A Novel Technique for Labral Reconstruction Using Long Head of Biceps Tendon: Duru Technique.

Arthroscopic capsulolabral repair is a well-established surgical treatment for traumatic anterior shoulder instability. When there is insufficient labral tissue during arthroscopic primary or revision Bankart repairs, various soft tissue procedures have been recommended. All these procedures aim to reattach glenohumeral ligaments to the glenoid rim and regain the tight anterior structures to prevent re-dislocation or subluxation. Some authors recommend the Latarjet procedure, even in the absence of critical bone loss in this patient group. The labrum increases the depth of the glenoid cavity, thereby, increasing the glenoid track. It behaves like a block for the humeral head. Reconstruction of the labral tissue may strongly contribute to shoulder joint stability when it is totally absent. In this article, we describe a novel labral reconstruction technique (Duru technique) using the long head of the biceps tendon in two patients without an existing labral tissue.

Acromioclavicular Dislocation Associated with Coracoid Process Fracture: Report of Two Cases and Review of the Literature.

Acromioclavicular dislocation associated with coracoid process fracture is a rare injury. Herein we reported two further cases with such combination of injuries and reviewed all previously published cases in current literature. In this review, we discussed the demographic characteristics, mechanism of injury, diagnosis, and treatment options extensively.

Intramedullary nailing versus minimally invasive plate osteosynthesis for distal extra-articular tibial fractures: a prospective randomized clinical trial.

PURPOSE: The purpose of this randomized clinical trial is to compare intramedullary nailing (IMN) versus minimally invasive plate osteosynthesis (MIPO) for the treatment of extra-articular distal tibial shaft fractures. MATERIALS AND METHODS: Twenty-five consecutive patients with distal extra-articular tibial fractures which were located between 4 and 12 cm from the tibial plafond (AO 42A1 and 43A1) were randomly assigned into IMN (n: 10) or MIPO (n: 15) treatment groups. All patients were followed for at least 1 year. Foot function index, time to weight bearing, union time, duration of operation, length of incision, intra-operative blood loss, intra-operative fluoroscopy time, rotational and angular malalignment, rate of infection, secondary interventions and complications were compared between groups. RESULTS: All patients completed the trial and were followed with a mean of 23.1 ± 9.4 months (range 12-52). Foot function index, weight bearing time, union time, rate of malunion, rate of infection and rate of secondary interventions were all similar between groups (p = 0.807, p = 0.177, p = 0.402, p = 0.358, p = 0.404, p = 0.404, respectively). Intra-operative blood loss, length of surgical incision, radiation time and rotational malalignment were higher in the IMN group (p = 0.012, p = 0.019, p = 0.004 and p = 0.027, respectively). CONCLUSIONS: Results of our study showed that both treatment methods have similar therapeutic efficacy regarding functional outcomes and can be used safely for extra-articular distal tibial shaft fractures, and none of the techniques had a major advantage over the other.

A new arthroscopic technique for lateral parameniscal cyst decompression.

BACKGROUND: The purpose of this study was to describe an arthroscopic technique for lateral parameniscal cyst (LPC) decompression with preservation of meniscal substance and to report the short- to mid-term outcome of 20 patients. METHODS: All patients underwent a complete physical examination and magnetic resonance imaging (MRI) of the knee prior to surgery. After arthroscopic diagnosis of a LPC, partial lateral meniscectomy was performed via anterolateral (AL) and anteromedial (AM) portals. For LPC treatment, we used AL and superomedial (SM) portals. We describe a SM portal at the most proximal part of suprapatellar pouch, just medial to quadriceps tendon for the arthroscope. To decompress the cyst, an intra-articular (IA) portal was created with a shaver on the anterior synovial wall of the cyst from the AL portal. Decompression was performed via the AL portal and through the IA portal under the view of the arthroscope in the SM portal in SM portal. At the last follow-up, Lysholm score was used, and patients' clinical outcomes were classified into four categories: excellent, good, acceptable, and poor. Additionally, during the last control, patients underwent an MRI which was assessed for recurrence. RESULTS: Mean follow-up period was 37.5±18.8 months. Clinical outcomes were excellent in 15 patients, good in four, and fair in one. The mean Lysholm score was 96.2±7.59. No recurrence of the cyst was seen on control MRIs. CONCLUSIONS: Arthroscopic LPC decompression with superior and anterior portals is a novel, safe, and effective technique for experienced surgeons. It allows conservation of meniscal tissue, easier handling of instruments, and provides an excellent view of the cyst.

Open versus percutaneous release for the treatment of trigger thumb.

