Percutaneous Partial Tenotomy of ITB for Secondary Genu Valgum Developing After Total Hip Arthroplasty in Patients with Crowe Type-Iv Dysplasia.

Background: The aim of this study was to make a prospective evaluation of the effect on the clinical results of percutaneous iliotibial band partial tenotomy (PITP) applied to cases of genu valgum which developed following total hip prosthesis for Crowe Type IV dysplastic hip. Methods: The study consists of 33 patients with unilateral crowe type IV dysplastic hip osteoarthritis who developed iatrogenic ipsilateral genu valgum after total hip arthroplasty. The patients were randomly separated into 2 groups of Group 1 (n = 16) where percutaneous iliotibial band tricut partial tenotomy was applied (PITP) and Group 2 (n = 17) where no treatment was applied. Pre and postoperative measurements were taken of the Harris Hip Score (HHS), the Lysholm-Gilquist Knee Score (LGS), Visual Analog Score (VAS), ipsilateral knee Q angle, and the spina ilica anterior superior medial malleolus distance (SIAS-MM). Results: In both Group 1 and Group 2, a statistically significant increase was seen in the values of SIAS-MM (p < 0.001), Q angle (p < 0.001) and HSS (p < 0.001) from preoperative to postoperative. A statistically significant decrease was determined in LGS (p < 0.001, p < 0.003). In Group 1, a statistically significant decrease in the Q angle was determined at the final follow-up after PITP compared to the early postoperative period (p < 0.001). The HSS values for Group 1 were statistically significantly high in the early postoperative period and at the final follow-up (p < 0.001). Conclusion: PITP application improves knee and hip clinical scores in the early postoperative period and hip clinical scores in the mid-term follow-up.

An analysis of cases presenting with a mass in the hand and an evaluation of treatment methods.

The aim of this study was to present and discuss our clinical experience of patients presenting with a mass in the upper extremity, in respect of demographic characteristics, localisation of the mass, clinical and pathological characteristics. A retrospective evaluation was made of 114 cases (60 females, 54 males) who presented at our clinic with complaints of localised pain and swelling in the upper extremity between 1 June 2016 and 31 December 2018. The cases were separated into 3 groups; Group 1 with a mass determined in the carpal region, Group 2 with localisation between the wrist and the metacarpophalangeal joint, and Group 3, in the distal of the metacarpophalangeal joint. The mass was of soft tissue origin in 90 cases, and of bone origin in 24 cases. The distribution of cases was 6 in Group 1, 20 cases in Group 2, and 88 in Group 3. The tumour was benign in 105 (92%) cases and a primary malignancy in 9 (7.8%) cases. Recurrence occurred in 4 cases, of which 2 were enchondroma, 1 was a giant cell tendon sheath tumour, and 1 was hemangioma The majority of painful masses seen in the hand are benign and very few are malignant. In the approach to hand tumours, clinical evaluation guided by demo- graphic data, and the evaluation of diagnostic and treatment options according to the radiological ap- pearance and anatomic localisation will determine the ideal approach providing a full cure.

Treatment of open wounds secondary to trauma using polyurethane foams with boric acid particles.

BACKGROUND: To investigate the efficacy of new foams with boric acid particles combined with a negative pressure wound treatment (NPWT) system in open fractures with tissue defects secondary to trauma. METHODS: Forty-nine patients with open fractures secondary to trauma with soft tissue defects who were admitted between 2016 and 2018 were included in the study. Patients were examined in two groups. In Group 1, boric acid-impregnated foams combined with the NPWT system were used in 27 patients, and in Group 2, silver nitrate-impregnated foams combined with NPWT systems were used in 22 patients. In addition to evaluating the broad-spectrum antibacterial feature of silver nitrate, the antimicrobial, angiogenetic, and epithelializing effects of boric acid were investigated macroscopically and histopathologically. RESULTS: A reduction in wound size and granulation was observed in each group. Macroscopically, the reduction in wound size, epithelialization and granulation were pronounced in Group 1 and in Group 2. Microscopically, the number of fibroblasts, collagen synthesis, and angiogenesis were significantly increased in Group 1 compared with Group 2. CONCLUSION: In this clinical trial, both the broad spectrum antimicrobial feature of boric acid and its positive effect on the cells responsible for wound healing were found to be an alternative compared with silver nitrate. The use of new foams with boric acid particles combined with the NPWT system may be a good alternative method in the treatment of open wounds due to trauma.

Epiphysis Salvage Reconstruction and Associated Complications Following Tumor Resections in Skeletally Immature Patients.

