Biallelic frameshift variants in PHLDB1 cause mild-type osteogenesis imperfecta with regressive spondylometaphyseal changes.

BACKGROUND: Osteogenesis imperfecta (OI) is a heterogeneous group of inherited disorders characterised by susceptibility to fractures, primarily due to defects in type 1 collagen. The aim of this study is to present a novel OI phenotype and its causative candidate gene. METHODS: Whole-exome sequencing and clinical evaluation were performed in five patients from two unrelated families. PHLDB1 mRNA expression in blood and fibroblasts was investigated by real-time PCR, and western blot analysis was further performed on skin fibroblasts. RESULTS: The common findings among the five affected children were recurrent fractures and/or osteopaenia, platyspondyly, short and bowed long bones, and widened metaphyses. Metaphyseal and vertebral changes regressed after early childhood, and no fractures occurred under bisphosphonate treatment. We identified biallelic NM_001144758.3:c.2392dup and NM_001144758.3:c.2690_2693del pathogenic variants in PHLDB1 in the affected patients, respectively, in the families; parents were heterozygous for these variants. PHLDB1 encodes pleckstrin homology-like domain family B member-1 (PHLDB1) protein, which has a role in insulin-dependent Akt phosphorylation. Compared with controls, a decrease in the expression levels of PHLDB1 in the blood and skin fibroblast samples was detected. Western blot analysis of cultured fibroblasts further confirmed the loss of PHLDB1. CONCLUSION: Two biallelic frameshift variants in the candidate gene PHLDB1 were identified in independent families with a novel, mild-type, autosomal recessive OI. The demonstration of decreased PHLDB1 mRNA expression levels in blood and fibroblast samples supports the hypothesis that PHLDB1 pathogenic variants are causative for the observed phenotype.

Cementless modular total hip arthroplasty with subtrochanteric transverse shortening osteotomy for high hip dislocations.

BACKGROUND: Performing a total hip arthroplasty for a high hip dislocation is technically demanding and presents several challenges, with appropriate evaluation of the bone morphology of the hip and proper implant selection being critical for successful outcomes. OBJECTIVE: The purpose of our study was to evaluate the clinical and radiographic outcomes of cementless modular total hip arthroplasty for the treatment of high hip dislocations with sub-trochanteric transverse shortening osteotomy. METHODS: Sixty-eight hips with a high hip dislocation, were treated using a sub-trochanteric transverse shortening osteotomy and cementless modular total hip arthroplasty, retrospectively reviewed. Hip function was assessed using the Harris hip score, with hip abduction strength evaluated using the Trendelenburg test. Radiographic assessment included the measurement of leg length discrepancy, identification of implant loosening, localization of the hip center, and union at the osteotomy site. RESULTS: The mean follow-up period was 12.9 (range 5.2-16.8) years. The mean Harris hip score improved from a pre-operative score of 48.6 ± 3.6 to 82.4 ± 4.2 (p < 0.05). The hip was within the true acetabulum in all patients, postoperatively. Osteotomy union was achieved in 67 of the 68 hips (98.5%) in a mean latency of 12.5 ± 0.6 weeks. The mean length of femoral shortening was 66.5 ± 4.5 mm, with a mean pull-down length of the proximal part of 35.5 ± 3.5 mm. CONCLUSION: For the treatment of high hip dislocations with satisfactory clinical outcomes, the modular stem offers an adjustable anteversion angle to restore sufficient rotational stability and the transverse osteotomy provides sufficient compression pressure across the osteotomy site to facilitate union. Trial registration It was a retrospective study and approved by Istanbul Research and Training Hospital institutional Ethics Review Board (772-05/02/2016).

Single-Stage Posterior Vertebral Column Resection With Circumferential Reconstruction for Thoracic/Thoracolumbar Burst Fractures With or Without Neurological Deficit: Clinical Neurological and Radiological Outcomes.

