The extensor hallucis longus tendon as the distal reference point in total knee arthroplasty and tibial alignment.

OBJECTIVE: The aim of this study was to compare the effects on tibial alignment of the use of the extensor hallucis longus (EHL) tendon with the use of the 2nd metatarsal as a reference in total knee arthroplasty (TKA) using the extramedullary technique. METHODS: The study evaluated 100 postoperative radiographs of 79 patients who underwent primary TKA between 2004 and 2008. Patients were grouped according to the distal anatomical landmark used during surgery. There were 36 patients (mean age: 68.3 years, range: 56 to 82 years) in the EHL-referenced (ERT) group and 43 patients (mean age: 70.2 years, range: 54 to 78 years) in the 2nd metatarsal-referenced (MRT) group. There were 47 components in the ERT group and 53 in the MRT group. Frontal alignments of the tibial components were measured. Angles of 90±2° were accepted as the normal boundaries while those above that value were labeled as 'varus' and those below as 'valgus'. RESULTS: Average frontal alignment was 88.57° in the MRT group and 89.17° in the ERT group. The number of tibial components in the normal range was significantly higher (p=0.017) and the number of varus-oriented components significantly lower (p=0.024) in the ERT group. There were no significant differences in valgus-oriented outliers between groups (p=1.000). CONCLUSION: The use of the EHL tendon as a reference improves coronal tibial alignment. The EHL is a reliable anatomical landmark to use with extramedullary guide systems.

Comparative results of percutaneous cannulated screws, dynamic compression type plate and screw for the treatment of femoral neck fractures.

BACKGROUND: The purpose of this study was to compare the period of union, functional outcomes and complications of patients with femoral neck fracture treated with percutaneous cannulated screws versus dynamic hip screw (DHS). METHODS: Sixty-six patients with femoral neck fracture were treated with percutaneous cannulated screws (n=33) or with DHS (n=33) between August 1999 and October 2003. Functional outcome was measured using Harris Hip Score, and period of union, amount of bleeding and complications were also recorded. RESULTS: The period of union and functional outcomes were not different between the two groups. Risk of avascular necrosis (AVN) was associated mainly with the grade of fracture displacement. In the percutaneous cannulated screw group, duration of surgery was shorter and blood loss was less than in the other group. CONCLUSION: There was no superiority between cannulated screws and DHS according to union times and functional results. Risk of AVN is related to the degree of displacement. However, a prospective randomized study is needed to determine the outcome of each technique for patients suffering similar displacement rates.

Functional results of conservative therapy accompanied by interscalane brachial plexus block and patient-controlled analgesia in cases with frozen shoulder.

OBJECTIVES: We evaluated the efficacy of simultaneous interscalene block and catheter analgesia applied as an aid to conservative treatment in improving shoulder functions in patients with frozen shoulder. METHODS: Three patients (2 women, 1 man; mean age 47 years) with frozen shoulder underwent conservative treatment including manipulation under interscalene brachial plexus block and subsequent rehabilitation under catheter analgesia to improve shoulder range of motion and function. Following manipulation under interscalene block, the patients were hospitalized for 15 to 28 days (mean 21 days) for an exercise program performed by a physiotherapist and orthopedist at least twice a day under interscalene catheter analgesia. Thirty minutes before each rehabilitation session, patient-controlled analgesia was administered via a pain relief pump. Active and passive range of motion (ROM) were measured and the severity of pain was rated using a visual analog scale (VAS) prior to and following interscalene block, during the exercise program, and at the end of the treatment. Functional assessments were made before and after treatment using the University of California in Los Angeles (UCLA) Shoulder Scale. The exercise program under interscalene analgesia was performed until pain-free and sufficient active movements were obtained, with at least 80% improvement in active and passive motion, a VAS score of 0-2, and an UCLA score of >27. RESULTS: Compared to pretreatment values, the ROM values showed remarkable increases at the end of the treatment. Active ROM reached at least 30 degrees external rotation, 40 degrees internal rotation, 150 degrees flexion, 45 degrees extension, and 100 degrees abduction in all cases. On presentation, the VAS scores of all cases were 10 for both active and passive movements, whereas they ranged from 0 to 2 on discharge. The mean UCLA score increased from 12.3 to 30.3 after treatment. Immediately after the interscalene block, two patients exhibited signs of Horner's syndrome which resolved spontaneously within an hour without the need for treatment. No complications or catheter-related problems such as infection, break-off, or displacement developed throughout the treatment period. There was no requirement for additional analgesia. CONCLUSION: In patients with frozen shoulder, interscalene block and continuous patient-controlled analgesia via an interscalene catheter provided sufficient analgesia and contributed to the recovery of shoulder functions through an effective and safe exercise program, with no side effects or complications. However, further studies are needed to assess the feasibility of home applications of interscalene patient-controlled analgesia to increase cost-effectiveness and patient satisfaction.