The purpose of this study was to discuss the epiphysis salvage reconstruction procedure outcomes and complications in skeletally immature patients. The study included 12 patients with pediatric malignant tumors (osteosarcoma, Ewing's sarcoma) located close to the epiphysis, who underwent epiphyseal-preservation surgery with vascularized fibula in the plastic surgery and orthopedics and traumatology clinic between January 2008 and November 2018. The study was designed retrospectively. Neoadjuvant and adjuvant chemotherapy was administered to all patients. None of the patients received radiotherapy. Functional evaluation was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system. The patients were followed up for a mean period of 51 (21­115) months. The mean age of patients was 10.4 (range, 5 to 15) years. Union times in the target region (epiphyseal region) and diaphyseal region were reported separately. Accordingly, the mean total union time in the target region of all patients was 7.9 months (5­11), and the mean total union time in the diaphyseal region was 6.5 months (5­9). According to the MSTS grading system, the mean score of the patients was 27.50 (range, 21­30). The mean operative time was 480 (390­540) min, the mean intraoperative blood loss was 790 (580­1100) cc, and the mean length of hospital stay was 6 (4­17) days. Six patients had shortness, 5 patients had delayed union, 3 patients had angular deformity, and 2 patients had infection. Epiphyseal-preservation surgery may be an alternative to other techniques used for malignant tumors located close to the growth line in skeletally immature patients. Despite the fact that this technique has plenty of complications, many of them can be successfully treated with secondary operations without leaving sequelae.

Does Body Mass Index Cause a Clinical Difference in Simultaneous Bilateral and Unilateral Knee Arthroplasty?

This study aims to investigate clinical and functional factors in patients undergoing unilateral and simultaneous bilateral total knee arthroplasty (TKA) who were classified into subgroups of nonobese, obese, and morbidly obese, and to determine perioperative and postoperative complications. We conducted an evaluation of 489 nonobese, obese, and morbidly obese patients who underwent TKA due to primary knee osteoarthritis between January 2006 and December 2013. The arthroplasties were performed by three different surgeons. Patients who underwent unilateral (group 1) or simultaneous bilateral (group 2) TKAs were divided into subgroups in accordance with BMI levels, that is, (a) nonobese (BMI < 30 kg/m2), (b) obese (BMI = 30-34.9 kg/m2), and (c) morbidly obese (BMI ≥35 kg/m2). Clinical and functional assessments were performed using Knee Society Scores (KSSs), the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), and range of motion (ROM) values. Perioperative and early postoperative complications were assessed. The mean follow-up period was 46.65 months (minimum: 24 months; maximum: 84 months). There were no significant differences between the patients undergoing unilateral or simultaneous bilateral TKA procedures regarding postoperative ROM, WOMAC indices, and KSSs (p > 0.05), except for morbidly obese patients. Most intraoperative and early postoperative complications occurred in the morbidly obese group, especially in those undergoing simultaneous bilateral TKA procedures (p < 0.001). Unilateral and simultaneous bilateral TKA procedures showed no differences regarding ROM, clinical scores, and perioperative and early postoperative complications in nonobese and obese patients. A moderate increase was detected in complication rates in the unilateral TKA morbidly obese patients (group 1c); however, morbidly obese patients constituted the major risk group in simultaneous bilateral TKA patients (group 2c) regarding clinical scores (lower WOMAC scores and KSSs) and the development of complications.

Is There a Relationship between Patellofemoral Alignment and Osgood-Schlatter Disease? A Case-Control Study.

This study was aimed to investigate the role of anatomic variations in patellofemoral alignment in patients with or without Osgood-Schlatter disease (OSD) and to determine the potential anatomic risk factors that may play role in the etiology. This prospective observational case-control study was conducted on two groups of adolescent patients. Group 1 comprised patients who were diagnosed as having OSD and group 2 consisted of an equal number of age-matched patients who presented to the outpatient clinic with traumatic knee injury and underwent knee radiographic examination but without a diagnosis of OSD. Age, height, weight, body mass index (BMI), dominant side, and level of sporting activity were recorded. Quadriceps (Q) angles were measured using a long-arm goniometer with patients lying in the supine position with their knees in full extension and contracting the Q muscles. On anteroposterior, lateral knee, and tangential patella (Merchant and Laurin views) radiographs, the following measurements were performed: Insall-Salvati (IS), Caton-Deschamps (CD), and Blackburne-Peel (BP) indexes, congruence angles, lateral patellofemoral angles, sulcus angles, and patella type according to Grelsamer's morphology classification. Both groups were similar in respect of age (p = 0.160), sex (p = 0.311), height (p = 0.326), weight (p = 0.596), BMI (p = 0.153), and dominancy (p = 0.500). The rate of patients engaged in sports activities was significantly greater in the OSD group (p = 0.003). No significant difference was determined between the groups in respect to IS index, CD index, BP index, sulcus angle, lateral patellofemoral angle, and congruence angle (p-values: 0.358, 0.995, 0.912, 0.802, 1.000, and 0.907, respectively). The mean Q angle was measured as 15.6 ± 2.2 degrees in the OSD group and 14.3 ± 2.5 degrees in the control group (p = 0.014). Despite the difference being statistically significant, it was clinically insignificant because the difference was only 1.3 degrees. The principle etiologic factor seems to be increased physical activity rather than subtle variations is patellofemoral anatomy and alignment of extensor mechanism.

