Does radiological evaluation of endobutton positioning in the sagittal plane affect clinical functional results in single-bundle anterior cruciate ligament reconstruction?

INTRODUCTION: Sports injuries are increasing today due to the increased interest in sports. The most common injured knee ligament is the anterior cruciate ligament (ACL) in sport injuries. Accordingly, surgical treatment of the ACL is performed frequently. In this study, it was aimed to retrospectively evaluate whether the location of an endobutton on lateral knee radiography was effective on knee functional scores in patients who underwent ACL reconstruction. MATERIALS AND METHODS: One hundred thirty patients who underwent ACL reconstruction between January 2015 and February 2019 were identified. The patients were divided into three groups according to the location of the endobutton on lateral radiographs taken in the postoperative period. Group 1 patients were classified as anterior, group 2 as middle, and group 3 as posterior according to the location of the endobutton. Functional scoring, physical examination tests, comparative thigh diameter measurements, and single-leg hop tests were compared between the groups. It was evaluated as to whether there was a statistically significant difference between the groups. RESULTS: There were 38 patients in group 1, 63 patients in group 2, and 29 patients in group 3. The mean age was 29.1 in group 1, 29.1 in group 2, and 29.7 in group 3. The mean follow-up period of the patients was 18.4 months in group 1, 19.1 months in group 2, and 21.4 months in group 3. The average Lysholm score was 92.9 in group 1, 93.3 in group 2, and 91.7 in group 3. The mean modified Cincinnati scores were 27.0, 27.1, and 26.6, respectively, in the groups. The mean IKDC score of the subjective knee assessments was 92.5, 92.8, and 91, respectively, according to the groups. The average thigh atrophy value was 1 cm, 1 cm, and 1.2 cm, respectively, in the groups. In the single-leg hop test, 34 patients in group 1 jump to over 85% of the distance compared with the intact side, while 58 patients in group 2, and 23 patients in group 3 were successfully able to jump this distance. The effect of the placement of the endobutton in the anterior, middle or posterior was not statistically significant on functional scores and physical examination results. In patients with endobuttons in the middle, functional scores were found better than in those with anterior or posterior placement. CONCLUSIONS: No statistically significant differences were found in clinical functional results when comparing patients' endobutton location on femur. For this reason, surgical time should not be extended using unnecessary extra effort to change the orientation of the exit hole during surgery.

Distal Oblique Metatarsal Osteotomy for Hallux Valgus Deformity: A Clinical Analysis.

We compared the outcomes of the distal oblique metatarsal (DOM) osteotomy, which is parallel to the articulation surface of the proximal phalanx, with those of the chevron osteotomy and evaluated whether displacement and shortening of the first metatarsal have any effect on the incidence of metatarsalgia and patient satisfaction. Patients treated with the DOM osteotomy (n = 30) or distal chevron osteotomy (n = 31) were evaluated retrospectively. The chevron and DOM osteotomies both provided significant improvement in the first intermetatarsal angle (p < .001), hallux valgus angle (p < .001), distal metatarsal articular angle (p < .001), range of first metatarsophalangeal joint motion (p < .001), American Orthopaedic Foot and Ankle Society score (p < .001), and sesamoid position (p < .001), without any significant differences between the 2 groups. Patient satisfaction and metatarsalgia also were not different between the study groups. The DOM osteotomy group had higher plantar displacement (0.1 ± 0.1 mm versus 1.0 ± 0.1 mm; p < .001) and absolute shortening of the first metatarsal (1.0 ± 0.4 mm versus 6.8 ± 1.0 mm; p < .001). In conclusion, the DOM osteotomy is an alternative treatment method for mild and moderate hallux valgus.

Ankle arthroplasty in a patient with bleeding diathesis and the mid-term clinical outcome of the case.