STUDY DESIGN: Retrospective study. OBJECTIVE: The aim of this study is to evaluate the clinical, neurological, and radiological outcomes of posterior vertebral column resection (PVCR) technique for treatment of thoracic and thoracolumbar burst fractures. METHODS: Fifty-one patients (18 male, 33 female) with thoracic/thoracolumbar burst fractures who had been treated with PVCR technique were retrospectively reviewed. Preoperative and most recent radiographs were evaluated and local kyphosis angle (LKA), sagittal and coronal spinal parameters were measured. Neurological and functional results were assessed by the American Spinal Injury Association (ASIA) Impairment Scale, visual analogue scale score, Oswestry Disability Index, and Short Form 36 version 2. RESULTS: The mean age was 49 years (range 22-83 years). The mean follow-up period was 69 months (range 28-216 months). Fractures were thoracic in 16 and thoracolumbar in 35 of the patients. AO spine thoracolumbar injury morphological types were as follows: 1 type A3, 15 type A4, 4 type B1, 23 type B2, 8 type C injuries. PVCR was performed in a single level in 48 of the patients and in 2 levels in 3 patients. The mean operative time was 434 minutes (range 270-530 minutes) and mean intraoperative blood loss was 520 mL (range 360-1100 mL). The mean LKA improved from 34.7° to 4.9° (85.9%). For 27 patients, the initial neurological deficit (ASIA A in 8, ASIA B in 3, ASIA C in 5, and ASIA D in 11) improved at least 1 ASIA grade (1-3 grades) in 22 patients (81.5%). Solid fusion, assessed with computed tomography at the final follow-up, was achieved in all patients. CONCLUSION: Single-stage PVCR provides complete spinal canal decompression, ideal kyphosis correction with gradual lengthening of anterior column together with sequential posterior column compression. Anterior column support, avoidance of the morbidity of anterior approach and improvement of neurological deficit are the other advantages of the single stage PVCR technique in patients with thoracic/thoracolumbar burst fractures.

Clinical, radiological and HRQoL outcomes after selective thoracic fusion with minimum 15-year follow-up.

INTRODUCTION: The purpose of the study was to provide a 15-year natural history evaluation of the radiographic appearance of uninstrumented compensatory lumbar curves in patients who had undergone selective thoracic fusion (STF) for scoliosis, measure any changes in health-related quality of life scores (HRQoL) and compare them with controls matched for age, gender and body-mass index (BMI). METHODS: STF group included 43 female adolescent idiopathic scoliosis (AIS) patients who underwent STF with mean age 33(27-42) years and a mean follow-up of 18.7 (15-28) years, mean BMI 22(18-29). Preop, early postop and follow-up radiographs were reviewed for behavior of lumbar curves. Control group included a random selection of healthy volunteers with no history of back pain and with mean age 33(27-41), and mean BMI 22(17-33). HRQoL scores were compared between two groups in latest f/up. Radiographs including low dose biplanar imaging with EOS were used to measure disc heights and assess for radiographic evidence of degenerative changes. Various parameters were statistically compared. RESULTS: Posterior fusion was performed in all 43, with all pedicle screws used in 41 and all-hook constructs in 2. Main thoracic curve correction was improved from pre-op to early-post-op and maintained at latest f/up (55.6°-16.1°-16.9°). Spontaneous lumbar curve correction (SLCC) was also maintained beyond 15 years (39.9°-16.6°-17.1°). Two patients developed coronal decompensation following surgery, but improved with time and were well compensated at final follow-up. Mean HRQoL scores, self-image and mental health scores were higher in STF group than control group (p < 0.05). SRS-22r pain and function, Oswestry Disability Index and Numeric Rating Scale, marital status, number of children were similar between the groups(p > 0.05). All disc heights except L5-S1 were significantly lower in STF group (p < 0.05). There was no significant difference between the groups for degenerative changes in the latest radiographs. CONCLUSION: In this group of patients, the uninstrumented lumbar curve spontaneously corrected and the correction was maintained after 18 years following surgery using STF. Mild degenerative changes were seen radiographically and HRQoL scores suggest that the psychological-functional well-being are quite good in the long term in AIS patients who have undergone STF when compared with an age-gender-BMI-matched population.

