksel olarak anlamlı fark mevcuttu (p=0.039). Displazi acısından yaşlar arasında istatiksel olarak anlamlı fark mevcuttu (p=0.001). Çıkarımlar: Bir yaşından sonra tedaviye başlanılan kalcalarda calışmamızda kapalı reduksiyon elde edememe, asetabuler displazinin düzelmemesine bağlı pelvik osteotomi uygulanma oranı daha yüksek bulunmuştur. Daha iyi sonuclar elde edebilmek icin tedaviye erken dönemde başlanılmalı ve bir yaşın üzerinde tedaviye başlanılan hastalar asetabular displazinin varlığını sürdürmesi acısından yakından takip edilmelidir.

The adaptation of scales to the native language and cultural setting of the patient is essential for obtaining more reliable results in scientific studies. In this study, the rotator cuff-quality of life scale (RC-QoLS) was translated into Turkish, and validity and reliability testing was performed on the scale. The scale was first translated into Turkish and then from Turkish to English by another language specialist. Subsequently, the two translations were evaluated by two orthopaedic surgeons who had comprehensive knowledge of English to create the final Turkish version of RC-QoLS. The scale was used for the assessment of 54 patients (average age 56 years) with rotator cuff tear scheduled for surgery. The scale was completed by each patient two times with 1-week interval. The Cronbach’s alpha coefficients ranged between 0.895 and 0.980 and intraclass correlation coefficients ranged between 0.807 and 0.976, this rendered all domains reliable. The scale gave results very near to those obtained by the original questionnaire with respect to the constructed validity and internal consistency as well as domain relationships. In general, the Turkish version of the RC-QoLS is a valid and reliable test with high differentiating power that may be used in the evaluation the quality of life of patients with RC tear in patients who are native Turkish speaker. The use of the Turkish version of RC-QoLS may contribute to the making of a more reliable evaluation in the studies on RC problems in the Turkish society.

Introduction: Radiofrequency microtenotomy is used to enhance healing by increasing vascularity in the degenerated tendon. In the present study, the effect of radiofrequency microtenotomy (Rf-mt) treatment on tendon degeneration was investigated. Materials and methods: A total of 32 New Zealand rabbits were enrolled in the current study. Experimental degeneration was performed by injecting prostaglandin E1 (PGE1) into the bilateral Achilles tendons of rabbits. After excluding 4 rabbits with an infection on the injection site, 4 other rabbits were sacrificed to define the histopathologic changes in the tendons. The remaining 24 rabbits were divided into 2 groups: the control group and the Rf-mt group. In the control group, the Rf-mt device was only applied to the Achilles tendon without running the device. In the Rf-mt group, the Rf-mt device was applied bilaterally at the fourth energy level for 500 ms to an area within 2 cm proximal to the insertion site at 0.5 cm intervals in order to form a grid. Six rabbits from each group were sacrificed at 6 and 12 weeks. The Achilles tendons were evaluated histopathologically by a modified Movin scale and by immunohistopathologic staining for vascular endothelial growth factor and type 4 collagen. Results: After the PGE1 injection, findings similar to chronic degenerative tendinopathy were observed. The Rf-mt group showed significant improvement in vascularity in the histopathological and immunohistochemical examination (P < 0.05). However, there was no significant difference in healing between the control and Rf-mt groups (P > 0.05). Conclusions: Rf-mt treatment increases vascularity in degenerated tendons but does not create difference to facilitate the healing process comparing control group. (C) 2013 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Introduction Total hip replacement in patients with developmental dysplasia of the hip (DDH) is a difficult technical procedure for surgeons to perform because of the potential for these patients to have severe anomalies in their bones and soft tissues. Materials and methods We performed acetabuloplasty in 54 hips from 44 patients by reaming the posterior wall of the native acetabulum and medialising the acetabular component to restore the anatomic centre of hip rotation using a small cup without bone grafting. Median time to post-surgery follow-up was 5 (range 2-14) years. Results Prosthetic survival rates in patients after 2 and 5 years post hip replacement were 93% (50/54) and 89% (48/54), respectively. 4 patients required early revision because of malposition and instability of the acetabular cup. 3 patients with Crowe type IV dislocations had transient sciatic nerve palsy and 3 had deep vein thrombosis. Conclusions Placement of the acetabular shell using posterior bone stock to provide normal hip rotation is a successful alternative technique for acetabuloplasty in patients with DDH.

