Relationship of Patellofemoral Angles and Tibiofemoral Rotational Angles With Jumper's Knee in Professional Dancers: An MRI Analysis.

BACKGROUND: Jumper's knee is a type of tendinopathy affecting the distal insertion of the quadriceps tendon (25% of cases) or the patellar tendon. It has been shown that frontal-plane measurements, such as genu valgum, genu varum, an increased quadriceps angle, a protuberant tibial tuberosity, patella alta, and short hamstring muscles, may be related to jumper's knee. PURPOSE: To investigate the effects of tibiofemoral rotational angles and patellofemoral (PF) angles on the development of jumper's knee in professional folk dancers. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We examined 26 dancers (16 male, 10 female) with knee pain using magnetic resonance imaging (MRI), for a total of 32 knees. Of the knees, 21 with quadriceps tendinopathy (QT) and 7 with patellar tendinopathy (PT) were detected. Using MRI scans, we measured PF angles (PF sulcus angle, lateral PF angle, patellar tilt angle, lateral trochlear inclination angle, lateral patellar tilt angle, and PF congruence angle) and tibiofemoral rotational angles (condylar twist angle, posterior condylar angle, femoral Insall angle, tibial Insall angle, posterior tibiofemoral angle, and angle between the Whiteside line and posterior femoral condylar line) and noted specifics such as patella alta, patella baja, and the Wiberg classification of the patellar shape between the patients with versus without QT and between patients with versus without PT to understand if there was any relationship with tendinopathy. RESULTS: No statistically significant difference was observed in age, sex, patella alta, or the Wiberg classification between the QT groups (with vs without) and between the PT groups (with vs without) (P > .05). Having QT was found to be significantly associated with the PF sulcus angle (P = .009), and having PT was found to be significantly associated with the femoral Insall angle (P = .029). CONCLUSION: Jumper's knee was found to be associated with anatomic variations of the PF sulcus angle and rotation of the patellar tendon in relation to the femur (femoral Insall angle) on axial MRI scans in professional dancers. Unlike those of other athletes, dancers' knees are exposed more to external rotation forces because of turnout, and this can be the cause of jumper's knee.

Patellofemoral Chondropathy Areas in Folk Dancers: An MRI Study.

BACKGROUND: Patellofemoral chondropathy (PFC) is one of the most important causes of patellofemoral pain syndrome. PFC may occur as a result of anatomic reasons such as patellar malalignment and/or increased patellofemoral joint stresses. Most research on this subject has involved sports injuries and anatomic variations. The literature is scarce on PFC related to the dance. METHODS: Fourteen dancers (14 knees, all male) were found to have PFC based on MRI evaluations and clinical examinations between January 2010 and December 2019 (3 dancers were excluded due to prior surgeries of the knee). Age, sex, side of injury, range of motion, Q angle, types of dances, body mass index, and patellar specifics (alta, baja, Wiberg) were recorded for 11 dancers included in the study. We observed PFC at the femoral contact areas (FCA) and patellar contact areas (PCA) of Goodfellow description. RESULTS: Chondral lesions were observed at Gooodfellow areas FCA-3 in 2 dancers, FCA-4 in 5 dancers, PCA-2 in 10 dancers, PCA-3 in 10 dancers, and PCA-4 in 9 dancers. CONCLUSION: Dance styles that include frequent deep flexions and strolling on a flexed knee joint may be risk factors for chondral lesions in the contact area of the femur in male dancers.

Evaluation of oxysterol levels of patients with silicosis by LC-MS/MS method.