High tibial osteotomy in obese patients: Is successful surgery enough for a good outcome?

INTRODUCTION: Knee osteoarthritis is the most common articular pathology. High tibial osteotomy (HTO) is a frequently used treatment procedure in medial osteoarthritis of the knee joint. We aimed to reveal factors that affect clinical and radiologic outcomes by evaluating the efficacy of HTO in patients with BMI ≥30 kg/m2 who were not appropriate for prostheses considering their activity, degree of pain, and age. MATERIAL AND METHOD: HTO was performed using the medial open wedge technique who presented to the orthopedics polyclinic with symptoms of knee pain, whose BMI was over 30 kg/m2. All patients were diagnosed as having mechanical axis deviation and isolated medial compartmental arthrosis between 2013 and 2015.The clinical and radiologic follow-ups of patients were performed on day 45, at month 3, month 6, and after 1 year. The knee scoring system from the American Knee Society (AKS), and range of motion (ROM) were used in the functional evaluation of the patients. RESULT: Eighteen patients were included in the study. Thirteen patients (72.2%) were women and 5 (27.8%) were men. Preop axis score was found significantly lower compared with the axis scores at postop month 6 and in final follow-up, the postoperative final follow-up axis score was found significantly lower than the axis score at month 6 (p < 0.05). CONCLUSION: We anticipated in our study that the better outcomes obtained in the early period might be maintained for longer in parallel with weight loss and decreased BMI in the postoperative period. We believe that it is important to perform complication-free HTO with the correct technique, and by organizing a rapid and systematic weight loss process.

Management of AO type 12C humerus proximal metadiaphyseal fractures with minimally invasive plate osteosynthesis in geriatric patients.

BACKGROUND: To evaluate the treatment efficacy and complications of the lateral minimally invasive plate osteosynthesis (MIPO) method in geriatric patients with a humerus diaphyseal fracture with proximal extension. PATIENTS AND METHODS: The study included a total of 21 patients (18 females, 3 males; mean age 74±6.3 years, range 65-89 years) who underwent surgery with the lateral MIPO technique for a humerus diaphyseal fracture with proximal extension during the period January 2011 to December 2016. None of the patients had additional injuries and all completed regular follow-up. According to the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation classification system, the fractures were evaluated as 12C1 in 17 cases and 12C3 in 4 cases. All patients were evaluated radiologically and functionally at 6 months and 1 year. In the follow-up evaluations, the Constant-Murley score and the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score were used. RESULTS: No non-union, avascular necrosis or infection was seen in any patient. The mean time to union was 15.7 weeks. Impingement syndrome was seen in 2 patients and radial nerve palsy in 2 patients. The mean Constant-Murley score was 70.6±10.2 at 6 months and 84±7.6 at the end of 1 year. The mean Q-DASH score was 38.6±15.1 at 6 months and 21.9±13.1 at the end of 1 year. The increase in the Constant-Murley scores from 6 months to 1 year was statistically significant (p<0.0001). The decrease in the Q-DASH scores between 6 months and 1 year was determined to be statistically significant. In the 2 patients with radial nerve palsy, the functions were seen to completely recover during follow-up. No axillary nerve palsy was seen in any patient. CONCLUSION: Metadiaphyseal humerus fractures with proximal extension in the elderly can be successfully treated with the lateral MIPO technique. When applied correctly, it is a method with high rates of union and low rates of complications.

Primary hydatid cyst in the posterior thigh, and its percutaneous treatment.

Hydatid cyst (echinococcosis) is an endemic parasitic disease, usually encountered in those dealing with agriculture and livestock. The most frequently affected organs are the liver and the lungs. The disease is very rarely encountered in soft tissues. Diagnosing a soft-tissue hydatid cyst may be challenging unless the mass possesses the characteristic features of a hydatid cyst. Soft-tissue hydatid cysts may be treated percutaneously, just like those encountered in the liver. In this case report, we present the radiological findings and modified percutaneous aspiration-injection-reaspiration (PAIR) treatment of a hydatid cyst located in the posterior aspect of the thigh.