Viper is a new device for arthroscopically all-inside meniscal repairing. In previous studies about Viper device, procedures were not applied arthroscopically despite this device has been designed for arthroscopic application. In this study, we evaluated primary fixation strength of arthroscopically applied meniscal repair using Viper device to obtain better clinical relevance. Two centimeter in length meniscal tear 2-3 mm far from periferic edge of medial meniscus of 50 calves were created arthroscopically. The menisci were divided into five groups including 10 menisci in each. In group 1, tears were repaired by outside-in vertical loop suture technique with No: 0 PDS. Tears were fixed by all-inside vertical suture by using Viper device with No: 0 PDS in group 2. In meniscal implant groups, RapidLoc, H-Fix, and Clearfix were applied in groups 3,4, and 5, respectively. Primary fixation strength of repairing techniques were evaluated with bio-mechanical testing machine. Fixation strengths determined in groups 1 and 2 were detected as 145 +/- 13 and 136 +/- 33 N, respectively. There was no difference in pull-out strength between groups 1 and 2. Fixation strengths in these two groups were significantly higher compared to groups 3, 4, and 5. There was no significant difference between group 3 (33 +/- 6 N) and 5 (28 +/- 6 N) in terms of fixation strengths whereas fixation strengths of these two groups were significantly higher compared to group 4 (20 +/- 3 N) (P = 0.005, P = 0.018, respectively). All-inside vertical suture technique using Viper device revealed comparable primary fixation strength with outside-in vertical suture technique for meniscal repair. We suggest that the Viper device is safe and reliable for meniscal repair.

Osteoid osteoma is a benign, osteoblastic and painful tumoral lesion. Apart from en-bloc resection, intralesional resection and percutaneous excision or destruction of the nidus, arthroscopic removal of the lesion in intraarticular locations have been reported. We present a patient with osteoid osteoma at distal femur which is accessible through knee joint, treated by arthroscopic complete excision.

PubMed: 16915400 We evaluated the results of polygonal triple (Kotz) osteotomy for the treatment of acetabular dysplasia over 10 years. This study included 31 hips of 27 patients who had the Kotz osteotomy for acetabular dysplasia. The mean age was 21.5 years. We performed the original Kotz osteotomy for the first 22 hips (group I), while the modified Kotz osteotomy through an intra-pelvic approach without damage to the abductor muscle was applied for the last 9 hips (group II). Patients were evaluated by clinically and radiologically. The average follow-up was 106 months in group I, and 18 months in group II. The Trendelenburg gait was unchanged for four patients in group I and for one patient in group II. The Harris Hip Score improved in all patients postoperatively. Radiographic assesment showed improvement in both groups in terms of the angle of CE, VCE, and Sharp postoperatively(P

Alteration of tibial slope is one of the important anatomical changes of the proximal tibia after high tibial osteotomy. Increased or decreased tibial slope can effect further total knee prosthesis procedure. In this retrospective study, 18 knees of 17 patients (17 female, mean age 51 range 43-61, mean BMI is 33.6 +/- 4.6 kg/m2) who were applied high tibial osteotomy using circular external fixator due to medial compartment arthrosis of the knee were evaluated in terms of tibial slope changes. While mean correction about 12.3 degrees in mechanical femoro-tibial angle was obtained in frontal plan (P = 0.0001), significant change in tibial slope was not determined in sagittal plan (P = 0.127). The mean posterior proximal femoral angle values were measured as 79.5 +/- 2.1 degrees preoperatively and as 80.3 +/- 2.7 degrees postoperatively and found to fall into the normal range (80.4 +/- 1.6 degrees). As there is no significant alteration in tibial slope after high tibial osteotomy performed with the Ilizarov system, complications due to alteration in tibial slope will not be experienced in follow-up or in further total knee prosthesis procedure.

In this retrospective study we evaluated the method of acute shortening and distraction osteogenesis for the treatment of tibial nonunion with bone loss in 17 patients with a mean age of 36 years (10 to 58). The mean bone loss was 5.6 cm (3 to 10). In infected cases, we performed the treatment in two stages. The mean follow-up time was 43.5 months (24 to 96). The mean time in external fixation was 8.0 months (4 to 13) and the mean external fixator index was 1.4 months/cm (1.1 to 1.8). There was no recurrence of infection. The bone evaluation results were excellent in 16 patients and good in one, while functional results were excellent in 15 and good in two. The complication rate was 1.2 per patient. We conclude that acute shortening and distraction osteogenesis is a safe, reliable and successful method for the treatment of tibial nonunion with bone loss, with a shorter period of treatment and lower rate of complication.

To study high frequency sonographic in the examination of plantar fasciitis (PF), which is a common cause of heel pain.Our study was done with 25 PF (21 unilateral, 4 bilateral) and 15 control cases of similar age, weight and gender. In this study, the plantar fascial thickness (mainly), fascial echogenity and biconvexity were examined using 7.5 MHz linear phase array transducer. Perifascial fluid collection, fascial rupture and fascial calcification that are rarely seen were also examined.The fascial thickness ranges for the PF cases: for the symptomatic heels: 3.9-9.1 mm (mean: 4.75 +/- 1.52 mm), for the asymptomatic heels: 2.0-5.9 mm (mean: 3.37 +/- 1.0 mm) and for the control group: 2.1-4.7 mm (3.62 +/- 0.68 mm). The results were significantly different in Group I for symptomatic heels and the control group statistically for PF (P.05). The echogenity of plantar fascia and biconvexity of plantar fascia were the major criteria for symptomatic heels. In three heels (10%), perifascial fluid was diagnosed, in three heels (10%) fascial calcification, in one heel (3%) partial fascial rupture. Subcalcaneal spur was encountered sonographically in both cases of Groups I and II.Ultrasonography (US) is the first step for PF, because of its easy and quick performance, availability and high sensitivity of diagnosis, low-cost and free radiation.