The purpose of this retrospective study was to compare the outcomes and complications of conventional open surgical release and percutaneous needle release in the treatment of trigger thumb. The study comprised 87 patients with trigger thumb who were treated with either open pulley (n=52) or percutaneous (n=32) release between 2008 and 2011. All patients were reevaluated at a mean follow-up of 22.7±9.6 months (range, 9-44 months). Main outcome measures were the rate of recurrence, pain on movement or tenderness over the pulley, infection rate, digital nerve injury, tendon bowstringing, joint stiffness or loss of thumb range of motion, and patient satisfaction. The groups were statistically similar regarding age, sex, laterality, dominant side involvement, and trigger thumb grade on initial admission. At final follow-up, no patient had recurrence, tendon bowstringing, joint stiffness, or loss of thumb range of motion. No patients in the open pulley release group and 2 (5.7%) patients in the percutaneous release group had a digital nerve injury (P=.159). No statistical difference was found in the infection rate between groups (P=.354). A total of 98.1% of patients in the open pulley release group and 97.1% of patients in the percutaneous release group were satisfied with treatment (P=.646). Both techniques resulted in similar therapeutic efficacy, and the rate of potential complications was also statistically similar in each group. Although statistically insignificant, the authors believe that the 5.7% rate of iatrogenic digital nerve injury seen in the percutaneous release group is clinically significant and serious. Therefore, they advocate using open surgical release of trigger thumb.

Cardiovascular effects of abduction shoulder sling in elderly patients; is it really safe?

OBJECTIVE: The purpose of the prospective study is to investigate the cardiovascular effects of abduction shoulder sling (ASS) in elderly patients who underwent rotator cuff surgery. METHODS: The study included 49 consecutive patients older than 50 years (mean 59.3 ± 8.2 years) who underwent arthroscopic rotator cuff repair surgery and used ASS in postoperative period. All cases underwent Holter electrocardiographic monitoring before (24 h) and after (48 h) the operation. The Holter findings were read by an experienced cardiologist and a pause of longer than 3 s and heart rate of <40 bpm was evaluated as significant bradycardia. RESULTS: One patient (61-year-old male) described feeling faint (presyncope) which was confirmed with the Holter finding of a pause more than 3 s which occurred in the day time. Two other patients (52-year-old male, and 62-year-old female) reported severe dizziness (hypotensive attack) which required admission to a general practitioner. However, Holter findings were normal in these patients. These three cases were referred to cardiology department for evaluation of carotid hypersensitivity syndrome (CSH). CSH was confirmed with tests made with provocative maneuvers in a sitting position. CSH was defined as at least 3 s of asystole (cardio-inhibitor type) during carotid massage or systolic blood pressure falling below 50 mmHg (vaso-depressor type). All three patients were obese patients and BMI was higher than 30. CONCLUSIONS: ASS may trigger CSH in short necked and obese patients by exerting mechanical stimulation to the carotid sinus. These patients should be informed about symptoms and signs of CSH and educated on the proper use of ASS and correct positioning of shoulder strap. CSH should be kept in mind in patients who present with dizziness, presyncope and palpitation during the postoperative period.

Triceps tendon avulsion and associated injuries of the elbow.

A rupture or avulsion of the triceps tendon is very rare but concomitant elbow injuries with avulsion of the triceps tendon are even rarer. In this study, an extraordinary and unusual injury combination (radial head and trochlear fracture associated with triceps tendon avulsion), which happened during a fall onto the elbow with outstretched hand, was identified and has been discussed in the literature.

Management of Vancouver type B2 and B3 femoral periprosthetic fractures using an uncemented extensively porous-coated long femoral stem prosthesis.

OBJECTIVE: The purpose of this study was to evaluate the clinical results of femoral revision using an uncemented extensively porous-coated long femoral stems with or without onlay strut allografts in the treatment of Vancouver type B2 and B3 periprosthetic femoral fractures. MATERIALS AND METHODS: We retrospectively reviewed 17 cases of periprosthetic femoral fracture (eight B2 and nine B3) treated with the uncemented extensively porous-coated long femoral stem. Clinical outcomes were assessed with Harris Hip Score and Barthel ADL index. Radiological evaluations were conducted using Beals and Towers' criteria. Any complication during the follow-up period was recorded. RESULTS: The average follow-up period was 41.7 ± 31.08 (range, 15-132) months. The average Harris Hip Score was 68.2 ± 18.4 (range, 32-100), and the average Barthel ADL index was 80.1 ± 19.75 (range, 30-100) points at the final follow-up. All fractures were united, and a good graft consolidation was achieved in 5 of 9 cases. There was femoral stem subsidence in 4 cases less than 10 mm without an evidence of loosening both radiologically and clinically. The radiological results using Beals and Towers' criteria were excellent in eight hips, good in five and poor in four. CONCLUSIONS: An uncemented extensively porous-coated long femoral stem together with or without onlay strut allografts provides a good fracture stability that promotes fracture healing and offers a successful solution for the management of Vancouver type B2 and B3 femoral periprosthetic fractures.