Silicosis is one of the prolonged and irreversible occupational diseases. Crystalline silica dust, which has been linked with silicosis, occurs in different industrial areas such as constructions, ceramic, quarry, and pottery. There are significant numbers of newly diagnosed cases every year in Turkey. Patients with silicosis suffer from inflammatory respiratory disorders and silicosis-related complications such as rheumatoid arthritis, systemic sclerosis, and vasculitis. Oxysterols are defined as 27-carbon intermediates or end products of cholesterol. They are also implicated in the etiology of disease states such as atherosclerosis, neurodegenerative, and inflammatory diseases. The aim of the study is to evaluate cholesterol oxidation products in the patients with silicosis and determination of sphingosine-1-phosphate (S1P) levels which is a sphingolipid metabolite. In addition to these parameters, it is aimed to determine the possible lipid peroxidation by different parameters. For this purpose, blood samples and urine were collected from 47 patients and 30 healthy individual with their consents. In order to evaluate oxysterols, 7-ketocholesterol and cholestan 3ß,5α,6ß-triol levels were measured by LC-MS/MS method. The measured levels of 7-KC were 0.101 ± 0.005 µmol/l in patient and 0.050 ± 0.003 µmol/l in control plasma samples. Triol levels were measured as 0.038 ± 0.005 µmol/l in patient group and 0.033 ± 0.004 µmol/l in control group (p < 0.001). In addition, lipid peroxidation products were measured by human-8-isoprostane, human-4-hydroxynonenal (4-HNE), and human malondialdehyde (MDA) ELISA kits. The measured levels of HNE in the patient and control groups were 735.14 ± 288.80 pg/ml and 595.72 ± 108.62 pg/ml in plasma and 606.02 + 118.23 pg/ml and 531.84 + 107.18 pg/ml in urine, respectively (p < 0.05). F2-iP results of patients and controls were 450.0 + 101.40 pg/dl and 386.9 + 112.7 pg/ml for urine and 432.7 ± 188,8 pg/dl and 321.9 ± 69.4 pg/dl for plasma, respectively (p < 0.05). MDA levels of plasma were measured as 44.1 ± 14.6 nmol/ml in the patient and 31.9 ± 10.5 nmol/ml in the control (p < 0.05). Levels of MDA for urine samples were 30.15 + 5.06 nmol/ml and 25.15 + 6.07 nmol/ml in patients and controls, respectively (p < 0.05). S1P levels were decreased in patients compared to control group (49.05 ± 10.87 and 67.57 ± 16.25, p < 0.001). The results not only indicate a correlation between cholesterol oxidation, lipid peroxidation, and silicosis, but also provide better understanding of the role of the lipids in the mechanism of this inflammatory disease.

Traumatic knee injury patterns in Anatolian folk dancers: a case series and literature review.

Lower extremities, especially the knee region, are susceptible to traumatic injuries because of long-lasting hard landings and impacts. Most of the injuries described in the literature are associated with ballet. In this review study, the authors tried to present the traumatic knee injury patterns of the Anatolian folk dance. The Fire of Anatolia dance group consists of 82 dancers (37 males [45.1%] and 45 females [54.9%]) with the mean age of 27.96 (SD = 5.05) years (range: 18-38 years). The major folk dances of the region are Zeybek, Halay, Horon, Teke, Roman, Karsilama, Bar and Lezginka ("the Caucasian"). The dancers suffered from 9 orthopedic injuries requiring surgical treatment (3 meniscus tears, 4 anterior cruciate ligament tears, 1 posterior cruciate ligament tear, 1 patellar dislocation) during a 10-year period. The authors investigated solely the traumatic injuries of these folk dance styles and aimed at revealing the traumatic knee injury patterns in this case series and literature review. On the one hand, the Anatolian folk dancers experienced meniscus tears following frequent squats and twists on single leg stances, typical of Horon and Zeybek. On the other hand, anterior cruciate tears happened after jumps and landings in the Caucasian (Lezginka jump) dance. A posterior cruciate ligament tear was also seen after the Caucasian dance landing. The split figure in the Karsilama dance ended up with patellar dislocation. Certain dance figures seem to be related to specific types of injuries. Int J Occup Med Environ Health. 2019;32(5):585-93.

Relationship of Popliteus Sulcus Depth and Tibiofemoral Rotational Alignment with Popliteus Tendinitis in Professional Folk Dancers Exposed to Turnout Positions: An MRI Analysis.