An alternative treatment for osteoporotic Su Type III periprosthetic supracondylar femur fractures: Double locking plate fixation.

INTRODUCTION: Patients with Su Type III fractures based on total knee arthroplasty (TKA) constitute a patient group with problematic treatment and management. Although it has difficulties, open reduction and internal fixation is one of the treatment options. METHOD: A retrospective evaluation was made of 22 patients surgically treated in our clinic with double locking, low contact titanium plate and screw for a Su Type III periprosthetic fracture based on TKA. The patients were evaluated with bone mineral densitometry, postoperative Knee Society Score (KSS), WOMAC and radiological evaluations. RESULTS: The mean follow-up period of the patients was 68.6 ± 15.5 months, with pain-free weight-bearing determined at 4.9 ± 1.1 months and mean radiological union at 18.5 ± 4.3 weeks. Revision was required because of non-union in 2 (9.09%) cases. The postoperative KSS value was 81.8 ± 7.8, the WOMAC value was 78.1 ± 5.3 and the T-score was -3.3 ± 0.3. At the final follow-up examination, a correction loss (4.9° ± 1.5°) was determined in the mean knee valgus angle according to the mechanical axis, which was statistically significant but remained within the physiological limits (p = 0.21). CONCLUSION: In addition to providing the advantages of rigid fixation together with early and effective rehabilitation, satisfactory clinical and radiological results were obtained with the application of double locking plate and screw in the treatment of periprosthetic femoral fractures based on TKA, with osteoporosis. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Single anterior portal: A better option for arthroscopic treatment of traumatic anterior shoulder instability?

OBJECTIVE: The aim of this study was to compare single and double anterior portal techniques in the arthroscopic treatment of traumatic anterior shoulder instability. METHODS: A total of 91 cases who underwent arthroscopic Bankart repair for anterior shoulder instability were reviewed. The patients were divided into 2 groups as Group 1 (47 male and 2 female; mean age: 25.8 ± 6.8) for arthroscopic single anterior portal approach and Group 2 (41 male and 1 female; mean age: 25.4 ± 6.6) for the classical anterior double portal approach. The groups were compared for clinical scores, range of motion, analgesia requirement, complications, duration of surgery, cost and learning curve according to a short questionnaire completed by the relevant healthcare professionals. RESULTS: No statistically significant difference was found between the 2 groups in terms of pre-operative and post-operative Constant and Rowe Shoulder Scores, range of motion and complications (p > 0.05). In Group 2 patients, the requirement for post-operative analgesics was significantly higher (p < 0.001), whereas the duration of surgery was statistically significantly shorter in Group 1 (p < 0.001). In the assessment of the questionnaire, it was seen that a single portal anterior approach was preferred at a higher ratio (p = 0.035). The cost analysis revealed that the cost was 5.7% less for patients with a single portal. CONCLUSION: In the arthroscopic treatment of traumatic anterior shoulder instability accompanied by a Bankart lesion, the anterior single portal technique is as successful in terms of clinical results as the conventional double portal approach. The single portal technique has advantages such as less postoperative pain, a shorter surgical learning curve and lower costs. LEVEL OF EVIDENCE: Level III, Therapeutic study.

Noncontact plating technique in an open fracture.

AIM: In comparison with closed fractures, open fractures have an increased risk of infection, there are soft tissue-related problems, and difficulties are experienced in union. The aim of this study was to evaluate and discuss the results of osteosynthesis applied with a noncontact plate in Gustilo-Anderson Type 2, 3a, and 3b fractures. METHOD: The study included 23 patients applied with debridement + noncontact plate osteosynthesis + soft tissue procedures in a single session for the treatment of an open fracture. A follow-up card was created to evaluate the patients in respect of age, gender, fracture level, fracture etiology, open fracture type, preoperative and postoperative sedimentation and C-reactive protein values, antibiotics used and duration of use, time to union, and complications. RESULTS: In all 23 patients, full bone union was obtained at mean 22.5 weeks (range: 16-36 weeks). Complications developed in 9 patients. Implant failure occurred in 3 patients. In 5 patients, infection developed which required repeated debridements. CONCLUSION: In open fractures, noncontact plating following debridement seems to be a good alternative treatment method to intramedullar nailing, especially in metaphyseal and metaphyseo-diaphyseal fractures and in spiral oblique diafiz fractures. Noncontact plating may also be a good alternative to intramedullar nailing for open fracture treatment if the patients have additional pathologies such as contusion and thoracic injury.