PURPOSE: The purpose of this report was to present the case of a patient with bleeding diathesis on whom we performed ankle arthroplasty for the first time. MATERIALS AND METHODS: A 29-year old male patient with bleeding diathesis, who had been treated and followed up over a long period, underwent ankle arthroplasty because of osteoarthritis of the ankle. The patient was prepared for surgery by the haematology department in accordance with the guidelines for surgical preparation, diagnosis and management of haemophilia. After ankle arthroplasty was performed, the preoperative and two-year postoperative clinical outcomes were evaluated using a subjective foot score and Maryland foot score. RESULTS: Preoperative factor VIII levels were raised to the target level of haemostasis prior to the surgical procedure. The factor VIII levels were maintained within the normal range up to postoperative day 14. The subjective foot score of the patient was 40 preoperatively and 85 postoperatively, whereas their Maryland foot scores were 33 preoperatively and 90 postoperatively. Both scoring systems indicate an excellent clinical outcome. CONCLUSION: As observed, the early and mid-term functional outcomes are promising for patients with bleeding diathesis who undergo ankle arthroplasty.

Major extremity injuries associated with farmyard accidents.

BACKGROUND: The aim of the study is to analyze the major agricultural injuries related to the extremities. PATIENTS: We evaluated a 3-year period including 41 patients. Data on age, sex, injury patterns, anatomical localizations, injury season, length of stay in the hospital, and infections were evaluated, and the patients were examined with SF-36 in the follow-up period. RESULTS: Hand was the most commonly injured part (n: 9) followed by the distal part of the lower limb (cruris) (n: 7) and foot (n: 7). Mean time between trauma and emergency-department arrival was 115 minutes (60-360). Mean length of stay was 24 days (4-150), and mean number of operations during hospitalization was 2.4 (1-30). Deep wound infection was seen in 8 patients. Seasonal distribution for accidents was even for spring and fall (27% each), high for summer (36%), and less for winter (10%). CONCLUSIONS: Distal parts of the elbow and knee were affected more frequently. Due to the high microbiological load and high incidence of crush-type injuries, repetitive debridements and long duration of hospital stay were needed. Attention should be paid in the harvesting times to the farmyard injuries. Due to the seasonal variation, more resources should be allocated to treat the increasing incidence of injury over the period from spring to fall.

[Isolated synovial chondromatosis of the proximal tibiofibular joint]. / Proksimal tibiofibular eklemde izole sinovyal kondromatozis.

Synovial chondromatosis is a chronic, progressive disease of the synovial tissue where free chondral loose bodies are formed after metaplasia. It is mostly seen as a monoarticular disease in the knee, hip, shoulder, ankle, and elbow joints. To our knowledge, isolated synovial chondromatosis of the proximal tibiofibular joint has not been reported. A 36-year-old male patient presented with a complaint of pain on the lateral side of the right knee, whose severity gradually increased within the past two years. Radiological findings were suggestive of synovial chondromatosis of the proximal tibiofibular joint. The patient was treated with resection of the fibular head, including the satellite lesions. Histopathological examination confirmed the diagnosis. At one-year follow-up, the patient was symptomless, had full range of motion of the knee without pain, and had no problems in maintaining daily activities. Pathologies of the proximal tibiofibular joint must be kept in mind in patients with lateral knee pain.

A complex variant of Lisfranc joint complex injury.

We report an unusual case of a variant of Lisfranc injury, plantar dislocation of the medial cuneiform with plantar fracture-dislocation of the intermediate cuneiform and dorsal fracture-dislocation of the lateral cuneiform, which has never been reported, to our knowledge. The entire pathologic abnormality was treated by open reduction and fixation with Kirschner wires, which were removed 8 weeks postoperatively because of pin-tract infection. Complex regional pain syndrome, which was a problem early in the recovery process, is now in remission, and at the 25-month follow-up examination, the patient was almost symptom free.

Sultan Bayezid II Külliyesi: one of the earliest medical schools--founded in 1488.

During the 8th to 13th centuries, Islamic medicine went through a golden age which influenced medical education and practice in the Ottomans, who conserved fundamental features of Islamic civilization. A külliye is an Ottoman architectural concept that designates a complex with a central mosque and a series of ancillary buildings surrounding it. Sultan Bayezid II Külliyesi of Edirne, Turkey is an early characteristic example with its sections, and in particular, with the medical school and hospital. The other constructed units were built to complete the hospital service in social, cultural, religious and financial aspects. This foundation (vakif, waqf in Arabic) of health was a trust with deeds that contain notable information regarding hospital management, and the duties, responsibilities, qualities, and proficiency standards requisite for physicians. The Külliye, established in the 15th century, provided substantial contributions to medical and scientific history, and patient care. Together with the history of the Külliye, I will focus on the medical books of the period, in particular works of Serefeddin Sabuncuoglu who used the Turkish language instead of Arabic and color illustrations and his two books which were the main medical books of the period combining knowledge of Greek, Roman, Arabic, and Turkish acquirements.