AIMS: The popliteus musculotendinous unit plays the major role in range of motion, rotation and stabilization of the knee. Frequent repetition of the rotational strains such as turnout in dancers may be the cause of popliteus tendinitis. In addition, popliteus sulcus depth (PSD) and PSD/lateral condyle width (LCW) ratio are also highly related with popliteal tendinitis in professional folk dancers. In this study, we evaluated the association between clinically diagnosed popliteus tendinitis and PSD with analysis of the PSD/LCW ratio as measured on MRI and tibiofemoral rotational alignment in professional folk dancers. This study was intended to clarify any anatomical liability to popliteal tendinitis in professional folk dancers. Therefore, we looked for the anatomical variances affecting popliteal musculotendinous unit. METHODS: Thirty-two MRI scans from 32 members of a professional folk dance group (mean age 30.2±7.9 yrs, range 18-38) were analyzed retrospectively. Popliteal tendinitis was detected in 5 knees (5 dancers). The relationship of popliteal tendinitis to the tibiofemoral rotational angles (condilary twist angle, posterior codilary angle, posterior tibiofemoral angle), PSD, and PSD/LCW ratio were investigated. RESULTS: The popliteus tendinitis group had statistically significantly higher PSD and PSD/LCW ratio than the group without popliteal tendinitis (p=0.0001). There was no statistically significant difference between the two groups in the tibiofemoral rotational angles. CONCLUSION: In addition to long hours of practice and the turnout position, PSD and PSD/LCW ratio can place the professional folk dancer at increased risk for popliteus tendon injury.

Overuse Injuries in Professional Anatolian Folk Dancers: A Descriptive Study Verified with MRI.

BACKGROUND: Professional dancers are artists as well as athletes who push their bodies beyond limits for aesthetic expression. Therefore, overuse injuries are common. We present our findings on overuse injuries in Anatolian (Turkish) folk dancers. METHODS: The Fire of Anatolia dance group comprises of 82 dancers (37 male, 45 female) with a mean age of 27.96±5.05 yrs (range 18 to 38). Forty-one dancers from this group presented to our clinic between February 2009 and April 2016 with complaints of pain, and 25 of them had magnetic resonance imaging (MRI) for verification. The type, frequency, and anatomical locations of their overuse injuries as found on MRI were investigated. RESULTS: We evaluated a total of 70 overuse injuries in 25 dancers. All injuries were seen on separate occasions, and multiple injuries in the same dancers at separate times were recorded. Most of the overuse injuries were seen around the knee joint. Ankle ligament injuries were not seen in our study, in contrast to ballet and modern dance. Overuse injuries were observed in the knee in 68% of cases, thigh in 24%, lumbar region in 24%, feet in 20%, shoulder in 16%, and hip in 12%. CONCLUSIONS: Overuse injuries occur mostly in the knee region in Anatolian folk dancers. There were no statistically significant differences between dancers with and without overuse injuries in terms of age, sex, and dance style (p>0.05).

Minimally invasive plate osteosynthesis (MIPO) in diaphyseal humerus and proximal humerus fractures.

OBJECTIVE: Our aim was to evaluate the results of minimally invasive plate osteosynthesis (MIPO) using locking plates in diaphyseal humerus and proximal humerus fractures. METHODS: Nine patients who underwent open reduction and MIPO for the treatment of diaphyseal and proximal humerus fractures between June 2006 and October 2009 were included in this study. One S3(®) and 8 PHILOS(®) plates were used. Mean age was 75.2 (range: 32 to 86) years and all patients were females. Mean follow-up was 33.9 (range: 14.8 to 54.8) months. According to AO/ASIF classification, four patients had 12C1, two patients 12A1, one patient 12A2, and two patients 11A2 fractures. Axillary and radial nerves were explored and protected in all patients. Patients were evaluated radiographically for union and functionally using the Constant-Murley score. RESULTS: None of the patients had nonunion, avascular necrosis, axillary or radial nerve paralysis or implant failure. Mean Constant-Murley score was 86.8 ± 2.2 (range: 70 to 100). Mean union time was 3.2 (range: 2.5 to 5) months. CONCLUSION: MIPO of humerus diaphysis and proximal fractures allows for preservation of blood supply in fracture fragments, owing to less soft tissue and periosteal injury. When the procedure is performed with the lateral double incision, exposure and preservation of the axillary and radial nerves are necessary. Early return of function in the shoulder and elbow joints and favorable healing time are the major advantages of this method in this rare subset of humerus fractures.