Sprengel Deformity: Comprehensive Evaluation of Concomitant Spinal and Extraspinal Anomalies in 90 Patients.

STUDY DESIGN: A retrospective, case series. OBJECTIVE: The aim of this study is to evaluate the concomitant anomalies in patients with Sprengel deformity (SD). SUMMARY OF BACKGROUND DATA: SD is the most common congenital anomaly of the shoulder. One or more associated anomalies may coexist in SD patients, similar to congenital scoliosis (CS); however, these anomalies and their relationship have not been studied in detail previously. METHODS: SD patients who have applied to our institution between 2005 and 2019 were retrospectively reviewed. The patients were evaluated clinically and radiologically. The patients were divided in two groups as SD patients with CS and without CS, to analyze if these anomalies are present due to CS or SD. Physical examination findings, MRI, CT, and USG reports were analysed for accompanying pathologies. Patients with missing data were excluded. Student-t and Fisher's exact tests were used to compare the groups. Significance value was set as p = 0.05. RESULTS: Ninety patients met inclusion criteria. The most common spinal anomaly was omovertebra, followed by spina bifida and Klippel-Feil. Tethered cord and diastematomiyelia were associated with CS (P = 0.0026 and P = 0.0057, respectively). The most common extra-skeletal anomaly was rib anomalies, followed by urinary and cardiac system anomalies. Rib anomalies were associated with CS (P = 0.00001). CONCLUSION: Concomitant anomalies may accompany SD. The prognosis of SD may be affected by these anomalies. Therefore, patients should be evaluated for possible coexistent congenital anomalies. LEVEL OF EVIDENCE: 4.

Academic productivity and obstacles encountered during residency training: A survey among residents in orthopedics and traumatology programs in Turkey.

OBJECTIVE: This study aimed to investigate the academic productivity of and the obstacles encountered by orthopedic residents in Turkey. METHODS: Overall, 220 orthopedic specialists who were registered in the Ministry of Health and had started orthopedic residency between 2009 and 2010 were invited to participate in a survey through e-mail. The survey comprised a total of 19 questions to evaluate the academic works conducted and obstacles encountered during residency. Academic work was defined as an article published in the peer-reviewed journals as well as an oral or poster presentation at a national or international congress. Case reports, letters to the editor, and technical notes were excluded. RESULTS: Data were obtained from 116 respondents who completed the survey. In peer-reviewed journals in Science Citation Index (SCI) or SCI-Expanded, the mean number of articles published with and without the first name per resident was 0.09 and 0.73, respectively. In peer-reviewed journals other than those in SCI and SCI-Expanded, the mean number of articles published with and without the first name per resident was 0.37 and 1, respectively. The mean number of oral and poster presentations per resident at national and international congresses was 2.63 and 4.67, respectively. No significant difference in the number of academic works was noted between the regions and institutions (p>0.05). A significant positive correlation was observed between the number of associate professors and assistant professors in the clinic and the total number of academic works (article plus presentation) (p<0.01 and p=0.017, respectively). Regarding encouragement and support to academic works, 6.9% of the respondents found the clinic to be excellent, 20.7% good, 24.1% moderate, and 48.3% bad. No significant difference in encouragement and support to academic works was noted among the institutions (p=0.115). The most common obstacle encountered in conducting academic works was long working hours (74.5%). CONCLUSION: Regardless of the region and institution, the participation of orthopedic residents in academic works is low in Turkey. Several obstacles were encountered in conducting academic works, with the most common being long working hours. LEVEL OF EVIDENCE: Level IV, Diagnostic study.

``Sandwich technique" with dual strut allograft in surgical treatment of femoral nonunion.