[Intra-articular sodium hyaluronate injections after arthroscopic debridement for osteoarthritis of the knee: a prospective, randomized, controlled study]. / Diz osteoartriti tedavisinde artroskopik debridman sonrasi eklemiçi sodyum hiyalüronat enjeksiyonu: Prospektif, randomize, kontrollü çalisma.

OBJECTIVES: The purpose of this study was to evaluate the effect of intra-articular hyaluronic acid (HA) injections after arthroscopic debridement on pain and functional parameters in patients with mild-to-moderate knee osteoarthritis. METHODS: Sixty-seven patients (21 men, 46 women; mean age 56 years; range 40 to 65 years) who underwent standard arthroscopic debridement for primary knee osteoarthritis of Kellgren-Lawrence grade II-III were randomly assigned to HA injections (n=33) or to only follow-up as controls (n=34). Intra-articular sodium hyaluronate injections (Orthovisc) were started three weeks after arthroscopic debridement, totaling three injections interspersed with a week. The two groups were evaluated with the pain and physical function subscales of the WOMAC osteoarthritis index before and after 6, 12, and 24 weeks of arthroscopic debridement. RESULTS: Improvement in pain scores at 6 weeks did not differ between the two groups (HA 21%, control 16%; p=0.478), whereas improvement in function scores was significantly higher in the HA group (23% vs 9.2%; p=0.018). The rates of improvement in pain and function scores increased in subsequent evaluations, but these did not differ significantly between the two groups. The percentages of patients who exhibited at least 30% and 40% improvement from baseline function scores were significantly greater in the HA group only at six weeks (p=0.025 and p=0.038, respectively). CONCLUSION: Intra-articular HA injections after arthroscopic debridement provide additional short-term benefits, but this combination therapy should be justified by further controlled studies with longer follow-up and larger patient groups.

[A survey study on "Turk-Orthopod", a Turkish electronic discussion group in orthopedics and traumatology]. / Türk ortopedisinin elektronik haberlesme ve tartisma grubu "Türk-Ortopod" üzerine bir anket çalismasi.

OBJECTIVES: This study evaluated demographic data of Turk-orthopod members, an electronic mailing list organized for communication between Turkish speaking orthopedic surgeons, and the contribution of the mailing list to the academic improvement and education of its members. METHODS: A twenty-seven item questionnaire was prepared for online survey and an e-mail massage was sent to the members of the e-group asking them to respond to the questionnaire. RESULTS: The response rate was 33% (n=225; 224 males, 1 female; mean age 36.5 years; range 25 to 64 years). A great majority of the respondents (74.2%) worked in a teaching hospital as a member of active education; 104 respondents worked in a medical school, and 76 respondents (33.8%) had a faculty membership. Access to scientific information (55.1%) was the most frequent reason for using the Internet. Messages related to case discussions (60.9%) and scientific announcements (27.6%) received the most attention and interest. Of the participants, 56.4% reported to have read all the incoming messages, and 35.1% reported not to have sent any messages to the group. CONCLUSION: Our electronic discussion group, Turk-orthopod, has proved to be a quick communication tool, presenting a considerable potential to contribute to continuous medical education of Turkish orthopedists.

Multiple huge osteomas of the mandible causing disfigurement related with Gardner's syndrome: case report.

As osteomas of the bones including the jaws may be the initial symptom or clinical finding in the Gardner's syndrome, this entity should always be included in the differential diagnosis. A 20-year-old boy was referred to our clinic from another medical center. Extra-oral examination of the patient revealed an obvious asymmetry and disfigurement of the left mandibular corpus, angle and ramus. A panoramic radiograph revealed two huge osteomas at the angle, ramus and two smaller osteomas at the inferior border of the mandible. At the same time, there were an impacted canine and premolar. Diffuse sclerosis of the whole mandible was also seen. Upon the suspicion of Gardner's syndrome, barium passage radiographs of the intestine were requested and multiple polyps were observed. All of these findings led us to the diagnosis of Gardner's syndrome. The oral and maxillofacial surgeon and the dentist needs to be aware of the components of this entity because manifestations in the head and neck including epidermoid cysts, osteomas, odontomas, exostoses, supernumerary and impacted teeth are common. At the same time, osteomas causing disfigurement on the face related with Gardner's syndrome with increased uptake in scintigraphic examination should be treated by surgical excision of the lesions.