Fractures of the fingers missed or misdiagnosed on poorly positioned or poorly taken radiographs: a retrospective study.

BACKGROUND: Missed fractures, the most common diagnostic error in emergency departments, are usually the result of a misread radiograph or the failure to obtain a radiograph. However, a poorly positioned or poorly taken radiograph may also result in diagnostic errors. We sought to analyze the frequency of missed or misdiagnosed finger fractures that could be attributed to inadequate radiographs. METHODS: We reviewed the medical records of the hand surgery divisions of Istanbul Bilim University Medical Faculty Hospital and the Orthopedics Department of Private Florence Nightingale Hospital between January 2008 and March 2010 for patients with fractures of the fingers that had been missed or misdiagnosed on the basis of inadequate radiographs. RESULTS: In 182 patients, we identified 7 missed and 7 misdiagnosed fractures of the fingers because of inadequate radiographs. Lack of a true lateral radiographic view of the fingers or a true anteroposterior radiographic view of the thumb was the most frequent reason for diagnostic errors (71%; 10 of 14), leading to missed fractures in six patients and to misdiagnosed fractures in four patients. Superimposition of the fingers on lateral radiographs led to misjudging of displaced proximal phalangeal fractures of the fifth finger in three patients. CONCLUSION: Diagnostic errors attributed to inadequate radiographs are rare. Proper radiographic evaluation of finger trauma requires at least true anteroposterior and lateral views. An oblique view can complement the lateral view but not replace it. Poor quality radiographs or inadequate views should never be accepted or used as a basis for treatment.

Simultaneous repair of chronic full-thickness rotator cuff tears during fixation of proximal humerus fractures and clinical results.

OBJECTIVES: We investigated the incidence of chronic rotator cuff tears encountered during fixation of proximal humerus fractures with locking plate-screw systems, and evaluated the functional results of simultaneous surgical repair of these injuries. METHODS: A total of 111 patients underwent surgical treatment for proximal humerus fractures. Of these, nine patients (8 females, 1 male; mean age 73 years; range 56 to 84 years) who had concomitant chronic full-thickness rotator cuff tears were included in the study. According to the AO classification, the fractures were type 11A1 (12C1 also present) in one patient, 11A2 (12C2 also present) in one patient, 11B1 in two patients, 11B2 in three patients, and 11C2 in two patients. None of the patients underwent preoperative magnetic resonance imaging. Fracture fixation was made with the PHILOS plate in five patients, and with the S3 Proximal Humerus Plate in four patients. All full-thickness rotator cuff tears were detected during the operation. Following open reduction and internal fixation after a deltoid splitting incision, rotator cuff tears were repaired by primary suture in two patients, and with a suture anchor in seven patients. All the patients used a padded shoulder-arm sling for six weeks and received a standard rehabilitation program. All the patients were evaluated radiographically and functionally using the Constant-Murley shoulder score at postoperative 6 weeks, 6 months, and 12 months. The mean follow-up period was 17.3 months (range 8 to 30 months). RESULTS: The incidence of full-thickness rotator cuff tears was 8.1%. All the patients had supraspinatus tears, which were accompanied by infraspinatus tears in three patients. The sizes of the tears were classified as large (between 3-5 cm) in three patients, intermediate (between 1-3 cm) in five patients, and small (<1 cm) in one patient. One patient had L-shaped, two patients had U-shaped, and six patients had C-shaped tears. None of the patients had healing problems or avascular necrosis. The mean Constant-Murley shoulder score was 85.4 (range 67 to 100). All the patients were satisfied with the results of surgical treatment. CONCLUSION: The integrity of the rotator cuff must be checked after reduction and fixation of proximal humerus fractures and, when present, the tears should be repaired simultaneously either primarily or with suture anchors. Simultaneous repair of rotator cuff tears does not negatively affect functional outcomes.

Complications encountered in proximal humerus fractures treated with locking plate fixation.