OBJECTIVE: The treatment of femoral nonunion is challenging for both the surgeon and the patient. Strut allografts increase the bone stock, enhance fracture healing and increase stability by acting as a biological plate. In this study, we aimed to report the results of the sandwich technique with two-strut allograft in the treatment of oligotrophic or atrophic femoral nonunions. METHODS: Medical records of the patients who were treated due to femoral nonunion in a single center were retrospectively reviewed. Twenty-one patients (10 males, 11 females) with a mean age of 49 (range: 21 to 79) years were included in the study. The left side was affected in 11 patients, whereas the right side was affected in ten. The patients had 11 femoral shaft fractures, seven proximal femoral fractures and three distal femoral fractures. The mean time from the previous operation to the nonunion surgery was 9.6 (range: 6 to 22) months. RESULTS: Union was achieved in all patients after a mean period of 6.2 (range: 4 to 10) months. The mean follow-up time was 46.8 (range: 12 to 86) months. One patient had superficial surgical site infection in the autologous graft donor site. CONCLUSION: The sandwich technique with two-strut allograft provides good results in the treatment of femoral nonunion. The technique can be used on any type of nonunion, at any segment of the femur and can be combined with different fixation techniques.

The Efficacy of Extracorporeal Shock Wave Therapy for Chronic Coccydynia.

OBJECTIVE: Coccydynia is a disorder that decreases quality of life with significant functional failure. Extra-corporeal shock wave therapy (ESWT) is used to treat several painful musculoskeletal disorders. SUBJECTS AND METHODS: The medical records of 34 patients (29 females, 5 males) who had been treated with ESWT between 2017 and 2018 for chronic coccydynia were evaluated. Visual analog scale (VAS) scores were noted at the initial consultation, at each session, and during the initial and follow-up (at 6 months) examinations after the treatment. The 36-item short form (SF-36) quality of life scale survey was conducted at the beginning and end of the treatment. MRI was performed before the start of the procedure and 1 month after the end of the treatment. RESULTS: The mean VAS score was 9.6 (9-10) before the treatment and 3.4 (0-2) after the treatment (p < 0.05). The VAS score decreased to ≤3 in 79.4% of patients. Bone marrow edema regressed in 6% of patients. Significant improvement was observed in all of the SF-36 parameters, except for two. CONCLUSION: In our patient group, ESWT provided effective pain control. In order to evaluate the efficacy of ESWT more accurately and sensitively, prospective randomized studies with longer follow-up periods, in which ESWT is compared with different energy doses and different treatment methods, are needed.

Open reduction of a total talar dislocation: A case report and review of the literature.

BACKGROUND: Total talar dislocation (TTD) is very uncommon for many orthopedic surgeons and emergency/trauma specialists. Scarce cases of TTD have been reported, mainly in the form of open fracture-dislocation injury. CASE SUMMARY: We report a very rare injury of closed TTD with a follow-up period of 36 mo. Initial closed reduction was not successful because of a fractured highly unstable medial malleolus displaced into the ankle mortise, blocking the relocation of the talus. The patient was able to walk pain-free after the 3rd month of surgery. At the 36-mo follow-up, there were 10 degrees of flexion loss and 10 degrees of extension loss in the tibiotalar joint. Furthermore, 5 degrees of subtalar joint inversion-eversion loss was present. CONCLUSION: Open reduction should be performed for closed TTDs unless closed reduction is successful.

Radiological and functional outcomes of ultrasound-guided PRP injections in intrasubstance meniscal degenerations.