Objective:The aim of this study was to investigate the effects of antioxidant molecules Melatonin and Caffeic Acid Phenethyl Ester (CAPE) on fracture healing under ischemic conditions.Methods: A right tibia fracture was created and fixed with an intramedullary pin in forty four male Wistar-albino rats. The rats were then randomly allocated to fracture, fracture-ischemia, fracture- ischemia-melatonin, and fracture-ischemia-CAPE groups. Ischemia was created by clamping femoral arteries four and a half hours. Animals were killed and radiographic, histological and biomechanical evaluation was performed sixth week after surgery.Results: The radiological and histological scores of the fracture-ischemia-CAPE group were significantly better than the fracture- ischemia group at 6th week follow-up. Complete radiographical and histological healing of all fractures was detected in all groups. There was a significant difference between the maximum fracture force between the groups (fracture-ischemia, Amaç:Çalışmada melatonin ve kafeik asit fenetil ester (CAPE) antioksidan moleküllerinin iskemik ortamda kırık iyileşmesi üzerine etkisinin incelenmesi amaçlandı.Çalışma planı: Kırk dört erkek Wistar-albino sıçan tibiasında kırık oluşturulup intramedüller pinleme ile tespit uygulandı. Daha sonra sıçanlar rastgele kırık, kırık-iskemi, kırık-iskemi-melatonin ve kırık-iskemi-CAPE gruplarına ayrıldı. İskemi gruplarındaki sıçanların femoral arterleri 4.5 saat süreyle klemplendi. Cerrahi girişimden 6 hafta sonra sıçanlar sakrifiye edildi ve radyografik, histolojik ve biyomekanik değerlendirmeler yapıldı.Bulgular: Radyografik ve histolojik olarak, 6. hafta sonunda kırık-iskemi-CAPE grubu kırık-iskemi grubundan anlamlı olarak iyi sonuçlar verdi. Tüm gruplarda, tüm kırıkların radyolojik ve histolojik olarak tam iyileştiği saptandı. Maksimum kırılma kuvvetlerinin (N) karşılaştırılmasında, gruplar arasında (kırık-iskemi

Objectives: Different techniques and choices exist for revision of pedicle screws, two of which are pedicle screw combined with cement augmentation and expansive pedicle screw fixation. This biomechanical study was designed to compare the pullout strengths of two different revision techniques.Methods: Fourteen lumbar vertebrae obtained from four calves (mean age 15 months) were divided into two groups equal in number. Monoaxial 6.0-mm pedicle screws were inserted into the right pedicles, and axial pullout testing was performed at a rate of 10 mm/min and failure strengths were recorded. Revision was performed with the same-sized pedicle screws reinforced with polymethylmethacrylate in group 1, and with 7.0-mm expansive pedicle screws in group 2, and pullout testing was repeated to record maximum revision pullout strengths.Results: The mean pullout strengths recorded before and after revision were significantly different in both groups, being 2,162.9±718.5 N and 2,794.3±979.2 N in group 1 (p=0.041) and 2,605.0±487.6 N and 3,327.1±640.8 N in group 2 (p=0.012), respectively. However, the mean pullout strengths recorded before and after revision did not differ significantly between the two groups (p>0.05).Conclusion: Our results showed that expansive pedicle screws 1 mm larger in diameter provide similar pullout strengths to those of same-sized, polymethylmethacrylatereinforced screws in revision of pedicle screw fixation, suggesting that they can be preferred with the additional advantages of ease of application and avoiding risks for pedicle fracture and cement leakage., Amaç: Pedikül vidalarının revizyonlarında çeşitli yöntemler ve seçenekler kullanılmaktadır. Bunlardan ikisi vidaların çimentoyla güçlendirilmesi ve ucu genişleyebilen pedikül vidalarının (UGPV) kullanılmasıdır. Bu biyomekanik çalışmada, pedikül vida revizyonlarında kullanılan iki farklı tekniğin sıyırma güçleri karşılaştırıldı.Çalışma planı: Ortalama 15 aylık dört adet dananın lomber omurgalarından, her biri yedi adet omur içeren iki grup oluşturuldu. Omurların sağ pediküllerine 6 mm çaplı monoaksiyel pedikül vidaları uygulandı ve 10 mm/dk hızında aksiyel sıyırma testi yapıldı, yetmezlik değerleri kaydedildi. Grup 1’deki pediküllerin revizyonu 6 mm’lik pedikül vidası ve polimetilmetakrilat güçlendirmesi ile yapıldı. Grup 2’deki pediküllerin revizyonu ise 7 mm’lik, uç kısımları genişleyebilen pedikül vidaları ile yapıldı. Revizyon sonrasında örneklere aynı hızda sıyırma testi uygulandı ve değerler kaydedildi.Sonuçlar: Revizyon öncesi ve sonrası sıyırma güçleri her iki grupta da anlamlı farklılık gösterdi (grup 1’de sırasıyla 2162.9±718.5 N ve 2794.3±979.2 N, p=0.041; grup 2’de 2605.0±487.6 N ve 3327.1±640.8 N, p=0.012). İki grup arasında hem başlangıç sıyırma güçleri hem de revizyon sonrası sıyırma güçleri ortalamaları arasında anlamlı fark bulunmadı (p>0.05). Çıkarımlar: Pedikül vida revizyonlarında, 1 mm daha geniş UGPV’nin sıyırma gücünün, polimetilmetakrilatla güçlendirilmiş ve revizyon öncesiyle aynı çaptaki pedikül vidalarıyla benzer olduğu görüldü. Uç kısmı genişleyebilen pedikül vidaları, pedikül kırığı ve çimento sızma gibi riskleri taşımaması ve daha kolay uygulanabilmeleri nedeniyle revizyon cerrahisinde tercih edilebilir.