OBJECTIVES: We evaluated the complications encountered following locking plate fixation of proximal humerus fractures. METHODS: The study included 103 patients (70 females, 33 males; mean age 62 years; range 21 to 90 years) who were treated with open reduction and locking plate fixation for proximal humerus fractures between September 2005 and April 2009. Fixation was performed using the PHILOS locking plate in 93 patients, and S3 humerus plate in 10 patients. Postoperatively, a shoulder-arm sling was applied for six weeks and a standard rehabilitation program was used in all the patients. Intraoperative, acute postoperative, and late postoperative complications were assessed on radiographs. Varus inclination was defined as less than 120 degrees of the inclination angle on immediate postoperative radiographs, and varus displacement as postoperative increases in the varus angle. The mean follow-up period was 19 months (range 2 weeks to 43 months). RESULTS: Complications were seen in 10 patients (9.7%; mean age 67 years). The PHILOS plate was used in nine patients and S3 plate was used in one patient. Five patients (4.9%) had varus inclination with a mean inclination angle of 112.6 degrees (range 105 degrees to 118 degrees), four patients (3.9%) developed varus displacement with a mean inclination angle of 102.5 degrees (range 95 degrees to 110 degrees), and intra-articular screw penetration was seen in five patients (4.9%). The remaining complications were fixation failure (n=1, 1%), implant fracture (n=1), and deep infection (n=1). Screw penetration exceeded 3 mm in three patients, requiring revision surgery. The mean ages of patients with varus inclination, varus displacement, and screw penetration were 76.6, 74.4, and 71 years, respectively. Three patients with varus inclination (60%) developed varus displacement. Screw penetration was observed in three patients (60%) with varus inclination, and in all patients with varus displacement. The mean Constant-Murley shoulder score was 67.8 (range 50 to 90) in patients who developed a complication. CONCLUSION: Our findings show that locking plate and screw systems represent a significant treatment option in the treatment of comminuted and displaced humerus fractures, with low complication rates. Accurate indication, protection of the head's inclination angle through appropriate surgical approach and proper technique, and fine calculation of screw length are essential for successful functional results.

Delayed rupture of the extensor hallucis longus and extensor digitorum communis tendons after breaching the anterior capsule with a radiofrequency probe during ankle arthroscopy: a case report.

A 40-year-old man with early arthritis, loose bodies, and anterolateral joint impingement symptoms in his left ankle, which was refractory to noninvasive therapeutic modalities for 1 year, underwent ankle arthroscopy and radiofrequency thermal ablation. The anterior capsule of the ankle joint was breached by the radiofrequency probe while the loose bodies were removed from the anterior recess, exposing the extensor tendons and resulting in a delayed spontaneous rupture of the extensor hallucis longus tendon and extensor tendons to the second and third toes. The extensor hallucis longus tendon was repaired with a semitendinosus tendon graft, and extensor digitorum tendons underwent primary repair. The patient regained full function and was symptom free 1 year after surgery.

The pedicle screw fixation with vertebroplasty augmentation in the surgical treatment of the severe osteoporotic spines.

STUDY DESIGN: Retrospective clinical study. OBJECTIVE: To present the early clinical results of pedicle screw fixation augmented by vertebroplasty using polymethylmethacrylate in severely osteoporotic patients requiring spine surgery due to the neurologic deficit. SUMMARY OF BACKGROUND DATA: It is postulated that combining a formal vertebroplasty-that is, maximum filling of the trabecular space with polymethylmethacrylate-with pedicle screw placement in osteoporotic vertebrae could result in resistance to pullout forces significantly. METHODS: Between the years 2003 and 2006, pedicle screw placement with vertebroplasty augmentation was performed in 49 patients who had severe osteoporosis and who required spine surgery due to neurologic deficit. Eleven patients with less than 2 years of follow-up and 2 patients who died from unrelated illness were excluded from the study. Thirty-six of 49 patients having minimum 2 years of follow-up were included. Cement augmentation was also performed in segments proximal and distal to instrumentation to prevent junctional segment fractures. Early and late postoperative complications were recorded during follow-up. RESULTS: The mean postoperative follow-up was 37 (24 to 48) months. The average age of the patients was 66 (59 to 78) years. The instrumentation was performed meanly at 5 segments and vertebroplasty was performed averagely at 7 segments. All patients had the T-score value of less than -2.5 from the anteroposterior and lateral lumbar spine and hip views, so regarded as severe osteoporosis. In our study group, there were no extravasation and subsequent thermal neural injury. Four superficial wound infections have been observed and they responded well to local debridement and antibiotics. There were no proximal and distal junctional segment fractures during the follow-up course. Postoperatively, all patients with neurologic symptoms had complete relief of their nerve compression symptoms. CONCLUSIONS: In patients requiring spine surgery due to neurologic deficit and having no sufficient time for the medical treatment of severe osteoporosis, pedicle screw fixation with vertebroplasty augmentation and vertebroplasty in segments proximal and distal to the instrumented segments can be good alternative methods to provide well fixation and fusion while preventing proximal and distal junctional fractures. One should be careful about pulmonary cement embolism after such kind of procedures.

