Comparison of pulley plasty, pulley venting and resection of flexor digitorum superficialis slip after zone II flexor tendon repair: a cadaver study.

LEVEL OF EVIDENCE: V.

Management of an Unusual Post-arthroscopic Complication: Subquadricipital Hematoma in the Presence of Complete Suprapatellar Plica.

Complete suprapatellar plica is a rare congenital anomaly that separates the suprapatellar bursa from the knee joint cavity. Although the pathological incidence of this condition is not known, it can cause patellofemoral symptoms, anterior knee pain, and rarely hemarthrosis. We report a patient with a hematoma in an unusual location just three weeks after an arthroscopic procedure, associated with a complete suprapatellar plica undetected during primary surgery. The hematoma was not in the synovial cavity, rather between the quadriceps tendon and the synovial membrane and presenting with pain and catching. This unusual location has not been reported before. Repeat arthroscopic surgery with drainage of hematoma and plica resection relieved the symptoms.

Increased survival rate in extension stemmed TKA in obese patients at minimum 2 years follow-up.

PURPOSE: Total knee arthroplasty (TKA) is frequently performed for obese patients. TKA in this population shows a high rate of complication, particularly tibial component loosening. The aim of this study is to compare the survival rate of tibial components in obese population using TKA with stem versus without stem. METHODS: From a prospective database of 4216 TKA, obese patients [body mass index (BMI) > 30 kg m²] with primary TKA using a tibial short stem extension (30 mm) at a minimum follow-up of 2 years were retrospectively reviewed and compared to a matched control group (1:3 ratio) with a standard tibial stem. Inclusion criteria were BMI > 30 kg m², first knee surgery and 24 months minimum of follow-up. The primary outcome was revision for tibial aseptic loosening. Secondary outcomes were all-cause revisions and Knee Society Scores (KSS). RESULTS: The final study population consisted of 35 TKA with tibial extension stem versus 105 TKA with standard stem. The mean age was 69.2 and 69.5 years, respectively, with a mean follow-up of 52 months. Both groups were comparable before surgery. After 2 years of follow-up, we observed seven tibial loosening in the group without stem (6.6%) versus no tibial loosening in the stemmed group (p < 0.001). The difference in KSS knee score (83 versus 86; p = 0.06) and the KSS function score (73 versus 77; p = 0.84) were not statistically significant at the final follow-up. CONCLUSION: Using stemmed TKA for obese patients significantly decreased tibial loosening rate at minimum 2 years of follow-up. LEVEL OF EVIDENCE: Case-control study, Level III.

A neglected causative agent in diabetic foot infection: a retrospective evaluation of 13 patients with fungal etiology

Background/aim: Clinicians often neglect fungal infections and do not routinely investigate deep tissue from the wound for fungal culture and sensitivity due to insufficient information in the literature. In this study, we aimed to evaluate fungal etiology of invasive fungal diabetic foot which is rarely reported in the literature. Materials and methods: The patients who were unresponsive to antibiotic therapy and those with positive fungal in bone or deep tissue culture were enrolled in the study. Detailed hospital records were retrieved for demographics and clinical features. Results: A total of 13 patients who were diagnosed with invasive fungal diabetic foot (ten females, three males, mean age 59.8 ± 9 years) were included. All of the patients had type-2 diabetes mellitus. Eleven (84.6%) patients had mixed infection. The most common cause of fungal infections of diabetic foot ulcers was the Candida species. Ten (76.9%) patients underwent amputation, two (15.4%) patients refused amputation, and one patient died before surgery. Conclusion: Invasive fungal infections may also be a causative pathogen in deep tissue infections. Therefore, fungal pathogens should be considered in patients unresponsive to long-term antibiotic therapy. Early detection of fungal infections in high-risk individuals is critical for the prevention of severe consequences such as foot amputation.

Value of CT, FDG PET-CT and serum tumor markers in staging recurrent colorectal cancer.

BACKGROUND: Serum tumor markers and computed tomography (CT) are the most widely accepted monitoring tools for the follow-up patients with colorectal cancer (CRC). Positron emission tomography (PET) with 18[F]-fluorodeoxyglucose (FDG) is a promising modality for the evaluation of recurrent CRC. The purpose of this study was to (1) investigate the sensitivity and specificity of serum tumor marker assay, CT and FDG PET-CT, (2) determine the correlation of these markers with FDG PET-CT quantitative indices such as maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients suspected to have recurrent CRC. PATIENTS: FDG PET-CT imaging was performed in 212 patients with possible CRC recurrence. A retrospective study was performed on patients with (1) a history of CRC with complete remission after treatment, (2) pathology of adenocarcinoma and (3) increase in cancer antigen 19-9 (CA 19-9) and/or carcinoembryonic antigen (CEA) or suspicious radiological evaluation during follow-up after complete remission. METHODS: All patients underwent integrated FDG PET-CT scan. Serum tumor markers were obtained within 3 months of PET-CT. All enrolled cases showed increase in a tumor marker over the reference value on at least two serial measurements or abnormal CT scan before PET-CT was performed. Results were compared with histopathological findings or clinical follow-up. RESULTS: Following exclusion of 57 patients with missing data or lost to follow-up, 155 patients (87 men, mean age: 61 years) remained for final analysis. Serum CEA and CA 19-9 had a sensitivity of 74 and 35% and specificity of 86 and 83% for the detection recurrent CRC, respectively. The sensitivities of CT and FDG PET-CT were 79 and 92% and specificities were 45 and 100%, respectively. At an adaptive threshold of 42%, the median SUVmax, SUVmean, MTV and TLG of these lesions were 8.8, 5.2, 11.3 cm[Formula: see text] and 55.4, respectively. All FDG PET-CT quantitative parameters correlated positively with serum CEA levels, and the correlation coefficients were 0.45, 0.44 and 0.49 for SUVmax, MTV and TLG [Formula: see text]. CONCLUSION: PET-CT scan, CEA and CA-19-9 results were correlated. However, both tumor markers had poor sensitivity to detect metastatic disease. PET-CT is more accurate than CT in detecting recurrent CRC in this study. Majority of the recurrences were in the liver and the sensitivity is affected by tumor histology. The correlation between semiquantitative FDG PET parameters and serum tumor marker levels is moderate.