Osteoid osteoma is a benign bone tumor representing approximately 10% of all benign bone tumors. Although osteoid osteoma of the long bones and carpus is frequent, the location in the trapezium is extremely rare. We found only one other report in the literature regarding osteoid osteoma of the trapezium.

Irreducible Galeazzi fracture–dislocation is a rare injury. Structures that mechanically block the reduction are usually soft tissues. We present an irreducible case due to distal ulnar intra-articular fracture.

Objective: The aim of this study was to compare the short-term results of total knee arthroplasty (TKA) surgeries performed with minimally invasive mini-midvastus (MMV) incision and the standard medial parapatellar technique (ST).Methods: Twenty patients (18 males, 2 females; mean age: 67.25±6.70) operated with the ST and 19 patients (4 males, 15 females; mean age: 64.53±7.53) operated with the MMV approach were retrospectively evaluated. The surgery time, blood loss, time to straight leg raise (SLR) postoperatively, range of motion (ROM) and Knee Society (KSS) score and Hospital for Special Surgery (HSS) score were compared between the groups. Radiological evaluation was made with standing orthoroentgenographs both pre- and postoperatively. Mean follow-up time was 29.4±8.2 months in the ST and 17.7±11.1 months in the MMV group.Results: In the early postoperative period (10th day), the MMV group was significantly better than the ST group in terms of ROM. Time to SLR and blood loss values were also significantly better in the MMV group. However, there was no significant difference between the groups after the sixth month, for ROM, KSS and HSS values (p>0.05). Surgery time was significantly longer (with a mean difference of 22 minutes) in the MMV group. Radiological examination revealed ideal alignment in both groups. No deep or superficial infection was detected. Two patients in the MMV group had skin problems which healed after clinical follow-up.Conclusion: Our results suggested that functional results of TKAs performed via the MMV approach are better in the first six months when compared to those of the ST., Amaç: Çalışmada minimal invazif midvastus insizyon (MMV) tekniği ve standart medial parapatellar teknikle (ST) yapılan total diz protezlerinin (TDP) kısa dönem sonuçlarının karşılaştırılması amaçlandı. Çalışma planı: Çalışmada TDP ameliyatı ST ile yapılan 20 hasta (18 erkek, 2 kadın; ort. yaş 67.25± 6.7) ile MMV yöntemle yapılan 19 hasta (4 erkek, 15 kadın; ort. yaş 64.53±7.53) geriye dönük olarak değerlendirildi. İki grup ameliyat süresi, kan kaybı, ameliyat sonrası düz bacak kaldırmaya başlama zamanı (DBK), eklem hareket açıklığı ve Knee Society (KSS) ve Hospital for Special Surgery (HSS) skorları yönünden karşılaştırıldı. Radyolojik olarak ise ameliyat öncesi ve sonrası ayakta çekilen boy filmleriyle değerlendirme yapıldı. Ortalama takip süresi ST grupta 29.4±8.2 ay, MMV grupta ise 17.7±11.1 aydı. Bulgular: Ameliyat sonrası erken dönemde (10. gün), eklem hareket açıklığı (EHA) yönünden MMV grubunun ST grubundan anlamlı derecede üstün olduğu gözlendi. DBK zamanı ve kan kaybı yönünden de MMV grubu anlamlı olarak üstündü. Bununla birlikte 6. aydan sonra EHA, KSS ve HSS değerleri açısından iki grup arasında anlamlı fark olmadığı saptandı (p>0.05). Ameliyat süresi MMV grubunda anlamlı olarak, ortalama 22 dakika daha uzundu. Radyolojik olarak ise her iki grupta da ideal dizilimin sağlandığı görüldü. Derin veya yüzeyel enfeksiyon saptanmazken, MMV gruptaki iki hastada klinik takiplerle düzelen cilt problemi gözlendi. Çıkarımlar: Standart teknikle kıyaslandığında MMV yaklaşımı ile yapılan TDP ameliyatı erken dönemde fonksiyonel olarak daha iyi sonuçlar vermekte, ancak 6. ay sonrasında her iki tekniğin sonuçları da benzer olmaktadır.