[Surgical treatment of elbow dislocations accompanied by coronoid fractures]. / Koronoid kiriklarinin eslik ettigi dirsek çikiklarinda cerrahi yaklasim.

OBJECTIVES: We evaluated the results of surgical treatment for elbow dislocations accompanied by Regan-Morrey type 2-3 coronoid fractures. METHODS: Eight patients (6 males, 2 females; mean age 44 years; range 23 to 76 years) underwent surgical treatment for elbow dislocations accompanied by a coronoid fracture. Three patients had Regan-Morrey type 2, five patients had type 3 coronoid fractures. Accompanying injuries were Mason-Johnston type 4 radial head fractures (n=6), olecranon fractures (n=4), lateral humeral condyle fracture (n=1), and lateral (n=5) or medial (n=2) collateral ligament ruptures. Coronoid fractures were fixed with a plate, screw, or a cerclage wire in all the patients except for one patient who underwent coronoid excision. For radial head fractures, plate or screw and K-wire fixation was performed in two patients and radial head prosthesis was used in four patients. Olecranon fractures were fixed with a plate or AO tension band. Functional results were assessed using the Mayo elbow performance score. The mean follow-up period was 22.6 months (range 1 to 65.5 months). RESULTS: Union was achieved in all the patients. At the latest assessments, the mean Mayo elbow performance score was 84.3 (range 50 to 100). All the patients expressed satisfaction with surgical treatment except for one patient who underwent coronoid excision. All the fixation materials used for olecranon fractures were removed after union due to implant-associated pain. Ulnar nerve transposition was required in two patients with fractures involving the anteromedial facet of the coronoid process. Two patients developed heterotopic ossification that did not affect the range of motion of the elbow. CONCLUSION: Surgical treatment of elbow dislocations associated with Regan-Morrey type 2-3 coronoid fractures enables a concentric reduction of the elbow, stability, and early motion.

Radiographic and pathological stages of the changes at the bone-cement interface: an in-vivo experimental study.

INTRODUCTION: Chemical and physical effects of cementation cause radiographic and histological changes at bone-cement interface. These changes can be of interest in the assessment of the residual lesions and subsequent recurrences after local resection and cementation of local aggressive tumours. AIM: The aim of the study was to evaluate the evolution and determine the stages of the changes that occur at the bone-cement interface after cementation of cavitary lesions. MATERIAL AND METHODS: We operated on 16 hind legs of 8 sheep (Ovies Aries) under general anaesthesia (Xylasin HCl, Ketamin HCl and Forane). A bone cavity of 12 cm(3) was produced by curettage of the distal femoral condyle and was filled with cement. Control radiographs were taken at 2 days; 3, 6 and 12 weeks, and again at 6 months. One sheep each time was killed after second day and sixth month and two sheep each time after the third, sixth and 12th week and the specimens underwent pathological examination. RESULTS: After the first 3 weeks, a reactive fibrous membrane was detected on pathological examinations. This membrane consisted of granulation tissue, necrotic bone and bone marrow, which were replaced gradually by fibrous tissue. The radiographic revelation of this fibrous membrane was a radiolucent zone of 0.5-1.5 mm at 3 weeks. A Sclerotic rim appeared around this radiolucent zone at 6 weeks. With new bone formation the fibrous membrane disappeared at 3 months. This was seen on radiographs as the replacement of the radiolucent zone by a sclerotic ring of 0.5-2 mm. This sclerotic ring disappeared at 6 months, when a diffuse sclerosis and cortical bone thickening was detected on radiographs. DISCUSSION: According to our findings we suggest to consider the pathological processes at the bone-cement interface in 3 phases: (1) Reactive phase (first 3 weeks); (2) Resorption phase (3-6 weeks), and (3) Formation phase (6 weeks to 6 months). We have distinguished five different radiographic stages: Stage 1-Early stage with no apparent zone (first 3 weeks); Stage 2-Radiolucent zone (3-6 weeks); Stage 3-Radiolucent zone with a sclerotic rime (6 weeks to 3 months); Stage 4-sclerotic ring (after 3 months) and Stage 5-Diffuse cortical thickening (after 6 months). Determining the phases of tissue reaction after cementation and its radiographic revelation will ease the diagnosis of residual lesions and subsequent recurrences after local resection and cementation of local aggressive tumors.