Low-cost antibiotic loaded systems for developing countries.

Treatment of osteomyelitis with local antibiotic delivery systems has become a common practice in orthopaedic surgery. This study attempted to show that locally produced pure or bioglass reinforced plaster of Paris, hydroxyapatite and sodium alginate are promising biomaterials and mainly because of economical reasons and availability, may be an alternative in clinical practice, especially for developing countries. A total of 32 rabbits were divided into four groups (n:8). In group A, sodium alginate + cephazoline; in group B, plaster of Paris + bioglass + cephazoline; in group C, plaster of Paris + hydroxyapatite + cephazoline and in group D, plaster of Paris + cephazoline were used. The blood serum cephazoline concentrations were analyzed by high performance liquid chromatography on days 1 to 10 everyday and then at days 13, 17, 18, 24, 25 and 30. The mean values +/- standard deviations and median values of blood serum antibiotic concentrations for groups A, B, C and D were 1.45 +/- 0.40 (1.42) mcg/ml, 1.53 +/- 0.64 (1.31) mcg/ml, 1.92 +/- 0.39 mcg/ml (1.90) and 1.41 +/- 0.65 (1.25) mcg/ml, respectively. The detected antibiotic level was constantly over the minimum inhibitory concentration for Staphylococcus aureus. In conclusion, it can be stated that these materials are promising as a antibiotic delivery system even with simple production methods.

Diagnostic ultrasound treatment increases the bone fracture-healing rate in an internally fixed rat femoral osteotomy model.

OBJECTIVE: To investigate the healing effects of diagnostic ultrasound in a standardized rat femur fracture model. METHODS: Thirty-two male rats aged 14 weeks were used, and each rat's right femur was osteotomized and stabilized under anesthesia. The rats were then divided into 4 groups. Five days after surgery, ultrasound was applied every fifth day with diagnostic sonographic equipment and a probe with a 7.5-MHz frequency and 11.8-mW/cm2 total output intensity for 10 minutes in each session. Ultrasound was applied 8 times in group A, 3 times in group B, and only once in group C. Ultrasound was not applied to sham-operated group D. Healing and callus formation of the rats' femur fractures were evaluated by radiography and dual-energy x-ray absorptiometry. RESULTS: Dual-energy x-ray absorptiometric and radiographic results showed that the ultrasound therapy accelerated the fracture healing. Radiographically, groups A and B showed better fracture healing than groups C and D. Ultrasound exposure increased both the whole-bone mineral density and the density at the fracture region, increasing in parallel with the exposure period. CONCLUSIONS: This study confirms the previously shown efficacy of low-intensity ultrasonic stimulation in acceleration of the normal fracture repair process even when performed with a diagnostic sonographic device.

Comparison of open carpal tunnel release and local steroid treatment outcomes in idiopathic carpal tunnel syndrome.

To compare the efficacy of local steroid injection and open carpal tunnel release, a symptom and functional status questionnaire (Boston Questionnaire) and sensory and motor nerve conduction studies were performed in 90 patients with electrophysiologically proven idiopathic carpal tunnel syndrome, of whom 44 were treated surgically and 46 by two-dose steroid injection. Electrophysiologic studies and the Boston Questionnaire were applied before and at the 3rd and 6th months after treatment. Both groups showed significant improvement at first follow-up. The surgically treated group showed a significant and further improvement of symptoms and conduction values between the 3rd- and 6th-month evaluations, whereas no significant change was observed in the patient group treated by steroid injection. By the end of follow-up, 5% of the hands in the open carpal tunnel release (OCTR) group and 13% of the hands in the local steroid injection (LSIG) group showed electrophysiological worsening, and 5% of the hands in the OCTR group and 22% of the hands in the LSIG group showed symptomatic worsening. Our results show that steroid injection provides an improvement comparable with that from surgical release of the median nerve at a 3-month interval. However, this improvement is not long-lasting.