Objective: Tissue repair that occurs after microfracture does not include hyaline-like cartilage. Therefore, other treatment modalities must be combined with microfracture to improve repair tissue quality. In this study, we combined exogenous hyaluronic acid with microfracture. Design: Thirty mature New Zealand rabbits were randomly divided into 3 groups as control, microfracture (MF), and microfracture and hyaluronic acid (MFHA). Four-millimetre full-thickness cartilage defects were created in the medial femoral condyle of each rabbit. Microfracture was performed on defects in the MF and MFHA groups. At 1 week following surgery, 1 mL of saline was injected into the knees of the control and MF groups, whereas 1 mL (15 mg/mL) hyaluronic acid was injected into the knees of the MFHA group 3 times weekly. At 6 months postsurgery, defects were evaluated according to the ICRS (International Cartilage Repair Society) and Wakitani scales. Results: According to the ICRS and Wakitani scales, the quality of repair tissue was improved in MF and MFHA groups as compared the control group ( P = 0.001 and 0.001, respectively). No significant difference was observed between the MF and MFHA groups ( P = 0.342). Conclusions: According to the model in this study, no beneficial effect was obtained when HA injection was combined with microfracture in the treatment of full-thickness cartilage defects.

Objective: Statins stimulate bone formation by inducing the expression of bone morphogenetic proteins (BMP-2). The aim of our study was to investigate the effects of orally administered simvastatin on spinal fusion in rats.Methods: Twenty rats were randomized into a spinal fusion group (SF) (n=10) or a spinal fusion and oral simvastatin administered group (SFS) (n=10). A spinal fusion was performed between L4-L6 representing two levels. Simvastatin (120 mg/kg/day) was administered orally in the SFS group. The rats were killed at the end of the 12 week study period.Results: Manual palpation revealed two moderate fusions in the SF group. The SFS group did not reveal any signs of pseudoarthrosis. An average three-point bending force causing failure of fusion revealed results of 148.80±39.403 Newtons and 123.80±28.479 Newtons in SFS and SF groups, respectively (p>0.05). Histological examination revealed better fusion grades in the SFS group (mean: 9.30±0.949) than in the SF group (mean: 6.80±2.044) (p=0.003). Radiographic examination revealed Grade C fusion in two levels and Grade A fusion in 18 levels in the SF group. In the SFS group, Grade C fusion was detected in one level and Grade A fusions in 19.Conclusion: Our results suggest that simvastatin can promote spinal fusion and can be used as an adjunct to spinal fusion procedures in an elderly population with high cholesterol levels., Amaç: Statinler kemik morfogenetik proteinlerinin (BMP-2) üretimini uyararak kemik oluşumuna katkıda bulunurlar. Çalışmamızda, sıçanlarda ağız yoluyla simvastatin alımının spinal füzyon üzerine olan etkilerini araştırmayı hedefledik. Çalışma planı: Yirmi adet sıçan spinal füzyon grubu (SF; n=10) ve spinal füzyon ve simvastatin grubu (SFS; n=10) olarak rastgele iki gruba bölündü. L4-L6 arasına (her sıçanda toplam 2 seviye) spinal füzyon modeli uygulandı. Simvastatin 120 mg/kg/gün dozunda SFS grubundaki sıçanlara ağız yoluyla verildi. Sıçanlar 12. hafta sonunda öldürüldü. Bulgular: Elle muayenede SF grubunda 2 orta dereceli füzyon tespit edilirken, SFS grubunda psödoartroz görülmedi. Ortalama 3 nokta eğme testi ile füzyonda yetmezlik oluşturan değerler SFS ve SF gruplarında, sırasıyla, 148.80±39.403 Newton ve 123.80±28.479 Newton olarak tespit edildi (p>0.05). Histolojik skorlamalarda SFS grubunda ortalama 9.30 ±0.949 değerle SF grubundan (ortalama: 6.80±2.044) daha iyi sonuçlar elde edildi (p=0.003). Radyolojik değerlendirmede SF grubunda 2 seviyede Derece C ve 18 seviyede Derece A füzyon tespit edilirken, SFS grubunda 1 seviyede Derece C ve 19 seviyede Derece A füzyon tespit edildi. Çıkarımlar: Sonuçlarımız simvastatinin spinal füzyona katkıda bulunabileceğini ve yüksek kolesterollü yaşlı hastalarda spinal füzyon girişimlerinde ek ilaç olarak kullanılabileceğini önermektedir.