[The results of internal fixation of proximal humeral fractures with the PHILOS locking plate]. / Proksimal humerus kiriklarinda kilitli plak PHILOS ile internal tespit sonuçlari.

OBJECTIVES: Proximal and diaphyseal humeral fractures are common especially in the elderly, presenting as a challenging problem due to their high complication rates following surgical treatment. In this prospective study, we evaluated the results of patients treated with the PHILOS (Proximal Humeral Internal Locking System) locking plate, a new technique recently developed by the AO/ASIF. METHODS: Forty-one patients who were treated with the PHILOS plate for proximal humeral fractures were evaluated in two age groups. Group A included 24 patients (12 males, 12 females; mean age 47 years; range 24 to 64 years) younger than 65 years, and group B involved 17 patients (4 males, 13 females; mean age 78 years; range 67 to 90 years) at or above 65 years. Radiographically, all fractures were classified according to the AO/ASIF system. Surgery was performed with the deltopectoral approach in 10 and two patients, and with a deltoid split in 14 and 15 patients in group A and B, respectively. Functional and radiographic results were evaluated after a mean follow-up of 15 months (range 6 to 28 months). RESULTS: The mean Constant scores were 95.0 (range 74 to 100) and 92.8 (range 72 to 100) in group A and B, respectively (p>0.05). After six months of surgery, Constant scores and functional outcomes were similar in patients operated on with the deltopectoral approach or deltoid split. There was neither nonunion nor implant failure. Complications included intra-articular screw penetration (n=1), displacement of the greater tuberculum (n=1) with oblique placement of the plate (n=1), insufficient reduction (n=4), and varus displacement of the humeral head (n=3). No avascular necrosis was seen. CONCLUSION: Locking plate system is superior over other means of fixation methods, particularly in osteoporotic fractures, because it allows early rehabilitation and does not result in implant failure.

Pseudomeningocele in communication with the facet joint: demonstration by computerized tomography-arthrography.

Pseudomeningocele is an uncommon but well-known complication of lumbar spine operations. Although it is mostly asymptomatic and managed conservatively in most cases, it is claimed as a causative factor of failed back surgery syndrome and requires surgery in some cases. Usually, its diagnosis is confidently done with imaging modalities such as magnetic resonance imaging, computed tomography and myelography. In this report, we describe a case of pseudomeningocele that communicated with a facet joint. The diagnostic approach for this unusual lesion and its probable causes are discussed.

Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of severe scoliosis (>100 degrees).

STUDY DESIGN: Retrospective clinical study. OBJECTIVE: To report the results of surgical correction achieved by intraoperative halo-femoral traction and posterior only pedicle screw instrumentation in severe scoliosis (scoliosis greater than 100 degrees ). SUMMARY OF BACKGROUND DATA: Although previous reports show the effectiveness of preoperative halo traction in the treatment of severe spinal deformity, the intraoperative use of halo-femoral traction in conjunction with posterior pedicle screw instrumentation has never been reported in patients with severe spinal deformity. METHODS: A total of 15 consecutive patients with severe (>100 degrees) thoracic idiopathic scoliosis and/or kyphoscoliosis operated by using intraoperative halo-femoral traction and posterior only pedicle screw instrumentation were included in the study. Subjects were analyzed by age at date of examination, gender, major coronal curve magnitude, major compensatory coronal curve magnitude, major sagittal curve magnitude, shoulder imbalance, and preoperative vital capacity of the lungs. Halo-traction related complications and short- and long-term complications were noted in each case. RESULTS: The average age at the time of surgery was 17.8 years (range, 16-19). There were 4 males and 11 females. The average improvement was 51% in the major thoracic curve, 33% in the compensatory lumbar curve, and 53% in the major sagittal curve. The average follow-up was 56 (range, 24-96) months. Loss of correction averaged 4 degrees for major thoracic curves and 2 degrees for thoracic kyphosis based on measurements at the final follow-up date. CONCLUSION: The use of intraoperative halo-femoral traction together with the wide facet resection and posterior release gradually provide a good correction and balance maintained by pedicle screw instrumentation. Intraoperative halo-femoral traction not only elongates spinal column but also elongates the thoracic cavity improving the compromised pulmonary function.