AIM: This retrospective study is aimed to analyze the effect of ultrasound-guided platelet-rich plasma (PRP) injections on grade 2 intrasubstance meniscal degenerations (IMDs). MATERIALS AND METHODS: Fifteen patients who underwent PRP injections for symptomatic grade 2 meniscal lesions were included in the study. All injections were performed with ultrasound in the degenerated menisci. Patients were evaluated with Lysholm score and magnetic resonance imaging (MRI) before the injection and after a mean of 32-month follow-up. T2-weighted MRI images were evaluated on sagittal by two authors as double-blind. RESULTS: Lysholm score was found to be statistically significantly increased, and in 67% of the patients, grade 2 degenerations were improved to grade 1. CONCLUSION: Intra-meniscal PRP injection under ultrasonography guidance provides good functional scores and radiological improvement in the patients with IMD.

Clinical and radiologic outcomes following resection of primary proximal fibula tumors: Proximal fibula resection outcomes.

PURPOSE: Reconstruction of the lateral collateral ligament (LCL) and biceps femoris tendon following proximal fibula resection is controversial. Postoperative knee instability and peroneal nerve dysfunction affect outcome. This study aimed to determine functional, clinical, and radiological outcomes of patients who underwent en bloc proximal fibula resections and to compare clinical and radiological instability rates for primary repair after type I and type II resections. MATERIALS AND METHODS: Eleven patients with primary tumors of the proximal fibula were included. Musculoskeletal Tumor Society (MSTS) score and Lysholm knee score were used in the evaluation of functional outcomes. Clinical outcome was assessed using knee range of motion and knee varus stress test. Radiological outcome was assessed using varus stress knee radiographs. Knee stability was evaluated using the varus stress test at 30° of knee flexion and varus stress knee radiographs and graded in millimeters. RESULTS: Of the 11 tumors, 6 (54.6%) underwent type I resection. In five (45.4%) patients, type II resection was performed. The mean follow-up period was 32 ± 13.9 months (range, 12-55 months; median, 27 months). The mean knee joint lateral opening, MSTS score, and Lysholm knee score with type I versus type II resection were 5.7 ± 1.2 mm versus 6.4 ± 1.1 mm ( p = 0.247), 28.7 ± 1.8 (95.6%) versus 20.4 ± 7.7 (68%) ( p = 0.011), and 92.2 ± 8.8 versus 62.8 ± 20.4 ( p = 0.026), respectively. Postoperative complications of all patients included one (9.1%) deep tissue infection and one (9.1%) long-term knee instability. In one patient (9.1%) who underwent type II resection, above-the-knee amputation was performed after local recurrence. CONCLUSIONS: Primary repair of the LCL and biceps femoris tendon to the surrounding soft tissues after resection of proximal fibular tumors provides good clinical outcomes. Primary repair is a simple technique to perform with minimal morbidity. Peroneal nerve palsy was a problem, especially in type II resections. Level of Evidence: Therapeutic Level III.

Chondroblastoma: An evaluation of the recurrences and functional outcomes following treatment.

OBJECTIVE: Chondroblastoma is a benign aggressive tumor which needs surgical treatment and has a recurrence rate up to 35%. Extended (aggressive) curettage is the mainstay of treatment and local adjuvants have been reported to decrease the recurrence rate. METHODS: The recurrence rates and the functional results of 14 patients who were treated in our institution and 2 other patients who were treated elsewhere between the years 2004-2016 were evaluated. Seventeen cases (13 male, 3 female; mean age: 17.1 [range: 13 to 32] years) who had been diagnosed, treated and followed up in our hospital between 2004 and 2016 were evaluated in terms of recurrence rates and functional outcomes. The average follow-up period was 41.6 (range: 12 to 132) months. RESULTS: Five cases of recurrence were observed. Two cases had undergone their primary treatment in another institution. Seven cases were performed curettage alone whereas nine others were administered adjuvant treatments. One of the five recurrence patients was advised to undergo disarticulation. Another was treated with curettage and grafting and the remaining three patients with curettage and cementing. No recurrence was observed in their follow-up period. Their mean MSTS score was 27.3 (range: 4 to 30) over a maximum of 30 points and their functional results were good. CONCLUSION: Chondroblastoma is a tumor with high recurrence rates in the post-treatment period. However, good functional outcomes can be achieved with early diagnosis and appropriate treatment even after recurrence. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Worldwide arthroplasty research productivity and contribution of Turkey.