One of the important factors effecting meniscal healing is the strength of primary fixation obtained by repairing technique. From this perspective, it is important to choose the technique ensuring a higher primary fixation strength for meniscal repairs. We described a new technique for meniscal repair called “butterfly” technique using Viper device and hypothesized that high primary fixation strength can be obtained with this technique. The study was performed on calve knees. Full-thickness longitudinal tears 2 cm in length and 3 mm medial from the periphery were created in corpora of medial menisci of 14 calves. After creating tears, menisci were divided into two equal groups. In Group 1, two vertical loop sutures 1 cm apart were placed using a Viper device. Whereas in Group 2, tears were repaired using “butterfly” sutures. The mean load to failure was 156.3 ± 13.1 and 186 ± 15.8 N in Group 1 and 2, respectively (p = 0.002). The fixation strength in Group 2 was significantly higher than in Group 1. We suggest that, using Viper device and all-inside “butterfly” suturing techniques, meniscal ruptures with appropriate locations can be repaired with higher primary fixation strength.

Objectives: We evaluated the clinical and radiographic results of total hip arthroplasties (THA) performed with the minimally invasive anterolateral (MIA) and standard anterolateral (SA) approaches.Methods: We retrospectively reviewed 25 patients (17 women, 8 men; mean age 57.7±12.5 years) and 15 patients (11 women, 4 men; mean age 68.9±5.5 years) who underwent THA with the SA and MIA approaches, respectively. The mean body mass index was 32.5±5.8 kg/m2 in the SA group and 28.7±2.7 kg/m2 in the MIA group. The two groups were compared with respect to blood loss, operation time, blood transfusions, and length of hospital stay. Pain was assessed with a visual analog scale (VAS), and functional results were assessed with the Harris hip score (HHS). The SF-36 questionnaire was administered pre- and postoperatively. Radiographic evaluations included femoral and acetabular components and signs of loosening. The mean follow-up was 25.2±8.7 months in the SA group and 26.1±7.2 months in the MIA group.Results: The amount of blood loss and blood transfusions were significantly reduced and length of hospital stay was significantly shorter in the MIA group (p0.05). Improvements in the VAS and HHS scores were significantly better in the MIA group (p, Amaç: Minimal invaziv anterolateral (MİA) ve standart anterolateral (SA) yaklaşımlarla yapılan total kalça protezi (TKP) ameliyatlarının klinik ve radyografik sonuçları değerlendirildi. Çalışma planı: Çalışmada, TKP ameliyatı SA yaklaşımla yapılan 25 hasta (17 kadın, 8 erkek; ort. yaş 57.7±12.5) ve MİA yaklaşımla yapılan 15 hasta (11 kadın, 4 erkek; ort. yaş 68.9±5.5) geriye dönük olarak incelendi. İki grupta ortalama vücut kütle indeksi sırasıyla 32.5±5.8 kg/m2 ve 28.7±2.7 kg/m2 idi. Hastalar kan kaybı, ameliyat süresi, kan transfüzyon miktarı ve hastanede yatış süresi açısından karşılaştırıldı. Ağrı görsel analog skala (GAS), fonksiyonel sonuçlar Harris kalça skoru (HKS) ile değerlendirildi. Ayrıca, tüm hastalara ameliyat öncesi ve sonrasında SF-36 uygulandı. Radyografik olarak, son kontrollerde femoral ve asetabular bileşenler ve gevşeme bulguları değerlendirildi. Ortalama takip süresi SA grubunda 25.2±8.7 ay, MİA grubunda 26.1±7.2 ay idi. Sonuçlar: Kanama ve kan transfüzyon miktarları ve hastanede yatış süresi MİA grubunda anlamlı derecede daha az idi (p0.05). İki grup arasında ameliyat öncesi GAS ve HKS skorları açısından anlamlı fark yoktu. Ağrı ve HKS skorlarındaki iyileşme MİA grubunda daha belirgin idi (p

