Early mobilization after sliding and Z-lengthening of heel cord: a preliminary experimental study in rabbits.

Sliding lengthening and Z-lengthening techniques are widely used in heel cord lengthening. Even though most surgeons performing these procedures apply a short leg cast after surgery, their postoperative immobilization intervals vary from 3 to 7 weeks. Nather et al. showed that there was no need for immobilization after the musculotendinous lengthening of long, deep flexor tendons. In the present study, we aimed to show the healing process of heel cords lengthened by sliding and Z-plasty lengthening in rabbits that did not undergo any postoperative immobilization. We performed sliding lengthening in the right heel cords of the rabbits and Z-lengthening in the left heel cords. We compared these two techniques radiographically, biomechanically, and histopathologically. Even though the biomechanical study showed superior results in the sliding lengthening group on the 7th day, elongation of the tendons at both sites was seen radiographically. There was no statistically significant difference between the sites according to the biomechanical study done on the 28th day. We concluded that the ankle should be immobilized in the early healing phase and that both types of lengthening gain a similar level of strength by the 4th week.

Assessment of tissue viability after frostbite injury by technetium-99m-sestamibi scintigraphy in an experimental rabbit model.

Frostbite causes injury to the tissue by direct ice-crystal formation at the cellular level with cellular dehydration and microvascular occlusion. Muscle that initially appears viable on reperfusion may subsequently become necrotic because of microcirculatory collapse. Since muscle is a sensitive tissue in frostbite injury, we used technetium-99m-sestamibi limb scintigraphy to assess tissue viability in an experimental rabbit model. Twelve rabbits were used for this investigation. The right hind limb of the rabbits was immersed to the ankle joint in a container filled with 90% ethanol at -25 degrees C for 10 min. Frostbitten limbs were allowed to thaw in air at room temperature. Imaging and pathological examination of the affected limbs were performed 2 h, 24 h, 48 h and 72 h after freezing. In 2-h images, initial hypoperfusion was seen that corresponded to circulatory collapse. In 24-h images, there was hyperperfusion (so-called period of temporary reperfusion), corresponding to circulatory restoration. In 48-h images, a second hypoperfusion corresponded to viable but ischaemic tissue. In 72-h images, there was non-perfusion of the limb that correlated with the pathologically determined diagnosis of necrosis. All scintigraphic patterns correlated with pathological findings. We suggest that these scintigraphic patterns in soft tissue may be helpful in distinguishing between frank infarction and reversible ischemia and therefore may be useful in selecting early therapeutic or surgical interventions to salvage bone and soft tissue. Further studies are needed to show the usefulness of 99mTc sestamibi scintigraphy in clinical frostbite cases.

Tracheobronchopathia osteochondroplastica.

Tracheobronchopathia osteochondroplastica (TO) is a rare disorder with unknown aetiology. We report one case of TO in a patient with non-Hodgkin pulmonary lymphoma and benign epidermal and trichylemmal cysts on the periorbital region and scalp. To the authors' knowledge, the coincidence of these processes has never been described before. The case was evaluated with conventional X-ray, computed tomography, magnetic resonance imaging, fibre-optic bronchoscopy with 2 months interval, histopathological evaluation, Tc-99 m MDP bone scintigraphy and microbiological studies including PCR testing of bronchial biopsy and lavage specimens for Mycobacterium tuberculosis. Additionally, case reports of TO in the Turkish literature are summarized.

The role of acromioclavicular arthritis in impingement syndromes.

The role of acromioclavicular (A-C) arthritis in stage 2 and 3 impingement syndromes was investigated in this study. Twenty-seven patients with stage 2 and 3 impingement syndrome were evaluated both clinically and radiologically for the presence of A-C arthritis. Patients with A-C arthritis who were treated by conservative or surgical methods were rated before and after therapy according to the University of California at Los Angeles (UCLA) shoulder rating scale. The follow-up period ranged from 7 to 16 months, with an average of 13 months. A-C arthritis was diagnosed in 21 of 27 patients (one grade 2 and 20 grade 3, according to Kellegren). Clinical and radiological evaluation of these 21 patients revealed A-C joint pain and a positive lidocaine injection test in all (100%), a positive horizontal adduction test in 20 (95.2%), decreased joint space in 18 (85.75%) and osteophytes in 11 (52.4%). Surgical treatment was considered for 12 A-C arthritis patients; and distal clavicle resection was performed in 11 of these cases. The average score measured by the UCLA rating scale increased from 13 to 28 in the group treated with surgery (satisfactory result), and from 10 to 13 in the group treated with conservative therapy (unsatisfactory result). The results of this study may be interpreted as demonstrating that A-C arthritis is a common etiologic factor in chronic impingement syndromes and its co-existence has a strategic importance in the choice of treatment method. Surgical resection of the distal clavicle should be considered in the presence of this pathology since this technique provides excellent results in pain relief and appears to be superior to conservative therapy in these cases.