PURPOSE: Bibliometrics is increasingly used to assess the quantity and quality of scientific research output in many research fields worldwide. However, to the best of our knowledge, no studies have documented the main characteristics of arthroplasty publications from different countries. This study aimed to evaluate the worldwide research productivity and status of Turkey in the field of arthroplasty using bibliometric methods and to provide an insight into the arthroplasty research for surgeons and researchers. METHODS: The Web of Science database was searched to identify arthroplasty articles published between 2006 and 2016. The contributions of countries were evaluated based on publication count, citation average, h-index and publication rate in the top 10 ranked journals. Each countries publication output was adjusted according to population size. RESULTS: A total of 26.167 articles were identified. World arthroplasty publications were increased significantly over time (p < .005). The United States was the most productive country with 9007 articles (34,4% of total) followed by England with 2939 articles (11,4 of total) and Germany with 1881 articles (7,1% of total). According to average citations per item, Scotland was in the first place followed by Denmark and Sweden, whereas in the first place according to publication output adjusted by population size was Switzerland followed by Denmark and Scotland. The United States was also in the first place according to h-index and publication rate in the top 10 ranked journals. Founding average was 28,8% (7539 of 26164) for the arthroplasty articles that were analyzed in the study. CONCLUSION: There is a rapid increase in the number of articles in arthroplasty research from 2006 to 2016. The United States was the most productive country as measured by total publications in the arthroplasty field. However, some small European countries with high in-come have higher quality of articles and better productivity when adjusted for population. Gross domestic product (GDP) per capita and research foundation had positive affect on arthroplasty publications, both qualitatively and quantitatively.

Cementless total hip arthroplasty for severely dislocated hips previously treated with Schanz osteotomy of the proximal femur.

INTRODUCTION: We report the short-term outcomes of total hip arthroplasty(THA) in patients previously treated with Schanz osteotomy (SO). MATERIALS AND METHODS: Eighteen patients [2 male, 16 female; mean age, 55.4 (range, 50-66) years] who had undergone THA after SO were retrospectively evaluated. Clinical evaluation was performed based on the Harris hip score. Radiological evaluation was performed using full-length radiographs of the lower extremities, pelvis, and hip. RESULTS: The mean follow-up period was 30.8 (range, 18-56) months. Mean femoral shortening was 3.7 (range, 2-5) cm. Perioperative complications occurred in 4 (22.2%) patients. Nonunion was not found at the osteotomy sites. No dislocation was observed. The Trendelenburg sign was positive for five (27.7%) patients, postoperatively. The mean Harris hip score improved from 42.7 to 78.7 (p < 0.05). CONCLUSION: THA for hips previously treated with SO is technically demanding. If careful preoperative planning is performed, successful treatment can be achieved.

Atypically localized glomus tumor causing anterior interosseous nerve syndrome: A case report.

This article presents a 48-year-old male patient who presented with pain in the left forearm and weakness and clumsiness in the left hand of 6 months' duration. Flexor motor strength loss of the thumb and the index finger was present and neurophysiologic tests showed findings compatible with axonal injury in the anterior interosseous nerve (AIN) innervated muscles. Magnetic resonance imaging revealed a space-occupying lesion in the proximal forearm resembling a glomus tumor. Excision of the mass and release of the AIN were performed. Histopathology confirmed a glomus tumor, and the patient remains asymptomatic at 1 year postoperatively. We stress the importance of imaging studies in patients when a suspected secondary nature of nerve entrapment is present.

Simultaneous bilateral correction of genu varum with Smart frame.