Prevalence and distribution of sesamoid bones of the hand: a radiographic study in Turkish subjects / Prevalencia y distribución de los huesos sesamoideos de la mano; un estudio radiográfico en sujetos turcos

The purpose of this study was to examine the plain anteroposterior radiographs of the hands in Turkish subjects in order to determine the prevalence of sesamoid bones and their distribution. A total of 923 hand radiographs from 459 men and 464 women with a mean age of 43.76±14.8 years (range, 18-85 years) were examined. Two sesamoid bones (ulnar and radial) were always present at the metacarpophalangeal (MCP) joint of the thumb (100 percent). One sesamoid bone in the thumb interphalangeal (IP) joint was observed in 21.3 percent of the cases. The prevalence of sesamoid bone of the index and little MCP joint were 36.6 percent and 53.2 percent respectively. Sesamoid bones palmar to the MCP joints of the middle finger and ring finger were rare; the incidence for these locations being 1.3 percent (12 hands) and 0.9 percent (8 hands), respectively. There were no significant differences between left and right hand digits. The distribution of sesamoid bones in different locations between male and female subjects were statistically similar in 1st IP joint (p=0.530), 4th MCP (p=0.631), 5th MCP (p=0.067) joints. However, the sesamoid bones in 2nd MCP and 3rd MCP joints were statistically more frequent in female subjects (p=0.024 and p=0.018 respectively). The present study represents the first report on the prevalence and distribution of sesamoid bones in the hand in Turkish subjects. The prevalence of sesamoid bones in Turkish population is considerably different from the Africans and Europeans, but rather resembles Mediterranean and Arab populations...

El objetivo de este estudio fue examinar radiografías anteroposteriores de manos en sujetos turcos para determinar la prevalencia y distribución de los huesos sesamoideos. Fueron examinadas 923 radiografías de mano, 459 hombres y 464 mujeres, con edad media de 43,76 ± 14,8 años (rango, 18-85 años). Dos huesos sesamoideos (ulnar y radial) estuvieron siempre presentes en la articulación metacarpofalángica (MCF) del primer dedo de la mano (100 por ciento). Un solo hueso sesamoideo en la articulación interfalángica (IP) del primer dedo de la mano se observó en el 21,3 por ciento de los casos. La prevalencia del hueso sesamoideo, índice y articulación MCP fueron fue de 36,6 por ciento y 53,2 por ciento respectivamente. Los huesos sesamoideos palmares a las articulaciones metacarpofalángica del dedo medio y dedo anular eran poco frecuentes, su incidencia fue 1,3 por ciento (12 manos) y 0,9 por ciento (8 manos), respectivamente. No hubo diferencias significativas entre los dígitos izquierdos o derechos. La distribución de los huesos sesamoideos en diferentes lugares entre los sujetos de ambos sexos fueron estadísticamente similares entre las articulaciones primera interfalángica (p = 0,530), cuarta MCP (p = 0,631) y quinta MCP (p = 0,067). Sin embargo, los huesos sesamoideos en las articulaciones segunda MCP y tercera MCP fueron estadísticamente más frecuentes en el sexo femenino (p = 0,024 y p = 0,018, respectivamente). El presente estudio representa el primer informe sobre la prevalencia y distribución de los huesos sesamoideos en la mano en sujetos turcos. La prevalencia de los huesos sesamoideos en la población turca es considerablemente diferente de los africanos y los europeos, pero se asemeja a las poblaciones mediterráneas y árabes...

Subcoracoid dislocation of the acromioclavicular joint.

Subcoracoid acromioclavicular dislocations are rarely seen injuries of the shoulder. We present a patient with multiple injuries and a subcoracoid acromioclavicular dislocation resulting from a falling injury. Physical examination revealed painful mechanical block at 90 degrees of abduction and swelling in the acromioclavicular region. Diagnosis was made with direct radiographs and computerized tomography. Treatment consisted of distal clavicular resection and coracoclavicular reconstruction with the transfer of the coracoacromial ligament over the clavicle. The patient had a pain-free shoulder after two years and was capable of performing daily activities despite the presence of coracoclavicular ossification.

[Diagnosis of septic arthritis and initial antibiotic treatment]. / Septik artritte tani ve baslangiç antibiyotik tedavisi.