[Hot saline irrigation as an alternative local adjuvant therapy in local aggressive bone tumors]. / Lokal agresif kemik tümörlerinde alternatif bir adjuvan tedavi olarak sicak su uygulamasi.

OBJECTIVES: This study aimed to develop an alternative thermoinactivation method for biological inactivation of microscopic contamination on the cavity wall following curettage of local aggressive tumors. Hot saline irrigation was applied at various temperatures to bone cavity, with or without tourniquet on the extremity and temperature changes and local effects were investigated in vivo. METHODS: Bone cavities 12 cm3 in size were created in the condylar regions of the hind legs in nine female adult sheep. The cavities were irrigated by hot saline solution at 60, 70, 75, 80, or 100 degrees C, with and without the presence of a tourniquet, and the temperatures 1, 2, 3, and 10 mm distant to the cavity wall were recorded. The animals were sacrificed postoperatively at 2 days, 3 and 6 weeks, and 3 and 7 months for histologic studies. RESULTS: The mean body temperature and temperature inside the bone prior to surgery were measured as 38.1 degrees C and 27.34 degrees C, respectively. Tourniquet application caused a mean decrease of 1.5 degrees C (range 1-2 degrees C) in bone temperature. The highest temperatures measured below 80 degrees C and at 80 degrees C were 55.5 degrees C and 62.5 degrees C in the cavity, and 40.5 degrees C and 42.5 degrees C in the bone, respectively. At 100 degrees C, the color of the bone together with the surrounding soft tissue and muscle tissue turned to yellow-brown-black, and the animal died on the second postoperative day. At temperatures

[Comparison of temperature increments in bone cavities induced by methylmethacrylate and heated saline solution]. / Metilmetakrilat ve isitilmis serum fizyolojik uygulamalarinda kemik kavitelerinde olusan sicaklik degisikliklerinin karsilastirilmasi.

OBJECTIVES: We administered saline solution at 70 degrees C and methylmethacrylate to varying volumes of bone cavities and compared temperature changes produced in bone regions at varying distances to the cavity wall. METHODS: We created varying sizes of cavities in the femoral heads of 20 human cadavers (6, 10, 12, and 20 cubic centimeters) and in the knee region of a human cadaver (6, 10, 12, 20, 30, and 40 cubic centimeters). Initially, saline solution at 70 degrees C was administered to all the cavities for 15 minutes by a pulse-irrigation method, during which temperature changes induced within the bone cavity and at specific distances (1, 2, 3, and 10 mm) to the cavity wall were recorded. The bone temperatures were allowed to return to initial values; thereafter, cement was applied and temperature changes at the same distances to the cavity wall, in the cement center, and on the cement surface were recorded. RESULTS: Cement volumes up to 40 cubic centimeters applied to the bone cavities did not produce temperature increments that are reported to be adequate to induce necrosis in the cavity wall. It was thought that cement-induced necrosis in the bone-cement interface was not related to heat, but to other effects exerted by cement application. Compared to cement-induced temperature changes, saline solution at 70 degrees C was always associated with higher temperature increments in the cavity wall. CONCLUSION: Due to its simple applicability at desired temperatures and for any lengths of time, heated saline solution seems to have credentials to be incorporated into local adjuvants that are utilized to eliminate tumoral contamination in the cavity wall following curettage for local aggressive tumors.