Rarely seen bilateral posterior shoulder fracture dislocation: Simultaneous bilateral hemiarthroplasty.

Posterior shoulder dislocation is a rare condition, while bilateral posterior shoulder fracture is extremely rare. Dislocations with a fracture of the bilateral posterior shoulder are observed more often after epileptic seizures. As dislocations with posterior shoulder fracture are rare, clinicians sometimes experience difficulty in diagnosing it timely. Although it can be diagnosed and treated early, based on a proper shoulder examination and accurate radiological imagery. In the treatment of posterior shoulder dislocations, closed reduction can be performed at an early stage, while methods of osteosynthesis with open reduction or arthroplasty are the most frequently used procedures at delayed stage. In this study, it was shown for the first time in literature, that a very rare case of dislocation with bilateral posterior shoulder fracture after epileptic seizure, in a 68 years old patient, had good clinical and functional results, following simultaneous hemiarthroplasty treatment.

Radiological and functional outcomes of modified Metaizeau technique in displaced radial neck fractures.

The management of displaced radial neck fractures in children is still a controversial topic. The objective of this study is to examine the outcomes of modified Metaizeau technique in the children with displaced radius neck fractures. The retrospective study included 15 children with displaced radial neck fracture with an angulation of more than 30° who were managed with the use of leverage technique by mosquito clamps and internal fixation with elastic stable intramedullary nailing (ESIN). Radiological and functional assessments were performed during follow-up. Additionally, the patients were evaluated using Mayo Elbow Per- formance Score (MEPS). All the children could be managed with clamp-assisted closed reduction. The average duration of follow up was 25.5 ± 6.1 months (15-36 months). An excellent elbow function was achieved in all but one patient. Based on Metaizeau classification, excellent, good, fair, and poor outcomes were achieved in 11, 1, 2, and 1 patients, respectively. The average postoperative MEPS score was 98.7 ± 5.1 (80-100). Clamp-assisted closed reduction and fixation with ESIN is a good choice in the children with displaced radial neck fractures. This technique is associated with good functional and radiologic outcomes in the medium-term. Further studies are warranted with larger sample sizes.

Biomechanical comparison of Bunnell, modified Kessler, and Tsuge tendon repair techniques using two suture types.

OBJECTIVE: The aim of this study was to compare the biomechanical properties of modified Kessler, Bunnell and Tsuge techniques in sheep Achilles tendon tear repaired using polyester and polydioxanone sutures which are also compared. METHODS: Sixty sheep Achilles tendons were cut transversely as a substitute for rupture and repaired using modified Kessler, Bunnell and Tsuge techniques with No. 2 braided polyester and monofilament polydioxanone sutures. Specimens were loaded to failure. Four biomechanical parameters - ultimate strength (US), strength to 2 mm gap (S2G), strength to 5 mm gap (S5G) and Young's modulus (YM) - were recorded for statistical analysis. RESULTS: The Tsuge-Polyester group demonstrated the highest results regarding S2G (21.24±4.75 N) (p=.002) and S5G (38.91±7.45 N) (p=.002). According to YM, the Bunnell-Polyester group was the most superior (1929.9±512.28 kilopascal) (p=.009). In the repairs with the polydioxanone suture, Bunnell technique achieved the best purchase with regard to S2G (18.14±6.86 N) (p=.006) and S5G (35.69±13.49 N) (p=.015). The difference between the three repair techniques with the polydioxanone suture was statistically insignificant regarding US (p=.252) and YM (p=.338). Concerning the repairs with the polyester suture, the repair techniques demonstrated no statistically significant difference in terms of US (p=.195), S2G (p=.667), S5G (p=.689) and YM (p=.195). Regarding the mean S2G and S5G values, the polyester suture was significantly superior to the polydioxanone suture in modified Kessler repairs (S2G: p<.001, S5G: p=.001) and Tsuge repairs (S2G: p<.001, S5G: p=.009). The polyester suture was also significantly superior to the polydioxanone suture in the modified Kessler repairs with respect to YM (p=.003). CONCLUSION: This study supports the opinion that Tsuge technique is a promising procedure in Achilles tendon repair (ATR). For Tsuge and modified Kessler repairs, braided polyester suture use appears more advantageous compared to monofilament polydioxanone suture use in biomechanical terms.

The effect of erythropoietin on biomechanical properties of the Achilles tendon during the healing process: an experimental study.

BACKGROUND: The aim of this study was to examine the potential biomechanical and histological benefits of systemic erythropoietin administration during the healing of Achilles tendon injury in a rat experimental model. METHODS: Eighty Sprague-Dawley female rats were included in this study. Animals were randomly assigned into two groups with 40 animals in each: erythropoietin group and control group. Then each group was further divided into four subgroups corresponding to four time points with 10 animals in each. A full-thickness cut was made on the Achilles tendon of each animal and then the tendon was sutured with modified Kessler method. Erythropoietin groups received intraperitoneal erythropoietin (500 IU/kg/day) every day at same time throughout the study period, and the control groups received saline in a similar manner. Animals were sacrificed at four time points, and tensile test was performed on each tendon sample to assess maximum load for each sample. In addition, histopathological examination and scoring was done. RESULTS: Both groups had improvement on tensile test (maximum load) over time. However, groups did not differ with regard to maximum load in any of the time points. Similarly, groups did not differ with regard to any of the histopathological scores over time. CONCLUSIONS: The findings of this study do not support the benefit of systemic erythropoietin administration in Achilles tendon healing process. Further evidence from larger experimental studies is required to justify any such potential benefit.