OBJECTIVES: This study was designed to determine the similarities and differences in clinical, laboratory and radiographic presentation of septic arthritis in childhood and at adult ages, to find out its etiological profile, and to establish an antibiotic treatment protocol for the initial period and for patients in whom the causative agent could not be identified. METHODS: Thirty-four patients (age range 15 months to 85 years) who underwent surgery with a diagnosis of septic arthritis were retrospectively studied in two groups, namely, children-adolescents (age = or < 15 years ; 16 patients) and adults (age >15 years; 18 patients). Clinical and laboratory findings of septic arthritis were compared with operation findings. The etiological profile and sensitivity patterns were investigated. RESULTS: Unflatering features in both groups were clinical findings of decreased range of motion and tenderness, laboratory findings of elevated erythrocyte sedimentation rate and C-reactive protein, and domination of polymorphonuclear leukocytes in the joint fluid. Gram staining of the joint fluid was highly informative in terms of probable bacteria. During the first two years of life, the most common bacteria were H. influenzae and S. pneumoniae, and after two years, staphylococci and streptococci. Ciprofloxacin and sulbactam-ampicillin were found effective against most of the Gram-positive microorganisms isolated in both groups. CONCLUSION: The most useful test for septic arthritis is arthrosynthesis and macroscopic and microscopic analyses of the material. Gram staining is of great help in the planning of initial antibiotic treatment. For patients older than two years of age, treatment with sulbactam-ampicillin is effective against staphylococci and streptococci, and amikacin against Gram-negative bacteria. Detection of Gram-negative bacteria in patients younger than two years should bring H. influenzae in mind, for which ampicillin must be the first choice.

[Factors affecting the results of treatment in traumatic dislocation of the hip]. / Travmatik kalça çikiginda tedavi sonucunu etkileyen faktörler.

OBJECTIVES: We evaluated the long-term results of conservative and surgical treatment and the effect of prognostic factors on these results in patients with traumatic dislocation of the hip. METHODS: The study included 30 patients (27 males, 3 females; mean age 35 years; range 16 to 69 years) with traumatic hip dislocations. The most common cause was traffic accidents (80%). Fifteen patients underwent closed reduction for posterior (n=10), anterior (n=2), and central (n=3) dislocations, of which eight were isolated and seven were fracture dislocations. Open reduction was performed in 15 patients with posterior (n=14) and central (n=1) dislocations. Of these, five patients had isolated hip trauma and 10 patients had multiple trauma. Surgery was performed within the first 24 hours (n=6) or between five and 21 days (n=9). Posterior, central, and anterior dislocations were classified according to the Thompson-Epstein, Judet, and Epstein classification systems, respectively. The Pipkin classification was also used for dislocations with femoral head fractures. The results were evaluated according to the criteria proposed by Matta. The mean follow-up was 49 months (range 16 to 84 months). RESULTS: Following closed reduction, the results were satisfactory (very good or good) in 11 patients (73.3%, all isolated dislocations and three posterior fracture dislocations) and unsatisfactory (moderate or poor) in four patients (26.7%). Following open reduction, nine patients (60%) with posterior fracture dislocations had satisfactory and six patients (40%) had unsatisfactory outcome. The results were unsatisfactory in all the central dislocations. One patient developed avascular necrosis of the femur head and four patients developed degenerative arthritis following closed reduction. Degenerative arthritis was seen in six patients after surgical treatment, two of whom also had avascular necrosis. CONCLUSION: Our data may provide insight into the factors affecting the prognosis of traumatic hip dislocations treated by closed or open reduction.

[The effect of open wedge osteotomy on the posterior tibial slope]. / Açik kama osteotomisinin posterior tibial egim üzerine etkisi.

OBJECTIVES: Proximal tibial osteotomy improves the alignment and weight distribution of the lower extremity on the coronary plane. However, upper end osteotomy of the tibia may cause changes in the sagittal plane. In this study, we evaluated open wedge osteotomy operations with regard to its effect on the sagittal plane. METHODS: The study included 22 knees of 20 female patients (mean age 54.1 years; range 43 to 64 years) who underwent proximal tibial osteotomy for osteoarthritis. Open wedge osteotomy was performed in all the patients with the use of a Puddu plate. Pre- and postoperative posterior tibial slope angles were measured on lateral radiographs. The mean follow-up period was 12.8 months (range 4 to 33 months). RESULTS: Union of the osteotomy line was obtained in all the patients in a mean of 10.8 weeks (range 8 to 14 weeks). While the tibiofemoral range of motion did not change in 15 knees, it decreased by 5 to 10 degrees in seven knees postoperatively. Complaints of pain or limitation of the patellofemoral joint were observed in three patients. No correction loss or deep infection developed. The mean posterior tibial slope angle showed a significant increase by 3.5 degrees, from preoperative 7.2+/-4.1 degrees to postoperative 10.8+/-4.1 degrees (p<0.005). The more anteriorly the plate was placed in the osteotomy line, the higher increase in the posterior tibial slope angle was noted. CONCLUSION: These findings suggest that open wedge osteotomy results in a significant increase in the posterior tibial slope angle, which may be associated with the triangular shape of the upper end of the tibia, the design of the plate, and the site of plate application. The use of a plate with a decreasing height from posterior to anterior may decrease these changes in the posterior tibial slope angle.