Peripheral vascular injury-related deaths.

BACKGROUND: Peripheral vascular injuries are frequently encountered in lethal and nonlethal trauma. Although significant improvements in treatment have been achieved, such injuries are still important causes of mortality. METHODS: In this study, the records of 6769 autopsies performed between 1996 and 2006 at the Council of Forensic Medicine Bursa Group Chairmanship Morgue Department were evaluated retrospectively. RESULTS: The 63 cases (0.9%) who were determined to have died due to vascular injury were included in this study. Fifty-seven cases (90.5%) were men (mean age: 36 years); 58.7% of the injuries were due to stab wounds. The femoral artery and vein were the most frequently injured vessels. The origin was a homicide in 85.7% of the cases. In 25% of the cases, blood alcohol levels were between 44 and 256 mg/dL. CONCLUSION: The availability of experienced surgical teams and effective prehospital emergency care are vital for decreasing the mortality due to extremity vascular injuries. In the autopsy of a patient who died primarily due to extremity vascular injury, the injured vessel, numbers of injuries and of lethal injuries, and locations and sides of the injuries shed light on the possible presence of intention.

[The evaluation of patients undergoing total knee arthroplasty with or without patellar resurfacing]. / Total diz protezi uygulamalarinda patella eklem yüzeyi degistirilen ve degistirilmeyen olgularin degerlendirilmesi.

OBJECTIVES: We evaluated the clinical and radiographic results of total knee arthroplasty (TKA) with or without patellar resurfacing. METHODS: The study included 149 knees of 126 patients who underwent TKA for primary knee osteoarthritis with (59 knees, group 1) or without (90 knees, group 2) patellar resurfacing. Clinical evaluations were made with the knee and function scores of the Knee Society, and patella scoring system; radiographic evaluations included changes in the joint line, Insall-Salvati ratio, lateral patellofemoral angle, and congruency angle. The mean follow-up period was 66.7 months (range 34 to 123 months) in group 1, and 68.1 months (range 30 to 117 months) in group 2. RESULTS: Although postoperative knee and function scores showed significant improvements in both groups (p<0.001), these did not reach significance between the two groups (p>0.05). The mean patella scores did not differ significantly, either (p>0.05). Postoperative radiographic assessments did not show significant differences between the two groups with respect to mechanical axis values, patellar tilt, and lateral subluxation (p>0.05). Symptomatic patellar subluxation, dislocation, fracture or rupture of the extensor mechanism did not occur in any of the treatment groups. None of the patients required revision associated with the patella and patellar prosthesis. CONCLUSION: Our findings suggest that patellar resurfacing is not necessary other than patients with significant degeneration of the patellar surface.

Turf toe in a taekwandoo player: case report.

Metatarsophalengeal joint injuries of great toe termed as ''turf toe" can occur in many sportive activities. However, it has not been reported before in taekwondoo players. These injuries may result in significant morbidity. Turf toe injuries, which are mainly treated with conservative methods, occasionally require surgery. In this case report, we present a surgically treated turf toe in a taekwondoo player. Key PointsMTP joint injury may occur when the joint is forced into hyperextension repeatedly if the exercise is being performed bare foot on hard and artificial surfaces.Surgery should be taken into consideration as a choice of treatment of Turf Toe.