An evaluation of two different methods of coccygectomy in patients with traumatic coccydynia.

PURPOSE: The aim of this study was to evaluate the results of partial and total coccyx excisions in patients with traumatic coccydynia resistant to conservative treatment. PATIENTS AND METHODS: The study included 22 patients (from a total of 27) who underwent partial or total coccygectomy because of persistent coccydynia between December 2007 and January 2014. There were 15 females and 7 males with a mean age of 33.6 years (range 23-46 years). Partial coccygectomy was performed in 14 patients and total coccygectomy in 8. They were evaluated according to their pre- and postoperative visual analog scale (VAS) scores. The mean follow-up period was 28 months (range 16-48 months). RESULTS: The mean VAS scores in the total excision group were 8.88±0.64 preoperatively and 2.5±2.67 at the final postoperative follow-up examination. In the partial excision group, these values were 8.79±0.89 preoperatively and 2.5±2.85 postoperatively. No statistically significant difference was determined between the two groups with respect to the mean scores (p>0.05). No rectum injury was seen in any patient. When the VAS scores of the patients were evaluated as a whole, excellent and good results were obtained in 78%. Patient satisfaction with the operation was 90%. CONCLUSION: Coccyx excision is a successful treatment method in patients with long-term coccydynia who are resistant to conservative treatment. Two different surgical methods can be applied in the treatment and both of them have low complication rates and high patient satisfaction.

Proximal femoral fracture surgery in a patient with osteopetrosis tarda: complications and treatment strategy.

Osteopetrosis is a rare, inherited disease characterized by defects in osteoclastic function that results in defective bone resorption. When fractures are encountered, fixation is extremely difficult. Osteopetrosis patients have an increased predisposition to infection. If infection develops after a fracture, treatment is more difficult. In this paper, treatment is presented of a 49-year old female to whom proximal femoral nailing was applied for fixation of an osteopetrotic proximal femur fracture; and when it was unsuccessful, revision was made with a locked anatomic plate, which subsequently led to development of infection.

Simultaneous Disruption of the Pubic Symphysis and Sacroiliac Joint during Vaginal Birth.

Background. Puerperal diastasis of the pubic symphysis is a rare intrapartum complication. This report presents the case of a woman who experienced synchronous pubic symphysis and sacroiliac joint separations induced by vaginal delivery. Case. A 32-year-old woman (gravida 2, parity 2) with an uncomplicated prenatal course developed acute-onset anterior pubic pain during vaginal delivery. The pain persisted postpartum and was exacerbated by leg movement. Physical and radiographic examinations showed a pubic symphyseal separation of 2.4 cm, accompanied by a 10 mm disruption of the left sacroiliac joint. The patient was treated conservatively with pain-relief medication; bed rest, mostly in the left lateral decubitus position; closed reduction and application of a pelvic binder; use of a walker; and physical therapy. Conclusion. The patient responded to conservative management. She was essentially pain-free and regained movement and ambulation by 12 weeks postpartum.

What should be the preferred choice of hemiarthroplasty technique in American Society of Anesthesiologists (ASA) class III patients with femoral neck fractures? Cemented or cementless.

The hypothetical basis of this trial specifies that hemiarthroplasty applications without cement will prove to be superior to applications with cement in terms of survival, complications, clinical and radiological improvements in the early stages of femoral neck fracture cases, which belongs to the Society of Anesthesiologists (ASA) class III group. Society of Anesthesiologists (ASA) class III elderly patients (minimum 70 years of age), who had undergone surgical interventions for femoral neck fractures were classified into two groups as those undergoing the intervention without cement (Group A) and those undergoing the procedure with cement (Group B), and these were retrospectively evaluated. The patients were followed up for a mean duration of 47.4 and 44.8 months, respectively. Survival in the early stage, duration of stay in the intensive care, intraoperative cardiac indexes, complications, clinical and radiological parameters were the main factors used in the evaluation and comparisons. The mean duration of operation in Group B cases was determined to be statistically significantly longer than that of Group A (p<0.001). The postoperative stay at the intensive care unit in both groups and the rate of mortality for 6 months in Group B were determined to be statistically significantly high (p<0.05). In group B, significant depressive findings were determined in the comparison of the intra-operative pre-and post-cement cardiac indexes. In the clinical assessment, no statistically significant results were obtained, although higher final Harris scores were determined in Group A cases (p=0.581). In the treatment of femoral neck fractures, bipolar hemiarthroplasty applications without cement provide favourable early and short-term results, which are at least as effective as the applications with cement.