PURPOSE: The aim of this study is to evaluate clinical and radiological results of simultaneous bilateral correction of genu varum with Smart frame. METHODS: Between 2011 and 2015, a total of 25 patients (10 females, 15 males) who had bilateral genu varum deformity were operated bilaterally with tibial and fibular osteotomy in the same session, using Smart frame. The mean follow-up period was 28.7 (range, 13-45) months. All patients had bilateral tibial varus deformity. Femoral deformity was corrected in an earlier session in nine patients. Mechanical axis deviation (MAD), mechanical lateral distal femoral angle, mechanical medial proximal tibial angle (mMPTA) and posterior proximal tibial angle (PPTA) were measured preoperatively and postoperatively. Short Form-36 questionnaire was filled by the patients preoperatively and during the last follow-up. RESULTS: The mean preoperative MAD was 37.6 mm (range, 9-98 mm), which improved to 8.4 mm (range, 3-44 mm) postoperatively ( p < 0.05). The mean preoperative mMPTA was 76°, which improved to 89° ( p < 0.05). The mean preoperative PPTA was 75.5°, which improved to 80.3 ( p < 0.05). Ten problems (20%), two obstacles (4%) and no sequelae occurred in 50 legs of 25 patients. CONCLUSIONS: In conclusion, Smart frame is an accurate and reliable method for performing bilateral simultaneous deformity correction in patients with bilateral genu varum deformity. It can be applied for various childhood-induced severe tibial deformities such as achondroplasia, rickets, skeletal dysplasia and Blount's disease.

The comparison of the effects of a novel hydrogel compound and traditional hyaluronate following micro-fracture procedure in a rat full-thickness chondral defect model.

PURPOSE: The aim of this experimental study was to investigate the impact of HA-CS-NAG compound (hyaluronate, sodium chondroitin sulfate, N-acetyl-d-glucosamine) on the quality of repair tissue after micro-fracture and to compare it with HA (hyaluronat), in a rat full-thickness chondral defect model. METHODS: Full-thickness chondral defects were created in a non-weight bearing area by using a handle 2.7-mm drill bit, in the right knees of 33 Sprague-Dawley rats. Each specimen then underwent micro-fracture using a needle. Two weeks after surgery, 3 groups were randomly formed among the rats (n = 33). In Group 1, 0.2 mL of sterile saline solution (0.9%) was injected. In Group 2, 0.2 mL HA with a mean molecular weight of 1.2 Mda was injected. In Group 3, 0.2 mL of HA-CS-NAG compound (hyaluronate, sodium chondroitin sulfate, N-acetyl-d-glucosamine) was injected. The injections were applied on the 14th, the 21st and the 28th postoperative days. All rats were sacrificed on the 42nd postoperative day. Histological analysis of the repair tissue was performed for each specimen by two blinded observers using Wakitani scoring system. RESULTS: There was significantly improved repair tissue in both Group 3 and Group 2 when compared with Group 1. Group 3 showed statistically significant improvement in terms of 'cell morphology' and 'integration of donor with host' when compared to Group 2 (p < 0.001). CONCLUSION: Intra-articular injection of HA-CS-NAG compound after micro-fracture results in significantly improved repair tissue in rats' chondral defects when compared to HA regarding the donor integration and cell morphology.

Total joint replacement for neglected posterior knee dislocation following septic arthritis after arthroscopy.