Objectives: Conservative treatment should be tried prior to surgical treatment in knee osteoarthritis. This study was designed to evaluate the short-term effects of mud-pack therapy on painrelief and functional improvement in knee osteoarthritis in comparison with intra-articular hyaluronic acid injections.Methods: The study included 23 patients who were diagnosed as having knee osteoarthritis according to the ACR (American College of Rheumatology) criteria, and had complaints lasting for more than three months. All the patients had stage 2 or 3 osteoarthritis radiographically according to the Kellgren-Lawrence criteria. Twelve patients (3 males, 9 females; mean age 54±6 years; range 46 to 67 years) received mud therapy bilaterally. Mud packs were heated to 45 °C and applied on both knees for 30 minutes daily for a total of 12 weekdays. Eleven patients (2 males, 9 females; mean age 53±9 years; range 40 to 66 years) received a total of three bilateral intra-articular hyaluronic acid injections, each interspersed by weekly intervals. The patients were evaluated before and after treatment in terms of pain and functionality using the pain subscale of the WOMAC (Western Ontario and McMaster Universities) osteoarthritis index, Hospital for Special Surgery (HSS) score, and Knee Society clinical rating system (knee and function scores). The patients were followed-up for a mean of 5.9±6.3 months (range 4 to 8 months) after mud pack therapy, and 5.8±0.8 months (range 5 to 7 months) after intra-articular hyaluronic acid injections.Results: No significant differences were found between the two groups with respect to pre-and posttreatment WOMAC, HSS, and knee and function scores (p>0.05). The scores of all instruments showed significant improvements following treatment in both groups (p0.05).Conclusion: Treatment of knee osteoarthritis with intra-articular hyaluronic acid injections or mud-pack therapy yielded similar results in the short-term in terms of functional improvement and pain relief. Mud-pack therapy is a noninvasive, complication-free, and cost-effective alternative modality for the conservative treatment of knee osteoarthritis., Amaç: Diz osteoartritinde cerrahi tedaviden önce zaman kazandırıcı konservatif yöntemler denenmelidir. Çalışmamızda, diz osteoartritinde tıbbi çamur tedavisinin kısa dönemde ağrı ve fonksiyonlar üzerine etkisi değerlendirildi ve eklemiçi hiyalüronik asit uygulamasıyla karşılaştırıldı. Çalışma planı: Çalışmaya, Amerikan Romatoloji Derneği ölçütlerine göre diz osteoartriti tanısı konan ve yakınmaları üç aydan uzun süren 23 hasta alındı. Kellgren-Lawrence sistemine göre radyografik olarak bütün hastalarda evre 2 veya 3 diz osteoartriti vardı. On iki hastanın (3 erkek, 9 kadın; ort. yaş 54±6.; dağılım 46-67) her iki dizine, günde bir kez, 12 gün süreyle, 45 ˚C sıcaklıkta ve 30 dakika süreyle, diz üzerine paket tarzında çamur tedavisi uygulandı. On bir hastanın (2 erkek, 9 kadın; ort. yaş 53±9; dağılım 40-66) her iki dizine de, birer hafta arayla üç kez hiyalüronik asit enjeksiyonu uygulandı. Hastalar tedavi öncesi ve tedavi sonrası son kontrollerinde WOMAC osteoartrit ölçeğinin (Western Ontario and McMaster Universities) ağrı altbölümü, HSS skoru (Hospital for Special Surgery) ve Diz Derneği (Knee Society) fonksiyon skoru ve diz skoru ile ağrı ve fonksiyon açısından değerlendirildi. Çamur tedavisi grubunda ortalama takip süresi 5.9±6.3 ay (dağılım 4-8 ay), hiyalüronik asit grubunda 5.8±0.8 ay (dağılım 5-7 ay) idi.Sonuçlar: Hem tedavi öncesi hem de tedavi sonrası WOMAC, HSS, diz ve fonksiyon skorları iki grup arasında anlamlı farklılık göstermedi (p>0.05). Her iki grup içinde de, işlem öncesine göre işlem sonrasında tüm skorlarda anlamlı iyileşme görüldü (p0.05).Çıkarımlar: Diz osteoartritinde eklemiçi hiyalüronik asit ve tıbbi çamur uygulamaları hastaların fonksiyonlarında iyileşme ve ağrının azaltılmasında kısa dönemde benzer sonuçlar göstermektedir. Girişim gerektirmemesi, komplikasyonsuz ve düşük maliyetli bir seçenek olması nedeniyle, tıbbi çamur diz osteoartritinde kullanılabilecek önemli bir konservatif tedavi seçeneğidir.

WOS:000271857900012 PubMed: 19881326 Objectives: It has been shown that reactive oxygen species (ROS) contribute to the onset and progression of osteoarthritis. We investigated cartilage destruction and oxidative stress parameters in the blood and synovial fluid of knee joints of rabbits exposed to varying periods of immobilization. Methods: Twenty-eight mature New Zealand albino male rabbits were divided into four groups equal in number. In three groups, the knees were immobilized with a rigid cast for 3. 6 and 9 weeks, respectively. The cartilaginous tissue of the femoral condyles and tibial plateau were analyzed with respect to total count., total volume.. and numerical density of chondrocytes using stereohistological methods. Antioxidant activities of superoxide dismutase (SOD), catalase (CAT), and glutathion peroxidase (GSH-Px), and oxidative stress parameters including nitric oxide (NO) and malondialdehyde (MDA) levels were measured in the plasma and synovial fluid. Results: Compared to the control group, total count and total volume of chondrocytes in the femoral condyle and tibial plateau showed significant decreases, while numerical density showed a significant increase at 3 weeks of immobilization. Subsequent immobilization periods resulted in significant decreases in all these parameters, being most remarkable compared to the control group at the end of nine weeks (p

Generally, surgeon-driven musculoskeletal evaluation systems are used for evaluating outcomes of patients who are treated with high tibial osteotomy. In this study, we investigated the effects of high tibial osteotomy using circular external fixator on quality of life. Twenty-one high tibial osteotomy of 19 patients were evaluated. Quality of life assessment was made using Short Form -36 at preoperative, before fixator removal and 6 months after fixator removal. After applying fixator, the physical function and physical role scores of Short Form-36 decreased and emotional role score did not improve. In other categories, significant improvements were observed when fixator in place. At the sixth month after fixator removal, significant improvements were dedected in all categories of Short Form-36. Although there was a decrease in physical functions after fixator application in patients who were treated with high tibial osteotomy using circular external fixator, significant improvement occurred in quality of life after fixator removal.