This report presents the first case of a knee dislocation following septic arthritis after arthroscopy. A 65-year-old woman had an arthroscopy with irrigation and debridement (I&D) of the joint and microfracture for the chondral lesions. She had complaints of postarthroscopic infection but non-steroidal anti-inflammatory medication and local ice compression was recommended. She revisited her physician twice and at the last visit she had a large purulent effusion in her knee. The gram stain of the joint fluid aspirate demonstrated gram-positive cocci and the cultures grew methicilline-sensitive Staphylococcus aureus. She underwent arthroscopic assisted I&D and received intravenous antibiotics. I&D was repeated after two weeks. Intravenous antibiotherapy was continued for one more week and was changed to oral antibiotherapy for six weeks. At the third month visit's physical examination, a deformity at the knee was noticed and was referred to us for further treatment. A posterior knee dislocation with no neurovascular deficit was detected. The patient had a history of knee sprain but did not seek medical advice immediately. The blood samples showed no abnormality. The patient underwent a surgery with a cemented hinged revision total knee prosthesis following the exclusion of the active knee joint infection. Intraoperative frozen sections were also taken to exclude the active infection. The patient's knee is pain-free with full range of motion after 3 years. The objective of this report was to highlight the importance of early diagnosis, prompt appropriate treatment of septic arthritis following arthroscopy and the awareness of the knee dislocation as a rare dreadful complication of postarthroscopic infection particularly in elderly patients.

Elastoplasty as a promising novel technique: Vertebral augmentation with an elastic silicone-based polymer.

OBJECTIVE: Percutaneous vertebroplasty with polymethylmethacrylate (PMMA) restores the stiffness and the strength of fractured vertebral bodies, but changes the pattern of the stress transfer. This effect may cause a secondary fracture of the adjacent vertebrae. Elastoplasty has emerged as a new technique to overcome this complication. The aim of this study is to retrospectively evaluate the clinical results of the elastoplasty procedure. MATERIALS AND METHODS: Thirthy nine patients (9 males, 30 females, 87 spinal levels) were clinically evaluated pre and postoperatively in terms of pain relief, leakage and silicone embolism. The mean age was 67 (range 38-84) years. The mean follow up period was 12,5 months. The patients were evaluated radiologically for the presence of adjacent level fractures postoperatively. Complications were recorded. RESULTS: The mean VAS score decreased from 7,5 to 3,5 during the last follow-up. Symptomatic silicone pulmonary embolism was not encountered in any patients. Leakage was observed in 5 (13%) cases. There was an adjacent level fracture in 1 case and another fracture which was not at the adjacent level in another one. A hematoma occurred in the needle entry site in a patient with trombocytopenia (<70,000). CONCLUSIONS: Elastoplasty is a safe, promising technique in the treatment of vertebral compression fractures (VCFs). Symptomatic silicone pulmonary embolism is not observed. The material's stiffness is close to intact vertebrae. Therefore, elastoplasty may be a good viable option in the treatment of VCFs as it cause less complications and can prevent adjacent level fractures. LEVEL OF EVIDENCE: Level IV, therapeutic study.

A comparison of the open reduction-internal fixation and resection arthroplasty techniques in treatment of Mason Type 3 radial head fractures.

OBJECTIVE: The aim of this study was to retrospectively compare a series of patients surgically treated with ORIF or early resection arthroplasty due to isolated comminuted radial head fractures. METHODS: Between the years 2009 and 2013, 34 patients with isolated comminuted fractures of the radial head (Mason Type 3) had been operated (ORIF in 19 patients, resection arthroplasty in 15 patients). The mean age of the patients in the ORIF group was 38.5 years and 54 years in the resection group. The carrying angle (CA) and ulnar variance were measured bilaterally, and radiographs were reviewed for degenerative elbow arthritis. The Mayo elbow performance score, Turkish version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH-T) and visual analog scale (VAS) were used to evaluate the clinical results. RESULTS: The mean follow-up period in the ORIF group was 40.2 months and 44.4 months in the resection group. In the ORIF group, 11 patients were clinically rated excellent, six good, and two fair. In the resection group, seven patients had excellent, five had good, and two had fair scores. We did not find a statistically significant difference between the ORIF and resection groups regarding the clinical and radiological outcomes. CONCLUSION: With these short-term results, resection arthroplasty may be considered an effective method in the treatment of isolated comminuted radial head fractures, as it is less technically demanding and it also allows for early postoperative motion. However, the patients should be evaluated in detail, regarding ligamentous injuries prior to resection arthroplasty. LEVEL OF EVIDENCE: Level III, Therapeutic study.