An intra-articularly located ligament in the first metatarsophalangeal joint of the left foot has been detected in a patient. The intra-articular ligament was dorsomedially attached to the head of the first metatarsal and to the inferior part of the articular face of the base of the proximal phalanx of the big toe. In a literature search we could not find any report of a ligament located intra-articularly in this particular joint. Such a variation may have a role in the etiology of hallux valgus.

WOS:000239172000012 PubMed: 16523336 In this experimental animal study the effects of calcitonin and alendronate on distraction osteogenesis are investigated. Forty-five mature female New Zealand type rabbits were used. Rabbits were randomized into three groups, each consisting of 15 animals. Under optimal operating conditions a pre-reconstructed circular external fixator was applied to the right tibia of rabbits, and osteotomy was performed with a Gigli saw just below the tibial tuberosity. During the ten days of distraction, a placebo was administered for group I (control group), group II received 10 U of calcitonin, and group III was treated with alendronate (0.5 mg/kg/day) gavages. Rabbits were examined histologically (at the third and eighth weeks, according to Huddlestone et al.), radiologically (at the third, sixth, and eighth weeks, according to Lane and Sandhu), and mechanically (at the eighth week, as torsional loading). During the first three weeks, the groups did not differ much with regard to radiological parameters. However, in the calcitonin and alendronate groups improved histological scores were detected compared with the control group. Radiological images obtained at the end of six weeks demonstrated improved consolidation in the calcitonin and alendronate groups compared with the control group. At the end of eight weeks postoperatively, radiological and histological parameters did not differ among the groups, while torsional failure load was found to be much improved in the calcitonin group (p=0.006). During the distraction osteogenesis period, calcitonin and alendronate affected the quality of regenerate favourably. This effect is sustained until the end of the consolidation period. However, this finding needs to be supported by experimental and human studies.

In the management of bone defects, pseudoarthrosis, deformities, chronic osteomyelitis and in extremity lengthening procedures, the technique of distraction osteogenesis (DO) has been frequently used. In this experimental animal study, the effects of two non-steroidal anti-inflammatory drugs, i.e., diclofenac and tenoxicam, on the outcomes of distraction osteogenesis are investigated.In this study, 30 mature New Zealand-type male rabbits (2.5-4.5 kg) were used. The rabbits were randomized into three groups, each consisting of ten animals. Under optimal operating conditions, a pre-reconstructed circular external fixator was applied on the right tibias of rabbits, and osteotomy was performed with a Gigli saw just below the tibial tuberosity. After seven postoperative days, distraction was initiated at a rhythm of 2 x 0.5 mm/day. During the 10 days of distraction, adjunctive therapy was not instituted for group I (control group). For 10 days, group II received i.m. diclofenac sodium (0.5 mg/kg per day) and group III was treated with tenoxicam (8 mg/kg per day i.m.). At the end of 3 weeks postoperatively, five rabbits from each group were killed for histologic examinations. The remaining rabbits were killed at the end of eight postoperative weeks for biomechanical and histological analysis. Besides, radiological examinations were performed at the end of 3, 6 and 8 weeks postoperatively for the radiologic evaluation of calluses. For statistical evaluations between groups, Kruskal-Wallis variance analysis, and for intergroup assessments, Mann-Whitney test were performed.For radiological evaluations, the scoring system developed by Lane and Sandhu, and for histopathological assessments, the grading system of Huddlestone et al. were used. Biomechanical tests were realized using torsional loading. During the first 3 weeks, the groups did not differ much in the radiological parameters. However, in the diclofenac group and in especially the tenoxicam group, the histological scores were lower than in the control group. Radiological images obtained at the end of 6 weeks demonstrated inadequate consolidation in the diclofenac and tenoxicam groups when compared with the control group. At the end of 8 weeks postoperatively, in consideration of biomechanical, radiological and histological tests, significantly worse regenerates were obtained in the diclofenac and tenoxicam groups.During the distraction osteogenesis period, diclofenac and tenoxicam affected the quality of regenerate unfavorably. This effect is sustained during all periods of bone healing. However, this finding should be supported by experimental and human studies.

We report a case of a subperiosteal osteoid osteoma on the talar neck that was removed arthroscopically. Intralesional excision, en bloc resection, and percutaneous ablation techniques have all been used for the treatment of osteoid osteoma. For intra-articular osteoid osteomas, arthroscopy-assisted removal of the tumor has been described in a few case reports. Obtaining a nidus fragment for pathologic evaluation is important during arthroscopic removal of intra-articular osteoid osteomas. Sometimes it is not possible to obtain a specimen for pathologic examination. In the present case, the osteoid osteoma on the talar neck was easily located, the nidus was completely removed, and the tumor was extirpated. (J Am Podiatr Med Assoc 97(3): 238–243, 2007)